Repetitive Peripheral Magnetic Stimulation (rpMS) in Combination with Muscle Stretch Decreased the Wrist and Finger Flexor Muscle Spasticity in Chronic Patients after CNS Lesion

Werner C,Schrader M

doi:10.4172/2329-9096.1000352

Abstract

Objective: The study assessed the effect of a single session of repetitive peripheral magnetic stimulation (rpMS) combined with manual stretch on wrist and finger flexor muscle spasticity. Methods: Forty chronic patients after CNS lesion with a severe wrist and finger flexor spasticity with a Modified Ashworth Score (MAS, 0-5) of either 2, 3 or 4 participated and formed two groups. A single session of rpMS (A) or sham (B) (5 Hz, Intensity 60% or 0%, 3s trains, 750 stimuli delivered within five minutes) was applied in an A-B (group I) or B-A (group II) design. A 30 min baseline (90 min follow-up) proceeded (followed) A or B. During the intervention, the wrist and metatarsophalangeal (MCP) joints were stretched manually. Primary variable was the wrist and finger flexor spasticity, assessed with the help of the Modified Ashworth Score (MAS, 0-5), by a rater blinded to treatment allocation. A- and B-data were pooled irrespective of group assignment. Results: At study onset, both groups were homogeneous. Following rpMS but not sham, the wrist and finger MAS significantly decreased over time. Accordingly, the MAS of the rpMS group was significantly less at t+5 min (wrist p=0.002, MCP joints p<0.001) and at t+90 min (MCP joints p=0.002). No side effects occurred. Conclusion: A single session of rpMS but not sham in combination with manual stretch significantly reduced the wrist and finger flexor muscle spasticity in chronically CNS-lesioned patients. Long-term studies including an rpMS group only should follow.

Highlights

The treatment of wrist and finger flexor muscle spasticity after CNS lesion is a major issue in upper limb neurological rehabilitation
Three months after stroke for instance, 25% of the surviving stroke patients present an upper limb flexor muscle spasticity impeding the activities of daily living and the restoration of arm function [4]
The low-intensity repetitive peripheral magnetic stimulation (rpMS) could have been less effective regarding muscle tone regulation; the authors combined the stimulation with a continuous manual muscle stretch, a method commonly applied by therapists to reduce muscle tone [13]

Summary

Introduction

The treatment of wrist and finger flexor muscle spasticity after CNS lesion is a major issue in upper limb neurological rehabilitation. Spasticity is defined as a velocity-dependent increased muscle tone and resistance to stretch. It results on one hand from neurogenic spasticity and one the other hand from immobility-related changes of the mechanical muscle properties including sarcopenia and contracture [1,2]. It is rapidly evolving within a time period of 12 weeks after CNS lesion. Three months after stroke for instance, 25% of the surviving stroke patients present an upper limb flexor muscle spasticity impeding the activities of daily living and the restoration of arm function [4]

Methods

Results

Conclusion