Abstract
Poststroke spasticity (PSS) patients with muscle spasticity are effectively relieved by low-frequency repetitive transcranial magnetic stimulation (rTMS) or extracorporeal shock wave treatment (ESWT). However, there are relatively few reports about the difference in the efficacy of rTMS and ESWT for PSS. In this study, we examined and recorded the levels of UE motor section of the Fugl–Meyer Motor Assessment Scale (FMA-UE), myoelectric signal time-domain range integral values (iEMG), Modified Ashworth Scale (MAS), and Modified Barthel Index (MBI) before and after treatment to observe the differences in treatment effects between rTMS and ESWT in patients with PSS. 66 patients with PSS were enrolled in the study and signed an informed consent form, and the study was approved by the Ethics Committee of the First Hospital of Soochow University (2019008). The patients were divided into rTMS group, ESWT group, and regular group according to the random number table method, and there were 22 patients in each group. The rTMS group and ESWT group were treated with rTMS and ESWT on the basis of conventional treatment in the regular group, 5 times a week, and the total treatment time was 4 weeks. The results of the study showed that iEMG, MAS, FMA-UE, and MBI scores in the rTMS, ESWT, and regular groups were significantly ameliorated after treatment compared with those before treatment. The efficacy of the ESWT group was significantly better than in the regular group and slightly better than in the rTMS group, as shown by the iEMG, MAS, FMA-UE, and MBI scores, and the iEMG score of the ESWT group was significantly better than the rTMS group, while there were no significant differences in other indexes. The FMA-UE and MBI scores in the rTMS group were significantly better than those in the regular group after treatment in the rTMS group; however, the comparison between iEMG and MAS scores was not statistically significant. It can be seen that both rTMS and ESWT can alleviate upper limb flexor spasm, improve upper limb motor function, and improve activities of daily living in patients with PSS. Among them, ESWT has better antispasmodic effect and better short-term treatment effect.
Highlights
Stroke is characterized by high morbidity and high disability
Most scholars generally agree that overexcitation of the detrusor reflex is the main mechanism leading to flexor muscle spasm in stroke patients [9], which may be mediated by two types of mechanisms: one is abnormal downstream regulation and the other is abnormal intraspinal processing function [10]. e ability to move the limb actively may be inhibited by the abnormally enhanced muscle tone, so in patients with muscle spasticity, relieving the spasticity is the key to promoting recovery of limb function [11]. e excitability of the contralateral premotor cortex and the ipsilateral reticular cortex of the complementary motor area are upregulated in the medial reticular nucleus after stroke, which is the main cause of poststroke spasticity and associated motor deficits [12]. e excitability
0 Pre-treatment of the affected hemisphere may be further reduced by hyperexcitability of the healthy hemisphere, while the neuromodulatory processes of interhemispheric balance and competition may have an effect on the M1 area of the affected side
Summary
Stroke is characterized by high morbidity and high disability. Data show that about 2 million new stroke patients occur each year in China, of which 70%∼80% of surviving stroke patients are unable to live independently because of their disability [1]. Extracorporeal shock wave therapy (ESWT) is a mechanical stimulation wave with relatively safe energy for the human body, which relies on high-speed vibration conduction to promote the differentiation and regeneration of human cells, serving to repair damaged muscle tissue within the target site [5]. Both rTMS and ESWT are nonpharmacological modalities that are widely used and recognized for their efficacy in clinical practice, but there are fewer reports on the difference in efficacy of these two treatment options for poststroke spasticity. Both rTMS and ESWT are nonpharmacological modalities that are widely used and recognized for their efficacy in clinical practice, but there are fewer reports on the difference in efficacy of these two treatment options for poststroke spasticity. e purpose of this paper is to analyze the difference in efficacy between rTMS and ESWT after treatment of stroke spasticity by observing the improvement of upper limb flexor spasticity after stroke and to provide a reference for more effective improvement of poststroke spasticity and more appropriate clinical treatment plan
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