Effects of synchronous versus sequential scalp acupuncture and transcutaneous auricular vagus nerve stimulation on post-stroke cognitive impairment based on multimodal assessments: a single-center randomized controlled trial protocol.
Wei J, Liu X, et al. • Frontiers in neurology • 2026
This is a trial protocol, not a results paper: it describes a planned single-center randomized controlled trial of 96 PSCI patients to compare synchronous versus sequential delivery of scalp acupuncture and taVNS using multimodal assessments of cognition, daily living, neuroimaging, electrophysiology and cerebral hemodynamics.
Key Findings
Methods
The paper presents a study protocol for a three-arm randomized controlled trial testing the timing of combined scalp acupuncture and taVNS in post-stroke cognitive impairment (PSCI); no efficacy results are reported.
The trial is described as prospective and randomized, and will allocate 96 eligible PSCI patients equally into three groups.
The stated aim is to evaluate the efficacy and safety of synchronous versus sequential delivery of scalp acupuncture and taVNS.
The trial is registered at the Chinese Clinical Trial Registry, identifier ChiCTR2600125558.
Background
The protocol identifies uncertainty about the optimal temporal sequence of scalp acupuncture and taVNS as the gap it addresses.
Scalp acupuncture and taVNS each 'show promise for alleviating cognitive deficits'.
The optimal temporal sequence of their combined delivery 'remains uncertain'.
PSCI is described as significantly burdening individuals and society.
Methods
The three arms differ only in the timing of scalp acupuncture and taVNS; all arms receive conventional treatment plus both interventions.
Synchronous group: concurrent acupuncture and taVNS.
Control Group 1: acupuncture followed by taVNS.
Control Group 2: taVNS followed by acupuncture.
Methods
The intervention schedule is once daily, 5 days per week, for 4 weeks, with assessments at baseline, week 4 and a week 8 follow-up.
Multimodal data will be compared at baseline, week 4, and week 8 follow-up to assess the impact of temporal sequencing.
The 8-week time point serves as the follow-up after the 4-week treatment period.
Methods
The protocol uses a multimodal outcome set spanning clinical, imaging, electrophysiological, hemodynamic and safety measures.
Cognitive function: MoCA and MMSE.
Activities of daily living: Modified Barthel Index (MBI).
Cerebral hemodynamics: transcranial Doppler (TCD); plus adverse events.
Conclusions
The authors expect the trial to evaluate preliminary efficacy and safety and to explore central-peripheral neuromodulatory dynamics related to intervention timing.
Findings may help explore temporal dynamics of neuromodulation across brain networks, neural electrical activity and cerebral hemodynamics.
The work aims to contribute to the evidence base for standardizing integrative Chinese-western cognitive rehabilitation protocols.
What This Means
This paper does not report results. It describes the plan for a clinical trial that has not yet produced findings. The trial will study people with cognitive problems after a stroke, such as difficulties with memory and thinking. It will test two treatments given together: scalp acupuncture and a gentle electrical stimulation of a nerve in the ear (transcutaneous auricular vagus nerve stimulation, or taVNS).
The central question is whether the timing of these two treatments matters. Ninety-six patients will be split into three equal groups. One group will get both treatments at the same time, one will get acupuncture and then taVNS, and one will get taVNS and then acupuncture. Everyone will also get usual care. Treatment will be given once a day, five days a week, for four weeks, and patients will be checked again at four weeks and eight weeks.
The researchers will track thinking ability, daily-living function, brain scans, brain electrical activity, and blood flow in the brain, plus any side effects. This research suggests that, if the trial is carried out as planned, it could help clarify whether the order or timing of combined treatments affects recovery and how the brain responds. Until results are published, nothing can be concluded about which approach works best.
Wei J, Liu X, Pan Z, Wei C, Wang R, Wang X, et al.. (2026). Effects of synchronous versus sequential scalp acupuncture and transcutaneous auricular vagus nerve stimulation on post-stroke cognitive impairment based on multimodal assessments: a single-center randomized controlled trial protocol.. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1931213