Peripheral Magnetic Stimulation and Motor Function Rehabilitation

 Your competent? doctor should immediately create protocols on this to address your spasticity. Is there even a TMS machine in your hospital?

To create peripheral intermittent theta burst stimulation (piTBS), you would use a transcranial magnetic stimulation (TMS) device to deliver a series of rapid bursts of magnetic pulses, where each burst consists of three pulses at a high frequency (typically 50 Hz), repeated at a slower "theta" frequency (around 5 Hz), with intervals of rest between trains of bursts, targeting the peripheral nerve area of interest, adjusting the stimulation intensity to elicit a visible muscle contraction while maintaining a comfortable level for the patient; essentially mimicking the pattern of iTBS used in brain stimulation but applied to peripheral nerves. 

Peripheral Magnetic Stimulation and Motor Function Rehabilitation

Peripheral magnetic stimulation (PMS) is an innovative non-invasive treatment technique that uses magnetic fields to stimulate nerves and muscles. This method has gained attention in the field of rehabilitation, particularly for improving motor function in individuals with neurological impairments, such as those recovering from strokes or dealing with spasticity. Recent research has focused on the effectiveness of various forms of PMS, including repetitive peripheral magnetic stimulation (rPMS) and peripheral intermittent theta burst stimulation (piTBS), in enhancing motor function and reducing spasticity in affected patients.

Recent Research

One significant area of research has been the application of rPMS in stroke rehabilitation. A systematic review and meta-analysis indicated that rPMS could effectively reduce spasticity and improve motor function in patients with spastic paralysis. The analysis included multiple studies and found that rPMS had a significant positive effect on spasticity, as measured by the Modified Ashworth Scale, and on overall motor function and activities of daily living, as assessed by the Barthel Index[4]. However, the evidence was deemed low certainty due to the small sample sizes of the included studies, highlighting the need for further research with larger participant groups[1].

Another promising technique, piTBS, was investigated for its ability to reduce spasticity directly in spastic muscles. A randomized controlled trial demonstrated that applying piTBS significantly decreased spasticity and the estimated Botulinum toxin dose required for treatment, suggesting that this method could be a time-efficient alternative to traditional high-frequency stimulation protocols[2].

Additionally, high-frequency rPMS has been explored for its effects on motor performance in patients with intracerebral hemorrhage. A clinical trial showed that this method significantly improved motor function in both upper and lower limbs, indicating its potential as a valuable rehabilitation tool in acute and early subacute phases of recovery[5].

Overall, the research indicates that peripheral magnetic stimulation techniques, particularly rPMS and piTBS, hold promise for enhancing motor function and reducing spasticity in patients with neurological impairments. However, the variability in study designs and the need for larger trials suggest that further investigation is essential to establish standardized protocols and confirm the efficacy of these interventions.

Repetitive peripheral magnetic stimulation alone or in combination with repetitive transcranial magnetic stimulation in poststroke rehabilitation: a systematic review and meta-analysis

 Instead of doing lazy crapola review research like this, WHY THE FUCK AREN'T YOU PROVIDING RESEARCH THAT GETS SURVIVORS RECOVERED? Are your mentors and senior researchers that fucking incompetent? 

Send me hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind? I would like to know why you aren't creating research that gets survivors recovered!

You'll want 100% recovery when you become the 1 in 4 per WHO that has a stroke!). I'd suggest you start working on that now!

Repetitive peripheral magnetic stimulation alone or in combination with repetitive transcranial magnetic stimulation in poststroke rehabilitation: a systematic review and meta-analysis

• Yong Wang,
• Kenneth N. K. Fong,
• Youxin Sui,
• Zhongfei Bai &
• Jack Jiaqi Zhang 

Journal of NeuroEngineering and Rehabilitation volume 21, Article number: 181 (2024) Cite this article

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Abstract

Objective

This study aimed to comprehensively review the effects of repetitive peripheral magnetic stimulation (rPMS) alone or in combination with repetitive transcranial magnetic stimulation (rTMS) on improving upper limb motor functions and activities of daily living (ADL) in patients with stroke, and to explore possible efficacy-related modulators.

Methods

A literature search from 1st January 2004 to 1st June 2024 was performed to identified studies that investigated the effects of rPMS on upper limb motor functions and ADL in poststroke patients.

Results

Seventeen studies were included. Compared with the control, both rPMS alone or rPMS in combination with rTMS significantly improved upper limb motor function (rPMS: Hedge’s g = 0.703, p = 0.015; rPMS + rTMS: Hedge’s g = 0.892, p < 0.001) and ADL (rPMS: Hedge’s g = 0.923, p = 0.013; rPMS + rTMS: Hedge’s g = 0.923, p < 0.001). However, rPMS combined with rTMS was not superior to rTMS alone on improving poststroke upper limb motor function and ADL (Hedge’s g = 0.273, p = 0.123). Meta-regression revealed that the total pulses (p = 0.003) and the number of pulses per session of rPMS (p < 0.001) correlated with the effect sizes of ADL.

Conclusions

Using rPMS alone or in combination with rTMS appears to effectively improve upper extremity functional recovery and activity independence in patients after stroke. However, a simple combination of these two interventions may not produce additive benefits than the use of rTMS alone. Optimization of rPMS protocols, such as applying appropriate dosage, may lead to a more favourable recovery outcome in poststroke rehabilitation.

Introduction

Repetitive peripheral magnetic stimulation (rPMS) is a non-invasive therapeutic approach for facilitating motor recovery following neurological diseases, which was first proposed for the purpose of neurological rehabilitation in 1996 [1]. The rPMS technique employs focused magnetic pulses over various peripheral targets (e.g., muscles, nerves, or spinal roots) [2], and this technique induces repetitive contraction-relaxation cycles by depolarizing neurons [3] and then provides proprioceptive inputs to afferent fibers [4,5,6,7], therefore modulating sensorimotor plasticity. In the literature, rPMS is considered a unique, promising neuromodulation technique due to its advantage of providing more deeply penetrating, focused, painless stimulation than conventional electrical stimulation provides [5, 8, 9].

In 2023, rPMS was delivered using a transcranial magnetic stimulator, which was originally used for repetitive transcranial magnetic stimulation (rTMS), and has been approved by the US Food and Drug Administration for relieving chronic pain [10]. In poststroke rehabilitation, rPMS is different from rTMS in the neural mechanism - rTMS has been extensively used to facilitate motor recovery by modulating cortical plasticity in a top-down approach [11] whereas rPMS is adopting a bottom-up approach through recruitment of proprioceptive afferents thus up-regulate the excitability of the sensorimotor areas via the ascending pathway [2, 6]. Therefore, combining central and peripheral magnetic stimulation may produce a synergistic effect on the facilitation of motor recovery after stroke [12].

The effects of rPMS for motor function of the hemiplegic upper extremity or ADL after stroke have been reviewed in previous systematic reviews, which generally have reported positive effects of rPMS [2, 8, 13,14,15,16,17,18]. However, these reviews are not free from methodological limitations. Firstly, a few reviews did not perform meta-analysis to quantitively evaluate the treatment effects [2, 14, 18]. Secondly, in the previous meta-analytic reviews, no detailed subgroup analysis or meta-regression was performed to identify the influence of different stimulation protocols, patient demographics, or patients’ clinical profiles on the treatment effect sizes [8, 13, 15, 16]. Thirdly, some reviews covered a wide range of neurological disease conditions, so the specific effect of rPMS in stroke rehabilitation was still not conclusive [2, 17]. Lastly, these reviews did not systematically investigate the effect of rPMS alone or in combination with rTMS to elaborate the possible synergistic effect of the combined interventions [2, 8, 13,14,15,16,17,18].

Therefore, a comprehensive understanding of clinical effectiveness as well as neural mechanisms underlying the therapeutic benefits of using rPMS alone or in combination with rTMS in poststroke rehabilitation is needed. Here, our review aimed to: (1) investigate the effects of these two interventional methods (using rPMS alone or in combination with rTMS) on upper limb motor function and ADL in poststroke patients, using meta-analysis; (2) identify any significant relationship between various rPMS parameters, patient demographics, clinical characteristics, and effect sizes using subgroup analyses and meta-regression; and (3) clarify the mechanisms underlying the therapeutic effects of rPMS by qualitatively assessing rPMS studies using neuroimaging and/or neurophysiological outcomes.

Repetitive peripheral magnetic stimulation for improving upper limb function in post-stroke hemiparesis

 No clue how available this is at your hospital.

Repetitive peripheral magnetic stimulation for improving upper limb function in post-stroke hemiparesis

• Shereen Ismail Fawaz,
• Shin-Ichi Izumi,
• Amr Saeed Zaki,
• Shaimaa Elmetwally Eldiasty,
• Amr Saadawy,
• Heba Gamal eldin Saber,
• May Farouk Gadallah &
• Hossam Salaheldin Labib 

• Cite this article

Abstract

Background

Stroke is one of the leading causes of disability worldwide, with hand and arm weakness, affecting the patients’ daily activities and quality of life. Recently, repetitive peripheral magnetic stimulation (rPMS) was found to enhance neuroplasticity and motor recovery post-stroke hemiparesis via its deep proprioceptive stimulation and simulation of lost voluntary movement.

Objective

To determine the therapeutic effect of rPMS on the functional improvement of upper limb in patients with hemiparesis following cerebrovascular insult and to compare the effect of therapy in subacute and chronic cases.

Results

Post-rehabilitation program both the Fugl-Meyer-Upper Extremity scale (FM-UE) and Functional Independence Measures (FIM) scale showed highly significant improvement in the active group, compared to controls. Regarding active range of motion (AROM) of the shoulder abductors, triceps, wrist extensors and supinators, significant differences were also found in the active group in comparison to controls. Modified Ashworth scale showed also significant change in the active group. When dividing our patients according to the duration post-stroke, into subacute group (6 weeks to 6 months post-stroke) and chronic group (more than 6-month post-stroke), the subacute group showed significant improvements in the FM-UE scale, and in the AROM of wrist extensors and supinators but not in the chronic group. Ultrasonographic measurements showed a significant decrease in cross sectional area of the control group.

Conclusion

rPMS is potentially effective in improving motor recovery post-stroke, especially in the subacute stage.

Background

Stroke is one of the principal causes of disability worldwide. It is estimated that 25% to 75% of stroke survivors suffer from partial physical or cognitive disability. One of the most disabling post-stroke sequelae is hand and arm weakness, affecting the patient’s daily activities and quality of life [1].

As proven from previous researches, the timeline of recovery post-stroke is maximal in the subacute stage, and up to 6 months post-stroke. The earlier the initiation of effective rehabilitation, the better is the functional motor outcome. Any delay in initiation of effective rehabilitation requires more intensive protocols and longer durations of therapy in order to achieve the same functional improvements [2].

Over the past few decades, functional electric stimulation or neuromuscular stimulation (NMES) has proven to be a mean of augmenting neurological recovery, especially in the acute and subacute stages post-stroke [3]. However, its disadvantages include pain at high intensities, and relatively shallow penetration, causing insufficient stimulation of the deep, and/or the spastic muscles [4].

Several studies researched the effect of rPMS on motor recovery post-stroke [5,6,7,8] and is now considered as one of the most innovative therapeutic options in rehabilitation [9], causing selective stimulation of a nerve or a muscle as in NMES, but with a stronger, deeper and nearly painless penetration and, hence, more tolerable [10]. In many stroke cases, introducing repetitive transcranial magnetic stimulation (rTMS) in the acute and early subacute stages is potentially hazardous, especially cases of hemorrhagic strokes. This leaves rPMS and NMES as the best available options for reducing the possibility of learned non-use and maladaptive plasticity, which leads to long-term disability [2, 11,12,13,14].

Repetitive peripheral magnetic stimulation enhances proprioceptive afferent input by producing deep muscle stimulation which induces movement in muscles that have lost their central drive, simulating the lost voluntary action patterns. This results in cerebral activation and induction of plasticity [14]. This plastic cortical reorganization is considered the basis of motor relearning and adaptive plasticity [15, 16], contributing to the synergistic control of movements from different joints by integrating proprioception in motor drive [14]. In a study, Struppler et al. proved by positron emission tomography (PET) scan the influence of rPMS on upregulation of the ipsilesional sensorimotor and premotor areas, increasing cortical excitability and causing a symmetrical increase of cerebral blood flow. This increase was parallel to an increase in finger movement, in both amplitude and velocity [17]. In another study, Struppler et al., suggested that rPMS can reduce spasticity post-stroke, causing improvement in both the amplitude and velocity of movement and hence its dynamics [14]. Similar to NMES, it is proposed that rPMS can produce equivalent effects of preventing muscle atrophy [18].

Moreover, focal and deep stimulation are currently considered one of the merits of rPMS, when using the figure of eight coil. This study used it to stimulate the supinator muscle, which performs one of the distal forearm functions that is mostly missed in hemiplegic patients. This movement is crucial for object manipulation during ADLs [19].

The aim of this study was to determine the therapeutic effect of peripheral magnetic stimulation on functional improvement of the upper limb in patients with hemiparesis following cerebrovascular insult, and to compare the effect of therapy in subacute and chronic cases.

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