重复经颅磁刺激对恢复期脑卒中患者步行的效果

doi:10.3969/j.issn.1006-9771.2023.02.005

Abstract

Abstract:

Objective To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) on walking function of stroke patients at recovery stage. Methods From January, 2021 to January, 2022, 60 stroke inpatients at recovery stage from Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine were randomly divided into group A (n = 20), group B (n = 20) and group C (n = 20). All the groups accepted conventional rehabilitation therapy and lower limb robot-assisted training, while group B accepted pseudo-rTMS, and group C accepted high-frequency rTMS, for four weeks. They were assessed with Fugl-Meyer Assessment-Lower Extremities (FMA-LE), Timed 'Up and Go' Test (TUGT) and gait analysis before and after treatment. Results The score of FMA-LE, TUGT, pace, stride width, stride, double support phase time, affected side support phase time, affected side swing phase time, healthy side support phase time and healthy side swing phase time improved after treatment in all the groups (|t| > 5.990, P < 0.001), and all the indexes improved the most in group C (F > 3.210, P < 0.05), except double support phase time. Conclusion High-frequency rTMS could facilitate the recovery of lower limb function and walking of stroke patients at recovery stage.

Key words: stroke, walking, repetitive transcranial magnetic stimulation, lower limb robot

CLC Number:

R743.3

MA Qishou, LI Zhongyuan, FU Weiwei, LIN Qian. Effect of repetitive transcranial magnetic stimulation on walking of stroke patients at recovery stage[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(2): 167-173.

Figures/Tables 11

References 34

[1]	DAI S, PISCICELLI C, CLARAC E, et al. Balance, lateropulsion, and gait disorders in subacute stroke[J]. Neurology, 2021, 96(17): 2147-2159.
[2]	潘毓健, 徐国会, 郑洁皎, 等. 本体感觉神经肌肉促进技术对脑卒中患者平衡功能的影响[J]. 中国康复理论与实践, 2012, 18(1): 22-24.
	PAN Y J, XU G H, ZHENG J J, et al. Effects of proprioceptive neuromuscular facilitation on balance function in stroke patients[J]. Chin J Rehabil Theory Pract, 2012, 18(1): 22-24.
[3]	VAN BLOEMENDAAL M, BUS S A, NOLLET F, et al. Feasibility and preliminary efficacy of gait training assisted by multichannel functional electrical stimulation in early stroke rehabilitation: a pilot randomized controlled trial[J]. Neurorehabil Neural Repair, 2021, 35(2): 131-144. doi: 10.1177/1545968320981942 pmid: 33410388
[4]	李宏伟, 张韬, 冯垚娟, 等. 外骨骼下肢康复机器人在脑卒中康复中的应用进展[J]. 中国康复理论与实践, 2017, 23(7): 788-791.
	LI H W, ZHANG T, FENG Y J, et al. Application progress of exoskeleton lower limb rehabilitation robot in stroke rehabilitation[J]. Chin J Rehabil Theory Pract, 2017, 23(7): 788-791.
[5]	MINKES-WEILAND S, REINDERS-MESSELINK H A, BOONSTRA A M, et al. Effects of asymmetrical support on lower limb muscle activity during Lokomat guided gait in persons with a chronic stroke: an explorative study[J]. Eur J Phys Rehabil Med, 2022, 58(5): 693-700.
[6]	肖长林, 潘翠环, 陈艳, 等. 不同频率高频重复经颅磁刺激对缺血性脑卒中患者上肢功能的效果[J]. 中国康复理论与实践, 2019, 25(5): 557-563.
	XIAO C L, PAN C H, CHEN Y, et al. Effects of high-frequency repetitive transcranial magnetic stimulation in different frequencies on upper limb function after ischemic stroke[J]. Chin J Rehabil Theory Pract, 2019, 25(5): 557-563.
[7]	陶峰, 王传杰, 陈本梅, 等. 低频重复经颅磁刺激联合镜像疗法对脑卒中偏瘫患者下肢运动功能及平衡能力的影响[J]. 中国康复医学杂志, 2022, 37(5): 611-615, 622.
	TAO F, WANG C J, CHEN B M, et al. Effects of low frequency repetitive transcranial magnetic stimulation combined with mirror therapy on lower limb motor function and balance in stroke patients with hemiplegia[J]. Chin J Rehabil Med, 2022, 37(5): 611-615, 622.
[8]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国各类主要脑血管病诊断要点2019[J]. 中华神经科杂志, 2019, 52(9): 710-715.
	Chinese Society of Neurology, Chinese Stroke Society. Diagnostic Criteria of Cerebrovascular Disease in China (version 2019)[J]. Chin J Neurol, 2019, 52(9): 710-715.
[9]	高玉玲, 刘勇, 宫晓洋. 重复经颅磁刺激治疗脑卒中后下肢运动功能障碍的机制及应用研究进展[J]. 中华神经医学杂志, 2022, 21(8): 847-852.
	GAO Y L, LIU Y, GONG X Y. Recent advance in application and mechanism of repetitive transcranial magnetic stimulation in lower limb motor function after stroke[J]. Chin J Neuromed, 2022, 21(8): 847-852.
[10]	林源, 钮美娥, 王丽. 脑卒中患者平衡功能评定方法的应用进展[J]. 中国康复理论与实践, 2016, 22(6): 667-671.
	LIN Y, NIU M E, WANG L. Advancement of balance function assessment for stroke patients (review)[J]. Chin J Rehabil Theory Pract, 2016, 22(6): 667-671.
[11]	CHAN P P, SI TOU J I, TSE M M, et al. Reliability and validity of the Timed Up And Go Test with a motor task in people with chronic stroke[J]. Arch Phys Med Rehabil, 2017, 98(11): 2213-2220. doi: 10.1016/j.apmr.2017.03.008
[12]	胡雪艳, 恽晓平, 张通. 基于数字视频和数字图像处理的步态分析在卒中康复训练中的应用[J]. 中国脑血管病杂志, 2009, 6(9): 456-460.
	HU X Y, YUN X P, ZHANG T. Application of gait analysis based on digital video and digital image processing in stroke rehabilitation training[J]. Chin J Cerebrovas Dis, 2009, 6(9): 456-460.
[13]	MORENO-SEGURA N, MARTIN-SAN AGUSTIN R, GARCIA-BAFALLUY S, et al. Effects of core training on trunk function, balance, and gait in stroke patients: a systematic review and meta-analysis of randomised controlled trials[J]. Clin Rehabil, 2022, 36(12): 1635-1654. doi: 10.1177/02692155221117220
[14]	THIMABUT N, YOTNUENGNITY P, CHAROENLIMPRASERT J, et al. Effects of the robot-assisted gait training device plus physiotherapy in improving ambulatory functions in patients with subacute stroke with hemiplegia: an assessor-blinded, randomized controlled trial[J]. Arch Phys Med Rehabil, 2022, 103(5): 843-850. doi: 10.1016/j.apmr.2022.01.146
[15]	张玉婷, 汪杰, 吕雪莹, 等. 跑台扰动训练对脑卒中偏瘫患者平衡功能及跌倒风险的影响[J]. 中国康复医学杂志, 2022, 37(5): 636-641.
	ZHANG Y T, WANG J, LÜ X Y, et al. Effects of treadmill-based perturbation training on balance function and fall risk in stroke patients with hemiplegia[J]. Chin J Rehabil Med, 2022, 37(5): 636-641.
[16]	FAN H, SONG Y, CEN X, et al. The effect of repetitive transcranial magnetic stimulation on lower-limb motor ability in stroke patients: a systematic review[J]. Front Hum Neurosci, 2021, 15(1): 1-2.
[17]	BARONCHELLI F, ZUCCHELLA C, SERRAO M, et al. The Effect of robotic assisted gait training with Lokomat^® on balance control after stroke: systematic review and meta-analysis[J]. Front Neurol, 2021, 12: 661815. doi: 10.3389/fneur.2021.661815
[18]	解二康, 李策, 陆蓉蓉, 等. 骨盆减重康复机器人训练对脑卒中后偏瘫患者下肢功能的影响[J]. 中国康复, 2020, 35(8): 404-408.
	XIE E K, LI C, LU R R, et al. Effects of weight bearing robot assisted training on the lower limb function of hemiplegic patients following stroke[J]. Chin J Rehabil, 2020, 35(8): 404-408.
[19]	刘畅, 郄淑燕, 王寒明, 等. 下肢康复机器人对脑卒中偏瘫患者下肢运动功能与步行能力的效果[J]. 中国康复理论与实践, 2017, 23(6): 696-700.
	LIU C, QIE S Y, WANG H M, et al. Effect of robot-assisted gait training on lower limb motor function and gait ability in patients with hemiplegia after stroke[J]. Chin J Rehabil Theory Pract, 2017, 23(6): 696-700.
[20]	MATJACIC Z, ZADRAVEC M, OLENSEK A. Feasibility of robot-based perturbed-balance training during treadmill walking in a high-functioning chronic stroke subject: a case-control study[J]. J Neuroeng Rehabil, 2018, 15(1): 32. doi: 10.1186/s12984-018-0373-z pmid: 29642921
[21]	李敏, 瓮长水, 毕素清, 等. 计时"起立-行走"测验评估脑卒中患者功能性步行能力的信度和同时效度[J]. 中国临床康复, 2004, 8(31): 6819-6821.
	LI M, WENG C S, BI S Q, et al. Timed "Up-Go" Test for evaluating the reliability and concurrent validity of walking function in stroke patients[J]. Chin J Clin Rehabil, 2004, 8(31): 6819-6821.
[22]	OSOBA M Y, RAO A K, AGRAWAL S K, et al. Balance and gait in the elderly: a contemporary review[J]. Laryngoscope Investig Otolaryngol, 2019, 4(1): 143-153. doi: 10.1002/lio2.252 pmid: 30828632
[23]	OLNEY S J, RICHARDS C. Hemiparetic gait following stroke. Part I: Characteristics[J]. Gait Posture, 1996, 4(2): 136-148. doi: 10.1016/0966-6362(96)01063-6
[24]	吴少璞, 李学, 祁亚伟, 等. 重复经颅磁刺激联合动作观察疗法对脑卒中患者运动及认知功能恢复的影响[J]. 中华物理医学与康复杂志, 2022, 44(1): 35-39.
	WU S P, LI X, QI Y W, et al. Combining transcranial magnetic stimulation with action observation therapy better improves the neurological functioning of stroke survivors[J]. Chin J Phys Med Rehabil, 2022, 44(1): 35-39.
[25]	韩茜茜, 徐宁, 王秀秀, 等. 强制性运动疗法联合重复经颅磁刺激对脑卒中患者上肢运动功能的影响[J]. 中华物理医学与康复杂志, 2020, 42(12): 1067-1071.
	HAN Q Q, XU N, WANG X X, et al. Constraint-induced movement therapy combined with repetitive transcranial magnetic stimulation can improve upper extremity motor function after stroke[J]. Chin J Phys Med Rehabil, 2020, 42(12): 1067-1071.
[26]	王璐, 钟明华, 高呈飞, 等. 基于双峰平衡恢复模型探究重复经颅磁刺激治疗脑卒中患者上肢运动功能障碍[J]. 中华物理医学与康复杂志, 2022, 44(6): 503-508.
	WANG L, ZHONG M H, GAO C F, et al. Corticospinal tract integrity and the upper limb functioning of stroke survivors treated with repetitive transcranial magnetic stimulation[J]. Chin J Phys Rehabil, 2022, 44(6): 503-508.
[27]	XIE Y J, CHEN Y, TAN H X, et al. Repetitive transcranial magnetic stimulation for lower extremity motor function in patients with stroke: a systematic review and network meta-analysis[J]. Neural Regen Res, 2021, 16(6): 1168-1176. doi: 10.4103/1673-5374.300341
[28]	CHIEFFO R, GIASIDES F, SANTANGELO R, et al. Repetitive transcranial magnetic stimulation with H-coil coupled with cycling for improving lower limb motor function after stroke: an exploratory study[J]. Neuromodulation, 2021, 24(5): 916-922. doi: 10.1111/ner.13228
[29]	田飞, 赵晨光, 孙晓龙, 等. 末端驱动型下肢机器人联合高频重复经颅磁刺激改善恢复期脑卒中患者步行功能的临床研究[J]. 中国康复医学杂志, 2020, 35(8): 980-982.
	TIAN F, ZHAO C G, SUN X L, et al. Clinical study of end-driven lower limb robot combined with high-frequency repetitive transcranial magnetic stimulation to improve walking function in patients recovering from stroke[J]. Chin J Rehabil Med, 2020, 35(8): 980-982.
[30]	董心, 郑洁皎, 朱婷, 等. 重复经颅磁刺激治疗脑卒中患者上肢运动功能障碍的研究进展[J]. 中国康复理论与实践, 2020, 26(9): 1024-1027.
	DONG X, ZHENG J J, ZHU T, et al. Research progress of repetitive transcranial magnetic stimulation in the treatment of upper limb motor dysfunction in stroke patients[J]. Chin J Rehabil Theory Pract, 2020, 26(9): 1024-1027.
[31]	GONG Y, LONG X M, XU Y, et al. Effects of repetitive transcranial magnetic stimulation combined with transcranial direct current stimulation on motor function and cortex excitability in subacute stroke patients: a randomized controlled trial[J]. Clin Rehabil, 2021, 35(5): 718-727. doi: 10.1177/0269215520972940 pmid: 33222502
[32]	LOW T A, LINDLAND K, KIRTON A, et al. Repetitive transcranial magnetic stimulation (rTMS) combined with multi-modality aphasia therapy for chronic post-stroke non-fluent aphasia: a pilot randomized sham-controlled trial[J]. Brain Lang, 2022, 236: 105216. doi: 10.1016/j.bandl.2022.105216
[33]	DOS SANTOS R B C, GALVAO S C B, FREDERICO L M P, et al. Cortical and spinal excitability changes after repetitive transcranial magnetic stimulation combined to physiotherapy in stroke spastic patients[J]. Neurol Sci, 2019, 40(6): 1199-1207. doi: 10.1007/s10072-019-03765-y pmid: 30852696
[34]	MILLER K J, GALLINA A, NEVA J L, et al. Effect of repetitive transcranial magnetic stimulation combined with robot-assisted training on wrist muscle activation post-stroke[J]. Clin Neurophysiol, 2019, 130(8): 1271-1279. doi: S1388-2457(19)30859-4 pmid: 31163373

组别	n	性别(男/女)/n	年龄/岁	偏瘫侧(左/右)/n	卒中类型(梗死/出血)/n	病程/d
A组	20	13/7	54.85±5.65	11/9	7/13	47.50±5.62
B组	20	10/10	56.10±5.92	9/11	10/10	49.65±6.14
C组	20	9/11	56.75±7.07	12/8	13/7	50.65±5.47
χ²/F值		1.741	0.478	0.938	3.600	1.566
P值		0.419	0.622	0.626	0.165	0.218

组别	n	治疗前	治疗后	t值	P值
A组	20	13.90±1.77	20.90±2.51	-13.927	< 0.001
B组	20	14.20±2.26	21.45±2.35	-15.826	< 0.001
C组	20	14.35±1.93	26.95±2.86^a,b	-24.043	< 0.001
F值		0.107	33.604
P值		0.899	< 0.001

组别	n	治疗前	治疗后	t值	P值
A组	20	30.66±3.14	23.15±2.90	21.597	< 0.001
B组	20	31.95±3.32	24.04±2.14	17.579	< 0.001
C组	20	29.98±4.01	19.68±3.04^a,b	16.683	< 0.001
F值		1.638	14.396
P值		0.203	< 0.001

组别	n	治疗前	治疗后	t值	P值
A组	20	35.71±5.82	49.47±6.41	-9.730	< 0.001
B组	20	34.07±6.46	48.21±6.04	-16.647	< 0.001
C组	20	34.86±6.23	54.60±5.91^a,b	-17.228	< 0.001
F值		0.353	6.109
P值		0.704	0.004

组别	n	治疗前	治疗后	t值	P值
A组	20	22.63±6.10	18.26±4.98	7.268	< 0.001
B组	20	21.81±5.89	17.07±4.19	9.296	< 0.001
C组	20	23.24±6.00	14.42±3.61^a	9.938	< 0.001
F值		0.288	4.186
P值		0.751	0.020

Effect of repetitive transcranial magnetic stimulation on walking of stroke patients at recovery stage

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 11

References 34

Related Articles 15

Metrics

Comments

Recommended 0

组别	n	治疗前	治疗后	t值	P值
A组	20	46.88±5.31	53.50±8.69	-6.899	< 0.001
B组	20	47.43±5.28	54.26±8.76	-6.661	< 0.001
C组	20	49.65±5.40	60.05±9.36^a,b	-10.236	< 0.001
F值		1.516	3.210
P值		0.228	0.048

组别	n	治疗前	治疗后	t值	P值
A组	20	44.19±9.09	39.48±6.67	7.119	< 0.001
B组	20	45.13±8.56	38.67±4.86	5.990	< 0.001
C组	20	47.85±8.07	35.64±7.20	10.991	< 0.001
F值		0.981	2.047
P值		0.381	0.139

组别	n	治疗前	治疗后	t值	P值
A组	20	71.07±6.59	67.49±5.13	6.258	< 0.001
B组	20	73.09±7.34	68.04±5.42	9.844	< 0.001
C组	20	71.41±5.05	63.78±5.71^a,b	16.536	< 0.001
F值		0.570	3.643
P值		0.569	0.032

组别	n	治疗前	治疗后	t值	P值
A组	20	28.93±6.59	32.51±5.13	-6.258	< 0.001
B组	20	26.92±7.34	31.97±5.42	-9.844	< 0.001
C组	20	28.60±5.05	36.22±5.71^a,b	-16.536	< 0.001
F值		0.570	3.643
P值		0.569	0.032

组别	n	治疗前	治疗后	t值	P值
A组	20	78.48±4.56	72.31±5.07	9.479	< 0.001
B组	20	79.43±4.99	73.13±4.29	11.966	< 0.001
C组	20	80.33±5.79	68.60±5.84^a,b	16.288	< 0.001
F值		0.649	4.474
P值		0.527	0.016

组别	n	治疗前	治疗后	t值	P值
A组	20	21.52±4.56	27.70±5.07	-9.479	< 0.001
B组	20	20.57±4.99	26.87±4.29	-11.966	< 0.001
C组	20	19.67±5.79	31.41±5.84^a,b	-16.288	< 0.001
F值		0.649	4.474
P值		0.527	0.016

[1]	ZHU Lili, ZHAO Jiaxin, CHENG Xue, WANG Huijuan, CHEN Xiaoxia. Experiences and needs of stroke patients during rehabilitation: a qualitative meta-synthesis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(3): 286-293.
[2]	LIU Ping, ZHOU Nan, XUE Xiaojie, SHAO Weibo. Application of rehabilitation therapy techniques for post-stroke dysphagia: a bibliometric analysis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(3): 294-303.
[3]	YANG Ling, WANG Qinglei, WANG Jie, XU Wenjie, WANG Tong, GUO Chuan, QIAN Xue. Activation patterns and mechanism in the prefrontal cortex of post-stroke anxiety patients: a study using functional near-infrared spectroscopy [J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(3): 329-336.
[4]	YUE Yuan, ZHANG Tong, LIU Yuanmin, WANG Ya'nan. Effect of lower extremity exoskeleton robots on balance and walking function of patients with post-stroke cerebellar ataxia [J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(1): 23-29.
[5]	WU Cheng, ZHANG Yunfeng, WANG Weining, YU Kewei, ZHANG Yanzheng, SHEN Jiarong, WU Yi. Effect of elbow-wrist functional orthosis on plantar pressure and balance function in stroke patients with hemiplegia [J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(1): 30-39.
[6]	ZHANG Junfeng, CHEN Hao, DU Yuzheng, LI Chen, YU Tao, YANG Yuanqing. Non-pharmacological management for post-stroke spasticity from 2004 to 2024: a bibliometric analysis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(1): 45-58.
[7]	GAO Kaixiang, LU Haitao. Research in neurorehabilitation from 2015 to 2024: a bibliometric analysis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(1): 59-68.
[8]	WEI Jingyi, WANG Xiaojing, WANG Ran, WEI Chen, MA Sai, LIU Xihua. Effect of acupuncture synchronized speech training on post-stroke motor aphasia [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(9): 1000-1008.
[9]	WANG Xiaojing, WEI Jingyi, WEI Chen, WANG Ran, MA Sai, LIU Xihua. Effect of synchronous acupuncture and articulation training on spastic dysarthria after stroke [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(9): 1009-1016.
[10]	ZHOU Xinyue, YE Ruixue, MA Yaqi, XU Ying, CAO Longyao, WANG Yulong. Researches on central post-stroke pain: a bibliometric analysis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(9): 1038-1049.
[11]	GAO Yunhan, HOU Shanshan, WANG Xinyu, ZHU Chongtian. Effect of brain-computer interface on upper limb motor dysfunction in stroke patients based on functional near-infrared spectroscopy [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(9): 1066-1073.
[12]	GAO Fei, LIU Lixu, HU Xueyan, WU Xiaoli, YANG Lingyu, YANG Yuqi, YE Changqing, DU Xiaoxia. Effect of unilateral or bilateral transcranial direct current stimulation on post-stroke dysphagia [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(9): 993-999.
[13]	ZHANG Ziang, CHEN Jing, SHEN Mengru, GENG Zongxiao, HAN Xue, ZHAO Xu, XU Lei. Comparison of effect of different types of exercise on gait and balance for stroke patients [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(8): 896-905.
[14]	WANG Xiaofeng, HU Mengqiao, WANG Yan, WEI Kun, XU Wenzhu, REN Dan, MA Ye. Effect of exoskeleton robot-assisted gait training on lower limb function after stroke and spinal cord injury: a systematic review [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(8): 914-921.
[15]	ZHANG Zihan, GUAN Jinzhi, HUANG Xing, ZHOU Li, ZHANG Yaxuan, ZHANG Mengyuan, CHANG Jingling. Characteristics of time-domain and time-frequency of Chinese word-picture matching task-related electroencephalogram in patients with post-stroke aphasia [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(8): 947-957.