Transcranial ultrasound stimulation for post-stroke dysfunction: a meta-analysis of randomized controlled trials

Abstract

Objective To systematically evaluate the efficacy of transcranial ultrasound stimulation (TUS) in improving neurological deficits, motor, cognitive, swallowing function, and activities of daily living (ADL) in stroke patients Methods PubMed, Embase, Web of Science, Cochrane Library, CNKI, and Wanfang Database were searched for randomized controlled trials (RCTs) on TUS for stroke patients from inception to December 1, 2025. Two reviewers independently conducted literature screening, data extraction, risk of bias assessment using the Cochrane tool, and methodological quality evaluation using the PEDro scale. Meta-analysis was performed with RevMan 5.3, and publication bias was assessed using Egger’s test in Stata 18.0 Results Twenty-one RCTs involving 1,748 patients were included. TUS combined with conventional rehabilitation significantly improved neurological deficits (NIHSS: MD = −1.98, 95% CI: −3.61 to −0.34, P = 0.02), upper-limb motor function (FMA-UE: MD = 7.96, 95% CI: 7.16–8.76, P < 0.001), lower-limb motor function (FMA-LE: MD = 3.98, 95% CI: 2.70–5.26, P < 0.001), cognitive function (MMSE: MD = 1.22, 95% CI: 0.74–1.71, P < 0.001), ADL (BI: MD = 9.08, 95% CI: 5.72–12.44, P < 0.001), and swallowing (Fujishima-Ichiro: MD = 1.72, 95% CI: 1.30–2.13, P < 0.001) Subgroup analyses suggested that cognitive benefits were more pronounced in non-acute patients, while ADL improvements were greater in those with moderate-to-severe dependence. Regarding TUS parameters, 800 kHz provided stable motor recovery, and unilateral temporal window stimulation was sufficient for meaningful functional gains. Methodological quality was acceptable (3 good, 18 fair trials), and no publication bias was detected for BI score (P > 0.05) Conclusion Current evidence supports that TUS combined with rehabilitation effectively promotes recovery of neurological, motor, cognitive, swallowing, and daily living functions in stroke patients, with particular value for those with moderate-to-severe dysfunction. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD420261296388.