OBJECTIVE: To investigate the treatment mechanism of the intelligent lower limb rehabilitation robot to promote the recovery of motor function in patients with subacute subcortical stroke, based on resting-state fMRI (rs-fMRI) in terms of functional activity and functional connectivity. METHODS: Twenty-four patients with subacute subcortical stroke were admitted to The Affiliated Hospital of Yunnan University between January 2022 and August 2023. They were randomly assigned to either robot group (conventional rehabilitation treatment combined with robot rehabilitation treatment, n = 12) or conventional group (conventional rehabilitation treatment, n = 12). Based on the rs-fMRI data, static amplitude of low-frequency fluctuation (sALFF), dynamic amplitude of low-frequency fluctuation (dALFF), static regional homogeneity (sReHo) and dynamic regional homogeneity (dReHo) were calculated to analyze changes in brain functional activity in 2 groups after treatment. The seed-based dynamic functional connectivity (dFC) and static functional connectivity (sFC) analysis methods were used to explore the distribution of changes in functional connectivity between brain regions exhibiting altered functional activity after treatment and other brain regions across the 2 groups. Neurological deficits, lower limb motor function and activities of daily living were assessed using the National Institutes of Health Stroke Scale (NIHSS), the Fugl-Meyer Assessment Scale for Lower Extremity (FMA-LE) and the modified Barthel Index (mBI), respectively. RESULTS: The differences in NIHSS score (F 17.806, p = 0.000), FMA-LE score (F 51.911, p = 0.000) and mBI score (F 130.224, p = 0.000) between robot group and conventional group before and after treatment were statistically significant. After treatment, the NIHSS score in robot group (t -2.785, p = 0.004) and conventional group (t -3.183, p = 0.011) were lower than those before treatment, while FMA-LE score (t 7.225, p = 0.000; t 2.964, p = 0.007) and mBI score (t 9.717, p = 0.000; t 6.442, p = 0.000) in robot group and conventional group were higher than those before treatment. After treatment, the robot group exhibited decreased sALFF in the right medioventral occipital cortex and left lateral occipital cortex and increased sReHo in the right precuneus (voxel level threshold of p < 0.005 and cluster level threshold of p < 0.05, for all). Decreased dFC in the right medioventral occipital cortex with right lobule VIII of the cerebellar hemisphere, and decreased sFC with the left medioventral occipital cortex, while increased sFC with the right inferior parietal lobule (voxel level threshold of p < 0.005 and cluster level threshold of p < 0.05, for all). Increased sFC in the left lateral occipital cortex with right lobule VII of the cerebellar hemisphere and right inferior parietal lobule (voxel level threshold of p < 0.005 and cluster level threshold of p < 0.05, for all). The conventional group showed increased sALFF in the left insula and left cingulate gyrus (voxel level threshold of p < 0.005 and cluster level threshold of p < 0.05, for all). Increased dFC in the left cingulate gyrus with left superior frontal and decreased sFC with the right lateral occipital cortex and right fusiform gyrus (voxel level threshold of p < 0.005 and cluster level threshold of p < 0.05, for all). The difference in sALFF of the left lateral occipital cortex in robot group was negatively correlated with the difference in mBI score (r -0.609, p = 0.036). CONCLUSIONS: The intelligent lower limb rehabilitation robot may facilitate the recovery of motor function in patients with subcortical stroke by improving the synchronization of neural activity in the right precuneus, to optimize motor control strategies and by modulating the functional connectivity between the occipital lobule and cerebellum, and between the occipital lobule and parietal lobule to enhance sensorimotor integration.

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