[Experience of using peripheral magnetic stimulation to restore diaphragm function in hemiparetic patients after stroke].

Abstract

Diaphragm dysfunction as one of the manifestations of hemiparesis, can play a certain role in the persistent respiratory, motor and postural complications of cerebral stroke. This disorder usually proceeds with few symptoms, is underestimated against the background of other manifestations of hemiparesis and may reduce the overall effectiveness of rehabilitation measures.

Objective: To evaluate the results of peripheral magnetic stimulation in hemiparetic patients due to stroke in order to restore diaphragm function and its potential influence on postural balance, respiratory function and upper limb motor function.

Material and methods: The study involved 106 people aged 31 to 86 years, including 80 patients with hemiparesis in the recovery period of stroke and 26 healthy volunteers demographically similar to the group of patients. Patients were randomly divided into three groups, two main and a control one. The control group of patients received a standard rehabilitation complex, the main group received an additional course of rPMS with the same parameters, but different localization. The effectiveness of the treatment was assessed based on the dynamics of the parameters of instrumental and clinical examination the diaphragm, respiratory function, postural balance and upper limb function.

Results: The patient groups were comparable in all baseline parameters. Diaphragm dysfunction was detected in 61.3% of patients, mainly on the hemiparetic side. The inclusion of a course of rPMS in the rehabilitation complex significantly increases the effectiveness of the treatment in terms of reducing ultrasound signs of diaphragm dysfunction (p<0.001), restoring postural balance (p=0.002), and upper limb function (p<0.0001). Bilateral stimulation of the phrenic nerves is more effective in bilateral and contralateral diaphragm lesions, multiple signs of diaphragm dysfunction (p=0.044). Unilateral stimulation of the deltoid muscle on the hemiparetic side is more effective in increasing the range of motion and reducing pain when moving the upper limb (p=0.009).

Conclusion: Inclusion of rPMS in the rehabilitation complex for patients with hemiparesis in the recovery period of stroke significantly improves immediate and long-term treatment results, contributing to a speedy recovery of diaphragm function, restoration of postural balance, upper limb and external respiration function. The method is safe and well tolerated by patients.