Abstract
BACKGROUND: Lower limb motor dysfunction is a common sequela of stroke that significantly impacts patients' walking safety and independence in daily living. Although brain-computer interface (BCI) technology has demonstrated efficacy in upper limb rehabilitation, its effects on lower limb recovery have not yet been systematically evaluated. METHODS: A systematic literature search was conducted across seven databases (PubMed, Web of Science, Embase, China National Knowledge Infrastructure, SinoMed, VIP Database, and Wanfang Data.) to identify studies investigating BCI for post-stroke lower limb dysfunction, encompassing records published up to September 2025. All statistical analyses were performed using Review Manager software (version 5.4.1). RESULTS: Thirteen studies involving 582 participants were included. BCI training significantly improved the scores of Fugl-Meyer Assessment for Lower Extremity (FMA-LE, MD = 2.67, 95%CI: 2.31-3.03, P < 0.00001, I (2) = 0%), Berg Balance Scale (BBS, MD = 7.04, 95%CI: 3.14-10.94, P = 0.0004), and Modified Barthel Index (MBI, MD = 6.72, 95%CI: 1.74-11.69, P = 0.008). Furthermore, a single study reported significant improvement in functional mobility measured by the Timed Up and Go Test (TUGT). Subgroup analysis for activities of daily living MBI showed that a cumulative training time of ≥ 500 min was associated with greater improvement. CONCLUSION: BCI-based training is an effective approach for improving lower limb recovery after stroke, demonstrating benefits in motor function, balance, and functional mobility. While evidence for certain outcomes remains limited, the dose-dependent effect on daily living activities underscores the importance of sufficient training duration. Future research should validate these findings and clarify effects across a broader range of functional measures. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251150558, identifier: CRD420251150558.