Evoked potentials in stroke rehabilitation: current applications, emerging technologies, and future directions

Abstract

Evoked potentials (EPs) are increasingly explored as objective neurophysiological biomarkers to complement scale-based assessment in stroke rehabilitation. This narrative review summarizes current evidence on the use of somatosensory evoked potentials (SEPs), motor evoked potentials (MEPs) and event-related potentials (ERPs) for monitoring recovery and guiding therapy. We first outline the physiological basis and stroke-relevant features of each modality, then synthesize data on how EP measures relate to motor, sensory, balance, cognitive and language outcomes, with particular emphasis on longitudinal changes during rehabilitation and responses to specific interventions, including neuromuscular electrical stimulation, robot-assisted training and non-invasive brain stimulation. Emerging applications such as perturbation-evoked cortical responses for postural control, EP-based brain–computer interfaces and EP-guided or closed-loop neuromodulation are discussed, together with advances in high-density recordings, connectivity analysis, and machine-learning–based multimodal prediction models. Finally, we highlight key methodological and practical challenges—protocol heterogeneity, small single-centre studies, limited trial evidence, feasibility constraints and gaps in clinical integration—and propose priorities for standardization and translational research. Overall, EPs hold substantial promise as pathway-specific, temporally precise biomarkers to enable more mechanism-informed and individualized stroke rehabilitation monitoring.