Utilizing fNIRS to investigate the impact of calligraphy training on cognitive and upper limb motor function in stroke patients: study protocol for a randomized controlled trial.

Publisher: BioMed Central Country of Publication: England NLM ID: 101263253 Publication Model: Electronic Cited Medium: Internet ISSN: 1745-6215 (Electronic) Linking ISSN: 17456215 NLM ISO Abbreviation: Trials Subsets: MEDLINE

Original Publication: [London] : BioMed Central, 2006-

Stroke Rehabilitation*/methods ; Upper Extremity*/physiopathology ; Upper Extremity*/innervation ; Cognition* ; Stroke*/physiopathology ; Stroke*/psychology ; Stroke*/therapy ; Stroke*/diagnosis ; Motor Activity*; Humans ; Spectroscopy, Near-Infrared ; Recovery of Function ; Treatment Outcome ; Randomized Controlled Trials as Topic ; Male ; Female ; Middle Aged ; China ; Time Factors ; Aged ; Adult ; Activities of Daily Living

Background: Stroke is a leading cause of long-term disability, often resulting in cognitive and upper limb motor impairments that significantly impact activities of daily living. While conventional rehabilitation approaches have shown effectiveness, challenges such as high cost, limited accessibility, and poor adherence hinder their widespread implementation. Calligraphy training has emerged as a promising rehabilitation strategy, offering a multimodal intervention that integrates motor and cognitive processes. However, the underlying neural mechanisms and the combined effects of calligraphy training on cognitive and motor recovery remain underexplored. This study aims to investigate the effects of calligraphy training on cognitive function and upper limb motor recovery in stroke patients.
Methods: A single-center, open-label, three-arm design, randomized controlled trial will be conducted at Shanghai Yangzhi Rehabilitation Hospital. A total of 93 subacute stroke patients will be randomly assigned in a 1:1:1 ratio to one of three groups: the calligraphy training group, the reading control group, or the conventional rehabilitation control group. The intervention group will receive a four-week calligraphy training program alongside routine rehabilitation, while the control group will undergo standard rehabilitation alone. Assessments will be conducted at baseline (T0) and post-intervention (T1). The primary outcome measure is cortical activation changes as assessed by functional near-infrared spectroscopy (fNIRS), with oxygenated hemoglobin (ΔHbO) levels serving as an indicator of brain activity. Secondary outcomes include cognitive function, upper limb motor function, hand dexterity, activities of daily living, grip strength, muscle strength, and muscle tone. Statistical analyses will be conducted using analysis of covariance (ANCOVA) to compare pre and post-intervention outcomes, adjusting for baseline values.
Discussion: This study provides empirical evidence regarding the efficacy of calligraphy training in improving cognitive function and upper limb motor skills in stroke patients. By utilizing fNIRS to monitor dynamic neural changes, this research will deepen our understanding of the neurophysiological mechanisms behind calligraphy-based rehabilitation. The findings may inform the development of cost-effective, accessible, and culturally relevant rehabilitation strategies, thereby bridging the gap between clinical and home-based recovery.
Trial Registration: chictr.org.cn ChiCTR2500095411. Registered on January 7, 2025.
(© 2025. The Author(s).)

Ethics approval and consent to participate: The study has been approved by the Ethics Committee of Shanghai Yangzhi Rehabilitation Hospital (approval no. 2024-102) and registered at chictr.org.cn (ChiCTR2500095411). Written informed consent will be obtained from all participants. Consent for publication: All authors have read and approved the final manuscript. Competing interests: The authors have declared no competing interests.

Disabil Rehabil. 2023 Mar;45(6):1097-1102. (PMID: 35357990)
J Psychiatr Res. 1975 Nov;12(3):189-98. (PMID: 1202204)
J Funct Morphol Kinesiol. 2022 Jul 07;7(3):. (PMID: 35893327)
Clin Interv Aging. 2011;6:269-73. (PMID: 22087066)
Int J Environ Res Public Health. 2023 Jan 06;20(2):. (PMID: 36673790)
Int J Stroke. 2022 Jan;17(1):18-29. (PMID: 34986727)
Healthcare (Basel). 2022 Jan 19;10(2):. (PMID: 35206805)
Neurology. 2019 Dec 10;93(24):e2257-e2271. (PMID: 31712368)
BMJ Open. 2022 May 13;12(5):e052046. (PMID: 35568494)
Behav Res Methods. 2007 May;39(2):175-91. (PMID: 17695343)
Mil Med Res. 2023 Jul 19;10(1):33. (PMID: 37468952)
Disabil Rehabil. 2016;38(7):673-82. (PMID: 26095817)
Trials. 2019 Mar 15;20(1):168. (PMID: 30876438)
Clin Rehabil. 2004 Jun;18(4):391-7. (PMID: 15180122)
J Alzheimers Dis. 2017;58(3):735-746. (PMID: 28482639)
PLoS One. 2019 Apr 4;14(4):e0214917. (PMID: 30947247)
Rev Panam Salud Publica. 2015 Dec;38(6):506-14. (PMID: 27440100)
BMC Psychiatry. 2018 Mar 7;18(1):62. (PMID: 29514660)
Disabil Rehabil. 1995 Jul;17(5):217-24. (PMID: 7626768)
Neuropsychiatr Dis Treat. 2018 Jan 31;14:407-417. (PMID: 29440902)
Eur Stroke J. 2018 Dec;3(4):309-336. (PMID: 31236480)
Evid Based Complement Alternat Med. 2013;2013:975190. (PMID: 23533532)
BMJ Case Rep. 2017 Mar 17;2017:. (PMID: 28314812)
Eur J Phys Rehabil Med. 2017 Apr;53(2):155-168. (PMID: 28382807)

2024SJKJGG109 Songjiang District Science and Technology Research Project; PWRd2022-16 Shanghai Pudong New Area Health System Discipline Leader Training Program; JS2210204 Project of High-level Teachers in Beijing Municipal Universities in the Period of 13th Five-year Plan

Keywords: Calligraphy; Cognitive function; Functional near-infrared spectroscopy; Stroke; Upper limb motor function

Date Created: 20251230 Date Completed: 20251230 Latest Revision: 20260114

20260115

PMC12751410

10.1186/s13063-025-09279-7

41466425