Study Of Repetitive Transcranial Magnetic Stimulation Combined With Constraint-induced Movement Therapy In The Treatment Of Upper Extremity Motor Dysfunction After Stroke

Objective To investigate the effect of repetitive transcranial magnetic stimulation(rTMS)combined with the constraint-induced movement therapy(CIMT)on the upper extremity motor function after a stroke through clinical randomized controlled trial,so as to provide a new rehabilitation program and clinical research evidence for improving the upper limb motor function after stroke.Methods Ninety stroke survivors with upper extremity motor dysfunctionwere selected as the study objects,and randomly divided into the rTMS group,the CIMT group,andthe combination group,30 cases each.In addition to routine medication and conventional rehabilitation,the patients of the rTMS group were provided with rTMS,while the patients in the CIMT group performed CIMT.Patients in the combination group received rTMS first,then converted to CIMT immediately.Treatment was performed once a day,5 days a week for 4 weeks.The Wolf motor function test(WMFT),simplified Fugl-Meyer assessment-upper extremity(FMA-UE),Carroll upper extremity function test(UEFT),and modified Barthel index(MBI)were uesd for assessment before and after the treatment.Results During the treatment,5 patients failed to complete the study,including 1 case in the rTMS group,2 cases in the CIMT group,2 cases in the combined group,and 85 patients were finally included.There were no significant differences(P>0.05)among the three groups in general information,WMFT,FMA-UE,UEFT and MBI scores before the intervention.After 4 weeks of treatment,the scores of WMFT,FMA-UE,UEFT and MBI in all three groups were significantly improved compared with those before treatment,and the differences were statistically significant(P<0.01).The average WMFT,FMA-UE,UEFT and MBI scores in the combination group were significantly better than those of the CIMT group and the rTMS group after treatmen(P<0.05).Compared with the rTMS group,the CIMT group showed more significant improvement in all of the measurements(P<0.05).Conclusion Repetitive transcranial magnetic stimulation combined with Constraint-induced movement therapy could significantly improve upper extremity motor function,hand fine motor ability and the ability in the activities of daily living of stroke survivors.There is a synergistic effect between the two,and the combined effect is better than single therapy,which is worthy of clinical promotion.