Scalp Acupuncture Synchronizing Dual Task Gait for Enhancing Prefrontal Cortex Response

Motor-cognitive dual task refers to the synchronous execution of a motor task and a cognitive task, requiring the synchronous participation of both motor and cognitive systems^1,2. Studies have shown that compared with a single motor task/cognitive task, a motor-cognitive dual task can greatly improve motor/cognitive function^3,4. Anson et al.⁵ randomly divided 20 Parkinson's patients into a single-task group (gait and cognitive training in sequence) and a dual-task group (gait and cognitive training synchronously) for an 8-week rehabilitation training. The results showed that both groups could significantly reduce the Movement Disorder Society-Unified Parkinson's Disease Rating Scale motor subscale score. Still, the dual-task group had a greater decrease, and the improvement of motor performance could last at least for 4 weeks. Shah et al.⁶ randomly divided 224 elderly community members into a physical exercise group, a computer cognitive training group, a motor-cognitive training group, and a blank control group for a 16-week rehabilitation training. All subjects received positron emission computed tomography scans before and after training. The results found that compared with the other three groups, the motor-cognitive training group had improved verbal memory function and significantly increased brain glucose metabolism in the left sensorimotor cortex. Moreover, higher brain glucose metabolism in this brain region was positively correlated with improved verbal memory, suggesting that a specific combination of motor-cognitive training can improve cognition and increase brain glucose metabolism. In addition, in terms of movement, the motor-cognitive dual task can improve balance function and reduce the risk of falls^7,8. Amanda et al.⁹ randomly divided 21 Parkinson's patients into single-task and dual-task groups for an 8-week rehabilitation training. The results showed that both groups could significantly improve clinical scores of motor function, but only the dual-task group significantly reduced falls by 60%.

However, the motor-cognitive dual task is a behavioral intervention, andalthough clinical studies have shown that its therapeutic efficacy is better than that of a single motor task/cognitive task, the therapeutic effect of the motor-cognitive dual task is still limited. Therefore, improving dual task performance is the key to solving this problem. At present, relevant studies have proved that combined central interventions on the basis of motor-cognitive dual tasks can improve motor-cognitive dual task performance^10,11,12,13. Common central interventions include transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS)¹¹. However, tDCS or TMS cannot be performed synchronously with motor-cognitive dual tasks. It can only be performed before and after dual tasks, and instruments are relatively expensive, leading to limited clinical promotion. Therefore, the key to improving dual-task performance is to find an alternative intervention that can be performed synchronously with dual-task and has a therapeutic effect similar to that of combined tDCS or TMS at a reasonable price. The study found that scalp acupuncture had an immediate effect similar to that of tDCS to some extent. Zhang et al.¹⁴ explored the short-term performance differences between tDCS and scalp acupuncture in working memory and included 44 college students in a randomized crossover experiment design. The results showed no statistical difference in the accuracy (ACC) or response time of tDCS and scalp acupuncture before or after intervention in the 0-back task and 1-back task. It is suggested that the therapeutic effect of scalp acupuncture on cognitive function is similar to that of tDCS.

Scalp acupuncture is a non-drug intervention method of traditional Chinese medicine to treat brain-derived diseases by acupuncturing the corresponding projection area of cerebral cortex function on the scalp. Scalp acupuncture is one of the stroke treatments recommended by the World Health Organization and has been shown to improve cognitive function in patients with post-stroke cognitive impairment (PSCI)¹⁵. Studies have shown that scalp acupuncture helps improve neuronal damage and cognitive dysfunction and plays a neuroprotective function in central nervous system diseases¹⁶. Chen et al.¹⁵ randomly assigned 56 patients with PSCI to a treatment group (receiving scalp acupuncture in addition to medication) or control group (receiving medication only) for a period of 4 weeks. The results of the study found that the application of scalp acupuncture in addition to medication significantly improved cognitive function and increased brain hemoglobin levels compared to patients who received medication only. Xiong et al.¹⁷ randomly divided 70 patients with post-stroke cognitive dysfunction into a scalp acupuncture group (scalp acupuncture + cognitive training) and a control group (sham scalp acupuncture + cognitive training) for 12 weeks of rehabilitation training. The results found that Mini-Mental Status Exam (MMSE), Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), and Fugl-Meyer Assessment (FMA) scores in the scalp acupuncture group were significantly higher than those in the control group, suggesting that scalp acupuncture combined with cognitive training can improve stroke patients' cognitive and motor functions.

However, no relevant studies have discussed the synergistic gain effect of motor-cognitive dual task and scalp acupuncture. Therefore, this protocol aims to include 39 healthy subjects to demonstrate the standardized operation of scalp acupuncture synchronizing motor-cognitive dual task and motor-cognitive dual task and compares the differences between these two tasks in healthy subjects through a randomized cross-over trial. The Gaitrite gait analysis system and functional Near-infrared spectroscopy (fNIRS) are utilized to explore the synergistic gain effect of scalp acupuncture on synchronous dual tasks. This protocol seeks to uncover the mechanism behind how scalp acupuncture synchronizing motor-cognitive dual task affects gait control and cortical brain function, providing a novel idea and theoretical basis for clinical exploration of new effective non-drug therapies.