Effect Of Time Relationship Between Transcranial Magnetic Stimulation And Occupational Therapy On Improvement Of Upper Limb Motor Dysfunction After Stroke

Objective: To compare the effect of the time interval between repetitive transcranial magnetic stimulation(r TMS)and occupational therapy(OT)on the rehabilitation of patients with upper limb motor dysfunction after stroke,that is,That is,whether there is a synergistic effect to increase the efficacy of the two treatments when occupational therapy is applied during the post-effect period of r TMS treatment.To explore whether magnetic stimulation can enhance the effect of rehabilitation and to explore the more suitable combination of upper limb function rehabilitation of stroke patients.Methods: In this trial,85 stroke patients who met the inclusion and exclusion criteria were randomly divided into group A,Group B,Group C and control group.All patients were underwent treatment of the primary disease and conventional rehabilitation.The control group received occupational therapy,and the other 3 groups were treated with r TMS in the M1 region of the affected cerebral cortex on the basis of the control group.In this study,the r TMS were operated using intermittent theta burst stimulation(i TBS)mode,in which group A received occupational therapy within 30 minutes after the end of i TBS treatment,group B received occupational therapy between 30 and 60 minutes after the end of i TBS treatment,and group C received occupational therapy within 8 hours after 60 minutes of i TBS treatment.The Fugl-meyer Movement Assessment(FMA)scale upper limb portion,Modified Barthel Index(MBI)and Hemiplegic Hand Ability Assessment Scale were used to evaluate all patients before and 4 weeks after treatment,and the difference between FMA and MBI scores before and after treatment was calculated.Motor evoked potential(MEP)of group A,B and C before and after treatment were also collected.The changes of the above indexes before and after treatment were compared.Results: 1.A total of 85 patients were included in this study,and 4 cases fell off during the experiment.Finally,81 patients completed 4-week treatment and obtained relevant data;Before treatment,there was no statistical significance in the general data of the 4groups and the comparison of the above indicators among the groups(P>0.05),indicating comparability.2.Improvement of upper limb function: After treatment,the upper limb FMA score and hemiplegic hand ability of the four groups were improved compared with that before treatment(P<0.05),and the improvement degree of FMA score of the three r TMS groups was better than that of the control group.However,there were no significant differences in FMA and hemiplegic hand ability among the four groups after treatment(P>0.05).3.Ability of daily living: The MBI score of the 4 groups was significantly improved compared with that before treatment(P<0.05),and the improvement degree of the 3 r TMS groups was better than that of the control group,but there was no statistical significance in the inter-group comparison of the MBI score of the 4 groups after treatment(P>0.05).4.Cortical excitability: After treatment,MEP latency and amplitude of r TMS in group A,B and C were significantly changed compared with those before treatment(P<0.05),but there was no statistical difference between the three groups in MEP latency and amplitude of MEP after treatment(P>0.05).Conclusion : Under the parameters of this study,it was observed that the application of OT training in different time ranges after r TMS treatment can improve the upper limb motor function and daily living ability of patients with hemiplegia after stroke,but the different time intervals between the two combined application have no significant effect on the rehabilitation effect of upper limb motor dysfunction after stroke.