Integrating Non-Invasive Brain Stimulation With Post-Stroke Rehabilitation: A Systematized Review of Synergistic...

Area of Science:

• Neuroscience
• Rehabilitation Medicine
• Biomedical Engineering

Background:

• Physiotherapy drives neuroplasticity post-stroke, but recovery plateaus.
• Non-invasive brain stimulation (NIBS) may boost cortical excitability and responsiveness to therapy.
• The synergistic effects of combining NIBS with physiotherapy require further investigation.

Purpose of the Study:

• To systematically review randomized controlled trials (RCTs) integrating physiotherapy with NIBS.
• To determine if combined interventions improve motor, gait, hand, and cognitive outcomes compared to physiotherapy alone.
• To assess the efficacy of different NIBS modalities when used with physiotherapy.

Main Methods:

• A PRISMA-guided systematic search of six databases was performed.
• Included RCTs combined physiotherapy with tDCS, tACS, rTMS, or tsDCS.
• Risk of bias was assessed; findings were synthesized narratively due to heterogeneity.

Main Results:

• Fifteen RCTs with 440 participants were analyzed.
• Combined NIBS-physiotherapy showed generally favorable, though heterogeneous, improvements.
• Anodal tDCS with high-intensity, task-specific training yielded stronger effects, especially for gait in chronic stroke.

Conclusions:

• NIBS is most effective as a cortical primer during intensive, task-specific physiotherapy.
• Benefits are influenced by stroke chronicity, behavioral context, and stimulation parameters.
• Future research should focus on standardized protocols, biomarkers, and stratified trial designs.