Background: Stroke is a leading global cause of disability, affecting millions annually (WHO). Objectives: This study aimed to evaluate clinical recovery and motor learning in the brain during shoulder rehabilitation by utilizing a shoulder wheel device, simultaneous electroencephalography (EEG) recording, and clinical assessments. Methods: A total of 120 participants were initially invited to participate in this study at the Health and Rehabilitation Center of Asadabad University of Medical Sciences. After applying exclusion criteria, 50 participants were included and divided into two groups: An intervention group (25 participants) and a control group (25 participants). The EEG signals were recorded, and clinical status evaluations were conducted for all participants. A specially designed game-based virtual environment shoulder wheel device for home use was employed in the intervention group. Clinical and EEG outcomes were analyzed and compared between the two groups. Results: Clinical evaluations indicated that the game-based shoulder wheel system significantly enhanced the rehabilitation process for stroke patients with shoulder mobility impairments compared to the control group. The EEG signal analysis demonstrated the effectiveness of this home-based rehabilitation approach, showing increased patient engagement in the training process. This study highlights the potential utility of EEG biomarkers, such as Pairwise-Derived Brain Symmetry Index (pdBSI) and DAR, to guide and monitor rehabilitation progress. Conclusions: A game-based telerehabilitation system for shoulder rehabilitation in stroke patients was successfully developed, refined, and clinically evaluated. The findings underscore the value of incorporating game-based interventions to improve shoulder function and prolong active recovery periods in stroke patients. Furthermore, this study suggests the integration of EEG biomarkers to optimize and personalize rehabilitation strategies.

Background and Aim: The recent studies aimed at reviewing the literature on the effects of neuroplasticity and factors affecting language recovery of patients with aphasia. Materials and Methods: An electronic search was performed in PMC, Web of Science, PubMed, Scopus, Ovid databases. The present information is available reviewing the Medline, SID, Google Scholar and articles from 1996 to 2020 through the search of the resources. Results: Aphasia is an acquired language injury as the result of stroke in the left hemisphere that may result in the loss of cerebral function. However, the brain can use neuroplasticity to adjust itself functionally, by reorganizing the cortical maps, which contributes to the stroke recovery. Neuroplasticity is the capacity of a brain to change or be modified at cellular or behavioral levels. The changes in the cortex organization include an increase in the number and density of dendrites, synapses and neurotrophic factors synthesis and establishing of new neuronal circuits. Recent advances in functional imaging reveal that cortical hemisphere contralateral to the infarction lesion plays an important role in this recovery process. There is also clinical evidence showing that the contralesional intact hemisphere plays an important role for compensation for impaired functions. This brain plasticity can lead to degree of spontaneous recovery and rehabilitative training may modify and boost the neuronal plasticity processes. Conclusion: The central nervous system is plastic, in that the number and strength of synaptic connections changes over time. The growing understanding of the nature of brain plasticity raises optimism that this knowledge can be capitalized upon to improve rehabilitation efforts and to optimize functional outcome. The therapists focus on maximizing the functional benefits of post stroke motor rehabilitation by developing interventions to promote motor learning-related neuroplasticity.