New Paradigms for Precision Rehabilitation of Brain Injury：Multimodal Brain Function Detection and Individualized Neuromodulation

In patients with brain injury, conventional clinical paradigm based on macro imaging and behavioral scales fails to achieve precise localization and dynamic assessment of neural functions and network connectivity. It is also difficult to effectively predict the recovery potential of neural plasticity, thereby limiting the improvement of rehabilitation outcomes. This article systematically reviews recent advances in novel technologies for brain function detection and neuromodulation in brain injury, and explores their role in transitioning brain injury rehabilitation from a standardized model to an individualized and precise model. In the area of brain function detection, technologies have evolved from assessing static structures to evaluating dynamic networks. High-density electroencephalography significantly enhances spatial localization, which enables the precise identification of electroencephalographic rhythm abnormalities in the prodromal stage of cognitive decline, assessment of post-stroke interhemispheric inhibition imbalance, and evaluation of level of consciousness. Functional near-infrared spectroscopy can reflect abnormal bilateral motor cortex activation patterns in stroke patients during motor tasks. Functional magnetic resonance imaging studies have revealed that alterations in functional connectivity within the default mode network were closely associated with the recovery of cognitive and motor functions after brain injury. Multimodal fusion technology enables simultaneous electroencephalogram and functional magnetic resonance imaging data acquisition. The combination of their respective advantages in temporal and spatial resolution significantly improves diagnostic efficacy in consciousness level assessment. Neuromodulation technologies are becoming increasingly precise and individualized. Navigated transcranial magnetic stimulation and deep transcranial magnetic stimulation enable precise intervention on specific cortical and deep brain areas. High definition transcranial direct current stimulation has been proven to be effective in enhancing the consciousness level in patients with disorders of consciousness and promoting upper limb functional recovery in stroke patients. Deep brain stimulation can significantly improve the prognosis in some patients with disorders of consciousness. The transcranial magnetic stimulation-electroencephalogram paradigm allows direct quantification of cortical excitability and network connectivity. Based on a closed-loop paradigm, responsive neurostimulation achieves real-time monitoring and automatic intervention of abnormal epileptic electrical activity. However, the realization of precision rehabilitation for brain injury still faces many challenges, including the complexity of multimodal data fusion, the lack of individualized biomarkers, insufficient understanding of underlying mechanisms, and difficulties in clinical translation. Future research should focus on constructing a closed-loop neuromodulation system based on multimodal sensing, exploring novel paradigms for spatiotemporal precision and synergistic modulation, and establishing a rehabilitation assessment-intervention framework integrating standardization and individualization. These efforts will drive the refinement and development of a precision rehabilitation system for brain injury.