Department of Rehabilitation Medicine, Chungnam National University Sejong Hospital, Sejong-si 30099, Republic of Korea.
Department of Physical Therapy, Sahmyook University, Seoul 01792, Republic of Korea.
Int J Environ Res Public Health. 2023 Jun 9;20(12):6093. doi: 10.3390/ijerph20126093.
Functional paralysis of the upper extremities occurs in >70% of all patients after having a stroke, and >60% showed decreased hand dexterity. A total of 30 patients with a subacute stroke were randomly allocated to either high-frequency repetitive transcranial magnetic stimulation combined with motor learning ( = 14) or sham repetitive transcranial magnetic stimulation combined with motor learning ( = 16). High-frequency repetitive transcranial magnetic stimulation combined with the motor learning group was conducted for 20 min (10 min of high-frequency repetitive transcranial magnetic stimulation and 10 min of motor learning) three times a week for 4 weeks. The sham repetitive transcranial magnetic stimulation combined with the motor learning group received 12 20-min sessions (10 min of sham repetitive transcranial magnetic stimulation and 10 min of motor learning). This was held three times a week for 4 weeks. Upper-limb function (Fugl-Meyer Assessment of the Upper Limbs) and upper-limb dexterity (box and block tests) concerning upper-limb motor function and grip force (hand grip dynamometer), and activities of daily living (Korean version of the modified Barthel index), were measured pre- and post-intervention. In both groups, there were significant improvements in the upper-limb motor function, grip force, and activities of daily living ( < 0.05). Regarding grip force, the high-frequency repetitive transcranial magnetic stimulation combined with the motor learning group improved significantly compared to the sham repetitive transcranial magnetic stimulation combined with the motor learning group ( < 0.05). However, except for grip force, there were no significant differences in the upper-limb motor function or activities of daily living between the groups. These findings suggest that high-frequency repetitive transcranial magnetic stimulation combined with motor learning is more likely to improve grip force than motor learning alone.
上肢功能障碍在所有中风患者中超过 70%,且超过 60%的患者手部灵巧度下降。共有 30 名亚急性中风患者被随机分配至高频重复经颅磁刺激联合运动学习组(n = 14)或假重复经颅磁刺激联合运动学习组(n = 16)。高频重复经颅磁刺激联合运动学习组每周进行 3 次共 4 周,每次治疗 20 分钟(10 分钟高频重复经颅磁刺激和 10 分钟运动学习)。假重复经颅磁刺激联合运动学习组每周进行 3 次共 4 周,每次治疗 20 分钟(10 分钟假重复经颅磁刺激和 10 分钟运动学习)。在干预前后分别测量了上肢功能(上肢 Fugl-Meyer 评估)和上肢灵巧性(盒和块测试)、上肢运动功能和握力(手握力计)、日常生活活动(改良 Barthel 指数的韩国版)。两组患者上肢运动功能、握力和日常生活活动均有显著改善(<0.05)。在握力方面,高频重复经颅磁刺激联合运动学习组的改善明显优于假重复经颅磁刺激联合运动学习组(<0.05)。然而,除了握力,两组之间上肢运动功能或日常生活活动均无显著差异。这些发现表明,高频重复经颅磁刺激联合运动学习比单纯运动学习更有可能改善握力。