| Background and prupose: Stroke is a high incidence of middle-aged and elderly people in China,with a high disability rate,has become the leading cause of death and disability in China.Limb spasm is the main motor dysfunction after stroke,and improving its rehabilitation evaluation and treatment level is of great significance to improve the motor function of patients.Studies have found that the post-activation depression(PAD)decreased to a certain extent in patients with cerebral apoplexy,and the decline of PAD is positively correlated with the spasm state,which is more objective than single H reflex and has potential value for the evaluation of spasm.But there is little research and no validation.Repetitive transcranial magnetic stimulation(rTMS),as an extracranial neuromodulation technique,has been proved to be effective in relieving spasm after stroke,with the advantages of non-trauma and accurate positioning.High frequency rTMS can stimulate the cerebral cortex of the affected side and promote the connection between synapses,regulate the secretion of neurotransmitters and neurotrophic factors in brain tissues,improve blood circulation and glucose metabolism in the brain,creating favorable environmental conditions for changes in neuroplasticity.Based on the theory of neuroplasticity,this study used the combination of high-frequency rTMS and conventional rehabilitation therapy to treat upper limb spasm in patients with subacute stage of stroke to reconstruct the upper limb motor nerve pathway,and observed the improvement of spasm,change of PAD and improvement of motor function,and compared with conventional rehabilitation therapy alone.We explored the improvement effect of high-frequency rTMS on limb spasm and the influence of high-frequency rTMS on changes of PAD in patients with subacute stage of stroke,and we explored the correlation between PAD and spasm in patients with subacute stage of stroke,so as to verify its application value.Aimed To provide theoretical support for the evaluation and treatment of post-stroke spasm,Improve and enhance the motor function of patients with post-stroke spasm,and reduce the burden of family and society.Method: 46 patients were randomly divided into two groups,the high-frequency stimulation group(n=23)and the pseudo-stimulation group(n=23).All the patientswere tested for the stimulation threshold and the optimal stimulation site,and the stimulation site was selected for the M1 region of the cerebral hemisphere.The high-frequency stimulation group received high-frequency rTMS and routine rehabilitation treatment intervention,Before treatment,the stimulation coil was placed tangentially with the skull,and the stimulation frequency was 5Hz,and the stimulation intensity was 80-120% of the resting motion threshold.The single stimulation time was 20 min.Routine rehabilitation treatment included: health guidance,limb placement,muscle drafting training,muscle strength training,operation treatment,neurodevelopmental therapy,etc.The treatment time was about120 min.While the pseudo-stimulation group received fake rTMS and routine rehabilitation treatment intervention,the stimulation coil in the pseudo-stimulation group was placed perpendicular to the section of the skull,stimulating the sound in high-frequency stimulation group but do not stimulated by rTMS,and the stimulation parameters were the same as those in the high-frequency stimulation group,and the routine rehabilitation treatment was consistent between the two groups.The intervention was once a day,5 times a week,for a total of 4 weeks.The patients were evaluated by neuroelectrophysiological evaluation and scale evaluation before and after the intervention.Neuroelectrophysiological measures included PAD detection,motor evoked potential(MEP)latency and CMCT detection,to observe the changes of patients’ nerve function;.Scale evaluation included modified Ashworth scale(MAS),muscle strength assessment of upper limbs and hands,upper Fugl-Meyer assessment(U-FMA),modified Barthel index(MBI),and Brunnstrom stage of upper limbs,to observe the changes of patients’ motor function.SPSS 23.0 statistical analysis software was used for the intervention results,and P < 0.05 was considered statistically significant.Results1.There was no significant difference in patients’ basic information(P >0.05),Clinically comparable.2.High frequency rTMS stimulation of the affected side of the brain had no significant effect on the latency of MEP and CMCT in the healthy side of the brain(p>0.05).The MEP ejection rate of the affected side increased in the high-frequency stimulation group,while the MEP ejection rate of the pseudo-stimulation group did not change.Shows that high-frequency rTMS can increase the extraction rate of MEP on the affected side brain and has no adverse effects on the unaffected side brain.3.The MAS scores of the flexor group of the elbow and the flexor group of the wrist in the high-frequency stimulation group were not increased(p >0.05),the MAS scores of the flexor group of the elbow in the pseudo-stimulation group were significantly increased(p <0.05),and the MAS scores of the flexor group of the wrist were not significantly increased(p >0.05).The muscle tension of flexor group of elbow and flexor group of wrist in the pseudo-stimulation group increased significantly compared with that in the high-frequency stimulation group(p <0.05).Shows that high-frequency rTMS combined with conventional rehabilitation is superior to simple conventional rehabilitation in inhibiting the increase of muscle tone in subacute stage of stroke.4.There was no significant decrease in upper limb PAD in the high-frequency stimulation group(p >0.05).In the pseudo-stimulation group,the upper limb PAD decreased significantly(p <0.05).The decrease of PAD in the high-frequency stimulation group was smaller than that in the pseudo-stimulation group,and the inhibitory effect of PAD in the high-frequency stimulation group was better than that in the pseudo-stimulation group(p<0.05).Shows that high-frequency rTMS combined with conventional rehabilitation is better than simple conventional rehabilitation in slowing down the decrease of PAD in subacute stage of stroke.5.Muscle strength of the flexor group of the shoulder,flexor group of the elbow,flexor group of the wrist and grasping muscle group of the hand in the two groups increased significantly compared with that before the intervention(p <0.05).The muscle strength of flexor group of shoulder,flexor group of elbow,flexor group of wrist and grasping muscle group of high frequency stimulation group was better than that of pseudo-stimulation group(p <0.05).6.The Brunnstrom stage of the upper limb and hand in the high-frequency stimulation group was significantly improved compared with that before(p <0.05).There was no significant improvement in Brunnstrom stage of upper limb and hand in the pseudo-stimulation group(p >0.05).The Brunnstrom stage improvement in the upper limb and hand of the high frequency stimulation group was better than that of the pseudo-stimulation group(p <0.05).7.U-FMA scores in both groups were significantly improved(p <0.05).The improvement of U-FMA score in the high frequency stimulation group was better than that in the pseudo-stimulation group(p <0.05).8.MBI scores in both groups were significantly improved(p <0.05),and MBI scores in the high-frequency group were significantly improved compared with those in the pseudo-stimulation group(p <0.05).9.Before the intervention,the upper limb PAD was negatively correlated with the MAS scores of the flexor group of the elbow and the flexor group of the wrist(p<0.05),after the intervention,the upper limb PAD was negatively correlated with the MAS scores of the flexor group of the elbow and the flexor group of the wrist(p<0.05).The decreased level of PAD was positively correlated with the degree of spasm,and the smaller the PAD,the more severe the spasm.Conclusion1.In the subacute stage of stroke,high-frequency rTMS can effectively inhibit the increase of upper limb muscle tone in patients,slow down the aggravation of spasm,improve the motor function of upper limb,and improve activities of daily living of patients with spasm.2.High-frequency rTMS can effectively slow down the decline of PAD in patients with subacute stage of stroke.3.The decrease of PAD is positively correlated with the increase of muscle tone,which has potential value for the evaluation of spasm and can play a guiding role in clinical and scientific research.4.High-frequency rTMS is safe and feasible in the subacute stage of stroke. |
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