Effects of multi-channel functional electrical stimulation combined with task-oriented robot training on lower limb motor function and brain network efficiency in individuals with sequelae in the subacute post-stroke phase: a randomized controlled trial

Previous research indicates that task-oriented robotic training can enhance lower limb motor function in stroke patients. Functional Electrical Stimulation (FES) is an effective therapy for lower limb dysfunction due to upper motor neuron disorders. This study examined the impact of multi-channel FES combined with task-oriented robotic training on lower limb function in individuals with subacute stroke, as well as the associated brain network efficiency. Eighty-one participants were randomly assigned to control, sham, or experimental groups. The control group received conventional rehabilitation. The sham group underwent robotic training with sham FES. The experimental group received robotic training with active FES. All treatments were administered for 25 min each, once daily, five days a week, over two weeks. Outcome measures included the Fugl-Meyer Assessment for Lower Extremity (FMA-LE), Berg Balance Scale (BBS), and Modified Barthel Index (MBI). Brain activity was recorded using a 35-channel fNIRS system. Data were analyzed using Repeated Measures ANOVA to assess group-by-time interactions, Spearman correlation for brain-behavior relationships, and False Discovery Rate (FDR) correction for multiple comparisons. The experimental group demonstrated significant improvements in FMA-LE, BBS, and MBI scores compared to the control group ( p < 0.05). They also showed greater brain activation in the left prefrontal cortex and enhanced connectivity between the left and right prefrontal cortices. Additionally, the experimental group had increased clustering coefficient ( C p ), characteristic path length ( L p ), and local efficiency ( E loc ), while the sham group only improved in L p . Both C p and E loc were significantly correlated with lower limb motor function ( p < 0.001). The combined intervention of multi-channel FES and task-oriented robotic training can improve lower limb function, balance, and daily living activities in subacute ischemic stroke patients. Furthermore, this combined intervention enhanced prefrontal cortex connectivity and brain network topological efficiency, providing a potential neural basis for motor recovery. Trial registration : This study was retrospectively registered with the Chinese Clinical Trial Registry (Trial registration number: ChiCTR2500104655) on 20 June 2025.