EFFECTIVENESS OF BRAIN–COMPUTER INTERFACE-ASSISTED REHABILITATION ON MOTOR RECOVERY IN STROKE SURVIVORS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Background: Stroke is a leading cause of long-term disability worldwide, with motor impairments significantly affecting functional independence and quality of life among survivors. Brain–computer interface (BCI)-assisted rehabilitation has emerged as a promising neurorehabilitation approach that facilitates motor recovery by translating neural activity into external feedback and promoting neuroplasticity. However, the effectiveness of BCI-assisted rehabilitation on motor recovery following stroke remains an area of ongoing investigation. Objective: To systematically evaluate and quantitatively synthesize the available evidence regarding the effectiveness of BCI-assisted rehabilitation on motor recovery in stroke survivors. Methods: A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Electronic databases including PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, and PEDro were searched. Randomized controlled trials and controlled clinical trials investigating BCI-assisted rehabilitation in adult stroke survivors were included. Data extraction and risk-of-bias assessment were independently performed by two reviewers using the Cochrane Risk of Bias 2 tool. Meta-analyses were conducted using a random-effects model, and pooled effect sizes were reported as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Results: The literature search identified 1,277 records, of which 22 studies involving 1,034 stroke survivors met the eligibility criteria for qualitative synthesis. Eighteen studies were included in quantitative meta-analysis. The pooled analysis demonstrated that BCI-assisted rehabilitation significantly improved overall motor recovery compared with control interventions (SMD = 0.58, 95% CI 0.34–0.82; p < 0.001). Significant improvements were also observed for upper-limb motor outcomes (SMD = 0.63, 95% CI 0.38–0.88; p < 0.001) and lower-limb motor outcomes (SMD = 0.42, 95% CI 0.11–0.73; p = 0.008). Subgroup analyses revealed favorable effects across different BCI paradigms, including motor imagery, action observation, and hybrid systems. Moderate heterogeneity was observed among studies, while publication bias assessment using funnel plot analysis, Egger’s regression test, and Begg’s test did not indicate significant publication bias. Conclusion: BCI-assisted rehabilitation significantly enhances motor recovery in stroke survivors and demonstrates beneficial effects on both upper-limb and lower-limb function. The findings support the integration of BCI technology as a promising adjunct to conventional stroke rehabilitation programs. Further large-scale randomized controlled trials with standardized protocols and long-term follow-up are needed to strengthen the evidence base and optimize clinical implementation.