Effectiveness of Multimodal Exercise and Technology-Assisted Interventions for Post-Stroke Motor Recovery : A Systematic Review
Abstract
Background: Post-stroke motor recovery remains a major rehabilitation challenge. Multimodal exercise and technology-assisted interventions are increasingly used, but their comparative efficacy and moderators of benefit remain unclear. Methods: This systematic review synthesized data from 80 sources (primarily RCTs, etc) examining multimodal exercise, technology-assisted, or combined interventions versus usual care or conventional rehabilitation in adult stroke patients. Outcomes included motor function (Fugl-Meyer Assessment, FMA), gait, balance, and activities of daily living (ADL). Results: In subacute stroke, exoskeleton-assisted anthropomorphic training produced superior FMA-UE gains (+4.51 points; 95% CI 1.13–7.90) [6]. Virtual reality (VR) exercise improved FMA-UE (SMD 0.45; 95% CI 0.21–0.68) [2], with doses >15 hours yielding greater gains (MD 9.67) [12]. Bihemispheric tDCS combined with physical/occupational therapy improved FMA by 20.7% vs. 3.2% [10]. High-volume constraint-induced movement therapy ranked second (SMD 0.86) [20]. In chronic stroke, brain-computer interface (BCI) with robotics produced significant FMA gains vs. standard therapy [9]. Telerehabilitation was noninferior to in-clinic therapy (FMA difference 0.06 points) [13]. For gait, end-effector robotic training improved velocity (MD 0.16 m/s) [14], and aerobic exercise improved 6MWT (p=0.011) [15] and gait velocity (0.21 vs. 0.06 m/s) [17]. Combined cardiorespiratory/resistance training improved walking speed (MD 0.09 m/s) [16]. FES plus motor relearning significantly improved Barthel Index (15.8 vs. 8.2) [37]. Discussion: Positive effects are most consistent in subacute stroke, with greater baseline impairment and active, volitional, high-dose practice. Technology often matches conventional therapy when intensity is equal, but adds value by enabling adherence, neurofeedback, or home delivery. Conclusion: Multimodal and technology-assisted interventions significantly improve post-stroke motor recovery, particularly in subacute patients and when providing high-repetition, volitional, or neurofeedback-driven training. Telerehabilitation and BCI systems offer promising scalable solutions.