Effects of brain-computer interface-based rehabilitation on lower limb function and activities of daily living after stroke: a systematic review and meta-analysis

TL;DR

This study reviews and analyzes the effectiveness of brain-computer interface (BCI) rehabilitation for improving lower limb function and daily living activities after stroke.

Contribution

The paper provides the first systematic review and meta-analysis of BCI-based rehabilitation for post-stroke lower limb dysfunction.

Findings

BCI training significantly improved lower limb motor function, balance, and daily living activities in stroke patients.

A dose-dependent effect was observed, with greater improvements in daily living activities for training durations of ≥ 500 minutes.

Only limited evidence was found for functional mobility improvements, based on a single study.

Abstract

Lower limb motor dysfunction is a common sequela of stroke that significantly impacts patients' walking safety and independence in daily living. Although brain-computer interface (BCI) technology has demonstrated efficacy in upper limb rehabilitation, its effects on lower limb recovery have not yet been systematically evaluated.

A systematic literature search was conducted across seven databases (PubMed, Web of Science, Embase, China National Knowledge Infrastructure, SinoMed, VIP Database, and Wanfang Data.) to identify studies investigating BCI for post-stroke lower limb dysfunction, encompassing records published up to September 2025. All statistical analyses were performed using Review Manager software (version 5.4.1).

Thirteen studies involving 582 participants were included. BCI training significantly improved the scores of Fugl-Meyer Assessment for Lower Extremity (FMA-LE, MD = 2.67, 95%CI: 2.31–3.03, P < 0.00001, I2 = 0%), Berg Balance Scale (BBS, MD = 7.04, 95%CI: 3.14–10.94, P = 0.0004), and Modified Barthel Index (MBI, MD = 6.72, 95%CI: 1.74–11.69, P = 0.008). Furthermore, a single study reported significant improvement in functional mobility measured by the Timed Up and Go Test (TUGT). Subgroup analysis for activities of daily living MBI showed that a cumulative training time of ≥ 500 min was associated with greater improvement.

BCI-based training is an effective approach for improving lower limb recovery after stroke, demonstrating benefits in motor function, balance, and functional mobility. While evidence for certain outcomes remains limited, the dose-dependent effect on daily living activities underscores the importance of sufficient training duration. Future research should validate these findings and clarify effects across a broader range of functional measures.

https://www.crd.york.ac.uk/PROSPERO/view/CRD420251150558, identifier: CRD420251150558.

Figures