| Background and ObjectiveCerebral infarction,which is also know as ischemic stroke,is a kind of local blood supply disorder caused by various reasons.A variety of reasons cause cerebral blood supply disorders,and thus it causes irreversible damage to local brain tissue,leading to cerebral ischemia,hypoxia necrosis.The survey results initiated by the World Health Organization show that: the incidence of cerebral infarction in China has been rising,which has become one of the most common diseases in the elderly.The third survey of the national death cause showed that cerebral infarction has risen to China's first cause of death.With the continuous progress of diagnosis and treatment technology,cerebral infarction mortality decreased significantly.However,there are still short of effective measures for the treatment of motor dysfunction after cerebral infarction.Therefore,it is an important subject in the medical field to carry out necessary clinical research on cerebral infarction,to develop effective prevention and treatment methods,and to restore the patient's motor function to the greatest extent.rTMS(repetitive transcranial magnetic stimulation,)is a neurophysiological technique based on transcranial magnetic stimulation reported by Professor Barker in 1985.It can transmit electromagnetic pulse signals through the skull to the cerebral cortex,stimulating the nerves of a particular brain area.And thus the electromagnetic pulse signals increas the excitability of the corticospinal system,improving the reactivity of the motor system.This is the principle of the technology how to achieve the purpose of treatment.rTMS can promote the functional reconstruction of the damaged cortex and improve the curative effect of rehabilitation therapy.It has the advantages of non-invasive,painless and safe,and has good time resolution and spatial resolution,which can be more easily accepted by patients.In recent years,this method has been widely used in the rehabilitation of patients with cerebral infarction,which has opened up a new field for the rehabilitation of motor dysfunction in patients with cerebral infarction.In this study,we observed the changes of exercise function,neurological function and activities of daily living in the experimental group and the control group.The experimental group was treated with repetitive transcranial magnetic stimulation(1Hz),and the control group was treated with conventional rehabilitation.This study employed a randomized,controlled,blinded principle.Experimental method:From August 2013 to May 2016,in our hospital,we selected 80 cerebral infarction patients with upper limb motor dysfunction.Patients were randomized to receive 40 patients in the trial group(transcranial magnetic stimulation group),40 patients in the control group(conventional treatment group).80 patients were eligible for inclusion in this study.Inclusion criteria:(1)first or unilateral onset or with previous onset but not left with neurological dysfunction;(2)vital signs stable,consciousness;(3)Brunnstrom classification of upper limb in I-III phase;(4)Age: 20 to 75 years old;(5)the course of the disease within four weeks;(6)motor evoked potentials can be measured after transcranial magnetic stimulation was applied to the affected area;(7)all patients signed informed consent.Exclusion criteria:(1)patients with severe cognitive impairment;(2)patients with visually impaired;hearing disorders;lalopathy;(3)patients with motor disorders such as bone joints,muscles,etc;(4)Patients cannot do rehabilitation training,who are suffering from obvious contraindications,such as severe heart disease;newly occurring myocardial infarction;the recent onset of angina is not well controlled;(5)patients who cannot be treated with rTMS,such as:acute brain injury;cerebral hemorrhage;epilepsy;EEG showed patients with epilepsy-like changes;(6)patient's condition unstable or exist an unstable health factor;(7)exist severe muscle cramps,tremors;(8)patients taking part in other trials or receiving other treatments.In the experimental group male 27 cases,female 13 cases,average age(58.15 ±9.54),cerebral infarction lesions for 24 cases on the left side,right side in 16 cases;the average duration(17.65±6.67)days.In the control group,male 23 cases,female 17 cases,average age(59.93±8.95),cerebral infarction lesions for 26 cases on the left side,right side in 14 cases;the average duration(16.00±4.88)days.There was no significant difference between the two groups(P > 0.05).After the vital signs were stable,in the experimental group: repetitive transcranial magnetic stimulation was used to stimulate the M1 area of the contralateral hemisphere.Stimulation parameters:frequency:1Hz;intensity:90 % MT;time:25min/d;pulse:1500.At the same time,routine drug treatment and rehabilitation training were presented.The control group was only treated with routine medication and rehabilitation training.Routine rehabilitation training includes:(1)The passive limb movement and the placement of good limb position were treated in patients who can't get up;(2)Patients were treated with exercise therapy,occupational therapy,upper limb training,walking,sitting and standing training medium frequency electrotherapy in the training room.The training was conduct once a day to all patients,5 days a week for 6 weeks.The upper limb Fuel-Meyer(FMA)motor function score,Barthel index(BI)score,neurological deficit score were scored for all patients at these three time points(before treatment,3 weeks of treatment,treatment for 6 weeks).Results:1.After 3 weeks treatment,the FMA score of transcranial magnetic stimulation group and the FMA score of the routine rehabilitation treatment group were improved to some extent.After 6 weeks of treatment,the FMA score of transcranial magnetic stimulation group was significantly higher compared with the conventional treatment group,and the difference was statistically significant compared with the score before treatment.The FMA score of test group was higher,the difference between the two groups was statistically significant.2.After 3 weeks and 6 weeks treatment,ADL scores of two groups were increased,and the difference was statistically significant.The ADL score of the experimental group was significantly higher than control group after 3 weeks and 6 weeks,and the difference was statistically significant.3.After 3 weeks and 6 weeks treatment,compared with pre-treatment,the NIHSS score of the two groups at the two time points was significantly lower,and the difference was statistically significant.After 3 weeks and 6 weeks treatment,the difference of ADL scores between the two groups was statistically significant.4.The incidence of adverse events in the two groups was low,and there was no statistically significant difference between two groups.conclusionThis study shows that 1Hz rTMS can significantly improve the patient's upper limb motor function when When it stimulates contralateral hemisphere M1 area of cerebral infarction patients.This is a effective method for the cerebral infarction patients with upper limb motor dysfunction.It is worth of clinical reference and promotion. |
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