Enhancing Post-Stroke Arm Function with Combined Brain Signals and Muscle Stimulation: A Quantitative Meta-Analysis and Critical Framework for Next-Generation Rehabilitation Systems

Enhancing Post-Stroke Arm Function with Combined Brain Signals and Muscle Stimulation: A Quantitative Meta-Analysis and Critical Framework for Next-Generation Rehabilitation Systems | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Enhancing Post-Stroke Arm Function with Combined Brain Signals and Muscle Stimulation: A Quantitative Meta-Analysis and Critical Framework for Next-Generation Rehabilitation Systems Aaryan Oza This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8159913/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Seventy percent of stroke survivors experience upper-limb compromised functionality, making it one of the greatest rehabilitation concerns. Thus, hybrid systems driven by motor imagery-based brain-computer interfaces (MI-BCI) and functional electrical stimulation (FES) can be clinically beneficial, yet systematic quantitative review yields significant heterogeneity in findings and methods. This meta-analysis of 21 randomized control trials (n = 886) on MI-BCI+FES shows that MI-BCI + FES is significantly more effective than control (pooled effect size standardized mean difference: 0.72, 95% CI: 0.58-0.86, p < 0.001) for conventional treatment. However, this novel integrative evaluative comparison championed by translational neuroscience reveals three glaring limitations which may impact clinical efficacy: (1) temporal overlap of movement intention and stimulation provision; (2) relative facilitation levels are limited in adjustability to promote relative neuroplasticity patterns; and (3) there are no compensatory recalibrative approaches to stimulate. These shortcomings are better understood through the lens of the NIAS model, or Neuroplasticity-Informed Adaptive Stimulation, as a single theoretical framework for cross-comparative understanding. In addition, costs associated with implementation pose a problem as an average price range of $12,000-18,000 per patient, per year, suggests that further advancements in technology are needed before MIAS becomes widely applicable across populations. Biomedical Engineering stroke rehabilitation motor imagery brain-computer interface functional electrical stimulation neuroplasticity meta-analysis cost-effectiveness Full Text Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8159913","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":547844711,"identity":"d348a6cc-7739-4ae2-8c47-ef7755f63d85","order_by":0,"name":"Aaryan Oza","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA60lEQVRIie2PsQrCMBCGUyLnEs2aUq2vUBG6KPZhhLi4OYmDg1AnXyc4KgFdlK4VF6vQTdBB0EEwCq6Jo2C+4e6G/+PuELJYfhpMs71qpPy9UiQ4eCnwvUIJsFc3KnSyydl91orouLQcXHvtCiCcHVKNwtbd0J2uOWayzHdV0VGHQaPR062Zc2ClWAKSKNy5AiuFgKdTakkO7iOWpKaUvitGZiVIOXhqCwskCZ2LkGalnua4WY15UJfQ8RyxIoANv/gJd7anuBX5iVxc7mIY0eI4O2rfR6jAPhMm76qPvyPnz+TczGmLxWL5Q573bkAJ3UmYTQAAAABJRU5ErkJggg==","orcid":"","institution":"Independent","correspondingAuthor":true,"prefix":"","firstName":"Aaryan","middleName":"","lastName":"Oza","suffix":""}],"badges":[],"createdAt":"2025-11-20 03:33:53","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-8159913/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8159913/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":96602944,"identity":"932d0be1-34a1-476a-826e-60beac350f10","added_by":"auto","created_at":"2025-11-24 09:05:13","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1833982,"visible":true,"origin":"","legend":"","description":"","filename":"EnhancingPostStrokeArmFunctionwithCombinedBrainSignalsandMuscleStimulationAQuantitativeMetaAnalysisandCriticalFrameworkforNextGenerationRehabilitationSystems2.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8159913/v1_covered_e164c6a7-d688-42a3-995f-31e7e1e90e16.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eEnhancing Post-Stroke Arm Function with Combined Brain Signals and Muscle Stimulation: A Quantitative Meta-Analysis and Critical Framework for Next-Generation Rehabilitation Systems\u003c/p\u003e","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Northern Highlands Regional Highschool","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"stroke rehabilitation, motor imagery, brain-computer interface, functional electrical stimulation, neuroplasticity, meta-analysis, cost-effectiveness","lastPublishedDoi":"10.21203/rs.3.rs-8159913/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8159913/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eSeventy percent of stroke survivors experience upper-limb compromised functionality, making it one of the greatest rehabilitation concerns. 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These shortcomings are better understood through the lens of the NIAS model, or Neuroplasticity-Informed Adaptive Stimulation, as a single theoretical framework for cross-comparative understanding. 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