Randomized controlled trial of sequential motor imagery–based brain–computer interface and scalp acupuncture for post-stroke motor recovery with a multimodal neuroimaging case exploration

Background To investigate the clinical efficacy of motor imagery (MI)-based brain–computer interface (BCI) combined with scalp acupuncture in upper limb motor rehabilitation of post-stroke hemiplegia patients. Methods Sixty-two patients with post-stroke hemiplegia were randomly assigned to an Acu-group ( n = 31) or a BCI-Acu group ( n = 31). Both groups received conventional medication and comprehensive rehabilitation training. Additionally, both groups underwent scalp acupuncture. The BCI-Acu group also received MI-based BCI training sequentially prior to scalp acupuncture. All interventions were conducted over a 4-week period. Fugl-Meyer Assessment of upper limb (FMA-UL), Wolf Motor Function Test (WMFT), Modified Ashworth Spasticity Scale (MAS), National Institutes of Health Stroke Scale (NIHSS), and Modified Barthel Index (MBI) scores were compared before and after treatment. Results After treatment, both groups showed increased FMA-UL, WMFT, and MBI scores ( p < 0.05) and decreased MAS and NIHSS scores ( p < 0.05). The improvements in FMA-UL, WMFT, and MBI scores were greater in the BCI-Acu group than in the Acu-group ( p < 0.05). Conclusion Our findings indicate that, in conjunction with conventional pharmacotherapy and comprehensive rehabilitation, the sequential administration of BCI training prior to scalp acupuncture facilitates neurological recovery in patients after ischemic stroke. Moreover, this sequential protocol was superior to scalp acupuncture monotherapy for improving upper limb motor function and self-care capacity, highlighting its promise for widespread clinical application.