Effects of electroacupuncture synchronised with motor imagery training on upper limb motor recovery and neural mechanisms in ischaemic stroke: protocol for a single-centre, randomised controlled trial

INTRODUCTION: Approximately half of stroke survivors experience persistent upper limb dysfunction, which impairs self-care, reduces independence and lowers quality of life. Electroacupuncture is an established intervention with evidence supporting its role in improving upper limb motor function following ischaemic stroke. Motor imagery training (MIT), which activates the sensorimotor cortex through the mental rehearsal of movement, has shown promise as an adjunctive therapy in stroke rehabilitation. The concurrent application of electroacupuncture and MIT may enhance sensorimotor recovery by promoting the integration of central and peripheral neural pathways, potentially establishing a central-peripheral-central closed-loop circuit. However, empirical evidence supporting this integrative approach remains limited.This study aims to investigate the effects of electroacupuncture synchronised with MIT on upper limb function in patients with ischaemic stroke. In addition, longitudinal analysis of multimodal neuroimaging data will be used to explore the associated neural mechanisms. METHODS AND ANALYSIS: A total of 72 patients with ischaemic stroke will be enrolled and randomly assigned (1:1) to receive either electroacupuncture synchronised with MIT or electroacupuncture. Each group will undergo 20 treatment sessions over 4 weeks (5 times per week). All participants will also receive standardised conventional rehabilitation training.The primary outcome is the Fugl-Meyer Assessment for the upper extremity. Secondary outcomes include the Modified Barthel Index for activities of daily living, the Modified Ashworth Scale (MAS) for spasticity, Brunnstrom stages, the 17-item Hamilton Depression Rating Scale, the Chinese version of the Massachusetts Acupuncture Sensation Scale and the Kinaesthetic and Visual Imagery Questionnaire. Assessments will be conducted at baseline, mid-treatment, post-treatment and at 8-week follow-up. In addition, functional connectivity of the cerebral cortex will be assessed using functional near-infrared spectroscopy and electroencephalography, which may serve as potential biomarkers of treatment response. ETHICS AND DISSEMINATION: This study has been approved by the Ethics Committee of Shanghai Second Rehabilitation Hospital (approval number: 2025-18-01) and has been registered with the International Traditional Medicine Clinical Trial Registry (ITMCTR; registration number: ITMCTR2025001311). The study will be conducted in accordance with the Declaration of Helsinki, relevant local regulations and applicable clinical guidelines. Informed consent will be obtained from all participants or their legal guardians, where applicable. The results will be disseminated through peer-reviewed publications and presentations at scientific conferences. TRIAL REGISTRATION NUMBER: ITMCTR2025001311.