Combining Visual Feedback and Noninvasive Brain Stimulation for Lower Limb Motor Rehabilitation in Stroke: A Systematic Review of the Current Evidence.

Background and Objectives: Recent technological advances have introduced new interventions in the field of stroke rehabilitation. Among them, visual feedback (VF) and non-invasive brain stimulation (NIBS) have gained considerable attention, with growing evidence supporting their efficacy. However, their combined application in lower limb recovery remains to be established. This systematic review aims to evaluate the current evidence on the therapeutic effect of combining VF and NIBS for lower limb motor rehabilitation in stroke patients. Methods: Following PRISMA guidelines, PubMed, Embase, Scopus, and Cochrane databases were searched for randomized controlled trials and observational studies comparing VF and NIBS interventions with either their monotherapy, placebo, or standard treatment. The outcomes evaluated for lower limb function included balance, gait, and motor performance. Results: From 997 studies screened, 5 studies (3 RCTs and 2 cohort studies) were included. Despite heterogeneity in the immersion level, NIBS protocols, and outcome measures, evidence emerged supporting the efficacy of combined VF and NIBS across multiple outcomes. However, the degree to which these interventions outperform standard therapies remains uncertain, primarily due to a limited number of comparator studies and the quality of the existing data. Conclusions: This review provides preliminary insights into the potential of combining VF and NIBS in stroke patients affected by lower limb motor impairments. Future research should focus on standardizing protocols and addressing demographic variability to enhance the reliability and comparability of findings.