Electroacupuncture for Motor Recovery in Subacute Stroke: A Randomized Trial Exploring CReST‐Related Modulation

BACKGROUND: Upper limb impairment is a common consequence of stroke, with unclear motor recovery mechanisms. Electroacupuncture (EA) has shown promise in promoting recovery, but its effects on the corticoreticulospinal tract (CReST), a key stroke rehabilitation pathway, remain underexplored. This study aimed to investigate the effects of EA on motor recovery and its potential modulation of CReST-related pathways in subacute stroke patients. METHODS: Thirty-two subacute stroke patients were randomly assigned to the EA or control group. Both groups underwent a two-week rehabilitation program, with the EA group receiving EA over the Hegu (LI4) and Quchi (LI11) acupoints before physical therapy. The Fugl-Meyer Assessment for Upper Extremity (FMA-UE) and the Modified Ashworth Scale (MAS) assessed motor function and spasticity before and after the intervention. Surface electromyography and functional near-infrared spectroscopy (fNIRS) measured motor performance and neural activity. RESULTS: The EA group exhibited significant improvements in FMA-UE scores and faster premotor reaction times compared to controls. Increased StartReact incidence and altered anticipatory muscle activations were observed in the EA group. fNIRS analysis revealed an enhanced contralateral sensorimotor network (SMN) activity during the early stage of EA intervention. Additionally, more severe motor impairments were associated with greater contralesional SMN connectivity improvement during the early EA phase. CONCLUSIONS: Preliminary evidence suggests that EA at LI4 and LI11 serves as a promising adjuvant intervention to enhance upper limb motor recovery in subacute stroke; this benefit is likely mediated by the modulation of CReST-related pathway and contralesional SMN reorganization. Larger, well-controlled studies incorporating sham-EA groups are warranted to validate these findings and establish definitive causal links.