Abstract
Background and aims
Stroke is a leading cause of long-term disability worldwide, with upper limb motor impairment profoundly affecting independence and quality of life. Despite conventional rehabilitation, recovery is often incomplete, driving the pursuit of adjunct therapies like non-invasive brain stimulation (NIBS) to enhance neuroplasticity and functional outcomes. This review evaluates the effects of various NIBS modalities on upper limb motor recovery post-stroke to inform clinical practice.
Methods: A systematic review was conducted following PRISMA guidelines. A PubMed search using MeSH terms ("Stroke" AND "Transcranial Magnetic Stimulation") identified 3,296 records. Filters for Randomized Clinical Trials published over the last 5 years and free full text yielded 79 studies. After the screening process, 13 studies were included.
Results
Trials evaluated protocols such as rTMS and theta-burst stimulation (TBS), often combined with peripheral stimulation (rPMS/ES). Outcomes were assessed via FMA-UE, ARAT, and Barthel Index. Active NIBS protocols, especially combined central-peripheral approaches, consistently outperformed conventional therapy in improving motor function, daily living, and reducing spasticity. Synergistic effects in combined protocols are attributed to enhanced cortical excitability with afferent feedback. Recovery mechanisms depended on baseline impairment: moderate-severe deficits correlated with increased interhemispheric connectivity, while mild impairment linked to intrahemispheric reorganization. Common limitations were small samples and limited long-term follow-up.
Conclusions
Conclusion: NIBS, particularly combined and personalized protocols, significantly enhances upper limb recovery post-stroke. The influence of baseline impairment severity on treatment response underscores the need for individualized strategies and neurophysiological monitoring in rehabilitation.
Conflict of interest
Isabela Bettu Bini: nothing to disclose. Lauren Zimmer Martins: nothing to disclose. Anna Thereza Rocha Pereira: nothing to disclose.