Neuroplasticity-Based Physiotherapy Approaches in Stroke Rehabilitation: A Systematic Review

Abstract Background: Stroke is a leading cause of adult disability worldwide, with motor impairments being the most common sequel. Neuroplasticity the brain’s capacity to reorganize neural networks underpins functional recovery and is enhanced by specific physiotherapy interventions. Objective: This systematic review aimed to evaluate the effectiveness of neuroplasticity-based physiotherapy approaches in improving motor recovery and functional independence among stroke survivors. Methods: A comprehensive search was conducted across PubMed, Scopus, PEDro, and Web of Science for randomized controlled trials (RCTs) published between January 2010 and August 2025. Eligible studies included adult stroke patients undergoing neuroplasticity-based physiotherapy interventions such as constraint-induced movement therapy (CIMT), mirror therapy, task-specific training, robotic-assisted therapy, and virtual reality. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the PEDro scale. The PRISMA guidelines were followed. Results: Twenty-three RCTs (n = 1,465 participants) met the inclusion criteria. CIMT and task-specific training consistently demonstrated significant improvements in upper limb motor function and activities of daily living (ADL). Mirror therapy showed moderate evidence for upper limb recovery, particularly in subacute stroke. Robotic-assisted therapy and virtual reality yielded positive but heterogeneous results, with effectiveness influenced by stroke chronicity and intervention intensity. Risk of bias was moderate, mainly due to small sample sizes and lack of blinding. Conclusion: Neuroplasticity-based physiotherapy approaches are effective in enhancing motor recovery after stroke, especially CIMT and task-specific training. However, heterogeneity in study protocols limits definitive conclusions. Larger, multicenter RCTs with standardized protocols are recommended.