True acupuncture treatment significantly alleviated neurological impairment and enhanced motor recovery in post-stroke hemiplegia, underpinned by specific neuroplastic changes including functional modulation of default mode network dynamics and structural promotion of gray matter plasticity in regions critical for sensorimotor and cognitive-motor integration.
Key Findings
Results
True acupuncture (TA) produced superior motor recovery compared to sham acupuncture (SA), as evidenced by significant gains in Brunnstrom scores only in the TA group.
Patients were randomly allocated in a 2:1 ratio to receive either true-acupoint (TA) or sham-acupoint (SA) treatment.
The intervention period lasted two weeks.
Clinical outcomes were assessed using the Fugl-Meyer Assessment (FMA), Brunnstrom Scale, and the National Institutes of Health Stroke Scale (NIHSS).
Both groups showed post-treatment improvements in NIHSS and FMA scores, but only the TA group exhibited significant gains in Brunnstrom scores.
The study focused on patients with hemiplegia following ischemic stroke.
TA treatment manifested as significantly reduced disjointedness in DMN dynamics.
A trend toward decreased flexibility in DMN dynamics was also observed in the TA group.
These DMN dynamic changes correlated with better motor outcomes.
No such modulatory effect on DMN dynamics was observed in the SA group.
Neuroplastic changes were evaluated through dynamic functional network metrics using a multilayer dynamic functional network topology approach.
Results
True acupuncture increased gray matter volume (GMV) in multiple brain regions involved in sensorimotor and cognitive-motor integration.
GMV increases were observed in the right middle frontal gyrus, right postcentral gyrus, right angular gyrus, left superior parietal gyrus, and left cerebellar Crus 1-2, 4-5, 7.
Additional GMV increases were found in bilateral middle occipital gyrus, superior temporal gyrus, angular gyrus of inferior parietal margin, dorsolateral superior frontal gyrus, inferior frontal gyrus of operculum, and cerebellar area 10.
No significant changes in GMV were detected in the SA group.
GMV analysis was used to evaluate structural neuroplastic changes.
Results
Increases in GMV in specific regions — the right opercular inferior frontal gyrus, postcentral gyrus, and cerebellar region 10 — were positively correlated with motor recovery in the TA group.
Correlation analyses were performed to examine relationships between post-acupuncture improvements in clinical scores and changes in neuroimaging indices.
The positive correlations between GMV increases and motor recovery were specific to the TA group.
The postcentral gyrus is associated with sensorimotor processing, and the inferior frontal gyrus operculum and cerebellar region 10 are implicated in motor and cognitive-motor integration.
No analogous structural-clinical correlations were reported for the SA group.
Methods
The study used a multimodal MRI design combining gray matter volume analysis and multilayer dynamic functional network topology to assess neuroplastic mechanisms of acupuncture.
The trial was randomized with patients allocated in a 2:1 ratio (TA:SA).
Neuroplastic changes were evaluated through both GMV analysis (structural) and dynamic functional network metrics (functional).
The study focused on post-stroke recovery involving reorganization of structural and functional brain networks.
The two-week intervention period was used for both TA and SA conditions.
The study population included patients with ischemic stroke presenting with hemiplegia.
What This Means
This research suggests that acupuncture at true acupuncture points — as opposed to sham (placebo) acupuncture points — produces measurable changes in the brain that help stroke survivors recover motor function. In a two-week randomized trial, stroke patients who received real acupuncture showed better improvement in movement quality (as measured by the Brunnstrom Scale) compared to those who received sham acupuncture. Both groups improved on some neurological and motor scales, but only the real acupuncture group showed this particular motor recovery benefit.
Using advanced brain imaging, the researchers found two types of brain changes in the real acupuncture group. First, the brain's 'default mode network' — a system active during rest and internally directed thought — became less disjointed and more stable, and these changes were linked to better motor outcomes. Second, the volume of gray matter increased in more than a dozen brain regions involved in movement control, sensory processing, and cognitive aspects of motor planning. Notably, gray matter growth in three specific areas (the opercular inferior frontal gyrus, postcentral gyrus, and cerebellar region 10) was directly correlated with how much motor function patients recovered. None of these structural brain changes were seen in the sham acupuncture group.
This research suggests that acupuncture's benefits in stroke rehabilitation are not merely a placebo effect but are associated with specific, measurable reorganization of brain structure and function. The findings point to acupuncture as a potential tool for promoting neuroplasticity — the brain's ability to rewire itself — during stroke recovery, particularly in regions critical for movement and sensorimotor integration. These results may help guide future research into how acupuncture could be incorporated into rehabilitation programs for stroke survivors.
Yu X, Zhao N, Liu Y, Zheng S, Luo D, Chen Q, et al.. (2026). Neuroplastic Mechanisms of Acupuncture in Post-Stroke Motor Recovery: A Randomized Multimodal MRI Trial.. CNS neuroscience & therapeutics. https://doi.org/10.1002/cns.70955