How Resting-State fMRI is Shaping Stroke Rehabilitation

In the field of stroke rehabilitation, resting-state functional MRI in stroke recovery is gaining attention as a powerful tool to understand and guide brain-based therapy. A new systematic review highlights how non-invasive brain stimulation (NIBS) methods—such as transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and vagus nerve stimulation (VNS)—can improve arm function after a stroke. At the same time, brain scans like resting-state fMRI (rs-fMRI) are helping researchers track and predict these improvements by observing how different parts of the brain connect and communicate.

What Is Resting-State fMRI?

Resting-state fMRI is a type of brain imaging that captures neural activity while a person is not performing a specific task. Instead of asking someone to solve a problem or move a limb, this scan tracks the natural rhythms of the brain. In stroke survivors, it provides insights into how communication between brain regions changes as recovery progresses.

When paired with NIBS therapies, rs-fMRI becomes a potential biomarker—a measurable signal—that could predict how well a person might respond to brain stimulation. This could revolutionize how rehabilitation is planned and tailored.

NIBS Therapies Improve Arm Function After Stroke

The review included 12 studies involving nearly 400 stroke survivors who experienced arm weakness. Most studies used TMS or tDCS over several sessions. The results were promising: participants showed significant improvements in arm movement and function compared to before treatment.

Crucially, the brain imaging data revealed increased "interhemispheric connectivity"—stronger connections between the left and right motor areas of the brain. This improvement in brain communication was closely linked with better physical recovery. In simpler terms, when brain areas started talking to each other more effectively, patients moved their arms more easily.

Using Resting-State fMRI as a Biomarker for Brain Stimulation

One of the review’s most exciting findings is that resting-state fMRI could help identify who is most likely to benefit from TMS or tDCS. This could lead to more precise, personalized treatment plans—especially for those in early recovery or those not responding well to physical therapy alone.

As researchers continue to explore this approach, combining rs-fMRI with NIBS may become a standard strategy in stroke care, helping to unlock the brain’s healing potential with greater accuracy and impact.

The Future of Brain-Based Stroke Rehabilitation

Using resting-state functional MRI in stroke recovery alongside non-invasive brain stimulation offers a promising new way to guide rehabilitation. It not only enhances our understanding of how the brain heals but also opens the door to more personalized and effective treatment for stroke survivors with arm weakness.

By identifying which brain circuits are involved in recovery, clinicians may soon be able to tailor therapy based on each person’s unique brain connectivity. This marks a significant step forward in interventional psychiatry and neurorehabilitation.

Discover more with Interventional Psychiatry Network.

Citations:

1. Aziz M, Baig S, Hai W, et al. (2025). Resting state functional MRI as a biomarker for non-invasive brain stimulation in upper limb recovery post-stroke: A systematic review. Neurological Sciences. https://doi.org/10.1007/s10072-025-08224-5 

2. Veerbeek JM, van Wegen E, van Peppen R, et al. (2014). What is the evidence for physical therapy poststroke? A systematic review and meta-analysis. PLoS One, 9(2):e87987. https://doi.org/10.1371/journal.pone.0087987