Clinical and neurophysiological effects of manual acupuncture for upper-limb motor dysfunction after ischemic stroke: a three-arm randomized controlled trial.
Min Y, Huang Z, et al. • Frontiers in neurology • 2026
Manual acupuncture combined with conventional rehabilitation produced greater improvements in upper-limb motor function and activities of daily living after ischemic stroke than either conventional rehabilitation alone or sham acupuncture plus conventional rehabilitation, accompanied by neurophysiological changes in muscle activation and cortical function.
Key Findings
Results
Manual acupuncture produced significantly greater improvement in Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) scores compared to both conventional rehabilitation alone and sham acupuncture.
Between-group difference versus conventional rehabilitation alone: 9.64 points (95% CI, 5.62 to 13.66; Bonferroni-adjusted p < 0.001)
Between-group difference versus sham acupuncture: 8.57 points (95% CI, 4.55 to 12.59; Bonferroni-adjusted p < 0.001)
The trial enrolled 84 patients with unilateral upper-limb impairment within 3 months after ischemic stroke, randomized 1:1:1 across three arms
Treatment duration was 4 weeks; all randomized participants were included in the full analysis set
Results
Manual acupuncture produced significantly greater improvement in Modified Barthel Index (MBI) scores compared to both comparison groups.
Between-group difference versus conventional rehabilitation alone: 7.32 points (95% CI, 1.52 to 13.13; Bonferroni-adjusted p = 0.040)
Between-group difference versus sham acupuncture: 11.29 points (95% CI, 5.48 to 17.09; Bonferroni-adjusted p < 0.001)
MBI measures activities of daily living
Results
Manual acupuncture was associated with larger increases in unnormalized surface electromyography (sEMG) RMS amplitudes in proximal arm muscles during voluntary contraction.
Larger increases were observed in both biceps brachii and triceps brachii RMS amplitudes
Effects were observed specifically during voluntary contraction rather than passive stretch
sEMG absolute RMS amplitudes were measured during both passive stretch and voluntary contraction as secondary outcomes
Results
Manual acupuncture was associated with greater ipsilesional prefrontal cortex and primary motor cortex activation as measured by functional near-infrared spectroscopy (fNIRS).
Greater activation was observed in the ipsilesional prefrontal cortex and primary motor cortex after false discovery rate correction
Altered prefrontal and sensorimotor functional connectivity was also observed
fNIRS measured both cortical activation and resting-state functional connectivity as secondary outcomes
Results
Sham acupuncture did not differ significantly from conventional rehabilitation alone for most outcomes.
Sham acupuncture used superficial nonacupoint needling without manipulation
This finding suggests that the observed benefits of manual acupuncture are not attributable solely to nonspecific needling effects
The three-arm design was specifically intended to separate acupuncture effects from nonspecific needling effects
Methods
Manual acupuncture was applied at specific acupoints with de qi manipulation, while sham acupuncture used superficial nonacupoint needling without manipulation.
Manual acupuncture points: GV20, GV14, LI11, PC6, ST36, and SP6
Manipulation was applied to elicit de qi sensation in the manual acupuncture group
Sham acupuncture used superficial nonacupoint needling without manipulation as an active control
The trial was single-center and assessor-blinded
Results
The safety profile of manual acupuncture was favorable, with only mild adverse events reported.
Three mild cases of subcutaneous bleeding occurred
No serious adverse events were reported across any group
Adverse events were included as a secondary outcome measure
What This Means
This research suggests that adding manual acupuncture to standard stroke rehabilitation can meaningfully improve arm movement and daily living abilities in people who experienced an ischemic stroke within the past three months. The study compared three groups of stroke patients: one receiving only conventional rehabilitation, one receiving a sham (fake) acupuncture plus conventional rehabilitation, and one receiving real manual acupuncture plus conventional rehabilitation. After four weeks of treatment, patients in the real acupuncture group showed notably better arm function scores — roughly 8 to 10 points higher on a standard motor assessment scale — compared to either of the other two groups.
Importantly, the fake acupuncture group performed no better than the group receiving only conventional rehabilitation. This matters because it suggests the benefits seen with real acupuncture are not simply due to the placebo effect of being needled — the specific technique and acupoint locations appear to matter. The study also found biological changes that may help explain why acupuncture worked: patients in the real acupuncture group showed stronger muscle electrical activity in their upper arm muscles during intentional movement, and brain imaging with near-infrared light showed increased activity in motor-related brain regions on the same side as the stroke.
This research suggests that manual acupuncture, when added to conventional rehabilitation, may offer meaningful benefits for stroke survivors struggling with arm weakness, and that these benefits are accompanied by measurable changes in how muscles and the brain function. The treatment was well tolerated, with only three minor instances of bruising and no serious side effects reported.
Min Y, Huang Z, Sun J, Peng Z, Guan H, Gong Y, et al.. (2026). Clinical and neurophysiological effects of manual acupuncture for upper-limb motor dysfunction after ischemic stroke: a three-arm randomized controlled trial.. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1886740