Effect Of 1 Hz RTMS On Upper Limb Function In Patients With Hemiplegia In Dominant And Non-dominant Hemispheres Stroke

Stroke often results in upper limb motor dysfunction,and it is difficult to recover upper limb motor dysfunction.Repeated transcranial magnetic stimulation(r TMS)can regulate cerebral cortex excitability and improve patients’ upper limb motor function.However,the results of different studies are not the same,and some scholars believe that the therapeutic effect of r TMS is related to the hemisphere advantage.Objective The purpose of this study was to investigate the effect of 1Hz r TMS combined with conventional rehabilitation on upper limb and overall function in patients with hemiplegia in dominant and non-dominant hemisphere stroke,so as to provide a theoretical basis for clinically formulate individualized rehabilitation treatment programs.At the same time,the patient’s surface electromyography signal(sEMG)was collected and analyzed,which further confirmed the role of sEMG in evaluating the function of stroke patients.Methods 30 patients with dominant hemisphere stroke(randomly divided into 1 Hz r TMS group and sham stimulation group,15 patients per group)and 30 non-dominant hemisphere stroke patients(randomly divided into 1 Hz r TMS group and sham stimulation group,15 patients per group).All patients were left with varying degrees of upper limb dyskinesia and received conventional rehabilitation treatments(including exercise therapy,physical factor therapy,occupational therapy and so on)for 2 weeks,once a day and 6 times a week.1 Hz r TMS group: combined with 1 Hz r TMS treatment.Stimulation site is the primary motor cortex(M1)region of the healthy side of the brain,the stimulation time is 15 minutes,the stimulation intensity is 80% rest motor threshold(RMT),once a day,6 times a week for a total of 2 weeks.The sham stimulation group:received conventional rehabilitation and sham stimulation(r TMS stimulation parameters and frequency were the same as those in the 1 Hz r TMS group,but the coil was at 90° to the stimulation target plane).Before and after treatment,the upper limb function of the affected side was evaluated by the upper-extremity Fugl-Meyer scale(u-FMA),the modified Barthel index(MBI)was used to evaluate the activity of daily living of the patients,and surface electromyography signals were recorded during maximum isometric voluntary contraction(MIVC)of biceps brachii and triceps brachii on the affected side,the root mean square(RMS)and integrated electromyography(iEMG)were analyzed.Each action was performed three times.The average of the obtained data were statistically analyzed.Results 5 patients withdrew,and a total of 55 patients completed the experiment.Including 25 patients with dominant hemisphere stroke(13 patients in 1 Hz r TMS group,12 patients in sham stimulation group)and 30 patients with non-dominant hemisphere stroke.Evaluation result:(1)Dominant hemisphere stroke group: There were no significant differences in u-FMA,MBI score,RMS and iEMG values between the 1 Hz r TMS group and the sham stimulation group before treatment.After treatment,u-FMA,MBI scores,RMS and iEMG values of biceps/triceps brachii during MIVC of elbow flexion /extension were significantly increased.The difference increased in the 1 Hz r TMS group was greater than those in the sham stimulation group(P<0.05),and the difference was statistically significant.(2)The non-dominant hemisphere stroke group: there were no significant differences in u-FMA,MBI scores,RMS and iEMG values between the 1 Hz r TMS group and the sham stimulation group before treatment(P > 0.05).After treatment,u-FMA,MBIscores,RMS and iEMG values of biceps/triceps brachii during MIVC of elbow flexion/extension were significantly higher in the two groups(P<0.05).And the 1 Hz r TMS group was more significantly improved than the sham stimulation group(P<0.05).(3)RMS and iEMG values of biceps brachii during MIVC of elbow flexion were positively correlated with u-FMA and MBI scores(r=0.492,0.442,0.896 and 0.672);RMS and iEMG values of triceps brachii during MIVC of elbow extension were positively correlated with u-FMA and MBI scores(r=0.975,0.733,0.953 and 0.715).Conclusion(1)1 Hz r TMS combined with conventional rehabilitation therapy can improve the function of patients’ upper limbs,and this improvement effect is beneficial for patients with dominant hemisphere and non-dominant hemisphere stroke.(2)sEMG,as an objective,non-invasive,and easy-to-operate rehabilitation assessment method,can be applied to clinical assessment of stroke hemiplegic patients’ functional recovery.