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Open research questions in Stroke Rehabilitation and Recovery

101 unresolved questions extracted from the limitations and future-work sections of 1,163 Stroke Rehabilitation and Recovery papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • Conclusion Digital technology-based interventions have the potential to enhance balance and cognitive function in PD patients, while their effects on depression and quality of life remain inconclusive.

    Effects of digital technology-based interventions on balance function and non-motor outcomes in Parkinson’s disease: a systematic review and meta-analysis · 2026 · DOI

  • Background Various digital technologies have been adopted for rehabilitation training and extended care in patients with Parkinson’s disease (PD), yet their effectiveness remains unclear.

    Effects of digital technology-based interventions on balance function and non-motor outcomes in Parkinson’s disease: a systematic review and meta-analysis · 2026 · DOI

  • Background Post-stroke depression (PSD) affects 25–50% of stroke survivors, yet its prognostic impact on mortality, functional disability, cognition, and health-related quality of life (HRQoL) remains incompletely characterised.

    Post-Stroke Depression and its Impact on Mortality and Functional Outcomes: A Systematic Review and Meta-Analysis · 2026 · DOI

  • While existing evidence supports BCI efficacy and safety in chronic stroke, its feasibility, safety, and cost-effectiveness during the acute and subacute phase (2 to 12 weeks post-stroke), when neuroplasticity is heightened, remain underexplored.

    Motor Imagery Brain–Computer Interface (MI-BCI)-Assisted Upper Limb Neurorehabilitation for Acute Stroke During Inpatient Rehabilitation: A Prospective Feasibility Study with Economic Evaluation Protocol · 2026 · DOI

  • Implications: A wider scale study is warranted, to determine feasibility and sample size for a randomised controlled trial investigating the effectiveness of trunk exercises using VR video games for improving trunk and balance ability in people with stroke.

    FEASIBILITY OF DELIVERING A TRUNK EXERCISE PROGRAMME POST-STROKE USING A VIRTUAL REALITY VIDEO GAME-BASED SYSTEM: A MIXED METHODS CASE SERIES · 2026 · DOI

  • of Cardiology, Diagnostic Centre, Silkeborg, DenmarkBackground: At present, there are no guidelines for rehabilitation following an acute pulmonary embolism (APE) although studies have shown that patients suffer long-term negative consequences like mental distress, dyspnea, fatigue, and reduced exercise capacity and physical activity.

    REHABILITATION FOLLOWING ACUTE PULMONARY EMBOLISM. A QUALITATIVE STUDY OF PATIENTS' AND HEALTH PROFESSIONALS' EXPERIENCES · 2026 · DOI

  • Despite being extensively studied, the therapeutic effects of RAT may be less pronounced than those of other non-pharmacological interventions, suggesting that allocating limited research resources to alternative non-pharmacological interventions may provide more informative guidance for clinical practice.

    Comparative effectiveness of non-pharmacological interventions for post-stroke upper limb motor dysfunction: a systematic review and network meta-analysis of randomized controlled trials · 2026 · DOI

  •  Future studies can include a larger sample size from different states of India.  Research can be conducted to evaluate the practical implementation of PACE therapy in clinical settings.  Comparative studies can be carried out between clinicians and newly practicing experienced regarding PACE awareness.  Training programs and workshops on functional communication approaches can be developed and evaluated for effectiveness. REFERENCES 1. Aten, J. L. Functional communication treatment in aphasia rehabilitation. Clinical Aphasiology, 1994; 22: 85-96. 2. Beeson, P. M., & Robey, R. R. Evaluating single- subject treatment research: Lessons learned from the aphasia literature. Neuropsychology Review, 2006; 16(4): 161–169. 3. Carlomagno, S. Pragmatic approaches to aphasia therapy. Whurr Publishers, 1994. 4. Chapey, R. (Ed.). Language intervention strategies in aphasia and related neurogenic communication disorders (5th ed.). Lippincott Williams & Wilkins, 2008. 5. Collins, M. communication Clinical Aphasiology, 1986; 16: 157–167.

    AWARENESS OF THE PROMOTING APHASIA COMMUNICATION EFFECTIVENESS TECHNIQUE AMONG PRACTICING SPEECH LANGUAGE PATHOLOGISTS IN KERALA · 2026 · DOI

  • ObjectiveThis study aimed to implement and evaluate a structured, team-based approach to integrating sexual health into stroke rehabilitation using the Permission-Limited Information-Specific Suggestions-Intensive Therapy model, operationalized through the Stroke Sexual Health Practice Profile.

    Implementation and evaluation of a stroke sexual health practice profile for rehabilitation in Ontario, Canada · 2026 · DOI

  • Therefore, future research should explore these processes to facilitate a more comprehensive understanding. Future research should investigate whether these processes differ between males and females after stroke, and whether sex-specific approaches to rehabilitation may be warranted. 1743882 inpatient rehabilitation in Japan, and their applicability to other settings and populations should be explored in future research.

    Psychological and behavioral processes in stroke survivors with recovery exceeding prognostic expectations: a qualitative study of positive deviance · 2026 · DOI

  • This study has several limitations. First, the relatively small sample size restricts the generalizability of the results. Second, the absence 98 doi.org/10.56984/8ZG2EFAYV72 www.fizjoterapiapolska.pl the experimental group of follow­up assessments prevented evaluation of the long­term sustainability of the intervention effects. In addition, the use of only a single cognitive task (e.g., subtraction) in the cognitive assessment limited the ability to determine the transfer effects of dual­task training on different cognitive domains. Finally, the intensive rehabilitation program administered to the control group may have reduced the visibility of the additional effects of dual­ task training.

    Multidimensional effects of dual-task-focused training added to structured neurological rehabilitation in individuals with chronic stroke: a randomized controlled trial · 2026 · DOI

  • Furthermore, a distinct and under-explored direction in the reviewed papers lies in the modeling of therapist HML. explicit Further investigation into promising fields such as closed-loop neuromodulation, adaptive feedback modalities (e.

    A narrative review of AI-driven stroke rehabilitation systems through the lens of human motor learning · 2026 · DOI

  • Based on the results of this NMA, GT+NMES demonstrated relatively stable ranking performance across multiple outcomes, including balance, walking ability, and lower limb functional mobility, suggesting that it warrants further investigation as a combined intervention for clinical application.

    Comparative effectiveness of neuromuscular electrical stimulation-based combination interventions for post-stroke lower limb rehabilitation: a systematic review and network meta-analysis · 2026 · DOI

  • duration paradigm engagement recovery, dose- heterogeneous response recovery paradigms Eleven studies spanning randomized controlled trials, cohort studies, and integrative frameworks. Across all paradigms, therapeutic intensity—operationalized through repetition density, physiological load, engagement, and temporal compression—consistently outperforms duration-based prescriptions. RCT, randomized controlled trial; FMA-UE, Fugl-Meyer Assessment Upper Extremity; ARAT, Action Research Arm Test; WMFT, Wolf Motor Function Test; MAL, Motor Activity Log; BI = Barthel Index; FIM, Functional Independence Measure; HIIT, high-intensity interval training; 6MWT = six-minute walk test; mRS, modified Rankin Scale. thereby extending effective stimulation while maintaining quality and safety (9). Critically, this transcultural validation challenges the false premise that advanced rehabilitation is exclusively the province of well-resourced settings. The Cogni-Famille protocol, delivering over five hours of daily stimulation through trained family members, achieved Fugl-Meyer gains of +43 points compared to +32 points in technology-rich European centers (9). This convergence across radically different contexts constitutes among the most powerful evidence that intensity— not in neuroplastic technology—is recovery, see Table 1. the active ingredient facilitation, or family-mediated amplification, the determinant of recovery remains the same: the amount of neuroplastic load delivered per unit time. This convergence sets the stage for a necessary conceptual shift—from describing rehabilitation in minutes and weeks to prescribing it in biologically meaningful units of intensity.

    Intensity is not time: reframing dose prescription in post-stroke neurorehabilitation · 2026 · DOI

  • HybridprotocolscombiningBobath-basedproximalpreparationwithMotorRelearningProgramme task repetition should be studied to determine whether sequential integration produces superior functional outcomes.

    Comparing the Effect of Bobath and Motor Relearning Programme on Upper Limb Function in Patients with Cerebrovascular Accidents: Case Study · 2026 · DOI

  • While previous research has estab- lished the importance of dyadic coping in stroke (19), the specific role of dyadic coping in the family resilience of young stroke couples remains unclear.

    Family risk factors, dyadic coping, and family resilience in young stroke dyads: an actor-partner interdependence mediation model · 2026 · DOI

  • Although this review was able to identify and discuss some potential mechanisms of motivation in stroke rehabilitation, it has several limitations. First, the data could not be pooled and analyzed in a meta-analysis due to the heterogeneity of outcome measures, particularly for motivation. Therefore, we decided to transfer the ratings into a direction of effect (44–46). On this basis, however, it was not taken into account which outcome measures represented the primary or most robust assessment. This could lead to an over-adjustment of the results. In this study, purely psychologically oriented databases were not included, as motor function represents the primary endpoint alongside motivational aspects. Such databases typically do not index motor-focused studies, so only few additional relevant hits were to be expected. Consequently, the results primarily cover evidence from the perspective of motor neurorehabilitation point of view. Further difficulties in comparability are reflected in the evaluation of assessments with subcategories, e.g., the IMI, where a varying number of subcategories could be selected. This means that some trials, for example, used four subcategories in the IMI, while others employed six subcategories.

    Motivation in motor training interventions after stroke—a systematic review · 2026 · DOI

  • Compared with control conditions, MBSR significantly reduced depressive symptoms in patients with PSD, suggesting a potential clinical benefit that warrants further investigation.

    Effectiveness of mindfulness-based stress reduction for depression in post-stroke patients: a systematic review and meta-analysis · 2026 · DOI

  • Declarations This review highlights key areas for future research and implementation strategies. Further high-quality clini- cal trials, particularly in MS, PD, and SCI, are essential. Standardization of intervention protocols, including treat- ment duration, intensity, and frequency, will be critical for enabling comparison across studies. Future studies should also focus on long-term outcomes, cost-effectiveness anal- yses, and barriers to adoption among both patients and healthcare providers. Investigations into usability, train- ing requirements, and psychological responses to robotic therapy will help shape more user-friendly and acceptable systems. Additionally, personalizing rehabilitation based on individual patient profiles, including severity and respon- siveness to therapy, will be vital for optimizing treatment and clinical decision-making. Integrating robotic systems into personalized patient-centered care pathways remains a central challenge and a necessary step for broader adoption.

    Unveiling the Clinical Impact of Lower Limb Robotic Devices in Neurorehabilitation: An Umbrella Review · 2026 · DOI

  • This study has several limitations that warrant attention. First, the sample was confined to a single regional population, which may increase sampling error; thus, future research should employ multi- center, large-sample designs to validate the generalizability of these con- clusions. Second, the reliance on self-reported outcomes may have introduced reporting bias to some extent. Additionally, while this study revealed the chained mediating effect of family functioning and relapse risk perception, the model did not account for potential confounding from variables such as self-efficacy. Crucially, key clinical variables, including the severity of neurological deficits and depressive symptoms, were not controlled for in this study. These factors are likely to influence the relationships among the studied variables, and therefore, future investigations should incorporate them to ensure more robust and pre- cise findings.

    Patient activation and health behavior decision-making in stroke patients: a longitudinal mediation mechanism of family function and risk perception · 2026 · DOI

  • It was notable that all interviews were undertaken virtually, a choice which may be explained by the disability of some stroke survivors, carer responsibilities, and the geographical spread of participants across the UK, which made face-to-face interviews more challenging. As participants were recruited via email or online adverts, and interviews were conducted online, participants who 1. Embed a personalized nutrition approach as a core – Assess nutritional risk and individual needs early, including medical, functional, cultural, and component of high-quality stroke care psychological factors. – Ensure visible and consistent inclusion of dietetic expertise within stroke MDTs. – Tailor recommendations to the individual’s unique characteristics, avoiding “one-size-fits-all” advice in favor of nuanced, context-aware guidance. – Offer culturally appropriate meal and snack options that respect individual preferences.

    Stroke survivors' and carers' experiences of nutritional care after stroke: a qualitative study · 2026 · DOI

  • The CV-based physiotherapy systems operate in home environments, clinical facilities, and remote platforms. Stroke rehabilitation applications use depth camera skeletal tracking to quantify reachto-grasp performance and identify trunk compensation.

    A Narrative Review on AI-assisted Clinical Decision Support System in Physiotherapy Practice: Computer Vision-based Posture Assessment and its Clinical Validation · 2026 · DOI

  • For clinical practice: • Implement VR rehabilitation primarily for subacute stroke patients (1-6 months post-stroke) with moderate-to-severe upper limb impairment • Use VR as an adjunct to, not replacement for, conventional occupational and physical therapy • Deliver interventions for >15 total hours over >4 weeks with >4 sessions weekly • Select VR platforms based on rehabilitation goals: immersive systems for gross motor recovery, non-immersive systems for fine motor dexterity • Prioritize purpose-built rehabilitation systems incorporating motor learning principles over commercial gaming systems • Monitor for transient simulator sickness, particularly during initial sessions For policy and healthcare systems: • Allocate VR resources preferentially to subacute rehabilitation settings • Develop reimbursement pathways for VR as an adjunctive rehabilitation service © The Indonesian Journal of General Medicine 79 Research Article Volume 38, Issue No.01. 2026 ISSN: 3048-104X • Invest in home-based VR telerehabilitation infrastructure to improve access and enable higher therapy doses • Establish standardized outcome measurement protocols across VR rehabilitation programs For future research: • Conduct large, multicenter RCTs with sample sizes >100 per group to provide definitive evidence • Develop and validate VR-specific outcome measures sensitive to clinically meaningful change • Include long-term follow-up (>6 months) to assess durability of treatment effects • Examine optimal dosing parameters through factorial design trials • Investigate mechanisms of VR-induced neuroplasticity using neuroimaging and neurophysiological measures • Study VR effectiveness in under-represented populations including patients with cognitive impairment, aphasia, and visuospatial neglect • Conduct economic analyses of VR implementation costs versus benefits • Compare different VR platforms directly in head-to-head RCTs • Examine the added value of novel features such as haptic feedback, functional electrical stimulation integration, and artificial intelligence-driven adaptive difficulty REFERENCES 1. Laver KE, Lange B, George S, et al (2025) Virtual reality for stroke rehabilitation. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD008349.pub5 © The Indonesian Journal of General Medicine 80 Research Article Volume 38, Issue No.01. 2026 ISSN: 3048-104X 2. Soleimani M, Ghazisaeedi M, Heydari S (2024) The efficacy of virtual reality for upper limb rehabilitation in stroke patients: a systematic review and meta-analysis.

    What is The Effectiveness of Virtual Reality Interventions On Upper Limb Motor Function Recovery In Stroke Survivors? : A Comprehensive Systematic Review · 2026 · DOI

  • This study had several limitations. First, only 16 RCTs and 22 observational study were included, leading to inevitable bias. Second, there are few studies that compare the effects of exercise training across all three stroke phases—acute, subacute, and chronic. Many studies only examine two of these phases. Future meta-analyses should aim for larger sample sizes, better study designs, and multi- center RCTs. Third, although 38 studies were included in this system- atic review, the number of studies available for each meta-analysis was substantially smaller. Specifically, the analyses for MAS, ARAT, and BBS were each based on a limited number of studies, which may have resulted in insufficient statistical power and compromised the robust- ness of the findings. Therefore, these results should be interpreted with caution. Future large-scale studies are needed to validate these pre- liminary findings. Fourth, although subgroup analyses were con- ducted for exercise type, intervention dose, and stroke type, other important variables—such as stroke severity and type of control group intervention—could not be examined due to insufficient data in the included studies. Finally, pooled results should be interpreted cau- tiously due to variations in patient profiles, case numbers, and ethnic backgrounds across studies.

    A systematic review and meta-analysis of the effects of exercise training on dysfunction in acute, subacute, and chronic stroke patients · 2026 · DOI

  • The interview schedule was based on normalisation process theory constructs (coherence, cognitive participation, collective action, reflexive monitoring) but the excerpt does not describe how behaviour change approaches identified in the scoping review were operationalized or measured within interviews. Future work should develop specific interview probes that directly assess behaviour change mechanisms within digital health technology rehabilitation implementations.

    Understanding digital health technology implementation in rehabilitation and development of the Rehabilitation Technologies Implementation model · 2026 · DOI

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101 open questions have been extracted from the limitations and future-work passages of 1,163 Stroke Rehabilitation and Recovery papers in our library. Each one below links back to the study that raised it, so you can read the original claim in context.

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