Study On Mechanism Of Enhanced External Counterpulsation To Improve Motor Function In Patients With Ischemic Stroke

Objective:1.To observe the effect of enhanced external counterpulsation on motor function in patients with ischemic stroke.2.To explore the mechanism of enhanced external counterpulsation in improving motor function in patients with ischemic stroke.Methods:From September 2021 to May 2022,60 patients with ischemic stroke who were admitted to the Department of Rehabilitation Medicine of Zhongda Hospital,Southeast University were selected and divided into experimental group(EECP group)and control group(sham EECP group)with a ratio of 1:1 according to the random number table method,with 30 patients in each group.All included patients met the inclusion criteria and did not meet the exclusion criteria,and all patients signed a written informed consent form.The EECP group was treated with conventional hemiplegia rehabilitation training+enhanced external counterpulsation.Conventional rehabilitation training for hemiplegia mainly includes physical therapy based on neurodevelopmental therapy and occupational therapy based on hand function training.The enhanced external counterpulsation therapeutic instrument is OM-A type produced by Omay(Guangzhou)Med Technologies Co.,Ltd.The pressure is 0.025～0.04 MPa,30 min/time,2 times/day,a total of 3 weeks,and the cumulative treatment time is 21 hours.The sham EECP group was only treated with the same conventional hemiplegia rehabilitation training+sham EECP as the EECP group.Sham EECP was treated with the same treatment instrument as the experimental group,the pressure was 0.01 MPa,30 min/time,2 times/day,a total of 3 weeks,and the cumulative treatment time was 21 hours.The following outcomes were observed before and after therapy in the two groups:simplified Fugl-Meyer Motor Function Scale(FMA),Berg Balance Scale(BBS),Barthel Index(BI),and motor evoked potential(MEP),central motor conduction time(CMCT),and integrated EMG(iEMG)of tibialis anterior muscle during isometric contraction during maximum dorsiflexion of the affected ankle.Results:1.Before treatment,there was no statistical difference in general information,FMA of upper and lower limbs,BBS,BI,iEMG,MEP evoked rate,MEP amplitude,latency,and CMCT of the two groups.2.After treatment,the average FMA of upper and lower limbs in the EECP group was higher than that in the sham EECP group,but there was no significant difference between the two groups(upper limbs P=0.612,lower limbsP=0.079).The FMA difference of lower limbs in the EECP group was significantly higher than that in the sham EECP group,and the difference was statistically significant(P=0.024),while the FMA difference of upper limbs in the two groups was not statistically significant(P=0.546).There was no significant difference in BBS,BI and their differences between the two groups after treatment.3.After treatment,compared with the sham EECP group,the MEP latency was basically the same,the amplitude increased,and the CMCT shortened,there was no significant difference between the two groups(P>0.05).The difference of MEP latency and CMCT in the EECP group before and after treatment was significantly higher than that in the sham EECP group,and the difference was statistically significant(P<0.05).There was no significant difference in MEP amplitude between EECP and sham EECP before and after treatment.4.After treatment,the unit time iEMG and its difference of lower limb tibialis anterior muscle in the EECP group were significantly higher than those in the sham EECP group(P<0.05),and the difference between the two groups was statistically significant.5.No serious adverse reactions were found in both groups during treatment.Conclusion:1.Enhanced external counterpulsation therapy combined with conventional rehabilitation therapy can significantly improve the motor function of the affected side of the lower limb of patients with ischemic stroke in the recovery period,and there is no obvious adverse reaction.It provides a safe and effective auxiliary method for the clinical rehabilitation of patients with ischemic stroke.2.Enhanced excitability of motor cortex and improvement of peripheral skeletal muscle function after enhanced external counterpulsation therapy may be one of the mechanisms of enhanced external counterpulsation therapy to improve motor function in patients with ischemic stroke.