Effects Of Transcranial Combined With Peripheral Magnetic Stimulation On Upper Limb Motor Function And Activities Of Daily Living In Patients With Stroke

Objective: To investigate the effects of transcranial magnetic stimulation combined with peripheral magnetic stimulation on upper limb motor function and activities of daily living(ADL)in patients with stroke.Method: 75 patients with stroke were randomly divided into routine group,central group and combined group,25 patients in each group.The patients in the routine group were given routine upper limb rehabilitation training.On this basis,the patients in the central group were given 10 Hz repetitive transcranial magnetic stimulation(r TMS),and the patients in the combined group were given 10 Hz r TMS combined with repetitive peripheral magnetic stimulation(r PMS),once a day,five times a week,for two weeks.The amplitude of motor evoked potential(MEP)in the affected cerebral hemisphere,root mean square value(RMS)of surface electromyographic signal(s EMG)and integrated electromyographic value(i EMG)during maximum isometric contraction(MIVC)of the affected triceps were measured before and after treatment;Fugl-Meyer AssessmentUpper Extremities(FMA-UE),Wolf motor function test(WMFT),motor assessment scale(MAS)of upper limb and Modified Bathel Index(MBI).Result: All patients completed the treatment.In the combined group,one patient complained of slight pain in the upper arm after r PMS intervention,and in the central group,one patient complained of slight pain in the head stimulation site after r TMS intervention.All patients were instructed to rest for a while,and the rest patients had no obvious adverse reactions.(1)Excitatory changes in the affected cerebral hemisphere:after 2 weeks of treatment,the amplitude of MEP in the affected cerebral hemisphere in the three groups was significantly higher than that before treatment,with a statistically significant difference(P<0.001).The amplitude of MEP in the affected hemisphere was compared among the three groups,the improvement effect of the combined group was the best,followed by the central group,and the routine group has the last,the difference was statistically significant(P<0.05);(2)Changes in muscle strength of upper limbs:After 2 weeks of treatment,RMS and i EMG of triceps brachii on the affected side of patients in the three groups were improved compared with those before treatment,with a statistically significant difference(P<0.05).Among them,the combined group has the best improvement effect,followed by the central group,and the routine group has the last,the difference is statistically significant(P<0.05);(3)Changes in motor function of upper limbs: After two weeks of treatment,the FMA-UE score,WMFT score and MAS score of upper limbs in the three groups were significantly improved compared with those before treatment(P<0.001).The FMA-UE score,WMFT score and MAS score of upper limbs were compared among the three groups.The improvement effect of FMA-UE score in the combined group and central group was better than that in the routine group,with a statistically significant difference(P<0.05),The improvement effect of the combined group was better than that of the central group,with a statistically significant difference(P<0.05);(4)Changes in activities of daily living: After 2 weeks of treatment,the MBI scores in the three groups were significantly improved compared with those before treatment(P<0.001).Although the MBI scores in the combined group and central group were higher than those in the routine group,there was no significant difference among the three groups(P>0.05).Conclusion:(1)Compared with single transcranial magnetic stimulation,transcranial magnetic stimulation combined peripheral magnetic stimulation can not only improve the motor function of the upper limb on the hemiplegic side of stroke patients and improve the muscle strength of the upper limb on the affected side,but also increase the excitability of the affected hemisphere and promote the reorganization of brain function.(2)All three treatment methods can improve the activities of daily living of stroke patients.Although there is no significant difference between the three groups in the short term,comprehensive analysis shows that the significance of transcranial magnetic stimulation combined peripheral magnetic stimulation is superior to the other two groups.Therefore,transcranial magnetic stimulation combined peripheral magnetic stimulation is an effective intervention method that can improve the activities of daily living of stroke patients.