Stroke Rehabilitation Targeting the Cerebello-Cerebral Neural Circuit： Advances from Neuromodulation to Closed-Loop Brain-Computer Interface Technology

Stroke remains the leading cause of death and disability among adults in China. Approximately one-third of stroke survivors experience varying degrees of functional impairment, significantly diminishing their quality of life and necessitating further rehabilitation interventions. Traditional non-invasive neuromodulation techniques primarily target cortical regions, such as the dorsolateral prefrontal cortex and the primary motor cortex; however, their clinical efficacy varies considerably among individuals. Therefore, identifying additional rehabilitation targets is crucial for enhancing functional recovery in stroke patients. In recent years, the cerebello-cerebral circuit has garnered increasing attention due to its pivotal role in regulating both motor and cognitive functions. Stroke events profoundly impact this neural circuit, with the cerebellum serving as a key node and a promising target for post-stroke functional rehabilitation. This review aims to elucidate the effects of stroke on the cerebello-cerebral circuit, summarize recent advances in cerebellum-targeted neuromodulation techniques, and explore the potential of closed-loop brain-computer interface technology to modulate neural plasticity within this circuit to promote functional recovery in stroke patients.