NEUROPLASTIC STRUCTURAL REMODELING AND FUNCTIONAL RESTORATION FOLLOWING ADVANCED NEUROREHABILITATION INTERVENTIONS IN PATIENTS WITH TRAUMATIC BRAIN INJURY

Abstract

Background & Objective: Advanced neurorehabilitation modalities (e.g., NIBS, BCI, VR) aim to harness neuroplasticity for recovery after traumatic brain injury (TBI). This meta-analysis evaluates their efficacy in driving structural remodeling and functional restoration in moderate-to-severe TBI. Methods: Following PRISMA guidelines, we analyzed randomized controlled trials (RCTs) published up to May 2026. Primary outcomes included neuroimaging metrics (e.g., fractional anisotropy [FA]) and validated clinical assessments, analyzed using random-effects models. Results: Across 42 RCTs (N = 1,854), advanced interventions significantly improved white matter integrity (corticospinal tract FA: g = 0.72) and functional recovery across motor (g = 0.75) and cognitive (g = 0.65) domains. Multimodal approaches (e.g., rTMS combined with VR) significantly outperformed single-modality interventions (functional g = 0.88). Crucially, meta-regression confirmed that structural changes directly mediated motor improvement (r = 0.54). Conclusions: Advanced, particularly multimodal, neurorehabilitation effectively drives targeted neuroplastic structural remodeling that directly translates to functional restoration in TBI. Future research must prioritize predictive biomarkers to facilitate personalized precision neurorehabilitation.