Non-invasive brain stimulation contributing to postural control with and without stroke: a systematic review and meta-analysis

Abstract

Abstract Non-invasive brain stimulation techniques demonstrate promising potential for enhancing neural plasticity and motor recovery, yet their comparative effectiveness for improving postural control across neurologically impaired and intact populations requires systematic investigation. This systematic review and meta-analysis evaluated the therapeutic efficacy of brain stimulation modalities on postural control, comparing outcomes between stroke survivors and neurologically intact adults through controlled trials. Systematic searches were conducted across major databases (CINAHL, Embase, MEDLINE, Web of Science) for randomized controlled trials and crossover studies published from 2014 to 2024. Study quality was assessed using the Risk of Bias 2 tool, with treatment effects analyzed through standardized mean differences in a random-effects model. Analysis of 15 studies revealed significant overall effects of brain stimulation (SMD = 0.79, 95% CI 0.47–1.11), with notably stronger responses in stroke participants (SMD = 0.95) versus neurologically intact individuals (SMD = 0.39). Transcranial direct current stimulation showed particular efficacy in stroke rehabilitation (SMD = 1.79), while intermittent theta burst stimulation demonstrated moderate effects (SMD = 0.68). Primary motor cortex stimulation yielded optimal outcomes (SMD = 1.21), followed by cerebellar (SMD = 0.75) and dorsolateral prefrontal cortex interventions (SMD = 0.35). These findings reveal differential response patterns between populations and stimulation parameters, suggesting enhanced neuroplastic potential in stroke survivors. This evidence supports the development of targeted neuromodulatory approaches for rehabilitation and performance enhancement.