Effect of adjunctive acupuncture on the brain structural-functional connectivity coupling in ischemic stroke patients

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dc.contributor.advisorFan, Jia
dc.contributor.advisorRobertson , Frances
dc.contributor.advisorZhang, Chunhong
dc.contributor.authorJoubert, Pearly
dc.date.accessioned2026-09-15T08:30:55Z
dc.date.available2026-09-15T08:30:55Z
dc.date.issued2026
dc.date.updated2026-09-01T12:19:45Z
dc.description.abstractIntroduction Ischemic stroke, which makes up about 85% of all cases, disproportionately impacts individuals in low- and middle-income countries (LMICs), where access to multidisciplinary rehabilitation is limited. Consequently, many survivors turn to complementary therapies such as acupuncture, a traditional Chinese practice with a long history. Although acupuncture shows promise for motor recovery, its underlying neural mechanisms remain unclear. Methods This study examined the effects of adjunctive acupuncture on whole-brain structural connectivity (SC) and functional connectivity (FC) in nineteen right-handed male ischemic stroke patients from China. Participants were randomly assigned to True Acupuncture (TA; n=5), TA plus Physiother apy (TA+PT; n=6), or Sham Acupuncture plus Physiotherapy (SA+PT; n=8). The Xing Nao Kai Qiao protocol (manual and electroacupuncture) was delivered over three weeks, with physiotherapy following the same regimen. Motor recovery was assessed using the Fugl-Meyer Assessment (FMA). Diffusion Weighted Imaging (DWI) and resting-state fMRI data were acquired pre- and post-treatment. For FC analysis, Fisher-Z–transformed correlations were calculated within a GLM framework, and the resulting significant FC findings guided the extraction of fractional anisotropy (FA) values from SC matrices. SC–FC coupling was calculated to evaluate structure–function relationships, and graph theory analyses assessed network-level changes pre- and post-treatment. Results In the TA group, FC significantly increased post-treatment compared to pre-treatment (p < 0.05), particularly in the thalamus, caudate, hippocampus, and vermis, but decreased in the left SMA coactivated with the Rolandic operculum, Heschl’s gyrus, and superior temporal gyrus. In the TA+PT group, FC increased between the insula and cerebellar vermis (lobules I–II) but decreased between the amygdala and bilateral orbital superior frontal gyrus, as well as the left middle temporal pole, post-treatment compared to pre-treatment. The SA+PT group showed the opposite trend, with post-treatment increases in connectivity among the amygdala, prefrontal cortex, fusiform gyrus, and SMA. Between-group post-treatment comparisons revealed that the TA group exhibited a significant increase in functional connectivity (FC) between brain regions associated with motor function compared to the SA+PT group. A similar trend was observed for the TA+PT group relative to the SA+PT group; however, in this case, FC between non-motor brain networks significantly decreased compared to the SA+PT group. Furthermore, the TA+PT group showed a significant reduction in FC between higher-order cognitive brain regions compared to the TA group. Across groups, FC and SC showed weak, non-significant decoupling post-treatment (TA: r = 0.15; TA+PT: r =–0.07; SA+PT: r =–0.11). FC metrics shifted toward a more random topology post-treatment (0.74 < Sigma ≤ 0.81), though not significantly, while SC remained a regular network (Sigma < 0.26) throughout. Lp for FC significantly decreased post-treatment compared to pre-treatment in the SA+PT groups. In contrast, Lp for SC showed a non-significant increase in the SA+PT group. Eloc for FC remained largely unchanged post-treatment compared to pre-treatment, whereas SC Eloc significantly increased in the TA group. Notably, only FC measures correlated significantly with FMA scores, restricted to the SA+PT group. Although no between group differences in FMA scores were observed, all groups showed significant within-group improvements post-treatment compared to pre-treatment (p < 0.001). Discussion Acupuncture combined with physiotherapy may enhance motor recovery by strengthening motor related networks while suppressing non-motor networks that could hinder recovery. Both SC and FC showed disrupted segregation–integration balance, which acupuncture may help restore toward a more efficient, random FC organization. FC thus holds potential as a biomarker for monitoring rehabilitation. Despite divergent neural patterns, all groups achieved significant FMA improvements, indicating convergent behavioral recovery. Conclusion Overall, these findings support integrating acupuncture into neurorehabilitation strategies, particularly in LMICs where access to conventional therapies is limited. However, the small sample size and absence of female participants constrain generalizability.
dc.identifier.apacitationJoubert, P. (2026). <i>Effect of adjunctive acupuncture on the brain structural-functional connectivity coupling in ischemic stroke patients</i>. (). University of Cape Town ,Faculty of Health Sciences ,Department of Human Biology. Retrieved from http://hdl.handle.net/11427/43775en_ZA
dc.identifier.chicagocitationJoubert, Pearly. <i>"Effect of adjunctive acupuncture on the brain structural-functional connectivity coupling in ischemic stroke patients."</i> ., University of Cape Town ,Faculty of Health Sciences ,Department of Human Biology, 2026. http://hdl.handle.net/11427/43775en_ZA
dc.identifier.citationJoubert, P. 2026. Effect of adjunctive acupuncture on the brain structural-functional connectivity coupling in ischemic stroke patients. . University of Cape Town ,Faculty of Health Sciences ,Department of Human Biology. http://hdl.handle.net/11427/43775en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Joubert, Pearly AB - Introduction Ischemic stroke, which makes up about 85% of all cases, disproportionately impacts individuals in low- and middle-income countries (LMICs), where access to multidisciplinary rehabilitation is limited. Consequently, many survivors turn to complementary therapies such as acupuncture, a traditional Chinese practice with a long history. Although acupuncture shows promise for motor recovery, its underlying neural mechanisms remain unclear. Methods This study examined the effects of adjunctive acupuncture on whole-brain structural connectivity (SC) and functional connectivity (FC) in nineteen right-handed male ischemic stroke patients from China. Participants were randomly assigned to True Acupuncture (TA; n=5), TA plus Physiotherapy (TA+PT; n=6), or Sham Acupuncture plus Physiotherapy (SA+PT; n=8). The Xing Nao Kai Qiao protocol (manual and electroacupuncture) was delivered over three weeks, with physiotherapy following the same regimen. Motor recovery was assessed using the Fugl-Meyer Assessment (FMA). Diffusion Weighted Imaging (DWI) and resting-state fMRI data were acquired pre- and post-treatment. For FC analysis, Fisher-Z–transformed correlations were calculated within a GLM framework, and the resulting significant FC findings guided the extraction of fractional anisotropy (FA) values from SC matrices. SC–FC coupling was calculated to evaluate structure–function relationships, and graph theory analyses assessed network-level changes pre- and post-treatment. Results In the TA group, FC significantly increased post-treatment compared to pre-treatment (p < 0.05), particularly in the thalamus, caudate, hippocampus, and vermis, but decreased in the left SMA coactivated with the Rolandic operculum ward a more efficient, random FC organization. FC thus holds potential as a biomarker for monitoring rehabilitation. Despite divergent neural patterns, all groups achieved significant FMA improvements, indicating convergent behavioural recovery. Conclusion Overall, these findings support integrating acupuncture into neurorehabilitation strategies, particularly in LMICs where access to conventional therapies is limited. However, the small sample size and absence of female participants constrain generalizability. um, Heschl’s gyrus, and superior temporal gyrus. In the TA+PT group, FC increased between the insula and cerebellar vermis (lobules I–II) but decreased between the amygdala and bilateral orbital superior frontal gyrus, as well as the left middle temporal pole, post-treatment compared to pre-treatment. The SA+PT group showed the opposite trend, with post-treatment increases in connectivity among the amygdala, prefrontal cortex, fusiform gyrus, and SMA. Between-group post-treatment comparisons revealed that the TA group exhibited a significant increase in functional connectivity (FC) between brain regions associated with motor function compared to the SA+PT group. A similar trend was observed for the TA+PT group relative to the SA+PT group; however, in this case, FC between non-motor brain networks significantly decreased compared to the SA+PT group. Furthermore, the TA+PT group showed a significant reduction in FC between higher-order cognitive brain regions compared to the TA group. Across groups, FC and SC showed weak, non-significant decoupling post-treatment (TA: r = 0.15; TA+PT: r =–0.07; SA+PT: r =–0.11). FC metrics shifted toward a more random topology post-treatment (0.74 < Sigma ≤ 0.81), though not significantly, while SC remained a regular network (Sigma < 0.26) throughout. Lp for FC significantly decreased post-treatment compared to pre-treatment in the SA+PT groups. In contrast, Lp for SC showed a non-significant increase in the SA+PT group. Eloc for FC remained largely unchanged post-treatment compared to pre-treatment, whereas SC Eloc significantly increased in the TA group. Notably, only FC measures correlated significantly with FMA scores, restricted to the SA+PT group. Although no between group differences in FMA scores were observed, all groups showed significant within-group improvements post-treatment compared to pre-treatment (p < 0.001). Discussion Acupuncture combined with physiotherapy may enhance motor recovery by strengthening motor related networks while suppressing non-motor networks that could hinder recovery. ward a more efficient, random FC organization. FC thus holds potential as a biomarker for monitoring rehabilitation. Despite divergent neural patterns, all groups achieved significant FMA improvements, indicating convergent behavioural recovery. Conclusion Overall, these findings support integrating acupuncture into neurorehabilitation strategies, particularly in LMICs where access to conventional therapies is limited. However, the small sample size and absence of female participants constrain generalizability. DA - 2026 DB - OpenUCT DP - University of Cape Town KW - Neuroscience KW - adjunctive acupuncture KW - ischemic stroke KW - Structural Connectivity KW - Structural-Functional Connectivity Coupling KW - Graph Theoretical Network Measurements KW - Motor Recovery KW - FMA LK - https://open.uct.ac.za PB - University of Cape Town PY - 2026 T1 - Effect of adjunctive acupuncture on the brain structural-functional connectivity coupling in ischemic stroke patients TI - Effect of adjunctive acupuncture on the brain structural-functional connectivity coupling in ischemic stroke patients UR - http://hdl.handle.net/11427/43775 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/43775
dc.identifier.vancouvercitationJoubert P. Effect of adjunctive acupuncture on the brain structural-functional connectivity coupling in ischemic stroke patients. []. University of Cape Town ,Faculty of Health Sciences ,Department of Human Biology, 2026 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/43775en_ZA
dc.language.isoen
dc.language.rfc3066eng
dc.publisher.departmentDepartment of Human Biology
dc.publisher.facultyFaculty of Health Sciences
dc.publisher.institutionUniversity of Cape Town
dc.subjectNeuroscience
dc.subjectadjunctive acupuncture
dc.subjectischemic stroke
dc.subjectStructural Connectivity
dc.subjectStructural-Functional Connectivity Coupling
dc.subjectGraph Theoretical Network Measurements
dc.subjectMotor Recovery
dc.subjectFMA
dc.titleEffect of adjunctive acupuncture on the brain structural-functional connectivity coupling in ischemic stroke patients
dc.typeThesis / Dissertation
dc.type.qualificationlevelMasters
dc.type.qualificationlevelMSc
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