Objective: To explore the application effect of robot-assisted training combined with acupuncture therapy on hemiplegic patients and analyze its impact on the rehabilitation of lower limb motor function and walking efficiency.Methods: A prospective study was conducted on 98 patients with post-stroke hemiplegia admitted to Xi"an Ninth Hospital from March 2022 to March 2025. Patients were randomly assigned into two groups using the lottery method, with 49 patients in the control group receiving conventional rehabilitation training and 49 patients in the experimental group receiving robot-assisted training combined with acupuncture in addition to conventional rehabilitation training. Lower limb motor function, walking efficiency, neuroelectrophysiological and imaging indicators, as well as activities of daily living (ADL) were compared between the two groups before and after treatment.Results: After treatment, both groups showed increased scores in the lower limb section of the Fugl-Meyer Motor Function Assessment Scale (FMA-LE) and the Berg Balance Scale (BBS), along with a decreased classification on the Improved Ashworth Scale (MAS), with the experimental group demonstrating superior outcomes (P < 0.05). Additionally, both groups exhibited improvements in the 6-minute walk distance, walking speed, and Functional Walking Scale (FAC) classification, with the experimental group achieving higher values (P < 0.05). Regarding neuroelectrophysiological and imaging indicators, both groups demonstrated reduced latency and increased amplitude of motor evoked potentials (MEP), as well as elevated fractional anisotropy (FA) values of the corticospinal tract, with the experimental group showing more pronounced improvements (P < 0.05). Furthermore, both groups exhibited increased scores on the Barthel Index and the Functional Independence Assessment Scale (FIM), with the experimental group achieving higher scores (P < 0.05).Conclusion: Robot-assisted training combined with acupuncture therapy can improve lower limb motor function, enhance walking efficiency, optimize neuroelectrophysiological and imaging indicators, and elevate activities of daily living in patients with post-stroke hemiplegia.