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

 The only therapy that is complementary with no basis in actual recovery is acupuncture. All the others have valid research to back them up. 

motor imagery (83 posts to January 2013)

• music (94 posts back to March 2011)

• music therapy (53 posts back to October 2014)

• musical training (13 posts back to June 2014)

• singing (12 posts to July 2013)

• virtual reality (205 posts to September 2011)

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

Umi Nabilah Ismail¹Noorazrul Yahya²Wan Asyraf Wan Zaidi³Zhe Kang Law³Hanani Abdul Manan^1,4*

• ¹Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), Department of Radiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
• ²Diagnostic Imaging & Radiotherapy Program, Centre of Diagnostic, Therapeutic and Investigative Sciences (CODTIS), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
• ³Neurology Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
• ⁴Department of Radiology and Intervention, Hospital Pakar Kanak-Kanak (Children Specialist Hospital), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia

Systematic Review Registration: 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.

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

1 Introduction

Stroke continues to be the world’s second-leading cause of death and the third-leading cause of death and disability (measured by disability-adjusted life-years lost, or DALYs) (Collaborators, 2021). Rehabilitation is a crucial component of stroke care, aimed at reducing disability and enhancing recovery (Maier et al., 2019). Standard rehabilitation approaches focus on physical and occupational therapy, but interest in complementary interventions to enhance stroke recovery is growing (Hart, 2010; Kadir et al., 2015).

Acupuncture, a traditional Chinese medicine practice, has been recognized by the World Health Organization for its potential role in stroke treatment. It works by stimulating specific points on the body, which activates the central nervous system (Chavez et al., 2017). While promising, acupuncture remains primarily an adjunctive therapy due to insufficient evidence from conflicting and methodologically weak studies (World Health Organization, 2002). Motor imagery has also been extensively studied for stroke rehabilitation. The concept behind motor imagery is that the regions activated during imagery tasks overlap significantly with those involved in actual movement execution. Thus, this therapy helps the affected areas of the brain engage in continuous training, promoting neuroplasticity in those regions (Guerra et al., 2017).

Virtual reality (VR), a novel approach to rehabilitation, immerses users in a synthetic three-dimensional environment. Compared to traditional methods, VR offers advantages such as high repetition, task specificity, objective feedback, and improved user engagement and motivation (Khokale et al., 2023). Repetition is essential for motor re-learning and neuroplasticity, which are key for improving stroke rehabilitation outcomes. Music therapy, which systematically uses musical elements as an intervention, has been shown to improve both neurological function and mood. Research suggests that musicians exhibit enhanced subcortical auditory and audiovisual processing. The high frequency of listening to or performing music can promote neural plasticity, regulate neural networks, and enhance motor function in stroke patients (Wan and Schlaug, 2010; Chatterjee et al., 2021).

Improved functional recovery post stroke is closely linked to the reorganization of the surviving central nervous system (Hodics et al., 2006; Grefkes and Fink, 2014; Hara, 2015). While the mechanisms behind various therapies have been studied, the key focus should be on how these therapies specifically influence brain activity, particularly in regions critical for stroke recovery. Understanding how these treatments activate important brain regions is essential for assessing their effectiveness in promoting neuroplasticity and functional recovery.

Functional magnetic resonance imaging (fMRI) is a non-invasive neuroimaging technique that that visualizes brain activity in response to different tasks or stimuli. It has been used to study the neural correlates of stroke rehabilitation interventions, providing insight into the changes in brain activation patterns associated with these interventions (Ward et al., 2003; Hodics et al., 2006). This systematic review examines complementary interventions—such as acupuncture, motor imagery therapy (MIT), music therapy, and VR—in terms of both their impact on functional recovery and their ability to activate brain regions critical for stroke recovery, as measured by fMRI. 

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