Abstract

This systematic review evaluates the efficacy, safety, feasibility, and clinical implications of contemporary innovations in stroke rehabilitation, drawing from 10 randomized controlled trials (RCTs) published between 2022 and 2025 that collectively enrolled 712 adult participants with ischemic or hemorrhagic stroke across acute, subacute, and chronic phases. Innovations assessed included robotic-assisted therapy (4 studies), im mersive and gamified virtual reality (VR) systems (3 studies), brain-computer interfaces (BCI) with or without functional electrical stimulation (2 studies), and AI-enhanced telerehabilitation platforms (1 study). Primary outcomes focused on motor function (Fugl-Meyer Assessment Upper Extremity [FMA-UE]), gait and balance (10-Meter Walk Test [10MWT], Berg Balance Scale [BBS]), activities of daily living (Modified Barthel Index [MBI]), and quality of life (Stroke Impact Scale [SIS]). Robotic interventions yielded moderate standardized mean differences (SMD 0.55-0.82) in motor recovery, with clinically meaningful FMA-UE gains (6.2-8.8 points) especially in subacute moderate-severe patients. Immersive VR produced FMA-UE improvements of 3.0-5.5 points and enhanced balance (BBS +3.2-4.9 points), with benefits amplified by sessions exceeding 45 minutes. BCI approaches achieved the largest gains in severe paresis (+5.0 to +9.2 FMA-UE points) by enabling motor imagery training. Telerehabilitation demonstrated non-inferiority to in-clinic therapy for ADL and mobility outcomes while improving adherence (92%) and reducing costs by 30-40%. Safety was excellent across all modalities with adverse events

DOI: doi.org/10.63721/26JACNR0118

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