Objective To investigate the effect of transcutaneous auricular vagus nerve stimulation (taVNS) combined with the rehabilitation robotic arm reinforcement training on upper limb motor function recovery in stroke patients with hemiplegia.Methods 128 stroke patients admitted to the rehabilitation department of our hospital from June 2022 to June 2024 were randomly divided into a control group, taVNS group, rehabilitation robotic arm group, and combination group, with 32 patients in each group. The control group received conventional rehabilitation treatment, while the taVNS group received additional taVNS treatment on top of conventional rehabilitation treatment. The rehabilitation robotic arm group received additional neural rehabilitation robotic arm treatment on top of conventional rehabilitation treatment. The combination group received both taVNS and rehabilitation robotic arm treatment on top of conventional rehabilitation treatment for a total of 6 weeks. Four groups were tested for motor evoked potential (MEP) cortical latency and central motor conduction time (CMCT) in the affected brain area before and after treatment. The treatment effect was evaluated using the simplified Fugl Meyer assessment upper limb (FMA-UE) and modified Barthel index (MBI) scores, and the blood flow velocity of the middle cerebral artery (MCA) on the affected side was measured. Results Before treatment, there were no significant differences in MEP latency, CMCT, FMA-UE score, MBI score, and MCA blood flow velocity among the four groups of patients (P>0.05). After treatment, all four groups of patients showed significant improvement in the above indicators compared to before treatment (P<0.05). The taVNS group, rehabilitation robotic arm group, and combination group had better effects than the control group, and the combination group was superior to the taVNS group and rehabilitation robotic arm group (P<0.05).Conclusion Both taVNS and rehabilitation robotic arm can improve the muscle strength of the affected upper limb in stroke patients with hemiplegia, enhance hand flexibility and upper limb motor function; And the combination of the two has a better effect