Study On The Effect Of Repeated Transcranial Magnetic Stimulation Combined Conventional Rehabilitation Measures On Early Stroke Shoulder And Joint Dysfunction

1 Research background:Shoulder joint dysfunction is very common in early stroke patients.It is a kind of disease which is induced by nerve dysfunction and develops gradually with the loss of shoulder joint innervation,mainly manifested as the loss of shoulder function or even loss of the affected side,which seriously affects the daily activity of patients.The patients showed decreased shoulder movement function,pain and weakness,which greatly reduced the quality of life of patients.At present,there are many methods to control shoulder joint dysfunction in stroke,but the therapeutic effect is not ideal.In recent years,repetitive transcranial magnetic stimulation(rTMS)technology has been gradually applied to the rehabilitation of stroke patients with its advantages of significant effect and small side effects.2 Research purpose:The purpose of this study is to observe the therapeutic effect and potential mechanism of rTMS on the recovery of shoulder dysfunction in early stage of stroke,so as to provide research basis for improving the clinical effect of hemiplegic shoulder pain after stroke.3 Research methods:31 patients with shoulder joint dysfunction in early stage of stroke recovery were recruited and screened as research objects.The patients were randomly divided into two groups: rTMS group(experimental group)and conventional rehabilitation group(control group).The experimental group received rTMS combined with conventional rehabilitation treatment,while the control group only received conventional rehabilitation treatment,1.5 hours a day,5 days a week,a total of 4 weeks.Thechanges of ROM,VAS,MMT,FMA,rMT,MEP(CMCT)and CPT were observed before and after the intervention.To explore the effect and mechanism of rTMS on the recovery of shoulder dysfunction after early stroke.4 Results:(1)Changes of shoulder pain before and after intervention: after 4 weeks of rTMS treatment,the VAS score of the experimental group decreased significantly(P<0.05),but there was no significant difference between the experimental group and the control group.(2)Changes of ROM of shoulder joint before and after intervention: after 4 weeks of intervention,the painless active and passive ROM of flexion,extension,adduction,abduction and rotation of shoulder joint in experimental group and control group were significantly increased(P < 0.05 and P < 0.01);the increase of active ROM in all directions of shoulder joint in experimental group was significantly higher than that of passive ROM(P<0.05 and P<0.01);the active extension and extension of shoulder joint in experimental group were significantly higher than that in control group(P<0.05 and P< 0.01)The ROM amplitudes of adduction,abduction,internal rotation and external rotation and passive adduction,abduction and external rotation were significantly better(P<0.05 and P<0.01).(3)MMT changes in the shoulder before and after intervention: after 4 weeks of rehabilitation,MMT in the experimental group increased significantly(P<0.05),and the effect was better than that in the control group(P < 0.05),and there was no significant change in the control group(P>0.05).(4)FMA changes of upper limbs before and after intervention: after 4 weeks of rehabilitation,FMA score of experimental group was significantly improved(P <0.01),and the curative effect was significantly better than that of control group(P<0.05),and there was no significant change in control group before and after intervention(P>0.05).(5)Changes of MEP latency,CMCT and rMT before and after intervention: after 4weeks of rehabilitation,there was no significant change in MEP latency,CMCT andrMT in the experimental group and the control group(P > 0.05).Before the intervention,the detection rate of MEP in the healthy side of the experimental group was 70.00% and 40.00% respectively,which were significantly increased after the intervention,95.00% and 75.00% respectively(P < 0.01,P < 0.05);before the intervention,the detection rate of MEP in the healthy side of the control group was63.63% and 27.00% respectively,with the increase of 81.82%(P<0.01)and 45.45%(P>0.05)after the intervention.There was no significant difference between the two groups(P>0.05).(6)Changes of CPT before and after intervention: after 4 weeks of rehabilitation,the CPT thresholds in the experimental group and the control group were significantly reduced under the stimulation of 2KHz and 250 Hz at the positions of C5 and C6 in the affected upper arm(P < 0.01,P < 0.05),while the CPT thresholds under the stimulation of 5Hz were significantly increased(P<0.01,P<0.05).There was no significant difference between the two groups(P>0.05).5 Conclusion:4-week rTMS rehabilitation therapy can significantly reduce shoulder pain,improve the range of shoulder joint activity and increase muscle strength and upper limb function in early stage of stroke recovery.Its potential mechanism may be related to rTMS promoting neural pathway reconstruction and hemispheric balance in stroke patients,increasing proprioception of upper limb and increasing pain threshold.