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重复经颅磁刺激应用于亚急性早期卒中的随机对照试验:对严重上肢功能障碍的影响

A Randomized Controlled Trial of Repetitive Peripheral Magnetic Stimulation applied in Early Subacute Stroke: Effects on Severe Upper-limb Impairment.

作者信息

Jiang Yi-Fan, Zhang Dai, Zhang Jing, Hai Hong, Zhao Ying-Yu, Ma Yue-Wen

机构信息

Department of Rehabilitation Medicine, the 159407First Affiliated Hospital of China Medical University, Shenyang, China *Equal contribution.

出版信息

Clin Rehabil. 2022 May;36(5):693-702. doi: 10.1177/02692155211072189. Epub 2022 Jan 5.

Abstract

OBJECTIVES

Repetitive peripheral magnetic stimulation (rPMS) is a non-invasive method that activates peripheral nerves and enhances muscle strength. This study aimed to investigate the effect of rPMS applied in early subacute stroke on severe upper extremity impairment.

DESIGN

Randomized controlled trial.

SETTING

Rehabilitation department of a university hospital.

SUBJECTS

People aged 30-80 years with no practical arm function within four weeks of a first stroke.

INTERVENTIONS

Participants were randomly assigned to either the rPMS group ( = 24, 20Hz and 2400 pulses of rPMS to triceps brachii and extensor digitorum muscles daily for two weeks in addition to conventional physiotherapy) or the control group ( = 20, conventional physiotherapy).

MAIN MEASURES

The primary outcome was the upper extremity motor section of Fugl-Meyer Assessment after treatment. Secondary outcomes included Barthel Index and root mean square of surface electromyography for muscle strength and stretch-induced spasticity of critical muscles of the upper extremity. Data presented: mean (SD) or median (IQR).

RESULTS

The rPMS group showed more significant improvements in the Fugl-Meyer Assessment (12.5 (2.5) vs. 7.0 (1.4),  < 0.001), Barthel Index (15 (5) vs. 10 (3.7),  < 0.001), and strength-root mean square (biceps brachii: 20.5 (4.8) vs. 6.2 (2.7),  < 0.001; triceps brachii: 14.9 (5.8) vs. 4.3 (1.2),  < 0.001; flexor digitorum: 5.1 (0.8) vs. 4.0 (1.1),  < 0.001) compared with the control group.

CONCLUSION

In patients with no functional arm movement, rPMS of upper limb extensors improves arm function and muscle strength for grip and elbow flexion and extension.

摘要

目的

重复经颅磁刺激(rPMS)是一种激活外周神经并增强肌肉力量的非侵入性方法。本研究旨在探讨早期亚急性卒中应用rPMS对严重上肢功能障碍的影响。

设计

随机对照试验。

地点

一所大学医院的康复科。

研究对象

首次卒中后四周内无实际手臂功能的30 - 80岁人群。

干预措施

参与者被随机分为rPMS组(n = 24,除常规物理治疗外,每天对肱三头肌和指伸肌进行20Hz、2400脉冲的rPMS治疗,持续两周)或对照组(n = 20,接受常规物理治疗)。

主要测量指标

主要结局是治疗后Fugl - Meyer评估的上肢运动部分。次要结局包括Barthel指数以及上肢关键肌肉力量和牵张诱发痉挛的表面肌电图均方根。数据表示为:均值(标准差)或中位数(四分位间距)。

结果

与对照组相比,rPMS组在Fugl - Meyer评估(12.5(2.5)对7.0(1.4),P < 0.001)、Barthel指数(15(5)对10(3.7),P < 0.001)和力量均方根(肱二头肌:20.5(4.8)对6.2(2.7),P < 0.001;肱三头肌:14.9(5.8)对4.3(1.2),P < 0.001;指屈肌:5.1(0.8)对4.0(1.1),P < 0.001)方面显示出更显著的改善。

结论

在无功能性手臂运动的患者中,上肢伸肌的rPMS可改善手臂功能以及抓握和肘部屈伸的肌肉力量。

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