# Evoked potentials in stroke rehabilitation: current applications, emerging technologies, and future directions

## TL;DR

This review explores how evoked potentials can be used as biomarkers to improve stroke rehabilitation by monitoring recovery and guiding therapy.

## Contribution

The paper provides a comprehensive overview of current and emerging uses of evoked potentials in stroke rehabilitation, highlighting methodological challenges and future research priorities.

## Key findings

- Evoked potentials correlate with motor, sensory, balance, cognitive, and language outcomes in stroke patients.
- Emerging technologies like EP-based brain-computer interfaces and closed-loop neuromodulation show potential for rehabilitation.
- Standardization and translational research are needed to address protocol heterogeneity and clinical integration gaps.

## Abstract

Evoked potentials (EPs) are increasingly explored as objective neurophysiological biomarkers to complement scale-based assessment in stroke rehabilitation. This narrative review summarizes current evidence on the use of somatosensory evoked potentials (SEPs), motor evoked potentials (MEPs), and event-related potentials (ERPs) for monitoring recovery and guiding therapy. We first outline the physiological basis and stroke-relevant features of each modality, then synthesize data on how EP measures relate to motor, sensory, balance, cognitive and language outcomes, with particular emphasis on longitudinal changes during rehabilitation and responses to specific interventions, including neuromuscular electrical stimulation, robot-assisted training and non-invasive brain stimulation. Emerging applications such as perturbation-evoked cortical responses for postural control, EP-based brain–computer interfaces and EP-guided or closed-loop neuromodulation are discussed, together with advances in high-density recordings, connectivity analysis, and machine-learning–based multimodal prediction models. Finally, we highlight key methodological and practical challenges—protocol heterogeneity, small single-center studies, limited trial evidence, feasibility constraints and gaps in clinical integration—and propose priorities for standardization and translational research. Overall, EPs hold substantial promise as pathway-specific, temporally precise biomarkers to enable more mechanism-informed and individualized stroke rehabilitation monitoring.