Effects of Neuromuscular Electrical Stimulation Combined with Repetitive Transcranial Magnetic Stimulation on Upper Limb Motor Function Rehabilitation in Stroke Patients with Hemiplegia

Abstract

Objective. To investigate the effect of neuromuscular electrical stimulation (NMES) combined with repetitive transcranial magnetic stimulation (rTMS) on upper limb motor dysfunction in stroke patients with hemiplegia. Methods. A total of 240 stroke patients with hemiplegia who met the inclusion criteria were selected and randomly divided into 4 groups (60 cases in each group): control group, NMES group, rTMS group, and NMES + rTMS group. Before treatment and 4 weeks after treatment, we evaluated and compared the results including Fugl-Meyer assessment of upper extremity (FMA-UE) motor function, modified Barthel index (MBI), modified Ashworth scale (MAS), and motor nerve electrophysiological results among the 4 groups. Results. Before treatment, there was no significant difference in the scores of FMA-UE, MBI, MAS, and motor nerve electrophysiological indexes among the four groups, with comparability. Compared with those before treatment, the scores of the four groups were significantly increased and improved after treatment. And the score of the NMES + rTMS group was notably higher than those in the other three groups. Conclusion. NMES combined with rTMS can conspicuously improve the upper extremity motor function and activities of daily life of stroke patients with hemiplegia, which is worthy of clinical application and promotion.

Effects of repetitive transcranial magnetic stimulation on upper-limb and finger function in stroke patients: A systematic review and meta-analysis of randomized controlled trials

“…In a subgroup analysis based on the rTMS method, a significant effect was noted in the rTMS group (21,26,28,33,34,36,59-62) (SMD, 0.48; 95% CI 0.21-0.76; P = 0.001) but not in TBS group (26,34,39,41,63) (SMD, 0.05; 95% CI −0.29-0.40; P = 0.76) (Supplementary Figure 4B and Table 2). Further, subgroup analysis based on rTMS frequency showed that 1 Hz rTMS (21,26,28,33,34,36,59-62) (SMD, 0.43; 95% CI 0.14-0.72; P = 0.004) produced better results than 3-10 Hz rTMS (33) (SMD, 0.23; 95% CI −0.59-1.06; P = 0.581) (Supplementary Figure 4C and Table 2).…”

“…Transcranial magnetic stimulation had a significant effect in patients with both severe baseline impairment (21,26,34,36,59,60,63) (SMD, 0.39; 95% CI 0.11-0.67; P = 0.006) and moderate baseline impairment (SMD, 0.34; 95% CI 0.03-0.65; P = 0.03) (Figure 2C and Table 2). In a subgroup analysis based on the rTMS method, a significant effect was noted in the rTMS group (21,26,28,33,34,36,59-62) (SMD, 0.48; 95% CI 0.21-0.76; P = 0.001) but not in TBS group (26,34,39,41,63) (SMD, 0.05; 95% CI −0.29-0.40; P = 0.76) (Supplementary Figure 4B and Table 2). Further, subgroup analysis based on rTMS frequency showed that 1 Hz rTMS (21,26,28,33,34,36,59-62) (SMD, 0.43; 95% CI 0.14-0.72; P = 0.004) produced better results than 3-10 Hz rTMS (33) (SMD, 0.23; 95% CI −0.59-1.06; P = 0.581) (Supplementary Figure 4C and Table 2).…”

“…Sub-studies were identified in sixteen studies. These studies included 2 (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31), 3 (32)(33)(34) and 4 experimental groups (35) (each group differed in terms of patient characteristics or TMS protocol) and indicated the FMA-UE scores respectively, for each subgroup separately. The mean age of patients varied from 51.0 to 74.0 years, and the mean age of controls ranged from 50.5 to 75.0 years.…”

“…Subgroup analyses revealed significant improvement on FMA-UE in individuals with post-stroke upper limb dysfunction in relation to stimulation site [unaffected side (21,26,28,33,34,36,(59)(60)(61)(62): SMD, 0.42, 95% CI 0.14-0.69; P = 0.003], but not the affected site (33,34,39,41,63) (SMD, 0.07, 95% CI−0.26-0.41; P = 0.67) or bilateral stimulation (28,33,34) (SMD, 0.56, 95% CI -−0.14-1.25; P = 0.116) (Supplementary Figure 4A and Table 2). Transcranial magnetic stimulation had a significant effect in patients with both severe baseline impairment (21,26,34,36,59,60,63) (SMD, 0.39; 95% CI 0.11-0.67; P = 0.006) and moderate baseline impairment (SMD, 0.34; 95% CI 0.03-0.65; P = 0.03) (Figure 2C and Table 2). In a subgroup analysis based on the rTMS method, a significant effect was noted in the rTMS group (21,26,28,33,34,36,59-62) (SMD, 0.48; 95% CI 0.21-0.76; P = 0.001) but not in TBS group (26,34,39,41,63) (SMD, 0.05; 95% CI −0.29-0.40; P = 0.76) (Supplementary Figure 4B and Table 2).…”

Therapeutic mechanism of transcranial iTBS on nerve regeneration and functional recovery in rats with complete spinal cord transection

“…As a non-invasive, safe, and easily accepted treatment technique, transcranial magnetic stimulation (TMS) has a wide effect on neural networks in the brain by altering the excitability of neurons [3][4][5][6][7] .…”