Ma Jiangping, Qian Siyu, Ma Nuo, Zhang Lu, Xu Linghao, Liu Xueyuan, Meng Guilin
Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Neurol. 2024 Aug 14;15:1439904. doi: 10.3389/fneur.2024.1439904. eCollection 2024.
Previous studies have demonstrated that repetitive transcranial magnetic stimulation (rTMS) can improve postural control in subacute and chronic ischemic stroke, but further research is needed to investigate the effect of rTMS on acute ischemic stroke.
We compared the therapeutic effects of rTMS plus conventional rehabilitation and conventional rehabilitation on postural control in patients with mild hemiparesis in acute ischemic stroke.
Eighty-six patients with acute ischemic stroke were randomly assigned to either the experimental group or the control group within 1-7 days of onset. Patients in both groups received conventional rehabilitation for 2 weeks. Patients in the experimental group received rTMS treatments lasting for 2 weeks. Before and after the 2-week treatment, patients were assessed based on the Timed up and Go (TUG) test, Dual-Task Walking (DTW) test, Functional Ambulation Category (FAC), Tinetti Performance Oriented Mobility Assessment (POMA), gait kinematic parameters, Barthel Index (BI), Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and National Institutes of Health Stroke Scale (NIHSS). Additionally, TUG and single-task gait velocity were assessed at 2 months after the start of treatment, and independent walking recovery was also followed up.
After 2 weeks of treatment, compared to conventional rehabilitation, participants who underwent rTMS treatment plus conventional rehabilitation exhibited notable enhancements in TUG, FAC, POMA, and some gait parameters [single-task gait velocity, gait stride length, gait cadence, gait cycle]. Changes in cognitive function partially mediated the improvement in single-task gait velocity and gait stride length by rTMS plus conventional rehabilitation. Generalized Estimating Equation (GEE) analysis showed that the trend of improvement in single-task gait velocity over time was more pronounced in the experimental group than in the control group. The results of the Kaplan-Meier curve indicated a median gait recovery time of 90 days for patients in the experimental group and 100 days for the control group. Multifactorial Cox regression analyses showed that rTMS plus conventional rehabilitation promoted faster recovery of independent walking compared with conventional rehabilitation.
rTMS plus conventional rehabilitation outperformed conventional rehabilitation in improving postural control in patients with acute ischemic stroke. Improvements in cognitive function may serve as a mediating factor in the favorable treatment outcome of rTMS plus conventional rehabilitation for improving postural control.
https://www.chictr.org.cn, identifier ChiCTR1900026225.
先前的研究表明，重复经颅磁刺激（rTMS）可改善亚急性和慢性缺血性卒中患者的姿势控制，但rTMS对急性缺血性卒中的影响仍需进一步研究。
比较rTMS联合传统康复治疗与单纯传统康复治疗对急性缺血性卒中轻度偏瘫患者姿势控制的疗效。
86例急性缺血性卒中患者在发病1-7天内被随机分为实验组和对照组。两组患者均接受2周的传统康复治疗。实验组患者接受为期2周的rTMS治疗。在2周治疗前后，根据计时起立行走测试（TUG）、双任务步行测试（DTW）、功能性步行分类（FAC）、Tinetti以功能为导向的运动评估（POMA）、步态运动学参数、Barthel指数（BI）、简易精神状态检查表（MMSE）、蒙特利尔认知评估量表（MoCA）和美国国立卫生研究院卒中量表（NIHSS）对患者进行评估。此外，在治疗开始2个月后评估TUG和单任务步态速度，并对独立步行恢复情况进行随访。
治疗2周后，与传统康复治疗相比，接受rTMS联合传统康复治疗的参与者在TUG、FAC、POMA和一些步态参数[单任务步态速度、步幅长度、步频、步态周期]方面有显著改善。认知功能的变化部分介导了rTMS联合传统康复治疗对单任务步态速度和步幅长度的改善。广义估计方程（GEE）分析表明，实验组单任务步态速度随时间的改善趋势比对照组更明显。Kaplan-Meier曲线结果显示，实验组患者的中位步态恢复时间为90天，对照组为100天。多因素Cox回归分析表明，与传统康复治疗相比，rTMS联合传统康复治疗能促进独立步行更快恢复。
在改善急性缺血性卒中患者的姿势控制方面，rTMS联合传统康复治疗优于单纯传统康复治疗。认知功能的改善可能是rTMS联合传统康复治疗改善姿势控制良好治疗效果的中介因素。
