Innovation Series: Advanced Science (ISSN 2938-9933, CNKI Indexed)

Volume 3 · Issue 9 (2026)
23
views
DOI number:
10.66521/2938-9933-2026092102

Integrating Emotional Stimulation into Post-Stroke Motor Rehabilitation: Evidence and Future Directions

 

Zhiling Liu, Weilin Tan, Qiuyi Lu, Zheng Yang, Lining Yang, Dingqun Bai*

Department of Rehabilitation Medicine, Key Laboratory of Physical Medicine and Precision Rehabilitation of Chongqing Municipal Health Commission, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China

Corresponding Author: Dingqun Bai (baidingqun@hospital.cqmu.edu.cn)

 

Abstract: Stroke is a leading cause of mortality and long-term disability worldwide. Among these, motor dysfunction is the most prevalent sequela and markedly reduces quality of life and independence. Although conventional motor rehabilitation strategies have demonstrated certain clinical efficacy, low motivation and inadequate adherence often limit patients’ active engagement and functional gains. In recent years, a novel treatment paradigm has shifted attention toward the role of emotional processes in motor rehabilitation. This approach treats emotion as a treatment variable and seeks to enhance neuroplasticity through targeted emotional stimulation aimed at strengthening sensorimotor circuits and promoting functional reorganization of the brain. This review synthesizes recent advances in applying emotional stimulation to post-stroke motor rehabilitation, provides an integrated perspective for medical staff and researchers, and outlines the theoretical foundations and future directions that can guide the development of more efficient and engaging interventions.

 

Keywords: Affective modulation; Neuroplasticity; Motivation; Virtual reality; Brain–computer interface; Dopamine

 

References

[1]
Naghavi M, Kyu HH, A B, et al. Global burden of 292 causes of death in 204 countries and territories and 660 subnational locations, 1990–2023: a systematic analysis for the global burden of disease study 2023. Lancet. 2025;406(10513):1811-1872. doi:10.1016/S0140-6736(25)01917-8.
[2]
Naghavi M, Kyu HH, A B, et al. Global burden of 292 causes of death in 204 countries and territories and 660 subnational locations, 1990–2023: a systematic analysis for the global burden of disease study 2023. Lancet. 2025;406(10513):1811-1872. doi:10.1016/S0140-6736(25)01917-8.
[3]
Tu WJ, Zhao Z, Yin P, et al. Estimated burden of stroke in China in 2020. JAMA Netw Open. 2023;6(3):e231455. doi:10.1001/jamanetworkopen.2023.1455.
[4]
Virani SS, Alonso A, Aparicio HJ, et al. Heart disease and stroke statistics—2021 update: a report from the American Heart Association. Circulation. 2021;143(8):e254-e743. doi:10.1161/CIR.0000000000000950.
[5]
Tsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and stroke statistics—2023 update: a report from the American Heart Association. Circulation. 2023;147(8):e93-e621. doi:10.1161/CIR.0000000000001123.
[6]
Jiang B. Current snapshots on stroke prevention and control and more proactive national strategies against it in China. J Cent Nerv Syst Dis. 2025;17:11795735251337605. doi:10.1177/11795735251337605.
[7]
Stinear CM, Lang CE, Zeiler S, Byblow WD. Advances and challenges in stroke rehabilitation. Lancet Neurol. 2020;19(4):348-360. doi:10.1016/S1474-4422(19)30415-6.
[8]
Feigin VL, Brainin M, Norrving B, et al. World Stroke Organization (WSO): global stroke fact sheet 2022. Int J Stroke. 2022;17(1):18-29. doi:10.1177/17474930211065917.
[9]
Motor learning following stroke: mechanisms of learning and techniques to augment neuroplasticity. Phys Med Rehabil Clin N Am. 2024;35(2):277-291. doi:10.1016/j.pmr.2023.06.004.
[10]
Khan M. Rehabilitation in animal models of stroke. Phys Ther Res. 2023;26(2):39-43. doi:10.1298/ptr.R0022.
[11]
Liu L, Xu M, Marshall IJ, Wolfe CDA, Wang Y, O’Connell MDL. Prevalence and natural history of depression after stroke: a systematic review and meta-analysis of observational studies. PLoS Med. 2023;20(3):e1004200. doi:10.1371/journal.pmed.1004200.
[12]
Risoli A, Antonietti A, Colautti L, et al. Sense and mind method: an innovative methodological approach to embodied rehabilitation. Cogn Process. 2025. doi:10.1007/s10339-025-01299-0.
[13]
Braun Janzen T, Koshimori Y, Richard NM, Thaut MH. Rhythm and music-based interventions in motor rehabilitation: current evidence and future perspectives. Front Hum Neurosci. 2022;15:789467. doi:10.3389/fnhum.2021.789467.
[14]
Menon V, D’Esposito M. The role of PFC networks in cognitive control and executive function. Neuropsychopharmacology. 2022;47:90-103. doi:10.1038/s41386-021-01152-w.
[15]
Kringelbach ML, Deco G. Prefrontal cortex drives the flexibility of whole-brain orchestration of cognition. Curr Opin Behav Sci. 2024;57:101394. doi:10.1016/j.cobeha.2024.101394.
[16]
Xia H, He Q, Chen A. Understanding cognitive control in aging: a brain network perspective. Front Aging Neurosci. 2022;14:1038756. doi:10.3389/fnagi.2022.1038756.
[17]
Pinson H, Van Lerbeirghe J, Vanhauwaert D, et al. The supplementary motor area syndrome: a neurosurgical review. Neurosurg Rev. 2022;45:81-90. doi:10.1007/s10143-021-01566-6.
[18]
Nakayama Y, Sugawara SK, Fukunaga M, Hamano YH, Sadato N, Nishimura Y. The dorsal premotor cortex encodes the step-by-step planning processes for goal-directed motor behavior in humans. Neuroimage. 2022;256:119221. doi:10.1016/j.neuroimage.2022.119221.
[19]
Patelaki E, Foxe JJ, Mazurek KA, Freedman EG. Young adults who improve performance during dual-task walking show more flexible reallocation of cognitive resources: a mobile brain–body imaging (MoBI) study. Cereb Cortex. 2023;33(6):2573-2592. doi:10.1093/cercor/bhac227.
[20]
Jackson TB, Bernard JA. Cerebello-basal ganglia networks and cortical network global efficiency. Cerebellum. 2023;22(4):588-600. doi:10.1007/s12311-022-01418-z.
[21]
Habas C. Functional connectivity of the cognitive cerebellum. Front Syst Neurosci. 2021;15:642225. doi:10.3389/fnsys.2021.642225.
[22]
Damasio A, Damasio H. Homeostatic feelings and the biology of consciousness. Brain. 2022;145(7):2231-2235. doi:10.1093/brain/awac194.
[23]
Felippin MR, Azevedo IL, Saunier G, Keniston L, Nogueira-Campos AA. Grasping affordance judgments depend on the object emotional value. Front Hum Neurosci. 2024;18:1331253. doi:10.3389/fnhum.2024.1331253.
[24]
Yu P, Dong R, Wang X, et al. Neuroimaging of motor recovery after ischemic stroke - functional reorganization of motor network. Neuroimage Clin. 2024;43:103636. doi:10.1016/j.nicl.2024.103636.
[25]
Schaum M, Pinzuti E, Sebastian A, et al. Right inferior frontal gyrus implements motor inhibitory control via beta-band oscillations in humans. eLife. 2021;10:e61679. doi:10.7554/eLife.61679.
[26]
Jarcuskova D, Tkac I, Hlavacova N, et al. Serotonin transporter 5-HTTLPR polymorphism and escitalopram treatment response in patients with major depressive disorder. BMC Psychiatry. 2024;24(1):690. doi:10.1186/s12888-024-06162-8.
[27]
Szelenberger R, Kostka J, Saluk-Bijak J, Miller E. Pharmacological interventions and rehabilitation approach for enhancing brain self-repair and stroke recovery. Curr Neuropharmacol. 2020;18(1):51-64. doi:10.2174/1570159X17666190726104139.
[28]
Engelter ST, Kaufmann JE, Zietz A, et al. Levodopa added to stroke rehabilitation: the ESTREL randomized clinical trial. JAMA. 2025;334(17):1523-1532. doi:10.1001/jama.2025.15185.
[29]
Neurobiology and systems biology of stress resilience. Physiol Rev. 2024. doi:10.1152/physrev.00042.2023.
[30]
Structural and functional connections between the autonomic nervous system, hypothalamic–pituitary–adrenal axis and immune system. Neurol Sci. 2021. doi:10.1007/s10072-021-05810-1.
[31]
Selective vulnerability of the locus coeruleus noradrenergic system: implications for cognition and neuroinflammation. Front Pharmacol. 2022;13:1030609. doi:10.3389/fphar.2022.1030609.
[32]
Mechanisms of memory under stress. Neuron. 2022;110(9):1450-1467. doi:10.1016/j.neuron.2022.02.020.
[33]
Brosens N, Lesuis SL, Rao-Ruiz P, van den Oever MC, Krugers HJ. Shaping memories via stress: a synaptic engram perspective. Biol Psychiatry. 2024;95(8):721-731. doi:10.1016/j.biopsych.2023.11.008.
[34]
Joffe ME, Maksymetz J, Luschinger JR, et al. Acute restraint stress redirects prefrontal cortex circuit function through mGlu5 receptor plasticity on somatostatin-expressing interneurons. Neuron. 2022;110(6):1068-1083.e5. doi:10.1016/j.neuron.2021.12.027.
[35]
Numakawa T, Kajihara R. Involvement of brain-derived neurotrophic factor signaling in the pathogenesis of stress-related brain diseases. Front Mol Neurosci. 2023;16:1247422. doi:10.3389/fnmol.2023.1247422.
[36]
Lin L, Zhang J, Dai X, et al. A moderate duration of stress promotes behavioral adaptation and spatial memory in young C57BL/6J mice. Brain Sci. 2022;12(8):1081. doi:10.3390/brainsci12081081.
[37]
Ruan Y, Cheng J, Dai J, et al. Chronic stress hinders sensory axon regeneration via impairing mitochondrial cristae and OXPHOS. Sci Adv. 2023;9(40):eadh0183. doi:10.1126/sciadv.adh0183.
[38]
Rojas-Thomas F, Artigas C, Wainstein G, et al. Impact of acute psychosocial stress on attentional control in humans: a study of evoked potentials and pupillary response. Neurobiol Stress. 2023;25:100551. doi:10.1016/j.ynstr.2023.100551.
[39]
Ashcroft SK, Ironside DD, Johnson L, Kuys SS, Thompson-Butel AG. Effect of exercise on brain-derived neurotrophic factor in stroke survivors: a systematic review and meta-analysis. Stroke. 2022;53(12):3706-3716. doi:10.1161/STROKEAHA.122.039919.
[40]
Kunikullaya U K, Pranjić M, Rigby A, et al. The molecular basis of music-induced neuroplasticity in humans: a systematic review. Neurosci Biobehav Rev. 2025;175:106219. doi:10.1016/j.neubiorev.2025.106219.
[41]
Yu H, Lu X, Kim SJ. Music-based interventions using digital technology for individuals with acquired brain injuries: a scoping review. Front Psychol. 2025;16:1532925. doi:10.3389/fpsyg.2025.1532925.
[42]
Janzen TB, Koshimori Y, Richard NM, Thaut MH. Rhythm and music-based interventions in motor rehabilitation: current evidence and future perspectives. Front Hum Neurosci. 2022;15:789467. doi:10.3389/fnhum.2021.789467.
[43]
Raz S. Enhancing cognitive abilities in young adults with ADHD through instrumental music training: a comparative analysis of musicians and non-musicians. Psychol Res. 2024;89(1):9. doi:10.1007/s00426-024-02048-2.
[44]
Gardener SH, Mukaetova-Ladinska EB, Perera NA. The effect of music therapy on psychological outcomes for neurological conditions: a systematic review. Medicina. 2025;61(9):1611. doi:10.3390/medicina61091611.
[45]
Kontaris I, East BS, Wilson DA. Behavioral and neurobiological convergence of odor, mood and emotion: a review. Front Behav Neurosci. 2020;14:35. doi:10.3389/fnbeh.2020.00035.
[46]
Kouhihabibidehkordi G, Ghanavatinejad F, Taheri K, et al. The protective effects of Lavender officinalis extract against impairment of antioxidant–detoxification system induced by glucose deprivation through Nrf2 expression. Proc Natl Acad Sci India Sect B Biol Sci. 2024;94:135-143. doi:10.1007/s40011-023-01474-3.
[47]
Bargeri S, Scalea S, Agosta F, et al. Effectiveness and safety of virtual reality rehabilitation after stroke: an overview of systematic reviews. EClinicalMedicine. 2023;64:102220. doi:10.1016/j.eclinm.2023.102220.
[48]
Voinescu A, Sui J, Stanton Fraser D. Virtual reality in neurorehabilitation: an umbrella review of meta-analyses. J Clin Med. 2021;10(7):1478. doi:10.3390/jcm10071478.
[49]
Khan A, Podlasek A, Somaa F. Virtual reality in post-stroke neurorehabilitation - a systematic review and meta-analysis. Top Stroke Rehabil. 2023;30(1):53-72. doi:10.1080/10749357.2021.1990468.
[50]
Karikari E, Koshechkin KA. Review on brain-computer interface technologies in healthcare. Biophys Rev. 2023;15:1351-1358. doi:10.1007/s12551-023-01138-6.
[51]
Liu X, Zhang W, Li W, et al. Effects of motor imagery based brain-computer interface on upper limb function and attention in stroke patients with hemiplegia: a randomized controlled trial. BMC Neurol. 2023;23(1):136. doi:10.1186/s12883-023-03150-5.
[52]
Nojima I, Sugata H, Takeuchi H, Mima T. Brain–computer interface training based on brain activity can induce motor recovery in patients with stroke: a meta-analysis. Neurorehabil Neural Repair. 2022;36(2):83-96. doi:10.1177/15459683211062895.
[53]
Yang W, Zhang X, Li Z, et al. The effect of brain–computer interface training on rehabilitation of upper limb dysfunction after stroke: a meta-analysis of randomized controlled trials. Front Neurosci. 2021;15:766879. doi:10.3389/fnins.2021.766879.
[54]
Derosiere G, Shokur S, Vassiliadis P. Reward signals in the motor cortex: from biology to neurotechnology. Nat Commun. 2025;16(1):1307. doi:10.1038/s41467-024-55016-0.
[55]
Liang S, Xie H, Ye L, Huang C, Yuan F, Tang Y. Supported transitional care applied to stroke survivors: a meta-analysis. Adv Clin Exp Med. 2025;34(4):479-486. doi:10.17219/acem/186957.
[56]
Boyd LA, Hayward KS, Ward NS, et al. Biomarkers of stroke recovery: consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair. 2017;31(10-11):864-876. doi:10.1177/1545968317732680.
[57]
Zhang JJ, Sánchez Vidaña DI, Chan JN-M, et al. Biomarkers for prognostic functional recovery poststroke: a narrative review. Front Cell Dev Biol. 2023;10:1062807. doi:10.3389/fcell.2022.1062807.
[58]
Salvalaggio S, Turolla A, Ando M, et al. Prediction of rehabilitation-induced motor recovery after stroke using a multi-dimensional and multi-modal approach. Front Aging Neurosci. 2023;15:1205063. doi:10.3389/fnagi.2023.1205063.
[59]
Olafson ER, Jamison KW, Sweeney EM, et al. Functional connectome reorganization relates to post-stroke motor recovery and structural and functional disconnection. Neuroimage. 2021;245:118642. doi:10.1016/j.neuroimage.2021.118642.
[60]
Kimberley TJ, Plow EB. Rehabilitation drives post-stroke motor recovery. Lancet Neurol. 2025;24(5):373-375. doi:10.1016/S1474-4422(25)00100-0.
Download PDF
Innovation Series

Innovation Series is an academic publisher publishing journals and books covering a wide range of academic disciplines.

Contact

Francesc Boix i Campo, 7

08038 Barcelona, Spain