重复经颅磁刺激联合镜像疗法对脑卒中偏瘫患者的影响OA

Objective To investigate the effects of repetitive transcranial magnetic stimulation(rTMS)combined with mirror therapy(MT)on lower limb motor function and motor evoked potentials(MEP)in patients with post-stroke hemiplegia.Methods A total of 60 patients with post-stroke hemiplegia admitted to the Department of Rehabilitation of the First Affiliated Hospital of Bengbu Medical University from February 2024 to March 2025 were randomly assigned into MT group,rTMS group and combined group,with 20 cases in each group.All groups received conventional rehabilitation therapy.The combined group received rTMS in addition to the conventional rehabilitation therapy,followed by mirror therapy.The rTMS was delivered at a frequency of 1 Hz with stimulation intensity at 90%of the resting motor threshold(RMT),targeting the lower-limb motor hotspot of the primary motor cor-tex(M1)on the unaffected or affected side,totaling 600 pulses,15 minutes per session,once daily,five days per week for four weeks.Mirror therapy was performed for 30 minutes per session,once daily,five days per week for four weeks.The rTMS group received the identical rTMS protocol as the combined group,followed by sham mirror therapy where the mirror's reflective surface faced the affected limb and its back faced the unaffected limb,while all other procedures maintained consistent with the mirror thera-py in the combined group.The MT group received sham rTMS with the coil positioned perpendicularly to the scalp and all other pa-rameters consistent with the protocol of the rTMS group,followed by the same mirror therapy with that of the combined group.Be-fore and after treatment,Fugl-Meyer Assessment of Lower Extremity(FMA-LE)was used to assess motor function;10-Meter Walk-ing Test(10MWT)was used to assess walking function;Modified Barthel Index(MBI)was used to assess activities of daily living.A magnetic stimulator was used to record the amplitude and latency of motor evoked potentials(MEPs)in both the affected and un-affected sides for the assessment of neural plasticity and recovery.Results(1)FMA-LE,MBI scores and 10MWT:compared with those before treatment,the FMA-LE and MBI scores in all three groups increased significantly after treatment(P＜0.05),while 10MWT decreased significantly(P＜0.05).Compared with the MT group and the rTMS group,FMA-LE and MBI scores in the com-bined group were significantly higher after treatment(P＜0.05),and 10MWT was significantly lower after treatment(P＜0.05).(2)MEP latency and amplitude:compared with those before treatment,the MEP latency on the unaffected side in all three groups was prolonged significantly after treatment(P＜0.05),whereas the MEP latency on the affected side shortened significantly(P＜0.05);the MEP amplitude on the unaffected side in all three groups decreased significantly(P＜0.05),while the MEP amplitude on the affected side increased significantly(P＜0.05).Compared with the MT group and the rTMS group,MEP latency of the unaffected side was longer and MEP amplitude of the affected side was significantly higher in the combined group(P＜0.05),and MEP latency on the affected side in the combined group was significantly shorter(P＜0.05).Conclusion rTMS combined with MT can effectively improve lower limb motor function,activities of daily living,and motor evoked potentials in patients with post-stroke hemiplegia.