Multimodal synthesis of neural correlates of motor imagery after spinal cord injury: a systematic review

Abstract

Spinal cord injury (SCI) profoundly disrupts motor output while also reshaping central motor systems. Motor imagery (MI) provides a valuable window into retained motor-related neural processes because it enables investigation of covert motor state generation in the absence of overt movement. However, evidence on MI after SCI remains fragmented across neurophysiological and neuroimaging modalities. The objective of this review was to systematically synthesize evidence on the neural correlates of MI after SCI across electroencephalography (EEG), functional magnetic resonance imaging (fMRI), magnetoencephalography (MEG), and intracortical recordings. A systematic search of MEDLINE, Web of Science, Scopus, Embase, and EBSCOhost was conducted from database inception to March 2026. Original studies were included if they involved individuals with SCI, used an explicit MI task, and reported MI-related neural outcomes derived from EEG, fMRI, MEG, or intracortical recordings. Because of substantial heterogeneity in injury profiles, task paradigms, modalities, and neural outcome measures, a narrative synthesis was performed. Thirty-four studies met the inclusion criteria, including 15 EEG, 10 fMRI, 4 MEG, and 5 intracortical recording studies. Across modalities, MI-related neural activity remained detectable after SCI, with evidence spanning oscillatory responses, regional recruitment, network organization, and fine-grained neural representations. Many studies also described altered recruitment patterns, modified connectivity, atypical task-related modulation, or changes in representational structure. Findings varied according to injury phenotype, chronicity, task design, and analytical framework. The four modalities provided complementary evidence on post-SCI motor imagery across temporal, spatial, network, and neuronal scales. Available evidence indicates that MI-related neural activity is generally detectable after SCI, although its organization is often altered. A multimodal perspective is therefore necessary for understanding both the persistence and the reshaping of motor representations after injury. These findings support continued investigation of MI in neurorehabilitation and neurotechnology, while also highlighting the need for approaches that account for post-injury heterogeneity.