Immediate Effect of Repetitive Peripheral Magnetic Stimulation in Hemiplegic Patients with Arm Paresis: A Pilot Study
Keywords:
magnetic stimulation, hemiparesis, upper extremityAbstract
Objectives: To compare the immediate effects of repetitive peripheral magnetic stimulation (rPMS) on upper extremity (UE) function of hemiplegic patients with different severity.
Study design: Experimental pilot study.
Setting: Rehabilitation Center at Ramathibodi Hospital, Mahidol University, Thailand.
Subjects: Thirteen participants (10 males and 3 females) with subacute to chronic UE paresis due to central nervous system lesion.
Methods: Each subject received one session of 12 minutes rPMS equally distributed over six hemiparetic shoulder-arm muscles (supraspinatus, infraspinatus, deltoid, biceps, triceps and pectoralis major). The train of stimulation was delivered to the affected arm with a figure eight coil at approximately 120% intensity of motor threshold at 20 Hz frequency in pulses of 4 seconds on alternating with 4 seconds of rest. Motor functions were assessed with upper extremity Fugl-Meyer motor (UE-FMA) scale, modified Ashworth Scale (MAS), and arm reach test (ART) before and then again 5 minutes after the stimulation. Patients with UE- FMA score of 16 or lower and those with score more than 16 were classified as more-severe and less-severe respectively. Statistical analysis was made comparing the difference between before and after of UE-FMA score, MAS, and ART of each group.
Results: The mean (SD) of UE-FMA score before and after rPMS stimulation were 21.6 (10.5) and 23.3 (8.9), respectively. Wilcoxon matched-pairs test confirmed that the results reached statistical significance (p = 0.018). The median (Q1-Q3) UE-FMA score before and after the stimulation in more-severe paresis group were 12.5 (9.3 to 13.3) and 16.0 (11.8 to 17.3), respectively. Wilcoxon matched-pairs test confirmed significant between group statistical difference (p = 0.027). The median (Q1-Q3) of UE-FMA score of the less-severe group before and after stimulation were 32.0 (24.0 to 35.0) and 32.0 (25.0 to 35.0), respectively. This difference has not reached significant level (p = 0.317). Analysis of the MAS and the ART, however, did not show any significances between groups.
Conclusion: The rPMS over six hemiparetic shoulder-arm muscles could result in immediate improvement of motor function in patients with severe upper extremity paresis, but not spasticity or arm and reach test.
Keywords: magnetic stimulation, hemiparesis, upper extremity
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