AccScience Publishing / IJB / Online First / DOI: 10.36922/IJB026050035
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CASE STUDY

Neuromodulation with a 3D-printed, patient-specific hand orthotic in stroke: A proof-of-concept fMRI case series on clinical application

Zikai Hua1* ,  Zhipeng Li1 ,  Ying Zhang2,3*
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1 School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China
2 Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
3 Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
IJB, 026050035 https://doi.org/10.36922/IJB026050035
Received: 28 January 2026 | Revised: 15 March 2026 | Accepted: 23 March 2026 | Published online: 24 April 2026
(This article belongs to the Special Issue 3D Printing in Clinical Application)
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Three-dimensional (3D) printing holds great promise for creating patient-specific rehabilitative devices. While previous studies have demonstrated that behavioral interventions can induce cortical reorganization in stroke, direct evidence that a device alone—specifically, a patient-specific 3D-printed orthotic—can modulate brain function remains lacking. This proof-of-concept case series bridges this gap by integrating a complete digital workflow—from upper limb 3D scanning to stereolithography (SLA) fabrication of a custom hand orthotic—with longitudinal multimodal functional magnetic resonance imaging (fMRI) to assess cortical reorganization in chronic stroke. Four patients participated, with two index cases wearing the 3D-printed orthosis daily for four months alongside conventional rehabilitation, while two reference patients underwent conventional therapy only. Pre- and post-intervention neuroimaging revealed consistent, orthosis-associated neural changes: enhanced activity in the primary somatosensory cortex and greater functional integration within sensorimotor networks. Structural adaptations in motor regions were also observed in both index cases. Quantitatively, the index cases exhibited functional changes in nine brain regions and structural changes in six regions, substantially exceeding the minimal changes observed in the reference cases. This work provides the first direct evidence that a 3D-printed, patient-specific orthotic can drive targeted neuroplasticity independent of intensive behavioral coaching, validating its role not merely as a passive assistive device but as an active neuromodulatory tool. It establishes a translational framework for using objective neuroimaging biomarkers to guide the development and personalization of 3D-printed interventions in neurorehabilitation.

Graphical abstract
Keywords
3D printing
Additive manufacturing
Stroke rehabilitation
Neuromodulation
Functional MRI
Proof-of-concept study
Funding
This work was self-funded by the authors.
Conflict of interest
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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International Journal of Bioprinting, Electronic ISSN: 2424-8002 Print ISSN: 2424-7723, Published by AccScience Publishing
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