Neuroplasticity-based active movement opens an avenue for functional recovery in post-stroke patients. Active rehabilitation techniques have attracted wide attention based on their abilities to enhance patient involvement, facilitate precise personalized intervention, and provide comprehensive treatment via cross-domain approaches. Emerging evidence suggests that active rehabilitation methods can respond to patients’ motor intentions in real-time and significantly increase motivation and engagement, leading to efficient utilization of critical recovery windows and better rehabilitation outcomes. In this review, we focus on the physiological basis of active rehabilitation, including mechanisms of neuroplasticity, and discuss recent advances in intent detection and feedback devices. We also examine treatment options for different stages of stroke recovery, providing a comprehensive reference for engineers to design optimized rehabilitation techniques and for clinicians to select appropriate rehabilitation protocols. These developments create new opportunities to improve the lives of stroke patients and offer greater hope for their recovery.

BACKGROUND: Dual-task impairment severely limits functional recovery post-stroke. This diagnostic accuracy study aimed to develop an eye-tracking-based system for objectively quantifying ankle-cognitive integration deficits in stroke survivors. METHODS: This diagnostic accuracy study was conducted from January 2022 to October 2023 at Tsinghua Changgung Hospital in Beijing. A total of 20 healthy adults (mean age 53.15±6.26 years) participated in the study. In addition, 30 patients with a history of stroke (mean age 64.13±8.16 years, 8 females, disease duration 9.12±6.60 weeks) participated in a standardised dual-task evaluation. The novel system utilised 17 parameters, encompassing ankle kinematics (range of motion, velocity) and eye tracking (gaze duration, sweep latency), which were measured simultaneously during the cognitive motor task. Reliability was assessed by intragroup correlation coefficients (ICC), while criterion validity was assessed using 12 clinical evaluation metrics, including Spearman correlation with Montreal Cognitive Assessment (MOCA) scores and dual-task cost (DTC) percentages. RESULTS: The system demonstrated that 88.2% of the evaluation parameters exhibited high consistency, with 55.8% showing a moderate correlation with clinical benchmark scales (p<0.05). Notably, MOCA, DTC%, and TUG-subtraction task duration were identified as key indicators of dual-task ability (P<0.05), while the Self-Rating Anxiety Scale showed lower sensitivity. Furthermore, ankle motion parameters exhibited a strong correlation with balance and fall risk (P<0.05), effectively serving as predictors of motor function recovery and fall risk in stroke patients. CONCLUSIONS: This multimodal system reliably quantifies post-stroke dual-task deficits, with ankle kinematics and eye-tracking metrics serving as sensitive biomarkers for balance recovery and fall risk stratification. Findings advocate integrating objective dual-task metrics into neurorehabilitation protocols to optimize functional outcomes. (ChiCTR2300067640; URL: https://www.chictr.org.cn/showproj.html?proj=188211 ).