Current and emerging neuromodulation techniques for motor recovery after ischemic stroke: a 2026 update

INTRODUCTION: Neuromodulation technologies have emerged as promising tools to enhance motor recovery following ischemic stroke. Acute reperfusion therapy remains highly time-dependent, underscoring the need for interventions that augment post-stroke neuroplasticity. Brain stimulation techniques aim to modulate cortical excitability and promote adaptive reorganization of motor networks during the critical recovery period after stroke. AREAS COVERED: The authors review recent advances in neuromodulation strategies for post-stroke motor recovery, as well as the key principles underlying neuromodulation. Major noninvasive modalities, including transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), and low-intensity focused ultrasound stimulation (LIFUS), are reviewed alongside emerging applications of invasive techniques such as deep brain stimulation (DBS) and vagus nerve stimulation (VNS). Recent randomized clinical trials and translational studies are also highlighted. This article is based on literature obtained through PubMed and ClinicalTrials.gov searches for content published between 1 January 2020 and 30 March 202630 March 2026 and was supplemented by earlier landmark studies relevant to stroke recovery and neuromodulation. EXPERT OPINION: Although neuromodulation technologies demonstrate encouraging safety profiles, clinical trial results feature notable neutral results. Future studies bear the burden of refining stimulation paradigms, patient selection, and rehabilitation dosing, possibly leveraging personalized, biomarker-driven patient selection.