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Peer-reviewedCC BYIbrain

Expert consensus on neuro-musculoskeletal functional reconstruction for post-stroke spastic hemiplegia.

  • Peng Wen1
  • Yihe Wang2
  • Zhongzheng He3
  • Zhizhong Zhu4
  • Chunbing Chen5
  • Kaifeng Wu6
  • Xiaohong Fu1
  • Guoguang Zhao2
  • Liulin Xiong1
  • “Zunyi Brain‐Computer Interface Medical Center” Working Group
6 affiliations
  1. 1Brain-Computer Interface Medical Center The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University) Zunyi China.
  2. 2Department of Neurosurgery, Xuanwu Hospital Capital Medical University Beijing China.
  3. 3Department of Neurosurgery Tianjin Huanhu Hospital Tianjin China.
  4. 4Department of Rehabilitation Tianjin Huanhu Hospital Tianjin China.
  5. 5Department of Radiology The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University) Zunyi China.
  6. 6Department of Clinical Laboratory The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University) Zunyi China.
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Abstract

Persistent motor dysfunction in post-stroke spastic hemiplegia may result from impaired voluntary motor control, abnormal muscle overactivity, fixed structural restriction, muscle force imbalance, or their combination. Advances in brain-computer interfaces (BCIs), peripheral nerve surgery, and tendon and soft-tissue reconstruction have expanded therapeutic options, yet optimal indications and sequencing remain unclear. A multidisciplinary expert panel reviewed current evidence, addressed key clinical questions, and developed consensus recommendations for noninvasive BCI, diagnostic motor nerve block (DNB), selective or hyperselective peripheral nerve surgery, and reconstructive procedures. The consensus emphasizes evaluation of four major components: central voluntary motor impairment, dynamic abnormal muscle overactivity, fixed structural limitations, and muscle force imbalance. Treatment should be guided by the patient's functional goals and the primary factor restricting performance. Task-oriented motor training remains fundamental when voluntary motor control is impaired, with BCI-based closed-loop training as a potential adjunct in selected patients. Focal, functionally significant muscle overactivity caused by abnormal neural drive may be considered for selective or hyperselective peripheral nerve surgery, with DNB assisting patient selection. Fixed structural restrictions may require tendon or soft-tissue procedures, while muscle force imbalance may benefit from tendon transfer or other dynamic reconstruction. When multiple impairments coexist, combined reconstruction followed by targeted motor retraining and comprehensive reassessment may be appropriate. Overall, neuro-musculoskeletal functional reconstruction should follow an individualized pathway linking functional goals, dominant pathophysiology, treatment targets, and outcomes. Given the variable evidence quality, no universal treatment sequence or combination strategy is currently supported.

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Cite

BibTeXRIS
BibTeX
@article{wen2026expert,
  title = {{Expert consensus on neuro-musculoskeletal functional reconstruction for post-stroke spastic hemiplegia.}},
  author = {Peng Wen and Yihe Wang and Zhongzheng He and Zhizhong Zhu and Chunbing Chen and Kaifeng Wu and Xiaohong Fu and Guoguang Zhao and Liulin Xiong and “Zunyi Brain‐Computer Interface Medical Center” Working Group},
  journal = {Ibrain},
  year = {2026},
  month = oct,
  doi = {10.1002/ibra.70032},
  url = {https://europepmc.org/article/MED/42948598},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Expert consensus on neuro-musculoskeletal functional reconstruction for post-stroke spastic hemiplegia.
AU  - Peng Wen
AU  - Yihe Wang
AU  - Zhongzheng He
AU  - Zhizhong Zhu
AU  - Chunbing Chen
AU  - Kaifeng Wu
AU  - Xiaohong Fu
AU  - Guoguang Zhao
AU  - Liulin Xiong
AU  - “Zunyi Brain‐Computer Interface Medical Center” Working Group
PY  - 2026
DA  - 2026/10/27
JO  - Ibrain
DO  - 10.1002/ibra.70032
UR  - https://europepmc.org/article/MED/42948598
AB  - Persistent motor dysfunction in post-stroke spastic hemiplegia may result from impaired voluntary motor control, abnormal muscle overactivity, fixed structural restriction, muscle force imbalance, or their combination. Advances in brain-computer interfaces (BCIs), peripheral nerve surgery, and tendon and soft-tissue reconstruction have expanded therapeutic options, yet optimal indications and sequencing remain unclear. A multidisciplinary expert panel reviewed current evidence, addressed key clinical questions, and developed consensus recommendations for noninvasive BCI, diagnostic motor nerve block (DNB), selective or hyperselective peripheral nerve surgery, and reconstructive procedures. The consensus emphasizes evaluation of four major components: central voluntary motor impairment, dynamic abnormal muscle overactivity, fixed structural limitations, and muscle force imbalance. Treatment should be guided by the patient's functional goals and the primary factor restricting performance. Task-oriented motor training remains fundamental when voluntary motor control is impaired, with BCI-based closed-loop training as a potential adjunct in selected patients. Focal, functionally significant muscle overactivity caused by abnormal neural drive may be considered for selective or hyperselective peripheral nerve surgery, with DNB assisting patient selection. Fixed structural restrictions may require tendon or soft-tissue procedures, while muscle force imbalance may benefit from tendon transfer or other dynamic reconstruction. When multiple impairments coexist, combined reconstruction followed by targeted motor retraining and comprehensive reassessment may be appropriate. Overall, neuro-musculoskeletal functional reconstruction should follow an individualized pathway linking functional goals, dominant pathophysiology, treatment targets, and outcomes. Given the variable evidence quality, no universal treatment sequence or combination strategy is currently supported.
SN  - 2313-1934
SN  - 2769-2795
ER  -