This study aims to investigate the rehabilitative effects and synergistic potential of combining Fastigial Nucleus Stimulation (FNS) with Sling Exercise Training (SET) on motor function in patients with post-stroke hemiplegia. Hemiplegia after stroke often results in unilateral motor impairment, balance dysfunction, and decreased proprioception. Although traditional rehabilitation methods can improve certain functions, they are often limited by insufficient central targeting and inadequate activation of deep core muscles, making it difficult to fundamentally repair damaged motor control circuits. FNS, as a non-invasive neuromodulation technique, can precisely target the fastigial nucleus-a critical hub for motor coordination and balance control-thereby modulating neuroplasticity and promoting regional cerebral blood flow to optimize cortical function. SET, on the other hand, utilizes an unstable sling system to efficiently activate deep core muscles (such as the transversus abdominis and multifidus), enhance proprioceptive input, and promote neural reorganization. Based on the concept of "central regulation-peripheral enhancement," this study hypothesizes that the combination of FNS and SET can create a bidirectional intervention pathway, breaking the vicious cycle between central damage and peripheral dysfunction, and achieving a "1+1>2" therapeutic effect. This study employs a randomized, double-blind, sham-controlled design and plans to enroll 54 eligible patients with post-stroke hemiplegia (aged 18-70 years, within 6 months of onset). Participants will be randomly assigned to three groups: Group A (FNS + sham SET), Group B (sham FNS + SET), and Group C (FNS + SET). FNS will be delivered using high-precision electrodes placed over the bilateral mastoid regions, with a stimulation frequency of 180 Hz and an intensity of 2 mA (sham stimulation at 0.1 mA) for 20 minutes per session. SET will include supine and prone bridging exercises for 30 minutes per session, while sham SET involves suspension without active movement. All patients will be assessed before and after the intervention using the Berg Balance Scale, Fugl-Meyer Assessment, three-dimensional gait analysis, trunk control test, and proprioceptive measurement instruments. The sample size was calculated based on previous data for lower extremity Fugl-Meyer scores (effect size f = 0.502), with an estimated 20% dropout rate, resulting in a target of 54 participants. The innovation of this study lies in its first-time combination of FNS-a more targeted neuromodulation approach-with SET-a high-intensity sensorimotor integration training-and the use of sham controls to precisely quantify the individual contributions of each intervention and validate the synergistic effect of central-peripheral co-stimulation. Potential risks will be strictly managed: FNS may cause localized tingling or mild headache, which can be addressed by adjusting or pausing stimulation; SET will be conducted under the supervision of trained therapists with individualized intensity adjustments to prevent muscle soreness or falls. All adverse events will be documented and managed promptly. The findings of this study are expected to provide an effective, non-invasive central-peripheral synergistic rehabilitation strategy for post-stroke hemiplegia and offer evidence-based guidance for clinical practice and future research.

This study delivers an in-depth technical and mechanistic elaboration of a novel central-peripheral synergistic rehabilitation paradigm for post-stroke hemiplegia, focusing on the combined application of Fastigial Nucleus Stimulation (FNS) and Sling Exercise Training (SET). It primarily expands on the neurophysiological rationale, technical intervention characteristics, synergistic working mechanisms, optimized trial design logic, standardized quality control and core innovative connotations of the combined intervention, avoiding repetitive descriptions of basic trial elements including participant eligibility, outcome measures, sample size calculation and statistical analysis plans. Targeting the key technical bottleneck of conventional post-stroke rehabilitation-non-specific central neural regulation and superficial muscle activation that fails to reverse pathological neural plasticity-this study focuses on the core deficit of cerebello-thalamo-cortical circuit dysfunction and insufficient deep sensorimotor pathway activation, aiming to develop a targeted, high-efficiency combined rehabilitation technical system.

Persistent motor dysfunction after stroke is not limited to superficial limb movement impairment, but essentially stems from defective central motor regulation and disrupted trunk deep sensorimotor integration. Conventional physical therapy mainly concentrates on passive joint protection and superficial limb functional training, which can only prevent secondary complications such as muscle atrophy and joint contractures. However, it lacks targeted modulation of the central balance and motor coordination hub, and cannot reverse stroke-induced neural plasticity inhibition. This leads to persistent deficits in core stability, proprioceptive acuity and dynamic balance, fundamentally restricting the recovery of fine motor skills and daily living function. To address this clinical technical gap, the present study constructs a bidirectional rehabilitation loop integrating precise central neuromodulation and high-sensitivity peripheral sensorimotor training, realizing organic combination of central neural priming and peripheral sensory feedback remodeling.

FNS is a refined, anatomically targeted non-invasive cerebellar neuromodulation technique with unique advantages over broad cortical stimulation modalities. It precisely targets the fastigial nucleus, the core functional node of the cerebellar motor regulatory network, to specifically activate the cerebello-thalamo-cortical neural circuit. This intervention upregulates the excitability of motor-associated cortical regions, enhances local cerebral microperfusion in motor functional areas, and reverses the post-stroke inhibitory state of endogenous neural plasticity. The high-frequency, low-intensity stimulation paradigm adopted in this study is technically optimized for stroke neural repair. It stably induces activity-dependent neural remodeling without triggering cortical over-excitation or neural fatigue, effectively improving the central nervous system's capacity for sensory information integration and precise motor command output, and building a favorable neurophysiological microenvironment for peripheral motor function reconstruction.

SET represents an upgraded sensorimotor integration training technology that breaks the inherent limitations of traditional planar rehabilitation training. By creating an unstable suspension mechanical environment, SET actively triggers autonomous fine regulation of deep trunk stabilizers, including the transversus abdominis and multifidus muscles, which are rarely activated by conventional training methods. The continuous unbalanced mechanical stimulation generated during training elicits high-density proprioceptive afferent signals from trunk and limb muscles, tendons and joints, activates complete human closed kinetic chains, and drives use-dependent functional reorganization of the sensorimotor cortex. Compared with conventional peripheral training, SET significantly improves the accuracy of somatic sensory input and the efficiency of neuromuscular recruitment, serving as a core technical means to improve dynamic balance, trunk control and gait symmetry in post-stroke patients.

The prominent technical innovation of this research lies in the "central priming + peripheral reinforcement" synergistic intervention mechanism, which targets the self-perpetuating pathological vicious cycle of post-stroke motor dysfunction. Central circuit damage after stroke disrupts normal motor command generation, inducing peripheral disuse muscle atrophy and proprioceptive degradation; in turn, distorted peripheral sensory feedback fails to provide effective remodeling stimuli for the central nervous system, further aggravating motor control disorders. The combination of FNS and SET effectively interrupts this pathological cycle. FNS pre-activates and primes the central cerebello-thalamo-cortical pathway to enhance central neural sensitivity to peripheral sensory signals. On this optimized central neural basis, SET delivers high-fidelity, multi-dimensional proprioceptive afferent input, which acts on the primed central circuit, strengthens synaptic connection efficacy via Hebbian plasticity, and produces superposed and amplified therapeutic effects-achieving a genuine synergistic "1+1>2" effect beyond the simple additive efficacy of single interventions.

A rigorous randomized, double-blind, sham-controlled parallel-group design is adopted in this study to ensure objective and accurate verification of the synergistic therapeutic effect, with optimized sham intervention settings to eliminate systematic bias. The sham FNS protocol applies subthreshold low-intensity current that produces identical cutaneous sensory perception without activating neuronal circuits, while sham SET maintains consistent suspension posture and environmental conditions as active training but excludes voluntary neuromuscular contraction. This standardized double sham-control system effectively isolates placebo effects and individual intervention efficacy, enabling accurate differentiation of the independent therapeutic contributions of FNS-mediated central neuromodulation and SET-mediated peripheral sensorimotor training, and providing reliable technical verification for the specific synergistic effect of central-peripheral co-intervention.

All intervention procedures implement unified standardized technical specifications to ensure trial homogeneity and reproducibility. FNS stimulation adopts standardized bilateral mastoid positioning to precisely target fastigial nucleus projection areas, with all stimulation parameters optimized based on existing neuromodulation mechanism evidence to guarantee stable and effective central neural priming. All SET interventions are delivered by professionally certified rehabilitation therapists, with real-time individualized adjustment of training difficulty based on patients' motor control level and fatigue status. The progressive unstable suspension training mode ensures sustained, graded sensorimotor stimulation, avoiding the dual defects of insufficient stimulus intensity and excessive training load existing in fixed conventional training protocols.

A full-process safety and quality control system is established to standardize intervention implementation and protect participant safety. For FNS neuromodulation, real-time sensory monitoring is conducted throughout stimulation sessions; mild adverse reactions such as local tingling and headache are managed by parameter adjustment or temporary stimulation suspension to ensure good neurological tolerance. For SET training, pre-experiment equipment safety inspection and whole-process therapist supervision are mandatory to prevent muscle strain, excessive fatigue and fall risks. Individualized training intensity matching is implemented for patients with different motor function levels to balance training efficacy and safety. All adverse events are recorded in detail and managed hierarchically to ensure standardized and consistent trial implementation.

In summary, this study focuses entirely on technical innovation, neurophysiological mechanisms and synergistic principles of combined central-peripheral rehabilitation, without redundant description of routine trial baseline elements. Its core research value lies in elucidating the synergistic rehabilitation mechanism between fastigial nucleus central neuromodulation and deep core peripheral sensorimotor activation, establishing a standardized, safe and minimally invasive combined rehabilitation technical system, and providing high-level mechanistic and clinical evidence for optimizing individualized rehabilitation strategies for post-stroke hemiplegia.

Inclusion Criteria:

1. Met the diagnostic criteria for cerebrovascular disease in Western medicine;
2. Were conscious, with stable vital signs and emotional state;
3. Were male or female, aged 18 to 70 years, with disease onset within the previous 6 months;
4. Had no significant cognitive or auditory comprehension impairments, were able to understand and execute relevant instructions, and could cooperate with the completion of relevant rehabilitation assessments;
5. Were informed about the study and had signed an informed consent form.

Exclusion Criteria:

1. Presence of severe organ dysfunction involving the cardiovascular, pulmonary, liver, or renal systems;
2. Severe joint diseases, incompletely healed fractures, or severe osteoporosis;
3. History of psychiatric illness or severe cognitive, visual, or auditory comprehension impairments that would prevent cooperation with instructions;
4. Concurrent vestibular dysfunction;
5. Unstable vital signs;
6. Patients requiring mechanical ventilation;
7. Contraindications to FNS, such as a history of epilepsy or the presence of intracranial metal foreign bodies.

Study data will be made available under reasonable request after publication. Data will include de-identified participant data and the data dictionary. Requests can be submitted to the corresponding author. Request will be analyzed and ethical and legal implications of data sharing will be considered. Data will be shared after consent of study participants

After publication under reasonable request.