RESUMO
BACKGROUND AND PURPOSE: Enhancing afferent information from the paretic limb can improve post-stroke motor recovery. However, uncertainties exist regarding varied sensory peripheral neuromodulation protocols and their specific impacts. This study outlines the use of repetitive peripheral sensory stimulation (RPSS) and repetitive magnetic stimulation (rPMS) in individuals with stroke. METHODS: This scoping review was conducted according to the JBI Evidence Synthesis guidelines. We searched studies published until June 2023 on several databases using a three-step analysis and categorization of the studies: pre-analysis, exploration of the material, and data processing. RESULTS: We identified 916 studies, 52 of which were included (N = 1,125 participants). Approximately 53.84% of the participants were in the chronic phase, displaying moderate-to-severe functional impairment. Thirty-two studies used RPSS often combining it with task-oriented training, while 20 used rPMS as a standalone intervention. The RPSS primarily targeted the median and ulnar nerves, stimulating for an average of 92.78 min at an intensity that induced paresthesia. RPMS targeted the upper and lower limb paretic muscles, employing a 20 Hz frequency in most studies. The mean stimulation time was 12.74 min, with an intensity of 70% of the maximal stimulator output. Among the 114 variables analyzed in the 52 studies, 88 (77.20%) were in the "s,b" domain, with 26 (22.8%) falling under the "d" domain of the ICF. DISCUSSION AND CONCLUSION: Sensory peripheral neuromodulation protocols hold the potential for enhancing post-stroke motor recovery, yet optimal outcomes were obtained when integrated with intensive or task-oriented motor training.
Assuntos
Recuperação de Função Fisiológica , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Reabilitação do Acidente Vascular Cerebral/métodos , Recuperação de Função Fisiológica/fisiologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Terapia por Estimulação Elétrica/métodosRESUMO
Abstract Background: Intermittent theta-burst stimulation and repetitive peripheral magnetic stimulation can improve motor function in poststroke patients, but the therapeutic effect of this combination remains unclear. Objective: To determine the effects of central intermittent theta-burst stimulation and repetitive peripheral magnetic stimulation on upper limb function. Methods: Fifty-six subacute stroke patients were randomly assigned to three groups: the CMS (n = 18), peripheral magnetic stimulation (PMS) (n = 19) and CPS (n = 19) groups. The CMS group received intermittent theta-burst stimulation and peripheral false stimulation, while the PMS group received repetitive peripheral magnetic stimulation and central false stimulation once a day for five days a week over four weeks. The CPS group received intermittent theta-burst stimulation and repetitive peripheral magnetic stimulation simultaneously once daily for four weeks. The Fugl-Meyer Assessment, Action Research Arm Test, Modified Barthel Index and Modified Ashworth Scale evaluated outcomes before and after four weeks of treatment. Results: The motor function scores of all groups were significantly increased after treatment compared with before treatment, while the Modified Ashworth Scale score showed no significant change. There was a significant difference in the motor function score of the CPS group compared with that of the CMS and PMS groups, but there was no significant improvement in the Modified Ashworth Scale score. Conclusion: Combining the two treatment methods can improve patients' motor function and daily living abilities but cannot improve muscle tone.
Resumen Antecedentes: La estimulación intermitente de theta-burst y la estimulación magnética periférica repetitiva pueden mejorar la función motora en pacientes postictus, pero el efecto terapéutico de esta combinación sigue sin estar claro. Objetivo: Determinar el efecto de la estimulacion central intermitente theta-burst y la estimulación magnética repetitiva periférica en la función del miembro superior. Métodos: Se asignaron aleatoriamente a tres grupos 56 pacientes con ictus subagudo: CMS (n = 18), estimulación magnética periferica (PMS) (n = 19) y CPS(Cm1) (n = 19). El grupo CMS recibió estimulación intermitente de theta-burst y falsa estimulación periférica, el grupo PMS recibió estimulación magnética periférica repetitiva y falsa estimulación central una vez al día durante cinco días a la semana a lo largo de cuatro semanas. El grupo SPC recibió estimulación intermitente theta-burst y estimulación magnética periférica repetitiva simultáneamente una vez al día durante cuatro semanas. Se utilizaron la Fugl-Meyer Assessment, Action Research Arm Test, Modified Barthel Index and Modified Ashworth Scale para evaluar losresultados antes y después de cuatro semanas de tratamiento. Resultados: Las puntuaciones de la función motora de todos los grupos aumentaron significativamente después del tratamiento en comparación con antes del tratamiento, mientras que la puntuación de la Escala de Ashworth Modificada no mostró cambios significativos. Hubo una diferencia significativa en la puntuación de la función motora del grupo CPS en comparación con la de los grupos CMS y PMS, pero no hubo una mejora significativa en la puntuación de la Escala de Ashworth Modificada. Conclusiones: La combinación de los dos métodos de tratamiento puede mejorar la función motora y las capacidades de la vida diaria de los pacientes, pero no puede mejorar el tono muscular.