The Clinical Study Of Repetitive Transcranial Magnetic Stimulation Combined With Deep Muscle Stimulator For Upper Limb Spasm Post Stroke

Objective:To observe the clinical efficacy of routine rehabilitation therapy,repetitive transcranial magnetic stimulation（rTMS）,deep muscle stimulator（DMS）,rTMS combined with DMS in the treatment of upper limb spasm after stroke by collecting clinical data,to compare the difference of the clinical effects among the four treatments,to investigate the influence of rTMS combined with DMS on patients with upper limb spasm after stroke,to provide a reference of therapy method in upper limb spasm after stroke for clinical treatment.Medthods:Patients with upper limb spasm after stroke who met the inclusion criteria were stochastically divided into routine rehabilitation therapy group,rTMS group,DMS group,rTMS combined with DMS group,20 cases in each group.The routine rehabilitation therapy group was treated with routine rehabilitation therapy,each treatment time was 60 minutes,once a day,5 times a week for 4 weeks;and the rTMS group was treated with rTMS on the basis of the routine rehabilitation therapy,each stimulation time was 20 minutes,once a day,5 times a week for 4 weeks;the DMS group was treated with DMS on the basis of the routine rehabilitation therapy,each stimulation time was 10 minutes,once a day,5 times a week for 4weeks;while the combination group was treated with rTMS combined with DMS on the basis of the routine rehabilitation therapy,that was,rTMS was given once a day for 20 minutes and DMS for 10 minutes,5 times a week for4 weeks.The changes of modified barthel index（MBI）,fugl-meyer assessment upper extremity scale（FMA-UE）,modified ashworth scale（MAS）,cerebral oxyhemoglobin（O₂Hb）concentration were observed and recorded before and after treatment for 4 weeks,IBM SPSS Statistic 26.0 was applied to analyze data.Results:There was a comparability,because there were not statistical significance in gender,age,course of disease,stroke type,hemiplegic side and other basic data of the four groups of patients（P>0.05）.Before treatment,there were no significant differences in MBI score,FMA-UE score,MAS score and cerebral O₂Hb concentration among the four groups（P>0.05）.Four weeks after treatment,MBI score,FMA-UE score,MAS score and cerebral O₂Hb concentration in four group showed obvious improvement compared with those before treatment（P<0.01）,and the difference was statistically significant.Comparison among groups of four weeks after treatment,in terms of MBI,FMA-UE,MAS score,the treatment effect of rTMS combined with DMS group was better than the other three groups（P<0.008）,and the difference was statistically significant.In the space of cerebral O₂Hb concentration S score,the therapeutic effect of rTMS group,DMS group and rTMS combined with DMS group was superior to that of routine rehabilitation therapy group（P<0.012）,the difference was statistically significant;the therapeutic effect of rTMS combined with DMS group was better than that of rTMS group（P<0.007）,and the difference was statistically significant.In the space of cerebral O₂Hb concentration mean,the therapeutic effect of rTMS group,DMS group and rTMS combined with DMS group was superior to that of routine rehabilitation therapy group（P<0.004）,the difference was statistically significant;the therapeutic effect of rTMS combined with DMS group was better than that of rTMS group and DMS group（P<0.046）,and the difference was statistically significant.Conclusion:1.Routine rehabilitation therapy,rTMS therapy,DMS therapy,rTMS combined with DMS therapy have significant improvement effects on the daily living ability,motor function,spasm state,cerebral O₂Hb concentration（S score and mean）of patients who with upper limb spasm after stroke.The therapeutic effect of rTMS combined with DMS is more significant,which is worthy of in-depth clinical research and implementation.2.Compared with single therapy,rTMS combined with DMS therapy has more obvious advantages in improving the daily living ability,motor function and spasm state of patients who with upper limb spasm after stroke.3.rTMS therapy,DMS therapy,rTMS combined with DMS therapy have more obvious advantages than routine rehabilitation therapy on the improvement of brain O₂Hb concentration in patients who with upper limb spasm after stroke.RTMS combined with DMS therapy has a significant advantage over rTMS therapy in improving the brain O₂Hb concentration S score in patients who with upper limb spasm after stroke;compared with rTMS therapy and DMS therapy,rTMS combined with DMS therapy has a significant advantage in increasing the brain O₂Hb concentration mean in patients who with upper limb spasm after stroke.The increase of brain O₂Hb concentration may be related to the enhancement of brain activity,the promotion of functional remodeling of the affected cerebral hemisphere,the inhibition of the circuit of antagonistic muscle neurons,the reduction of antagonistic muscle excitability and the activation of active muscle excitability by rTMS combined with DMS.4.rTMS combined with DMS organically integrates central intervention and peripheral intervention to regulate and repair the central nervous system through the direct stimulation of rTMS and the indirect influence of DMS,so as to improve the spasticity of the upper limb after stroke.