The potential of robotics: A systematic review of neuroplastic changes following advanced lower limb rehabilitation in neurological disorders

Abstract

Neurological diseases are among the most common pathologies that strongly influence a person's ability to walk and move, affecting the lower extremities. They disrupt motor brain networks that enable precise movement, leading to deficits in gait, balance, and coordination; while conventional therapies remain essential, advances in robotic technologies show growing promise for rehabilitation. This systematic review aims to investigate the role of robotic rehabilitation in improving neuroplasticity and motor outcomes for individuals with neurological disorders, with a particular focus on studies incorporating neurophysiological or neuroimaging techniques to assess neuroplastic changes and their long-term impact on recovery. A systematic review was carried out utilizing an online search of articles from 2014 to 2025 on the PubMed, Web of Science, Cochrane Library, Embase, EBSCOhost, and Scopus databases in accordance with PRISMA guidelines. Studies were chosen based on predetermined inclusion criteria, with an emphasis on robotic rehabilitation therapies targeted at improving neuroplasticity in lower limb rehabilitation for people with neurological conditions. This review has been registered on Prospero with the following number: CRD42025640347. The search identified 12,769 records; after screening and eligibility assessment, 25 studies met inclusion criteria. Studies demonstrate that robot-assisted gait training (RAGT) and exoskeleton-based therapies improve motor function, gait, balance, and neuroplasticity across stroke, spinal cord injury, cerebral palsy, and brain injury populations. Adjunctive approaches such as brain–computer interface (BCI) integration, virtual reality feedback, and neuromodulation further enhance outcomes, with increases in cortical activation and improvements in functional connectivity supported by convergent neurophysiological and neuroimaging data; changes in corticospinal excitability are also reported. Taken together, robotic interventions, often combined with neuromodulation or virtual reality (VR), appear to catalyze neuroplasticity in ways that align with clinically meaningful gains. These findings underscore their transformative potential for tailored, multimodal rehabilitation strategies in neurological recovery. • Robotic therapy promotes neuroplasticity in lower limbs post-stroke, evidenced by increased cortical activation and improved motor function. • Neurophysiological measures like fNIRS, EEG, and TMS offer objective tools to detect neuroplastic changes in lower limb robotic rehabilitation. • Combining robotic therapy with neuromodulation techniques may further enhance neuroplasticity and recovery outcomes. • Longitudinal neurophysiological monitoring can track neuroplastic changes over time, informing rehabilitation strategies.