{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T07:02:23Z","timestamp":1782975743555,"version":"3.54.5"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Hum. Neurosci."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>BCI-based lower limb robots (BCI-LLR) represent a novel technology used in neurological rehabilitation for stroke patients. However, the effectiveness of BCI-LLR compared to traditional rehabilitation in improving lower extremity function and cognition remains a topic of debate. This study aimed to determine whether BCI-based lower limb robots are more effective than traditional rehabilitation for lower limb dysfunction after stroke.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A comprehensive search was conducted across multiple databases, including PubMed, Embase, Web of Science, and Cochrane Library. The database retrieval was performed up until November 21, 2025. A systematic review of findings was conducted due to the limited number and the heterogeneity of studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of four studies (three RCTs and one single-arm pre-post study) with 117 stroke patients were included. BCI-LLR training significantly improved lower limb function, with one RCT showing significant between-group differences in FMA-L (+4.5 vs. +2.1,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.022), and another RCT demonstrating significant advantages in TUG (\u221212.03 vs. \u22124.65\u202fs,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.038) and BBS (+5.50 vs. +3.38,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.042). The single-arm study also reported significant improvements in all lower limb outcomes (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.01). For cognition, SDMT improvements significantly favored BCI-LLR in two RCTs (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.036 and\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.013) and in the single-arm study (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.047). MoCA showed improvement only in the single-arm study (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.044). The attention index increased significantly in three studies (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.01). Neurophysiological benefits were reported in one RCT (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Preliminary evidence suggests BCI-LLR may improve lower limb function (FMA, BBS, TUG) and information processing speed (SDMT). However, effects on global cognition (MoCA) remain unclear, and sample sizes are critically small.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>This study was registered on the international system evaluation registration platform PROSPERO (CRD420251232191).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnhum.2026.1782862","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T05:35:15Z","timestamp":1782970515000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of BCI-based lower limb robots on lower limb function and cognition in stroke patients: a preliminary systematic review"],"prefix":"10.3389","volume":"20","author":[{"given":"Mengqi","family":"Shao","sequence":"first","affiliation":[{"name":"Rehabilitation Medicine Department, Yangzhou Second People\u2019s Hospital","place":["Yangzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiurong","family":"Wang","sequence":"additional","affiliation":[{"name":"Blood Purification Center, Northern Jiangsu People\u2019s Hospital","place":["Yangzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kui","family":"Wang","sequence":"additional","affiliation":[{"name":"Rehabilitation Medicine Department, Northern Jiangsu People\u2019s Hospital","place":["Yangzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kang","family":"Yang","sequence":"additional","affiliation":[{"name":"Rehabilitation Medicine Department, Northern Jiangsu People\u2019s Hospital","place":["Yangzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andi","family":"Zou","sequence":"additional","affiliation":[{"name":"Rehabilitation Medicine Department, Northern Jiangsu People\u2019s Hospital","place":["Yangzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Chen","sequence":"additional","affiliation":[{"name":"Rehabilitation Medicine Department, Northern Jiangsu People\u2019s Hospital","place":["Yangzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Zhang","sequence":"additional","affiliation":[{"name":"Rehabilitation Medicine Department, Sunshine Union Hospital","place":["Weifang, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaoxiang","family":"Meng","sequence":"additional","affiliation":[{"name":"Rehabilitation Medicine Department, Yangzhou Second People\u2019s Hospital","place":["Yangzhou, Jiangsu, China"]},{"name":"Rehabilitation Medicine Department, Northern Jiangsu People\u2019s Hospital","place":["Yangzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xing","family":"Jin","sequence":"additional","affiliation":[{"name":"Rehabilitation Medicine Department, Yangzhou Second People\u2019s Hospital","place":["Yangzhou, Jiangsu, China"]},{"name":"Rehabilitation Medicine Department, Northern Jiangsu People\u2019s Hospital","place":["Yangzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1186\/s12984-021-00820-8","article-title":"Brain\u2013computer interface robotics for hand rehabilitation after stroke: a systematic review","volume":"18","author":"Baniqued","year":"2021","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1229681","DOI":"10.3389\/fneur.2023.1229681","article-title":"A prospective study of MRI biomarkers in the brain and lower limb muscles for prediction of lower limb motor recovery following stroke","volume":"14","author":"Elameer","year":"2023","journal-title":"Front. Neurol."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"6863","DOI":"10.3390\/s21206863","article-title":"Biosignal-based human\u2013machine interfaces for assistance and rehabilitation: a survey","volume":"21","author":"Esposito","year":"2021","journal-title":"Sensors"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1186\/s13643-025-02759-6","article-title":"The effect of lower limb rehabilitation robot on lower limb-motor function in stroke patients: a systematic review and meta-analysis","volume":"14","author":"Hao","year":"2025","journal-title":"Syst. Rev."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1186\/s12984-025-01723-8","article-title":"Multimodal assessment of a BCI system for stroke rehabilitation integrating motor imagery and motor attempts: a randomized controlled trial","volume":"22","author":"He","year":"2025","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1097\/NPT.0000000000000303","article-title":"Clinical practice guideline to improve locomotor function following chronic stroke, incomplete spinal cord injury, and brain injury","volume":"44","author":"Hornby","year":"2020","journal-title":"J. Neurol. Phys. Ther."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1006763","DOI":"10.3389\/fncom.2022.1006763","article-title":"Status of deep learning for EEG-based brain\u2013computer interface applications","volume":"16","author":"Hossain","year":"2023","journal-title":"Front. Comput. Neurosci."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1186\/s12984-024-01463-1","article-title":"Efficacy of robot-assisted gait training on lower extremity function in subacute stroke patients: a systematic review and meta-analysis","volume":"21","author":"Hu","year":"2024","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1007\/s10072-024-07780-6","article-title":"Effect and optimal exercise prescription of robot-assisted gait training on lower extremity motor function in stroke patients: a network meta-analysis","volume":"46","author":"Huang","year":"2024","journal-title":"Neurol. Sci."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1109\/EMBC58623.2025.11253164","article-title":"Motor network efficiency in stroke patients: comparing activation likelihood estimation-based and whole brain parcellations","volume":"2025","author":"Karnadipa","year":"2025","journal-title":"Annu. Int. Conf. IEEE Eng. Med. Biol. Soc"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1142","DOI":"10.47391\/JPMA.23-39","article-title":"Overview of gait rehabilitation in stroke","volume":"73","author":"Khalid","year":"2023","journal-title":"J. Pak. Med. Assoc."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"917909","DOI":"10.3389\/fnhum.2022.917909","article-title":"Toward an adapted neurofeedback for post-stroke motor rehabilitation: state of the art and perspectives","volume":"16","author":"Le Franc","year":"2022","journal-title":"Front. Hum. Neurosci."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"e31590","DOI":"10.1097\/MD.0000000000031590","article-title":"Effects of a lower limb rehabilitation robot with various training modes in patients with stroke: a randomized controlled trial","volume":"101","author":"Lee","year":"2022","journal-title":"Medicine"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"833","DOI":"10.7507\/1001-5515.202211055","article-title":"Research status of lower limb exoskeleton rehabilitation robot","volume":"41","author":"Li","year":"2024","journal-title":"Sheng Wu Yi Xue Gong Cheng Xue Za Zhi"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"105807","DOI":"10.1016\/j.jstrokecerebrovasdis.2021.105807","article-title":"Effect of robot assisted gait training on motor and walking function in patients with subacute stroke: a random controlled study","volume":"30","author":"Li","year":"2021","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1186\/s12883-023-03150-5","article-title":"Effects of motor imagery based brain-computer interface on upper limb function and attention in stroke patients with hemiplegia: a randomized controlled trial","volume":"23","author":"Liu","year":"2023","journal-title":"BMC Neurol."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"80","DOI":"10.3390\/brainsci14010080","article-title":"Minimal clinically important difference of scales reported in stroke trials: a review","volume":"14","author":"Mishra","year":"2024","journal-title":"Brain Sci."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"101936","DOI":"10.1016\/j.eclinm.2023.101936","article-title":"Global burden of chronic respiratory diseases and risk factors, 1990\u20132019: an update from the global burden of disease study 2019","volume":"59","author":"Momtazmanesh","year":"1990","journal-title":"EClinicalMedicine"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"4","DOI":"10.23736\/s1973-9087.20.06183-3","article-title":"The effects of lower extremity cross-training on gait and balance in stroke patients: a double-blinded randomized controlled trial","volume":"57","author":"Park","year":"2021","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1017\/S1041610218001370","article-title":"Is the montreal cognitive assessment (MoCA) screening superior to the mini-mental state examination (MMSE) in the detection of mild cognitive impairment (MCI) and Alzheimer\u2019s disease (AD) in the elderly?","volume":"31","author":"Pinto","year":"2019","journal-title":"Int. Psychogeriatr."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"3435","DOI":"10.1007\/s10571-023-01396-8","article-title":"The role of progranulin (PGRN) in the pathogenesis of ischemic stroke","volume":"43","author":"Purrahman","year":"2023","journal-title":"Cell. Mol. Neurobiol."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"S6","DOI":"10.1212\/wnl.0000000000012781","article-title":"Global epidemiology of stroke and access to acute ischemic stroke interventions","volume":"97","author":"Saini","year":"2021","journal-title":"Neurology"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"104688","DOI":"10.1016\/j.jstrokecerebrovasdis.2020.104688","article-title":"Early cognitive assessment following acute stroke: feasibility and comparison between mini-mental state examination and montreal cognitive assessment","volume":"29","author":"Suda","year":"2020","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1186\/s13195-024-01479-8","article-title":"The impact of incident stroke on cognitive trajectories in later life","volume":"16","author":"Vishwanath","year":"2024","journal-title":"Alzheimer\u2019s Res. Ther."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1002\/pmrj.13324","article-title":"Impact of motor imagery-based brain-computer interface combined with virtual reality on enhancing attention, executive function, and lower-limb function in stroke: a pilot study","volume":"17","author":"Wan","year":"","journal-title":"PM R."},{"key":"ref26","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1186\/s12984-025-01730-9","article-title":"Effects of dual-task mode brain-computer interface based on motor imagery and virtual reality on balance and attention in patients with stroke: a randomized controlled pilot trial","volume":"22","author":"Wan","year":"","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"3927","DOI":"10.1109\/TNSRE.2023.3312692","article-title":"Research on a new rehabilitation robot for balance disorders","volume":"31","author":"Wu","year":"2023","journal-title":"IEEE Trans. Neural Syst. Rehabil. Eng."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"2569","DOI":"10.1109\/TNSRE.2021.3132944","article-title":"Effect of BCI-controlled pedaling training system with multiple modalities of feedback on motor and cognitive function rehabilitation of early subacute stroke patients","volume":"29","author":"Yuan","year":"2021","journal-title":"IEEE Trans. Neural Syst. Rehabil. Eng."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1186\/s12984-024-01391-0","article-title":"Exoskeleton rehabilitation robot training for balance and lower limb function in sub-acute stroke patients: a pilot, randomized controlled trial","volume":"21","author":"Zhang","year":"2024","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref30","doi-asserted-by":"publisher","first-page":"7949","DOI":"10.3390\/jcm14227949","article-title":"Alterations in supine position mobility and dynamics in post-stroke individuals with hemiparesis compared to neurologically intact controls: a video-based observational assessement","volume":"14","author":"\u017bukowska","year":"2025","journal-title":"J. Clin. Med."}],"container-title":["Frontiers in Human Neuroscience"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnhum.2026.1782862\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T05:35:17Z","timestamp":1782970517000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnhum.2026.1782862\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,2]]},"references-count":30,"alternative-id":["10.3389\/fnhum.2026.1782862"],"URL":"https:\/\/doi.org\/10.3389\/fnhum.2026.1782862","relation":{},"ISSN":["1662-5161"],"issn-type":[{"value":"1662-5161","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,2]]},"article-number":"1782862"}}