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Utilizing fNIRS to investigate the impact of calligraphy training on cognitive and upper limb motor function in
Yang Liao1, Yiyan Wang1, Qingqing Dai1
1Neurological Rehabilitation Center, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, People's Republic of China.
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.
