Integration, Closed-Loop, Precision: Neuromodulation Technology Reshaping Stroke Rehabilitation

doi:10.3969/j.issn.1673-5765.2025.09.001

Abstract

Abstract: Stroke is characterized by high incidence, high mortality, and high disability rates. The burden of stroke is severe in China, with survivors often experiencing motor, cognitive, and other functional impairments. However, conventional rehabilitation techniques have certain limitations. Against this backdrop, neuromodulation technology is driving innovation in stroke rehabilitation, guided by the key trends of integration, closed-loop systems, and precision. As a current research focus, brain-computer interface (BCI) demonstrates strong potential in the field of stroke rehabilitation through unique mechanisms such as the “intent-action” closed loop. However, the efficacy of single neuromodulation techniques remains limited, making multimodal integration strategies an emerging application and research trend aimed at enhancing rehabilitation outcomes through technological synergy. The mechanisms of neuromodulation primarily involve neuroplasticity and functional reorganization. The closed-loop systems combining BCI with other devices have shown remarkable advantages in stroke rehabilitation. Currently, the field still faces challenges such as heterogeneous treatment effects and unclear response mechanisms. Future development should focus on individualization, precision, and intelligence. With the deep integration of neuromodulation technology and cutting-edge technologies such as artificial intelligence, the prospect of individualized and precision stroke rehabilitation is promising.

Key words: Stroke; Rehabilitation; Neuromodulation technology; Brain-computer interface; Neuroplasticity

摘要： 卒中具有高发病率、高死亡率和高致残率的特点。我国卒中负担沉重，幸存者多遗留运动、认知等功能障碍，而传统康复技术存在一定局限性。在此背景下，神经调控技术正以融合化、闭环化、精准化为主要趋势，引领卒中康复领域的革新。其中，脑机接口（brain-computer interface，BCI）作为当前研究热点，凭借“意念-动作”闭环等独特机制，在卒中康复领域展现出了强劲的潜力。不过，单一神经调控技术的效果较为有限，而多模态融合策略可通过技术协同进一步提升康复疗效，逐渐成为了应用和研究的新趋势。神经调控技术的作用机制主要涉及神经可塑性与功能性重组，其中BCI与其他设备联合构成的闭环调控系统，在卒中康复中表现突出。目前，神经调控领域仍面临疗效异质性、响应机制不明确等挑战。未来发展应聚焦个体化、精准化和智能化方向。随着神经调控技术与人工智能等前沿科技的深度融合，卒中的个体化精准康复前景可期。

关键词: 卒中; 康复; 神经调控技术; 脑机接口; 神经可塑性

CLC Number:

R74
R318

LIU Lixu. Integration, Closed-Loop, Precision: Neuromodulation Technology Reshaping Stroke Rehabilitation[J]. Chinese Journal of Stroke, 2025, 20(9): 1073-1077.

刘丽旭. 融合·闭环·精准：神经调控技术重塑卒中康复[J]. 中国卒中杂志, 2025, 20(9): 1073-1077.

References

[1] WU S M，WU B，LIU M，et al. Stroke in China：advances and challenges in epidemiology，prevention，and management[J]. Lancet Neurol，2019，18（4）：394-405.
[2] 王拥军，李子孝，谷鸿秋，等. 中国卒中报告2020（中文版）（1）[J]. 中国卒中杂志，2022，17（5）：433-447.
WANG Y J，LI Z X，GU H Q，et al. China stroke statistics 2020（1）[J]. Chin J Stroke，2022，17（5）：433-447.
[3] KESER Z，IKRAMUDDIN S，SHEKHAR S，et al. Neuromodulation for post-stroke motor recovery：a narrative review of invasive and non‑invasive tools[J]. Curr Neurol Neurosci Rep，2023，23（12）：893-906.
[4] LEFAUCHEUR J P，ALEMAN A，BAEKEN C，et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation（rTMS）：an update（2014-2018）[J]. Clin Neurophysiol，2020，131（5）：474-528.
[5] CHENG J L，TAN C，LIU H Y，et al. Past，present，and future of deep transcranial magnetic stimulation：a review in psychiatric and neurological disorders[J]. World J Psychiatry，2023，13（9）：607-619.
[6] ZHANG R Q，FENG S S，HU N，et al. Hybrid brain-computer interface controlled soft robotic glove for stroke rehabilitation[J]. IEEE J Biomed Health Inform，2024，28（7）：4194-4203.
[7] WANG A X，TIAN X，JIANG D，et al. Rehabilitation with brain-computer interface and upper limb motor function in ischemic stroke：a randomized controlled trial[J]. Med，2024，5（6）：559-569.
[8] WANG T T，DU S Z，DONG E Z. A novel method to reduce the motor imagery BCI illiteracy[J]. Med Biol Eng Compu，2021，59（11/12）：2205-2217.
[9] PARK H，JUN S C. Connectivity study on resting-state EEG between motor imagery BCI-literate and BCI-illiterate groups[J/OL]. J Neural Eng，2024，21（4）[2025-08-16]. https://doi.org/10.1088/1741-2552/ad6187.
[10] SUN Y K，LI Y H，CHEN Y Z，et al. Efficient dual-frequency SSVEP brain-computer interface system exploiting interocular visual resource disparities[J/OL]. Expert Systems with Applications，2024，252：124144[2025-08-16]. https://doi.org/10.1016/j.eswa.2024.124144.
[11] JIANG L，LI X Y，PEI W H，et al. A hybrid brain-computer interface based on visual evoked potential and pupillary response[J/OL]. Front Hum Neurosci，2022，16：834959[2025-08-16]. https://doi.org/10.3389/fnhum.2022.834959.
[12] DING Q，LIN T，WU M F，et al. Inﬂuence of iTBS on the acute neuroplastic change after BCI training[J/OL]. Front Cell Neurosci，2021，15：653487[2025-08-16]. https://doi.org/10.3389/fncel.2021.653487.
[13] GAO T H，HU Y Q，ZHUANG J，et al. Repetitive transcranial magnetic stimulation of the brain region activated by motor imagery involving a paretic wrist and hand for upper-extremity motor improvement in severe sstroke：a preliminary study[J/OL]. Brain Sci，2022，13（1）：69[2025-08-16]. https://doi.org/10.3390/brainsci13010069.
[14] LIMA J P S，SILVA L A，DELISLE-RODRIGUEZ D，et al. Unraveling transformative effects after tDCS and BCI intervention in chronic post-stroke patient rehabilitation-an alternative treatment design study[J/OL]. Sensors，2023，23（23）：9302[2025-08-16]. https://doi.org/10.3390/s23239302.
[15] WON K，KIM H，GWON D，et al. Can vibrotactile stimulation and tDCS help inefficient BCI users？[J/OL]
J Neuroeng Rehabil，2023，20（1）：60[2025-08-16]. https://doi.org/10.1186/s12984-023-01181-0.
[16] BIASIUCCI A，LEEB R，ITURRATE I，et al. Brain-actuated functional electrical stimulation elicits lasting arm motor recovery after stroke[J/OL]. Nat Commun，2018，9（1）：2421[2025-08-16]. https://doi.org/10.1038/s41467-018-04673-z.
[17] BRUNNER I，LUNDQUIST C B，PEDERSEN A R，et al. Brain computer interface training with motor imagery and functional electrical stimulation for patients with severe upper limb paresis after stroke：a randomized controlled pilot trial[J/OL]. J Neuroeng Rehabil，2024，21（1）：10[2025-08-16]. https://doi.org/10.1186/s12984-024-01304-1.
[18] DI PINO G，PELLEGRINO G，ASSENZA G，et al. Modulation of brain plasticity in stroke：a novel model for neurorehabilitation[J]. Nat Rev Neurol，2014，10（10）：597-608.
[19] 唐睿，宋洪文，孔卓，等. 经颅直流电刺激治疗常见神经精神疾病的临床应用专家共识[J]. 中华精神科杂志，2022，55（5）：327-382.
TANG R，SONG H W，KONG Z，et al. Chinese experts’consensus on clinical application of transcranial direct current stimulation in the treatment of common neurological diseases and mental disorders[J]. Chin J Psychiatry，2022，55（5）：327-382.
[20] ZHANG J，ZHOU F Y，ROBERTS N，et al. Invasive or non-invasive vagus nerve stimulation modulation of brain function and remodeling after stroke：a review[J]. Int J Surg，2025，111（2）：2148-2161.
[21] WANG C R，WU B Q，LIN R L，et al. Vagus nerve stimulation：a physical therapy with promising potential for central nervous system disorders[J/OL]. Front Neurol，2024，15：1516242[2025-08-16]. https://doi.org/10.3389/fneur.2024.1516242.
[22] BAKER K B，PLOW E B，NAGEL S，et al. Cerebellar deep brain stimulation for chronic post-stroke motor rehabilitation：a phase Ⅰ trial[J]. Nat Med，2023，29（9）：2366-2374.
[23] ZHENG M X，HUA X Y，FENG J T，et al. Trial of contralateral seventh cervical nerve transfer for spastic arm paralysis[J]. N Engl J Med，2018，378（1）：22-34.
[24] LUO W M，YAN Z C，GUO Y，et al. Contralateral seventh cervical nerve transfer for central spastic arm paralysis：a systematic review and meta-analysis[J/OL]. Front Neurol，2023，14：1113254[2025-08-16]. https://doi.org/10.3389/fneur.2023.1113254.
[25] HONG X，LU Z K，TEH I，et al. Brain plasticity following MI-BCI training combined with tDCS in a randomized trial in chronic subcortical stroke subjects：a preliminary study[J/OL]. Sci Rep，2017，7（1）：9222[2025-08-16]. https://doi.org/10.1038/s41598-017-08928-5.