Resting-State Functional Connectivity After Acquired Brain Injury: Patterns of Network Disruption, Reorganisation, and Recovery - A Systematic Review.

Background

Resting-state functional MRI (rs-fMRI) provides a non-invasive method for assessing intrinsic connectivity changes associated with neurological recovery. This systematic review evaluated patterns of functional connectivity change after acquired brain injury (ABI), with a focus on network disruption, reorganisation, and recovery-related change.

Methods

A systematic review was conducted according to PRISMA 2020 recommendations using a Population-Intervention-Outcome framework. PubMed, Scopus, Cochrane Library, and Google Scholar were searched for studies published between January 2010 and March 2026 examining rs-fMRI connectivity following ABI. Screening was performed independently by two reviewers, and eligible studies were appraised using Joanna Briggs Institute critical appraisal tools. Narrative synthesis was undertaken to evaluate connectivity disruption, compensatory reorganisation, and recovery-related network changes.

Results

Twenty studies were included, predominantly involving stroke and traumatic brain injury populations. rs-fMRI identified alterations in functional connectivity, spontaneous activity, hub organisation, and network efficiency associated with motor, cognitive, behavioural, language, and consciousness outcomes. Only one included study directly evaluated functional connectivity following cranioplasty, providing limited evidence of recovery-related changes in default mode and whole-brain network organisation.

Conclusion

Resting-state fMRI demonstrates heterogeneous patterns of network disruption, reorganisation, and recovery-related connectivity change following ABI. These findings support the use of rs-fMRI as a research tool for characterising network-level recovery, while further prospective longitudinal studies using standardised imaging and outcome measures are needed to establish its clinical utility.