Jul 2026· Journal of Stroke & Cerebrovascular Diseases· Vol 35, pp.
108719
· 0 citations· 55 references
Medicine
TL;DR
Across studies, MSPs were consistently associated with upper limb motor improvement compared with conventional rehabilitation alone, accompanied by significant reorganization of brain networks, suggesting network-level neuroplastic adaptations.
Abstract
Background
AND
Purpose
Stroke is a leading cause of disability, associated with impaired motor function and brain connectivity. Mental Simulation Practices (MSP), including Motor Imagery, Mirror Therapy and Action Observation Therapy, have been proposed as neurorehabilitation strategies capable of modulating neural networks. This review aimed to clarify the effects of MSP on brain connectivity using fMRI.
Methods
A PRISMA-based review was conducted and registered in PROSPERO (CRD420251086743). PubMed, Scopus and Web of Science were searched for randomized controlled trials published between 2015 and 2025 evaluating MSP-based rehabilitation versus conventional rehabilitation in stroke patients. Studies were included if they assessed fMRI-based connectivity changes before and after treatment. Meta-analysis was not performed because of heterogeneity in connectivity metrics and neuroimaging methodologies. Risk of bias was assessed using the Cochrane RoB 2 tool, showing low risk or some concerns.
Results
Of 467 identified records, 8 randomized controlled trials involving 249 stroke patients met inclusion criteria. Most studies investigated Motor Imagery-based interventions, while two evaluated Mirror Therapy. Across studies, MSPs were consistently associated with upper limb motor improvement compared with conventional rehabilitation alone, accompanied by significant reorganization of brain networks. Neuroimaging findings demonstrated enhanced connectivity within sensorimotor regions, including the primary motor cortex, postcentral gyrus and inferior parietal lobule, together with modulation of corticospinal and interhemispheric pathways. Several studies also reported normalization of maladaptive activation patterns, reduced excessive sensorimotor connectivity and stronger interactions between motor and cognitive networks, changes correlated with clinical motor recovery. Additional reorganization involved attentional, visual and cognitive systems, suggesting network-level neuroplastic adaptations.
Conclusions
Mental simulation practices may represent promising adjunctive interventions in standard stroke rehabilitation programs, given their potential role in modulating brain connectivity.
Overall, the certainty of evidence was low to very low, downgraded primarily for these risk of bias concerns, severe imprecision (due to small sample sizes), and potential publication bias.
Yu Qin, Mei-xuan Li, Yan-fei Li et al.· Cochrane Database of Systema...· 0 citations
Stroke is a leading cause of long-term neurological disability, frequently producing persistent motor impairment, loss of independence, and limitations in social participation. Virtual reality and robot-assisted rehabilitation have emerged as strategies for increasing treatment intensity, repetition, task specificity, feedback, and patient engagement. This study aimed to analyze their effectiveness in promoting neuroplasticity and improving motor and functional outcomes in adults after stroke. A structured integrative literature review based on the Scientific Method and PRISMA 2020 principles was conducted using PubMed/MEDLINE, the Cochrane Library, Scopus, Web of Science, IEEE Xplore, PEDro, and official journal databases. Twenty publications were selected, including systematic reviews, meta-analyses, randomized controlled trials, narrative reviews, and a clinical practice guideline. Ten publications were systematic reviews or meta-analyses; five presented predominantly favorable findings, four reported conditional or mixed results, and one found no clear additional benefit. Virtual reality was associated with selected improvements in upper-limb motor function, dexterity, functional independence, quality of life, cortical activation, and functional connectivity. Robot-assisted rehabilitation provided intensive and measurable movement practice and improved selected impairment-based outcomes, although its superiority over dose-matched conventional rehabilitation was inconsistent. Improvements in motor control and strength did not always translate into greater independence or spontaneous use of the affected limb in daily life. The findings indicate that digital neurorehabilitation is most effective when it provides active, repetitive, intensive, task-specific, progressively challenging, and feedback-rich training. Virtual reality and robotics should be integrated as complementary components of conventional rehabilitation rather than universal replacements. Further randomized trials with standardized protocols, equivalent treatment doses, clinically meaningful outcomes, direct neuroplasticity measurements, safety assessment, and long-term follow-up are required.
Pedro Raúl Abad Valencia, Priscilla Maria Franco Acosta, Jose Gabriel Benalcazar Game et al.· IECCMEXICO· 0 citations
Background: Stroke is one of the leading causes of long-term disability worldwide and is increasingly being reported among young adults, resulting in substantial physical, psychological, and socioeconomic challenges. Although conventional physiotherapy plays a central role in stroke rehabilitation, many individuals with severe motor deficits do not achieve complete functional recovery. In recent years, Brain–Computer Interface (BCI) technology has emerged as a promising adjunct to rehabilitation by directly interpreting brain activity to facilitate movement, promote neuroplasticity, and enhance motor recovery through external assistive devices.
Objective: To review the current evidences on the role of Brain-Computer Interface (BCI) approaches and comparison with conventional physiotherapy in stroke rehabilitation.
Methods: A literature review was performed by searching electronic databases, including PubMed, Google Scholar, ScienceDirect, ProQuest, and Mendeley, for studies published between 2015 and 2025. The search was carried out using keywords related to Brain–Computer Interface (BCI), EEG-based BCI, stroke rehabilitation, neuroplasticity, and neurorehabilitation. Studies were screened according to predefined inclusion and exclusion criteria, and 10 relevant articles comprising systematic reviews, meta-analyses, randomized controlled trials, review articles, and case studies were included for critical appraisal and evidence synthesis.
Results: The Reviewed studies consistently showed that non-invasive EEG-based Brain–Computer Interface (BCI), when used alongside conventional physiotherapy and other rehabilitation approaches such as functional electrical stimulation, robotic-assisted therapy, and virtual reality, was associated with improved upper-limb motor function, motor control, functional independence, and neuroplasticity in individuals with stroke. Several studies also reported that BCI enhanced communication abilities in patients with severe paralysis and locked-in syndrome. While invasive BCI systems offered greater signal accuracy, non-invasive EEG-based BCIs were considered safer, more practical, and better suited for routine clinical rehabilitation.
Conclusion: Based on the reviewed evidences, Brain–Computer Interface (BCI) shows promise as an adjunct to conventional physiotherapy for improving stroke rehabilitation outcomes. Further high-quality studies are needed to establish standardized protocols and confirm its long-term clinical effectiveness.
kumar S Anil, B. Sharvani, M. H· World Journal of Advanced Re...· 0 citations
Stroke remains a major cause of long-term neurological disability worldwide, creating a growing need for rehabilitation strategies capable of promoting functional recovery through intensive, repetitive, task-oriented, and personalized interventions. Digital neurorehabilitation has emerged as a multidisciplinary approach that integrates neuroscience, physical and rehabilitation medicine, neurology, and biomedical engineering through technologies such as virtual reality, robot-assisted rehabilitation, brain-computer interfaces, wearable sensors, artificial intelligence, and telerehabilitation. This review analyzed international scientific evidence regarding the application of these technologies after stroke, with particular attention to their relationship with experience-dependent neuroplasticity, functional outcomes, implementation challenges, and applicability across different healthcare environments, including Latin America. Scientific evidence was identified and critically synthesized from internationally recognized databases, prioritizing randomized controlled trials, systematic reviews, meta-analyses, clinical guidelines, and relevant contemporary studies. The reviewed literature showed that virtual reality and robot-assisted rehabilitation constitute the most extensively investigated technological approaches, with favorable findings particularly in upper-limb motor function, balance, gait, functional mobility, and activities of daily living. Telerehabilitation and wearable technologies provide additional opportunities for extending therapeutic continuity and objective monitoring beyond specialized rehabilitation facilities, while brain-computer interfaces and artificial intelligence represent emerging approaches for neural feedback and personalized rehabilitation. Despite these advances, considerable heterogeneity remains regarding intervention protocols, technological platforms, therapeutic intensity, outcome measures, and patient characteristics. Furthermore, acquisition costs, infrastructure requirements, professional training, accessibility, connectivity, and digital literacy continue to influence implementation, particularly in resource-constrained healthcare systems. Current evidence supports digital technologies as complementary components of multidisciplinary stroke rehabilitation rather than substitutes for conventional therapy. Future research should prioritize standardized protocols, multicenter studies, long-term functional outcomes, cost-effectiveness, equitable accessibility, and greater representation of Latin American populations to advance toward evidence-based precision neurorehabilitation.
Benitez Barrios Sosimo Isaac, Melany Patricia Bolagay Apráez, Dr. Robinson Alexander Morey Contreras et al.· IECCMEXICO· 0 citations
BCI-based training effectively improves lower-limb motor recovery after stroke, and subgroup analyses suggested that a moderate total dose combined with 20-40-minute sessions may represent a potentially optimal regimen, although these findings are based on limited RCTs and require confirmation in larger studies.
Xingyu Liu, Peng Huang, L. Wu et al.· Journal of Stroke & Cerebrov...· 0 citations
Post-stroke depression (PSD) is a common neuropsychiatric complication after stroke and is associated with poorer functional recovery and quality of life. This systematic review and meta-analysis evaluated the efficacy and safety of non-invasive brain stimulation (NIBS), specifically repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), for PSD.
PubMed, Embase, Web of Science, the Cochrane Library, and Scopus were searched from inception to April 2025. Randomized controlled trials comparing rTMS or tDCS with sham stimulation, placebo, usual care, or other control interventions in adults with PSD were eligible. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated for depressive symptoms and secondary outcomes. Fixed- or random-effects models were selected according to heterogeneity.
Seventeen randomized controlled trials involving 917 participants were included. Compared with control interventions, NIBS was associated with a greater reduction in depressive symptoms (SMD = −1.24, 95% CI: −1.74 to −0.73,
p
< 0.001). Subgroup analyses showed significant effects for both rTMS (SMD = −1.06, 95% CI: −1.59 to −0.52) and tDCS (SMD = −1.94, 95% CI: −3.25 to −0.63), although the difference between modalities was not statistically significant. High-frequency rTMS showed a numerically larger effect than low-frequency rTMS, but the subgroup difference was not significant. NIBS was also associated with improvements in activities of daily living (SMD = 0.80) and quality of life (SMD = 0.83). No serious stimulation-related adverse events were reported.
Current randomized evidence suggests that rTMS and tDCS may improve depressive symptoms in patients with PSD and appear generally well tolerated. However, the certainty of these findings is limited by substantial heterogeneity, small sample sizes in several trials, and variation in stimulation protocols. Further well-designed trials are needed to define optimal stimulation parameters, treatment timing, and long-term clinical effects.
Pei-Zhang Huang, Hao-Jie Wang, Cheng Huang et al.· Frontiers in Psychology· 0 citations