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Brain-computer interface for upper limb functional recovery post-stroke: a meta-analysis of improvement in upper limb motor function and changes in neurophysiological markers.

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Τίτλος: Brain-computer interface for upper limb functional recovery post-stroke: a meta-analysis of improvement in upper limb motor function and changes in neurophysiological markers.
Συγγραφείς: Zhang H; School of Physical Education, Southwest Medical University, Luzhou, Sichuan, China., Xian R; School of Physical Education, Southwest Medical University, Luzhou, Sichuan, China., Zhang Y; School of Physical Education, Southwest Medical University, Luzhou, Sichuan, China., Liu X; School of Health and Rehabilitation, Zigong Vocational and Technical College, Zigong, Sichuan, China., Yang G; Acupuncture and Rehabilitation Department, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, Sichuan, China., Chen G; School of Physical Education, Southwest Medical University, Luzhou, Sichuan, China. chenguiquan1973@126.com.; Acupuncture and Rehabilitation Department, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, Sichuan, China. chenguiquan1973@126.com.
Πηγή: Journal of neuroengineering and rehabilitation [J Neuroeng Rehabil] 2026 Aug 24; Vol. 23 (1). Date of Electronic Publication: 2026 Aug 24.
Τύπος έκδοσης: Journal Article; Meta-Analysis; Systematic Review
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: BioMed Central Country of Publication: England NLM ID: 101232233 Publication Model: Electronic Cited Medium: Internet ISSN: 1743-0003 (Electronic) Linking ISSN: 17430003 NLM ISO Abbreviation: J Neuroeng Rehabil Subsets: MEDLINE
Imprint Name(s): Original Publication: [London] : BioMed Central, 2004-
Ιατρικοί όροι (MeSH): Upper Extremity*/physiopathology , Recovery of Function*/physiology , Stroke Rehabilitation*/methods , Brain-Computer Interfaces*, Stroke/physiopathology ; Humans
Περίληψη: Background: Brain-Computer Interface (BCI) has emerged as a promising intervention, facilitating recovery of upper limb motor function, enhancing associated neurophysiological markers, and improving activities of daily living (ADL) performance, which is measured using the Modified Barthel Index (MBI). Nevertheless, most existing research has centered on individual outcome domains, and thus critical questions remain unanswered. These questions include heterogeneity in treatment efficacy across different post-stroke phases, in addition to the consistency of BCI's effects across specific functional assessment scales, such as the Fugl-Meyer Upper Extremity Scale (FMA-UE) and the Action Research Arm Test (ARAT)-and on neurophysiological markers.
Objective: To perform a systematic review and meta-analysis of the effects of BCI-mediated rehabilitation versus conventional rehabilitation on upper limb motor function, functional activities, neurophysiological markers, and MBI performance in patients with stroke.
Methods: Systematic searches were performed in 7 databases for this study: PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wan Fang Data, and China Biology Medicine Database (CBM). Inclusion criteria were randomized controlled trials (RCTs) comparing BCI-mediated rehabilitation with conventional rehabilitation in patients with upper limb dysfunction following stroke. The primary outcome measure was FMA-UE scores. Secondary outcome measures included functional activity levels as assessed by ARAT, neurophysiological markers (e.g., motor evoked potentials, MEPs, electroencephalography, EEG indices), and MBI scores. The methodological quality of the included studies was assessed using the validated evidence-based Cochrane Collaboration's RoB 2.0. In the meta-analysis, if the results of the heterogeneity test were less than 25%, the fixed-effect model was employed; otherwise, the random-effects model was used. For each outcome measure, the mean difference (MD) or standardized mean difference (SMD), together with their corresponding 95% confidence intervals (95% CI), were calculated.
Results: After screening against the inclusion and exclusion criteria, 16 eligible randomized controlled trials (RCTs) were ultimately included, encompassing a total of 1761 patients. Compared with conventional rehabilitation interventions, BCI rehabilitation interventions exert a certain effect on improving patients 'upper limb motor function (SMD = 0.49, 95%CI;0.26-0.73, p = 0.037).Additionally, significant improvements were observed in ARAT scores (SMD = 0.53, 95% CI: 0.14-0.91, p = 0.035),neurophysiological markers(SMD = 0.53, 95% CI;0.08-0.98, p < 0.05)and MBI scores(SMD = 0.85, 95% CI;0.55-1.14, p < 0.001).Subgroup analyses of BCI-mediated rehabilitation interventions for upper limb motor function recovery in stroke patients demonstrated certain subgroup-specific disparities in the magnitude of therapeutic effects across different subgroups. With respect to stroke staging, BCI-mediated rehabilitation interventions conferred superior efficacy for motor function recovery in patients with subacute stroke, a finding plausibly attributable to the temporal course of post-stroke neural remodeling. Subgroup analyses stratified by intervention dosage demonstrated that both 10-15 and 20-30 sessions of BCI-mediated rehabilitation interventions resulted in clinically meaningful improvements in patients' upper limb function. No statistically significant difference was detected between these two treatment regimens, yet the 20-30-session protocol was associated with a relatively larger effect size. Furthermore, subgroup analyses stratified by intervention modality demonstrated that no statistically significant differences emerged across the distinct intervention approaches, and this observation plausibly suggests the rehabilitative benefits of divergent BCI paradigms in patients are uniformly mediated through neural circuit remodeling.
Conclusion: BCI emerges as a promising therapeutic modality for stroke rehabilitation, delivering substantial, statistically significant improvements across multiple key outcomes, including FMA-UE, ARAT, neurophysiological markers, and MBI scores with consistent statistical significance observed across all aforementioned domains.
(© 2026. The Author(s).)
Competing Interests: Declarations. Ethics approval and consent to participate: This study is a meta-analysis based on previously published open-access literature. No original human or animal experiments were conducted, nor was any direct contact made with research participants. Therefore, ethical approval from an institutional review board (IRB) is not required for this work. Meanwhile, informed consent from participants is not applicable, as all data utilized in the study were obtained from publicly available publications. Consent for publication: All authors have reviewed and approved the final version of the manuscript, and unanimously consented to its submission and publication in this journal. Neither the full text nor any part of this manuscript has been previously published elsewhere, nor is it under consideration for publication by any other journal. Competing interests: The authors declare no competing interests.
References: Ann Neurol. 2013 Jul;74(1):100-8. (PMID: 23494615)
Med. 2024 Jun 14;5(6):559-569.e4. (PMID: 38642555)
J Neurol Neurosurg Psychiatry. 2003 May;74(5):646-8. (PMID: 12700310)
J Neuroeng Rehabil. 2019 Aug 2;16(1):101. (PMID: 31375122)
Lancet Neurol. 2020 Apr;19(4):348-360. (PMID: 32004440)
IEEE Rev Biomed Eng. 2025;18:26-49. (PMID: 39186407)
Neurorehabil Neural Repair. 2007 May-Jun;21(3):279-91. (PMID: 17353458)
BMC Neurol. 2023 Mar 31;23(1):136. (PMID: 37003976)
Ann Neurol. 2008 Mar;63(3):272-87. (PMID: 18383072)
IEEE Trans Neural Syst Rehabil Eng. 2003 Jun;11(2):120-3. (PMID: 12899251)
Exerc Sport Sci Rev. 2019 Oct;47(4):223-229. (PMID: 31283528)
Brain Sci. 2025 Mar 24;15(4):. (PMID: 40309789)
Nat Rev Neurol. 2011 Feb;7(2):76-85. (PMID: 21243015)
J Neuroinflammation. 2015 Dec 30;12:247. (PMID: 26714866)
Electroencephalogr Clin Neurophysiol. 1994 Jun;90(6):444-9. (PMID: 7515787)
Front Neurosci. 2023 May 11;17:1146146. (PMID: 37250399)
Lancet Neurol. 2008 Nov;7(11):1032-43. (PMID: 18835541)
West J Med. 1993 Jul;159(1):56-60. (PMID: 8351906)
J Physiol. 2021 May;599(9):2361-2374. (PMID: 33728656)
Occup Ther Int. 2016 Mar;23(1):39-47. (PMID: 26301519)
Front Comput Neurosci. 2020 Jan 21;13:87. (PMID: 32038208)
Front Neurosci. 2022 Mar 11;16:808830. (PMID: 35360158)
Clin Neurophysiol. 2022 May;137:92-101. (PMID: 35303540)
Int J Mol Sci. 2015 Oct 26;16(10):25605-40. (PMID: 26516838)
Cerebrovasc Dis. 2014;38(4):233-9. (PMID: 25402763)
Neural Regen Res. 2020 Jan;15(1):16-19. (PMID: 31535636)
Handb Clin Neurol. 2020;168:51-65. (PMID: 32164868)
Brain Topogr. 2022 Nov;35(5-6):651-666. (PMID: 36136166)
Lancet Neurol. 2009 Aug;8(8):741-54. (PMID: 19608100)
IEEE Trans Neural Syst Rehabil Eng. 2022;30:1737-1744. (PMID: 35731756)
Nat Med. 2002 Sep;8(9):963-70. (PMID: 12161747)
Front Neurosci. 2020 Oct 21;14:591435. (PMID: 33192277)
J Neural Eng. 2025 Mar 12;22(2):. (PMID: 39978072)
J Neurol Neurosurg Psychiatry. 2000 Mar;68(3):323-31. (PMID: 10675214)
Clin Neurophysiol. 2007 Nov;118(11):2525-32. (PMID: 17889600)
Contributed Indexing: Keywords: BCI; MBI; Meta-analysis; Neurophysiological markers; Stroke; Upper limb recovery
Entry Date(s): Date Created: 20260825 Date Completed: 20260825 Latest Revision: 20260924
Update Code: 20260924
PubMed Central ID: PMC13501825
DOI: 10.1186/s12984-026-02080-w
PMID: 42638125
Βάση Δεδομένων: MEDLINE
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  Data: Brain-computer interface for upper limb functional recovery post-stroke: a meta-analysis of improvement in upper limb motor function and changes in neurophysiological markers.
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  Data: &lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Zhang+H%22&quot;&gt;Zhang H&lt;/searchLink&gt;; School of Physical Education, Southwest Medical University, Luzhou, Sichuan, China.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Xian+R%22&quot;&gt;Xian R&lt;/searchLink&gt;; School of Physical Education, Southwest Medical University, Luzhou, Sichuan, China.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Zhang+Y%22&quot;&gt;Zhang Y&lt;/searchLink&gt;; School of Physical Education, Southwest Medical University, Luzhou, Sichuan, China.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Liu+X%22&quot;&gt;Liu X&lt;/searchLink&gt;; School of Health and Rehabilitation, Zigong Vocational and Technical College, Zigong, Sichuan, China.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Yang+G%22&quot;&gt;Yang G&lt;/searchLink&gt;; Acupuncture and Rehabilitation Department, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, Sichuan, China.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Chen+G%22&quot;&gt;Chen G&lt;/searchLink&gt;; School of Physical Education, Southwest Medical University, Luzhou, Sichuan, China. chenguiquan1973@126.com.; Acupuncture and Rehabilitation Department, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, Sichuan, China. chenguiquan1973@126.com.
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  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%22101232233%22&quot;&gt;Journal of neuroengineering and rehabilitation&lt;/searchLink&gt; [J Neuroeng Rehabil] 2026 Aug 24; Vol. 23 (1). &lt;i&gt;Date of Electronic Publication: &lt;/i&gt;2026 Aug 24.
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  Data: Journal Article; Meta-Analysis; Systematic Review
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  Data: &lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Upper+Extremity%22&quot;&gt;Upper Extremity*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Upper+Extremity+physiopathology%22&quot;&gt;physiopathology&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Recovery+of+Function%22&quot;&gt;Recovery of Function*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Recovery+of+Function+physiology%22&quot;&gt;physiology&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Stroke+Rehabilitation%22&quot;&gt;Stroke Rehabilitation*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Stroke+Rehabilitation+methods%22&quot;&gt;methods&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Brain-Computer+Interfaces%22&quot;&gt;Brain-Computer Interfaces*&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Stroke%22&quot;&gt;Stroke&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Stroke+physiopathology%22&quot;&gt;physiopathology&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Humans%22&quot;&gt;Humans&lt;/searchLink&gt;
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: Brain-Computer Interface (BCI) has emerged as a promising intervention, facilitating recovery of upper limb motor function, enhancing associated neurophysiological markers, and improving activities of daily living (ADL) performance, which is measured using the Modified Barthel Index (MBI). Nevertheless, most existing research has centered on individual outcome domains, and thus critical questions remain unanswered. These questions include heterogeneity in treatment efficacy across different post-stroke phases, in addition to the consistency of BCI&#39;s effects across specific functional assessment scales, such as the Fugl-Meyer Upper Extremity Scale (FMA-UE) and the Action Research Arm Test (ARAT)-and on neurophysiological markers.&lt;br /&gt;Objective: To perform a systematic review and meta-analysis of the effects of BCI-mediated rehabilitation versus conventional rehabilitation on upper limb motor function, functional activities, neurophysiological markers, and MBI performance in patients with stroke.&lt;br /&gt;Methods: Systematic searches were performed in 7 databases for this study: PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wan Fang Data, and China Biology Medicine Database (CBM). Inclusion criteria were randomized controlled trials (RCTs) comparing BCI-mediated rehabilitation with conventional rehabilitation in patients with upper limb dysfunction following stroke. The primary outcome measure was FMA-UE scores. Secondary outcome measures included functional activity levels as assessed by ARAT, neurophysiological markers (e.g., motor evoked potentials, MEPs, electroencephalography, EEG indices), and MBI scores. The methodological quality of the included studies was assessed using the validated evidence-based Cochrane Collaboration&#39;s RoB 2.0. In the meta-analysis, if the results of the heterogeneity test were less than 25%, the fixed-effect model was employed; otherwise, the random-effects model was used. For each outcome measure, the mean difference (MD) or standardized mean difference (SMD), together with their corresponding 95% confidence intervals (95% CI), were calculated.&lt;br /&gt;Results: After screening against the inclusion and exclusion criteria, 16 eligible randomized controlled trials (RCTs) were ultimately included, encompassing a total of 1761 patients. Compared with conventional rehabilitation interventions, BCI rehabilitation interventions exert a certain effect on improving patients &#39;upper limb motor function (SMD = 0.49, 95%CI;0.26-0.73, p = 0.037).Additionally, significant improvements were observed in ARAT scores (SMD = 0.53, 95% CI: 0.14-0.91, p = 0.035),neurophysiological markers(SMD = 0.53, 95% CI;0.08-0.98, p &amp;lt; 0.05)and MBI scores(SMD = 0.85, 95% CI;0.55-1.14, p &amp;lt; 0.001).Subgroup analyses of BCI-mediated rehabilitation interventions for upper limb motor function recovery in stroke patients demonstrated certain subgroup-specific disparities in the magnitude of therapeutic effects across different subgroups. With respect to stroke staging, BCI-mediated rehabilitation interventions conferred superior efficacy for motor function recovery in patients with subacute stroke, a finding plausibly attributable to the temporal course of post-stroke neural remodeling. Subgroup analyses stratified by intervention dosage demonstrated that both 10-15 and 20-30 sessions of BCI-mediated rehabilitation interventions resulted in clinically meaningful improvements in patients&#39; upper limb function. No statistically significant difference was detected between these two treatment regimens, yet the 20-30-session protocol was associated with a relatively larger effect size. Furthermore, subgroup analyses stratified by intervention modality demonstrated that no statistically significant differences emerged across the distinct intervention approaches, and this observation plausibly suggests the rehabilitative benefits of divergent BCI paradigms in patients are uniformly mediated through neural circuit remodeling.&lt;br /&gt;Conclusion: BCI emerges as a promising therapeutic modality for stroke rehabilitation, delivering substantial, statistically significant improvements across multiple key outcomes, including FMA-UE, ARAT, neurophysiological markers, and MBI scores with consistent statistical significance observed across all aforementioned domains.&lt;br /&gt; (&#169; 2026. The Author(s).)
– Name: Abstract
  Label: Competing Interests
  Group: Ab
  Data: Declarations. Ethics approval and consent to participate: This study is a meta-analysis based on previously published open-access literature. No original human or animal experiments were conducted, nor was any direct contact made with research participants. Therefore, ethical approval from an institutional review board (IRB) is not required for this work. Meanwhile, informed consent from participants is not applicable, as all data utilized in the study were obtained from publicly available publications. Consent for publication: All authors have reviewed and approved the final version of the manuscript, and unanimously consented to its submission and publication in this journal. Neither the full text nor any part of this manuscript has been previously published elsewhere, nor is it under consideration for publication by any other journal. Competing interests: The authors declare no competing interests.
– Name: Ref
  Label: References
  Group: RefInfo
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– Name: SubjectMinor
  Label: Contributed Indexing
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  Data: &lt;i&gt;Keywords: &lt;/i&gt;BCI; MBI; Meta-analysis; Neurophysiological markers; Stroke; Upper limb recovery
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  Group: Date
  Data: &lt;i&gt;Date Created: &lt;/i&gt;20260825 &lt;i&gt;Date Completed: &lt;/i&gt;20260825 &lt;i&gt;Latest Revision: &lt;/i&gt;20260924
– Name: DateUpdate
  Label: Update Code
  Group: Date
  Data: 20260924
– Name: PubmedCentralID
  Label: PubMed Central ID
  Group: ID
  Data: PMC13501825
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1186/s12984-026-02080-w
– Name: AN
  Label: PMID
  Group: ID
  Data: 42638125
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=cmedm&AN=42638125
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1186/s12984-026-02080-w
    Languages:
      – Code: eng
        Text: English
    Subjects:
      – SubjectFull: Stroke physiopathology
        Type: general
      – SubjectFull: Humans
        Type: general
      – SubjectFull: Upper Extremity physiopathology
        Type: general
      – SubjectFull: Recovery of Function physiology
        Type: general
      – SubjectFull: Stroke Rehabilitation methods
        Type: general
      – SubjectFull: Brain-Computer Interfaces
        Type: general
    Titles:
      – TitleFull: Brain-computer interface for upper limb functional recovery post-stroke: a meta-analysis of improvement in upper limb motor function and changes in neurophysiological markers.
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Zhang H
      – PersonEntity:
          Name:
            NameFull: Xian R
      – PersonEntity:
          Name:
            NameFull: Zhang Y
      – PersonEntity:
          Name:
            NameFull: Liu X
      – PersonEntity:
          Name:
            NameFull: Yang G
      – PersonEntity:
          Name:
            NameFull: Chen G
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      – BibEntity:
          Dates:
            – D: 24
              M: 08
              Text: 2026 Aug 24
              Type: published
              Y: 2026
          Identifiers:
            – Type: issn-electronic
              Value: 1743-0003
          Numbering:
            – Type: volume
              Value: 23
            – Type: issue
              Value: 1
          Titles:
            – TitleFull: Journal of neuroengineering and rehabilitation
              Type: main
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