Objective To investigate dynamic changes in brain functional connectivity (FC) in patients with prolonged disorders of consciousness (pDOC) during and after Xingnao Kaiqiao(XNKQ) acupuncture therapy using functional near-infrared spectroscopy (fNIRS). Methods 36 patients with pDOC were enrolled. After one patient was excluded because of data quality issues, the final analysis included 35 patients who completed the acupuncture intervention with fNIRS monitoring. fNIRS assessments of changes in oxygenated hemoglobin (HbO) concentration were conducted before, during, and after XNKQ acupuncture sessions. Intra- and interregional FC analyses were performed across eight predefined regions. FC analysis was performed by extracting HbO time series before, during, and after acupuncture. Results Compared with the baseline FC, FC was significantly greater during acupuncture. Subgroup analysis revealed increased FC during acupuncture in patients with unresponsive wakefulness syndrome (UWS). In contrast, no such increase was detected in individuals in the minimally conscious state (MCS) or in the sham acupuncture group. The intraregional FC in the left frontal lobe (LFL), right frontal lobe (RFL), left temporal lobe (LTL), and left dorsolateral prefrontal cortex (LDLPFC) markedly increased during acupuncture. FC remained elevated in the LFL, RFL, LTL, right temporal lobe (RTL), and right primary motor cortex (RPMC) after acupuncture. The interregional FC between the LFL-LTL, LFL-RFL, LFL-RTL, RFL-LTL, RFL-RTL, and LTL-RTL was significantly greater during acupuncture. These enhancements persisted after acupuncture for LFL-LTL, LFL-RFL, RFL-LTL, RFL-RTL, and LTL-RTL FC. In the UWS subgroup, the intraregional FC in the LFL, RFL, LTL, RTL, and LDLPFC, as well as the interregional FC between the LFL and LTL, increased during acupuncture. After acupuncture, FC was increased in the LFL, LTL, and RPMC. In the MCS subgroup, FC in the RFL was elevated after acupuncture. Additionally, interregional FC between the LFL and RFL increased both during and after acupuncture, and connectivity between the RFL and LFL also increased following acupuncture. Conclusion XNKQ acupuncture selectively increases FC in consciousness-related networks, particularly within frontal and temporal cortices, with sustained effects postintervention. These findings support the therapeutic potential of XNKQ for pDOC patients through targeted reorganization of higher-order cognitive networks, providing neurophysiological evidence for its clinical application.

Objective: This study examined whether contralateral-limb balance training, grounded in cross-education theory, enhances gait speed and reconstructed-knee kinematics during early postoperative recovery from anterior cruciate ligament reconstruction (ACLR). Methods: A single-blind randomized controlled trial enrolled 40 patients 5–6 weeks post-ACLR, randomized 1:1 to an experimental group ( n = 20; contralateral-limb balance training plus conventional rehabilitation) or a control group ( n = 20; conventional rehabilitation alone), for 6 weeks (three sessions per week). Lower-limb kinematics during walking were captured using a Vicon three-dimensional motion-capture system, quantifying gait speed and knee-joint range of motion (ROM), peak angular velocity, and peak angular acceleration in the sagittal, coronal, and transverse planes. Data were analyzed using generalized estimating equations (GEE), with analysis of covariance (ANCOVA) examining whether gait-speed changes confounded the kinematic outcomes. Results: The groups showed no baseline differences (all P > 0.05). Gait speed increased in both (both P < 0.001), with a significant time × group interaction favoring the experimental group (χ² = 11.98, P < 0.001; Hodges–Lehmann estimate 0.08 m/s, 95% CI 0.05–0.11). Sagittal-plane knee ROM likewise improved more in the experimental group (interaction χ² = 9.79, P = 0.002; mean difference 8.97°, 95% CI 5.40–12.54°; d = 1.61). No significant interactions emerged for coronal or transverse ROM, or for peak angular velocity or acceleration in any plane (all P > 0.05). ANCOVA showed that the sagittal-ROM advantage persisted after adjustment for gait-speed change ( P = 0.002), indicating an independent benefit, whereas an apparent sagittal peak-angular-velocity advantage disappeared after adjustment ( P = 0.165). Against available cross-population minimal clinically important difference (MCID) values (no ACLR-specific standards exist), the gait-speed difference fell below the multi-pathology range (0.10–0.20 m/s), whereas the sagittal-ROM difference exceeded the chronic-stroke reference (8.48°), although its 95% CI lower bound did not. Conclusion: Contralateral-limb balance training, as an adjunct to conventional rehabilitation, yielded greater improvements in gait speed and sagittal-plane knee ROM following ACLR, with the ROM benefit being independent of concurrent gait-speed gains. Kinematic gains were confined to the sagittal plane. Because the between-group differences did not consistently exceed existing MCID thresholds, these findings are statistically robust but of questionable clinical importance, necessitating larger studies and ACLR-specific MCID benchmarks. Trial registration: Chinese Clinical Trial Registry, ChiCTR2400087325. Registered on 25 July 2024.