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David P. McMullen, Tessy M. Thomas, Matthew S. Fifer, Daniel N. Candrea, Francesco V. Tenore, Robert W. Nickl, Eric A. Pohlmeyer, Christopher Coogan, Luke E. Osborn, Adam Schiavi, Teresa Wojtasiewicz, Chad R. Gordon, Adam B. Cohen, Nick F. Ramsey, Wouter Schellekens, Sliman J. Bensmaia, Gabriela L. Cantarero, Pablo A. Celnik, Brock A. Wester, William S. Anderson, and Nathan E. Crone

Defining eloquent cortex intraoperatively, traditionally performed by neurosurgeons to preserve patient function, can now help target electrode implantation for restoring function. Brain-machine interfaces (BMIs) have the potential to restore upper-limb motor control to paralyzed patients but require accurate placement of recording and stimulating electrodes to enable functional control of a prosthetic limb. Beyond motor decoding from recording arrays, precise placement of stimulating electrodes in cortical areas associated with finger and fingertip sensations allows for the delivery of sensory feedback that could improve dexterous control of prosthetic hands. In this study, the authors demonstrated the use of a novel intraoperative online functional mapping (OFM) technique with high-density electrocorticography to localize finger representations in human primary somatosensory cortex. In conjunction with traditional pre- and intraoperative targeting approaches, this technique enabled accurate implantation of stimulating microelectrodes, which was confirmed by postimplantation intracortical stimulation of finger and fingertip sensations. This work demonstrates the utility of intraoperative OFM and will inform future studies of closed-loop BMIs in humans.