{"title":"重复性外周磁刺激联合重复性经颅磁刺激对慢性脑卒中患者下肢运动功能和平衡的影响：一项随机对照试验。","authors":"Qing Cai, Xuan Zhang, Guirong Liu, Yanzhi Cai, Jing Luo, Mingyu Yin, Haiqing Zheng","doi":"10.1002/pmrj.13391","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>In the chronic phase of stroke, repetitive transcranial magnetic stimulation (rTMS) exhibits limited effectiveness in improving motor recovery due to reduced brain plasticity. Patients with chronic stroke also typically present with lower limb motor dysfunction and disability. Recent studies suggest that repetitive peripheral magnetic stimulation (rPMS) can promote brain plasticity and potentially offer additional improvement in patients with chronic stroke.</p><p><strong>Objective: </strong>To investigate whether combining a designed rPMS program with rTMS could further improve lower limb motor function, mobility, and balance function in patients with chronic stroke.</p><p><strong>Design: </strong>Two-arm randomized controlled trial.</p><p><strong>Setting: </strong>Inpatient clinic.</p><p><strong>Participants: </strong>20 patients with chronic stroke with lower limb hemiparesis were recruited.</p><p><strong>Interventions: </strong>One group received ipsilateral rTMS, and the other received rTMS and rPMS designed based on the lower limb myofascial chain and neural pathways.</p><p><strong>Main outcome measures: </strong>The primary outcome measure was the lower extremity motor section of the Fugl-Meyer Assessment (FMA-LE), evaluating lower limb motor function. Secondary outcomes included the timed up and go test (TUG), the 10-meter walking test (10MWT), the 6-minute walking test (6MWT), Berg balance scale (BBS), and parameters measured by the balance training and evaluation system (Rx, mediolateral sway; Ry, anteroposterior sway; and RecArea, total sway area). All outcome assessments were conducted at baseline, 2 weeks post intervention, and 4 weeks post intervention. Two-way repeated measures analysis of variance (ANOVA) was then performed to analyze any group differences over time.</p><p><strong>Results: </strong>Two-way ANOVA revealed a significant interaction effect between time and group for FMA-LE (p = .001), 6MWT (p < .001), TUG (p = .015), BBS (p = .046), Rx (p = .008), Ry (p = .009), and RecArea (p < .001). Effect size (the value of partial ɳ<sup>2</sup>) of FMA-LE was 0.40.</p><p><strong>Conclusions: </strong>This study provides evidence that combining rTMS with rPMS may be a more practical approach for improving lower limb motor function, ambulation, and balance in patients with chronic stroke compared to rTMS alone.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2000,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The effects of repetitive peripheral magnetic stimulation combined with repetitive transcranial magnetic stimulation on lower limb motor function and balance in patients with chronic stroke: A pilot randomized controlled trial.\",\"authors\":\"Qing Cai, Xuan Zhang, Guirong Liu, Yanzhi Cai, Jing Luo, Mingyu Yin, Haiqing Zheng\",\"doi\":\"10.1002/pmrj.13391\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>In the chronic phase of stroke, repetitive transcranial magnetic stimulation (rTMS) exhibits limited effectiveness in improving motor recovery due to reduced brain plasticity. Patients with chronic stroke also typically present with lower limb motor dysfunction and disability. Recent studies suggest that repetitive peripheral magnetic stimulation (rPMS) can promote brain plasticity and potentially offer additional improvement in patients with chronic stroke.</p><p><strong>Objective: </strong>To investigate whether combining a designed rPMS program with rTMS could further improve lower limb motor function, mobility, and balance function in patients with chronic stroke.</p><p><strong>Design: </strong>Two-arm randomized controlled trial.</p><p><strong>Setting: </strong>Inpatient clinic.</p><p><strong>Participants: </strong>20 patients with chronic stroke with lower limb hemiparesis were recruited.</p><p><strong>Interventions: </strong>One group received ipsilateral rTMS, and the other received rTMS and rPMS designed based on the lower limb myofascial chain and neural pathways.</p><p><strong>Main outcome measures: </strong>The primary outcome measure was the lower extremity motor section of the Fugl-Meyer Assessment (FMA-LE), evaluating lower limb motor function. Secondary outcomes included the timed up and go test (TUG), the 10-meter walking test (10MWT), the 6-minute walking test (6MWT), Berg balance scale (BBS), and parameters measured by the balance training and evaluation system (Rx, mediolateral sway; Ry, anteroposterior sway; and RecArea, total sway area). All outcome assessments were conducted at baseline, 2 weeks post intervention, and 4 weeks post intervention. Two-way repeated measures analysis of variance (ANOVA) was then performed to analyze any group differences over time.</p><p><strong>Results: </strong>Two-way ANOVA revealed a significant interaction effect between time and group for FMA-LE (p = .001), 6MWT (p < .001), TUG (p = .015), BBS (p = .046), Rx (p = .008), Ry (p = .009), and RecArea (p < .001). Effect size (the value of partial ɳ<sup>2</sup>) of FMA-LE was 0.40.</p><p><strong>Conclusions: </strong>This study provides evidence that combining rTMS with rPMS may be a more practical approach for improving lower limb motor function, ambulation, and balance in patients with chronic stroke compared to rTMS alone.</p>\",\"PeriodicalId\":20354,\"journal\":{\"name\":\"PM&R\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.2000,\"publicationDate\":\"2025-05-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"PM&R\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1002/pmrj.13391\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"REHABILITATION\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"PM&R","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/pmrj.13391","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"REHABILITATION","Score":null,"Total":0}
The effects of repetitive peripheral magnetic stimulation combined with repetitive transcranial magnetic stimulation on lower limb motor function and balance in patients with chronic stroke: A pilot randomized controlled trial.
Background: In the chronic phase of stroke, repetitive transcranial magnetic stimulation (rTMS) exhibits limited effectiveness in improving motor recovery due to reduced brain plasticity. Patients with chronic stroke also typically present with lower limb motor dysfunction and disability. Recent studies suggest that repetitive peripheral magnetic stimulation (rPMS) can promote brain plasticity and potentially offer additional improvement in patients with chronic stroke.
Objective: To investigate whether combining a designed rPMS program with rTMS could further improve lower limb motor function, mobility, and balance function in patients with chronic stroke.
Design: Two-arm randomized controlled trial.
Setting: Inpatient clinic.
Participants: 20 patients with chronic stroke with lower limb hemiparesis were recruited.
Interventions: One group received ipsilateral rTMS, and the other received rTMS and rPMS designed based on the lower limb myofascial chain and neural pathways.
Main outcome measures: The primary outcome measure was the lower extremity motor section of the Fugl-Meyer Assessment (FMA-LE), evaluating lower limb motor function. Secondary outcomes included the timed up and go test (TUG), the 10-meter walking test (10MWT), the 6-minute walking test (6MWT), Berg balance scale (BBS), and parameters measured by the balance training and evaluation system (Rx, mediolateral sway; Ry, anteroposterior sway; and RecArea, total sway area). All outcome assessments were conducted at baseline, 2 weeks post intervention, and 4 weeks post intervention. Two-way repeated measures analysis of variance (ANOVA) was then performed to analyze any group differences over time.
Results: Two-way ANOVA revealed a significant interaction effect between time and group for FMA-LE (p = .001), 6MWT (p < .001), TUG (p = .015), BBS (p = .046), Rx (p = .008), Ry (p = .009), and RecArea (p < .001). Effect size (the value of partial ɳ2) of FMA-LE was 0.40.
Conclusions: This study provides evidence that combining rTMS with rPMS may be a more practical approach for improving lower limb motor function, ambulation, and balance in patients with chronic stroke compared to rTMS alone.
期刊介绍：
Topics covered include acute and chronic musculoskeletal disorders and pain, neurologic conditions involving the central and peripheral nervous systems, rehabilitation of impairments associated with disabilities in adults and children, and neurophysiology and electrodiagnosis. PM&R emphasizes principles of injury, function, and rehabilitation, and is designed to be relevant to practitioners and researchers in a variety of medical and surgical specialties and rehabilitation disciplines including allied health.
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