SYSTEMATIC REVIEW article
Front. Neurol.
Sec. Neurorehabilitation
Efficacy and Safety of Neuromodulation and Multimodal Therapies for Traumatic Brain Injury-Induced Disorders of Consciousness: An Updated Umbrella Review
Provisionally accepted
- 1Minzu University of China, Beijing, China
- 2Huzhou College, Huzhou, China
- 35th Medical Center of Chinese PLA General Hospital, Beijing, China
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Background: Post-traumatic disorders of consciousness (DoC) remain a major barrier to recovery after traumatic brain injury (TBI), yet therapeutic guidance is fragmented across modalities. Objective: To synthesize the highest-level evidence on efficacy and safety of interventions for TBI-related DoC and derive practice-oriented recommendations. Methods: Following PRISMA and a prospectively registered protocol (INPLASY202480015), we systematically screened PubMed, Embase, Web of Science, and CNKI through June 2024 for peer-reviewed systematic reviews and meta-analyses focused on TBI-induced DoC. Methodological quality was appraised using AMSTAR-2. Primary outcomes were CRS-R, GCS, GOS, and overall efficacy rate; random-or fixed-effects models were applied per heterogeneity. Results: Seven high-quality evidence syntheses encompassing 121 trials and eight interventions were included. Neuromodulation showed consistent benefits: repetitive transcranial magnetic stimulation (rTMS) improved CRS-R (MD 3.00, 95% CI 2.47–3.52) and GCS (MD 2.92, 1.65 –4.19); transcranial direct current stimulation (tDCS) improved CRS-R (MD 2.08, 0.63– 3.25) . Peripheral and sensory approaches were robust: acupuncture improved GCS (MD 2.03, 1.54 – 2.52), GOS (RR 1.22, 1.16 – 1.29), and Efficacy Rate (RR 1.48, 1.40 – 1.56); multisensory stimulation improved GCS (MD 2.28, 2.02–2.54) and GOS (MD 1.11, 0.77–1.45). Right median nerve stimulation (RMNS) and family-centered sensory-affective stimulation also yielded significant gains, while single-study Trigeminal nerve stimulation(TNS) effects were mixed. Conclusions: tDCS, rTMS, median nerve stimulation, multisensory stimulation, and acupuncture emerge as leading strategies for TBI-related DoC. We highlight priorities for the field: adequately powered multicenter RCTs with standardized protocols, mechanistic studies to refine dosing and targets, and predictive tools for personalized therapy selection. This umbrella synthesis provides a pragmatic evidence map to accelerate recovery and improve long-term outcomes in this vulnerable population.
Keywords: disorders of consciousness, Neuromodulation, Neurorehabilitation, Transcranial Magnetic Stimulation, Traumatic Brain Injury
Received: 10 Nov 2025; Accepted: 11 Feb 2026.
Copyright: © 2026 Yang, Li, Zhang, Luo, Zhao and Qing-Shan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Chunying Zhao
LIU Qing-Shan
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