Effects Of Dual-task Training Combined With RTMS On Mobility And Cognitive Function Performance After Stroke

Objectives:1.In recent years,noninvasive brain stimulation technology plays a important role in the rehabilitation process of neurological diseases.By regulating cortical excitability,it causes neuroplastic changes,thus affecting the walking,balance and cognitive ability of different people under dual-task condition.The first part of this paper explores the effects of different non-invasive brain stimulation methods on dual-task performance in various populations through systematic review.2.As one of the noninvasive brain stimulation techniques,repetitive transcranial magnetic stimulation(rTMS)has been widely used in the rehabilitation of depression,cognitive function,upper limb motor function,balance and gait function after stroke.However,its influence on dual task ability in stroke patients has not been clear.The second part of this trail tried to through the walking ability,continuous subtraction correct response rate,language fluency task,cognitive scale,balance scale,and daily life activity ability to explore the influence of rTMS on mobility and cognitive function in stroke patients.Methods:1.Systematic review: Extensive electronic databases search was conducted to search for randomized controlled trials of different non-invasive brain stimulation methods for dual-task abilities in different populations.The primary assessment outcomes were motor and cognitive function performance under single-and dual-task conditions.2.Clinical randomized controlled trial: Subjects were collected from that admitted to the Rehabilitation Medicine Department of the Second People’s Hospital of Kunming from March to December 2022.After screening,the subjects were randomly divided into experimental group and control group by a random number table.The experimental group received rTMS training on the dorsolateral prefrontal cortex combined with dual-task training,however,the control group received sham-stimulation combined with dual-task training.The assessments included:population characteristics about the subject’s age,sex,length of onset and disease;Waling abilities:10-meter walk and timed-up and go test(TUGT);Cognitive function:correct response rate of continuous subtraction,verbal fluency task,Montreal Cognitive Scale(Mo CA),Stroop Test and Trail Making Test(TMT);Balance function and Others: Mini balance evaluation system test(Mini-BESTest),Activity-specific balance confidence scale(ABC),Modified Barthel Index and the Short-Form Geriatric Depression Scale(GDS-SF).Functional improvements before and after intervention was assessed by the Gait testing system and scales assessment.Results:1.Fifteen studies were included,involving two types of non-invasive brain stimulation methods: transcranial direct current stimulation(t DCS)(twelve trials)rTMS)(three trials);and four different population groups: healthy young adults,older adults,Parkinson’s disease(PD),and stroke patients.For t DCS,significant improvements in speed were observed in two trails(one PD and one stroke),whereas a significant improvement in step time variability was observed in only one trail in older adults.Only one study showed significant reduction in postural sway speed and area during standing under DT condition in young adults.For rTMS,significant improvements in fastest walking speed and time taken to TUGT under both ST and DT conditions were observed at follow-up in one PD trial only.No significant effects of both interventions on cognitive function were observed in any randomized controlled trials.2.There were no significant differences between baseline characteristics or stroke characteristics between two groups.There were no significant differences in the walking ability,cognitive function,balance function and other functions before the intervention.The within-group analysis showed that walking speed,step length and the time taken to perform TUGT showed significant improvement in both the experimental group and control groups under the single-and dual-task conditions(P<0.05),and the change of the time taken to perform TUGT was significant(P<0.05),and the treatment effect of the experimental group was better than that of the control group.After the intervention,the Mini-BESTest and ABC scores were significantly improved(P<0.05),but the change between groups in this improvement did not reach significant statistical significance(P>0.05).Under dual-task condition,the improvement in the correct response rates of continuous subtraction and naming task in the experimental group were significant(P<0.05).Conclusions:1.Both tDCS and rTMS showed great results in improving dual-task walking and balance function in different populations.For motor function,t DCS showed significant improvement in healthy young adults,PD and stroke patients.However,rTMS related articles showed no significant improvement in mobility function or cognitive function of different populations.Therefore,to further explore the therapeutic effect of rTMS on mobility and cognitive function in stroke patients,the second part of the clinical study will be conducted.2.As an intervention method to regulate the central nerve stimulation,rTMS and dual-task training could effectively improve the mobility and cognitive ability of stroke patients,which can be used as an effective method in the rehabilitation treatment of stroke patients.However,the long-term maintenance of the therapeutic effect of rTMS in stroke patients is still unclear,and further verification and exploration requires more large,multi-center and high-quality trails.