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Stroke remains a leading cause of adult disability, underscoring why research continues to focus on advancing new treatment methods and neurophysiological indexes. While these studies may be effective, many lack a clear theoretical framework. The current study first determined the optimal combination effects of mirror therapy (MT) with transcranial direct current stimulation (tDCS) on the premotor or primary motor cortex on its short-term and sustained clinical outcomes. We then introduced electroencephalogram (EEG) indexes derived from the gating-by-inhibition model to explore the underlying therapeutic mechanisms. The EEG indexes used in this study focused on the functional involvement for motor generation: alpha power at temporal regions (inhibiting non-motor activity) and central-frontal regions (releasing motor regions from inhibition). Results showed that post-training benefits, measured by Fugl-Meyer Assessment (FMA), were similar across 3 tDCS interventions (premotor, primary motor, sham). EEG seemed more sensitive to the training, with notable responses in the premotor tDCS group. Three months after training, only the premotor tDCS group maintained the gains in FMA, with these improvements correlated with the EEG indexes. Again, this pattern was specific to premotor tDCS. Since the gating-by-inhibition model suggests that EEG index reflects an individual’s psychomotor efficiency, we also found that the baseline EEG index could predict FMA retention. Our findings demonstrate the superiority of combined premotor tDCS with MT and identify functionally oscillatory alpha-band activity in the temporal and central-frontal regions as potentially underlying the therapeutic mechanism. An individual’s spatial pattern of EEG may be effective in predicting upper extremity retention effect.

Combined exercise and cognitive training have been evidenced to be effective in cognitive and physical functions in post-stroke survivors. Recent interest has gradually shifted to technology-aided cognitive rehabilitation. However, clear neural makers or comprehensive behavioral indexes used for evaluating rehabilitation remain unexplored. The study aimed to examine the effects of two types of combined exercise-cognitive training on stroke patients with cognitive dysfunction, focusing on neural and behavioral markers. 39 patients were randomly assigned to sequential exercise-cognitive training, simultaneous exercise-cognitive training or active control groups and underwent 60 minutes/day training, 3 days/week, for 12 weeks. 29 patients ultimately completed the training. The markers/indexes included cognitive function, physical function, instrumental activities of daily living, and caregiver strain. Cognitive function included working memory task performance, neurophysiological markers, and cognitive indexes. The results indicated no d-prime difference between groups after the training. The simultaneous training demonstrated significant improvements in the neurophysiological marker of P300 and theta coherence compared to the other groups. Moreover, the simultaneous training also led to significant enhancements in physical function, as measured by the Rivermead Mobility Index, comparing to the other groups. Further analysis contrasting the two exercise-cognitive trainings revealed that improvements in cognition and multifaceted domains (i.e., instrumental activities of daily living and caregiver strain) were manifested in the simultaneous training. Together with the neural markers identified in the current interventions, the differential impacts of the two interventions indicates the potential of technology-driven and personalized rehabilitation in post-stroke patients.