Does your hospital even have an rTMS machine? It has been suggested for rehab for a long time. Only a decade for your competent? hospital to figure out how to get one and use it? Or didn't your doctors have one in medical school and thus have no interest in learning something new? You'll have to be prepared for the excuses they will use for their incompetence!
rTMS (66 posts to January 2013)
Effect of short-term 10 Hz repeated transcranial magnetic stimulation on postural control ability in patients with mild hemiparesis in acute ischemic stroke: a single-blinded randomized controlled trial
Jiangping Ma
Siyu Qian1,3
Xueyuan Liu- 1Department of Neurology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- 2Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- 3Department of Neurology, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
- 4Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
Background: 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.
Objective: 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.
Methods: 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.
Results: 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.
Conclusion: 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.
Clinical trial registration: https://www.chictr.org.cn, identifier ChiCTR1900026225.
Introduction
Stroke is an acute focal injury to the central nervous system of vascular origin, causing neurological deficits (1). Ischemic stroke, which carries a lifetime risk of 18.3% worldwide, is the third most common cause of adult disability (2). Postural control (PC) refers to the body’s ability to maintain stability and orientation through the motor system by integrating information from somatosensory, vestibular, and visual inputs (3–5). After a stroke, various abnormalities such as reduced muscle strength, impaired feedforward mechanisms, sensory deficits, and cognitive impairment can arise, leading to a reduction in postural control (6–10). Postural control is significantly associated with decreased mobility and impaired ability to carry out daily activities, and it is one of the main risk factors for falls in stroke patients (11). Relevant studies have demonstrated that stroke patients have a high incidence rate of falls within 6 months, ranging from 37 to 73% (12–14). Therefore, rehabilitation programs should prioritize enhancing postural control to prevent falls.
In clinical practice, traditional conventional manipulative rehabilitation is considered relatively effective for restoring neurological function in stroke patients, but its effectiveness is constrained (15, 16). In recent years, numerous novel rehabilitation therapies have emerged, including virtual reality (VR) technology, repetitive transcranial magnetic stimulation (rTMS), dual-task training (DT), and others (17–19). rTMS is a non-invasive neuromodulation therapy that can modify the excitability of the cerebral cortex and restore the inhibitory balance of both hemispheres (20, 21), resulting in noteworthy enhancement in neurological function of individuals who experienced a stroke (22). The impact of rTMS on the functional rehabilitation of stroke patients’ upper limbs in the acute phase is relatively evident (23). However, further research is needed to provide additional evidence for the therapeutic effectiveness of rTMS in restoring motor function in the lower limbs of patients in the acute stage of stroke (24). A recent systematic review and meta-analysis suggests that stimulating the primary motor cortex (M1) area with rTMS significantly improves walking speed, balance, and postural control in stroke patients (25–27). However, Huang and colleagues discovered that applying 1 Hz low-frequency rTMS (LF-rTMS) to the cortex opposite the lesion did not result in a significant improvement in motor or walking capabilities for stroke patients (28). The therapeutic effect of rTMS on lower limb motor function in stroke patients still remains controversial. Regarding the optimal timing of lower limb motor rehabilitation in stroke patients, clinical evidence only supports the use of rTMS in the subacute phase of stroke (1–6 months after stroke) and in the chronic phase of stroke (> 6 months after stroke) to improve balance and gait, and more evidence-based medical evidence is needed for the use of rTMS in the acute phase of stroke (< 1 month after stroke onset) (29, 30). Hence, further research is necessary to generate more advantageous clinical evidence supporting the utilization of rTMS in the rehabilitation of lower limbs in stroke patients and to continue advancing the field of rTMS.
Although there is evidence of the efficacy of rTMS in lower limb motor rehabilitation of stroke patients, experimental studies have used different stimulation times, intensities, and sites. Furthermore, stroke patients are at varying stages of the disease, resulting in significant outcome variability. The efficacy of some treatments remains contentious, and concise and standardized treatment protocols backed by evidence have yet to be established. The absence of high-quality clinical studies with large samples hinders the formulation of a consensus on rTMS treatment guidelines, thus impeding the widespread use of rTMS in lower limb motor rehabilitation for stroke patients. The aim of this study is to investigate the clinical effectiveness of transcranial magnetic stimulation plus conventional rehabilitation in lower limb motor rehabilitation for patients with mild hemiparesis in acute ischemic stroke and provide a foundation for post-stroke rehabilitation strategies for postural control disorders.
More at link.
No comments:
Post a Comment