A systematic review: enhancing stroke recovery through complementary interventions-Clinical outcomes and neural activity insights

Abstract

The growing interest in complementary interventions for stroke recovery necessitates the need for neural insights to aid in making evidence-based clinical decisions. This systematic review examined the brain activation effects of complementary therapies, including acupuncture (n = 5), motor imagery therapy (MIT) (n = 5), music (n = 3), and virtual reality (VR) interventions (n = 3), on clinical outcomes and neural activity in stroke patients. All therapies engaged motor and sensory networks, frontal regions, parietal regions, and temporal regions, suggesting their potential to improve motor control, attention, memory, and cognitive function. Acupuncture activated motor areas in both hemispheres, while MIT stimulated frontoparietal regions in both sides of the brain, supporting whole-body integration in recovery. In contrast, VR therapy exhibited ipsilesional lateralization, while music therapy showed left-lateralization. The review also found that increased interhemispheric connectivity between motor regions, along with intrahemispheric ipsilesional connectivity between motor, cognitive, and sensory areas, is key to achieving better clinical outcomes.

Systematic review registration: http://www.crd.york.ac.uk/PROSPERO, identifier (ID: CRD42023455192).

Keywords: acupuncture; complementary therapy; fMRI; motor imagery; music; neuroimaging; stroke; virtual reality.

Figure 1

Flow diagram for study search and selection according to PRISMA guideline.

Figure 2

Acupoints used in the articles selected. (a) International Standardized Scalp Acupoints (ISSA) included MS5, MS6, MS7, Qianshencong [1 cun anterior to GV20 (Baihui) obliquely to GB6 (Xuanli)]. (b) Acupoints used for motor dysfunction included Baihui (GV 20), Fengchi (GB20, bilateral), Xuanzhong (GB 39), bilateral, Quchi (LI- 1 bilateral), Hegu (LI 4, bilateral), Zusanli (ST 36, bilateral), and Sanyinjiao (SP 6, bilateral). Created with BioRender.com.

Figure 3

Significant brain alterations reported in the included studies for the following complementary therapies: (a) acupuncture, (b) melodic intonation therapy (MIT), (c) virtual reality (VR), and (d) music therapy. The lines represent functional connectivity changes, and the color of the dots indicates the number of times a region was reported as activated post-treatment. Blue dots represent regions identified in 1 study, green dots in 2 studies, and red dots in 3 or more studies.

Figure 4

Significant brain alterations consistently reported in more than one study for the following complementary therapies: (a) acupuncture, (b) melodic intonation therapy (MIT), (c) virtual reality (VR). Green dots represent regions identified in 2 studies, while red dots represent regions identified in 3 or more studies. Only regions reported in multiple studies from different dataset are highlighted to emphasize consistent findings.