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Non-invasive brain stimulation (NIBS) techniques such as transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and transcutaneous vagus nerve stimulation (tVNS) may improve arm weakness after stroke. Resting-state functional MRI (rs-fMRI) and near-infrared spectroscopy (rs-fNIRS) assess brain connectivity. Identifying the effect of NIBS on rs-fMRI\/rs-fNIRS may illuminate the post-stroke recovery process. This systematic review assesses NIBS effects on clinical and rs-fMRI\/rs-fNIRS outcomes in stroke survivors with arm weakness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Systematic searches were conducted in EMBASE and MEDLINE. Articles involving adults with arm weakness from stroke, treated with more than one session of NIBS (TMS\/tDCS\/tVNS) and reporting clinical and rs-fMRI\/rs-fNIRS outcomes at baseline and post-intervention were included. The Cochrane Risk of Bias tool was used to assess the methodological quality of included studies. Data extraction and narrative synthesis were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twelve articles containing 393 participants were included. Nine studies assessed TMS, two studies assessed tDCS, and one study used dual-mode stimulation (TMS and tDCS). All studies showed significant improvements in clinical measures of arm function compared to baseline following NIBS. All studies showed changes in functional connectivity post-intervention. Enhanced interhemispheric connectivity, particularly between primary motor cortices, was positively correlated with functional outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Both TMS and tDCS are promising adjunctive therapies for arm weakness post-stroke. Rs-fMRI, particularly interhemispheric connectivity, may provide a valid biomarker of restitution of function with NIBS. Future research should involve.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10072-025-08224-5","type":"journal-article","created":{"date-parts":[[2025,6,1]],"date-time":"2025-06-01T23:34:36Z","timestamp":1748820876000},"page":"4233-4257","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Systematic review: Resting state functional MRI as a biomarker for non-invasive brain stimulation in upper limb recovery post-stroke"],"prefix":"10.1007","volume":"46","author":[{"given":"Mudasar","family":"Aziz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheharyar","family":"Baig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen","family":"Hai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Ali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arshad","family":"Majid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6347-3986","authenticated-orcid":false,"given":"Li","family":"Su","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,6,2]]},"reference":[{"issue":"3","key":"8224_CR1","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1161\/CIRCRESAHA.116.308413","volume":"120","author":"VL Feigin","year":"2017","unstructured":"Feigin VL, Norrving B, Mensah GA (2017) Global burden of stroke. 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