Effect of repetitive transcranial magnetic stimulation combined with robot-assisted gait training on lower limb motor function in ischemic stroke patients
Objective To investigate the effects of repetitive transcranial magnetic stimulation(rTMS)combined with robot-assisted gait training(RAGT)on motor,balance,and walking function of lower limb in patients with ischemic stroke.Methods Ischemic stroke patients admitted to the Department of Rehabilitation Medicine,Nantong First People's Hospital were prospectively included from December 2022 to September 2023.According to random number table method,patients meeting the inclusion and exclusion criteria were divided into the control group,rTMS group,RAGT group,and combination group,with 21 cases in each group.The 4 groups of ischemic stroke patients received routine rehabilitation therapy after the condition stabilized,including muscle strength training,transfer training,sit-stand balance training,walking training,daily activity ability training,physical factor therapy,once a day,5 days a week,lasting for 3 weeks.Patients in rTMS group were given rTMS on the basis of routine rehabilitation therapy,with each pulse frequency of 1 Hz/s,lasting for 12 s,with a 2 s interval,totaling 1 200 pulses and 1 400 s in accumulation;1 400 s per session,once a day,5 days a week,lasting for 3 weeks.Patients in RAGT group were given RAGT on the basis of routine rehabilitation therapy,30 min per session,once a day,5 days a week,lasting for 3 weeks.On the basis of routine rehabilitation therapy,the combination group were received RAGT immediately after rTMS treatment,using the same methods as single rTMS or RAGT.The lower limb motor function,balance function,range of motion,and walking function of the four groups of patients were assessed before and after treatment using the Fugl-Meyer assessment for lower extremity(FMA-LE),Berg balance scale(BBS),range of motion,and the Holden walking ability grading.Results(1)There were no statistically significant differences in terms of sex,age,lesion site,course of disease,and Brunnstrom stage of the affected lower limb among the four groups(all P＞0.05).(2)Before treatment,the FMA-LE scores for the control group,rTMS group,RAGT group,and combined group were(14.4±2.9),(13.6±3.0),(13.5±2.8),and(14.3±3.0)points,respectively.After treatment,the FMA-LE scores for the control group,rTMS group,RAGT group,and combined group were(20.4±2.4),(23.1±3.1),(22.8±2.4),and(27.1±3.4)points,respectively.There were statistically significant differences in the main effects of time,group,and the interaction effect of group and time for FMA-LE scores among the four groups(F values were 1 083.102,6.535,23.522,respectively;all P＜0.01).Compared to before treatment,FMA-LE scores in 4 groups were increased after treatment(all P＜0.05).After treatment,the FMA-LE scores of the rTMS group,RAGT group,and combined group were higher than those of the control group,and the combined group had higher scores than the rTMS group and RAGT group(all P＜0.05).(3)Before treatment,the BBS scores for the control group,rTMS group,RAGT group,and combined group were(25±5),(25±6),(25± 6),and(26±6)points,respectively.After treatment,the BBS scores for the control group,rTMS group,RAGT group,and combined group were(30±5),(34±6),(35±6),and(43±6)points,respectively.There were statistically significant differences in the main effects of time,group,and the interaction effect of time and group for BBS scores among the four groups(F values were 1 057.204,6.377,59.140,respectively;all P＜0.01).Compared to those before treatment,BBS scores in 4 groups were increased after treatment(all P＜0.05).After treatment,the BBS scores of the rTMS group,RAGT group,and combined group were higher than those of the control group,and the combined group had higher scores than the rTMS group and RAGT group(all P＜0.05).(4)Before treatment,the anteroposterior range of motion scores for the control group,rTMS group,RAGT group,and combined group were(7.3±0.8),(7.4±0.8),(7.4±0.8),and(7.6±0.7)points,respectively.After treatment,the anteroposterior range of motion scores were(8.8±0.7),(9.3±0.7),(9.4±0.7),and(9.9±0.6)points,respectively.Before treatment,the left-right range of motion scores for the control group,rTMS group,RAGT group,and combined group were(7.1±0.7),(7.2±0.8),(7.2±0.8),and(7.3±0.7)points,respectively.After treatment,they were(8.3±0.8),(8.9±0.9),(9.0±0.9),and(9.7±0.8)points,respectively.There were statistically significant differences in the main effects of time,group,and the interaction effect of group and time for both anteroposterior and left-right range of motion scores among the four groups(anteroposterior:F values were 818.773,3.834,6.075,respectively;left-right:F values were 1 935.147,3.114,40.516,respectively;all P＜0.05).Compared to before treatment,anteroposterior and left-right range of motion scores in 4 groups were increased after treatment(all P＜0.05).After treatment,the rTMS group,RAGT group,and combined group had higher scores than the control group,with the combination group had higher scores than the rTMS group and RAGT group(all P＜0.05).(5)rTMS and time(OR,1.948,95％CI 1.465-2.590),RAGT and time(OR,2.043,95％CI 1.529-2.728),and the interaction effect of the combination group and time(OR,4.376,95％CI 3.116-6.146)all showed statistically significant differences(all P＜0.01).Compared to the baseline grading before treatment,all four groups of patients showed an improvement in Holden walking grading after treatment,with statistically significant differences(OR,1.948,95％CI 1.592-2.383,P＜0.01).Using the control group as a reference,there was no significant difference in the main effect of Holden walking ability grading among rTMS group,RAGT group and combined group(all P＞0.05).Conclusion The combination of rTMS and RAGT can significantly improve the recovery of lower limb motor function,balance function,and walking ability in patients with ischemic stroke.
Robot-assisted gait trainingTranscranial magnetic stimulationStrokeLower limb
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