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
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.
kumar S Anil, B. Sharvani, M. H· World Journal of Advanced Re...· 0 citations
Current evidence supports digital technologies as complementary components of multidisciplinary stroke rehabilitation rather than substitutes for conventional therapy, and 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
Objective
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.
Methods
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.
Results
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.
Conclusion
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, Chen Huang et al.· Frontiers in Psychology· 0 citations
We use cookies to run the site and, with your consent, for analytics and to show ads.
See our Cookie Policy.
