Abstract
BACKGROUND: Stroke survivors often experience residual motor dysfunction in their limbs. Additional physical rehabilitation therapies may further improve patients' functional outcomes. By combining direct interventions targeting the cerebral cortex or subcortical structures with indirect approaches that promote central nervous system reorganization, a closed-loop regulatory system can be established. This integrated approach may generate synergistic effects, thereby enhancing functional recovery outcomes. METHODS: This 3-week single-center randomized, single-masked study involved participants randomly assigned to either the electroacupuncture (EA) combined with robot-assisted gait training (RAGT) group (n = 22) or the RAGT alone group (n = 23). EA treatment was administered once daily for 30 min, 5 days per week, while RAGT treatment received the same duration of daily sessions. Baseline and endpoint assessments included the Fugl-Meyer lower extremity (FMA-LE) motor function assessment, functional ambulation category (FAC) scale, Berg Balance Scale (BBS) and electroencephalogram. RESULTS: After a 3-week intervention period, participants in both groups showed significant improvements in FMA-LE, FAC, and BBS scores compared to baseline levels. The EA combined RAGT group exhibited a reduction in the brain symmetry index within the alpha frequency band, along with enhanced coherence between the CZ electrode and the FCZ, FC2, and C1 electrodes. Furthermore, in the theta frequency band, a shortened average path length and improved global efficiency were observed. CONCLUSION: Both interventions can safely and effectively improve lower limb motor function, and EA combined with RAGT combination therapy may have an advantage in promoting neuroplasticity, which may involve reversing pathological frequency spectrum imbalance after stroke, enhancing functional connections between sensorimotor-related brain regions, and optimizing the topological properties of brain functional networks. Trial registration Chinese Clinical Trial Registry (Registration No.: ChiCTR2500102382).