Emerging brain computer interface-based approaches in stroke rehabilitation: A review of current evidence and comparison with conventional physiotherapy

Abstract

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.