Repetitive Peripheral Magnetic Stimulation Enhances Modified Constraint-Induced Movement Therapy Outcomes After Stroke
2026年4月24日 更新者：The First Hospital of Jilin University
Priming Wrist Extension With Repetitive Peripheral Magnetic Stimulation Enhances Modified Constraint-Induced Movement Therapy Outcomes After Stroke: A Retrospective Cohort Study
This is a retrospective observational study to investigate the effect of repetitive peripheral magnetic stimulation (rPMS) combined with modified constraint-induced movement therapy (m-CIMT) on upper extremity and finger fine motor function in patients with stroke hemiplegia.
We hypothesize that rPMS priming immediately before m-CIMT can enhance wrist extensor activation during task practice and lead to better upper limb motor recovery than m-CIMT alone.
Outcome measures include joint range of motion, muscle tone, grip strength, upper limb motor function, and activities of daily living.
調査の概要
詳細な説明
Modified constraint-induced movement therapy (m-CIMT) is an evidence-based intervention for post-stroke upper limb rehabilitation, yet therapeutic gains are often limited by compensatory wrist flexion.
This maladaptive pattern reflects insufficient wrist extensor recruitment and persistent flexor synergy dominance, which biomechanically places finger flexors in an unfavorable length-tension relationship and compromises grasp force generation.
Repetitive peripheral magnetic stimulation (rPMS) non-invasively enhances wrist extensor excitability and exerts priming effects on sensorimotor pathways.
We hypothesized that rPMS priming immediately prior to m-CIMT would facilitate wrist extensor engagement during task practice and produce superior upper limb motor recovery compared with m-CIMT alone.
研究の種類
観察的
入学 (実際)
50
連絡先と場所
このセクションには、調査を実施する担当者の連絡先の詳細と、この調査が実施されている場所に関する情報が記載されています。
研究場所
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Jilin
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Changchun、Jilin、中国、130000
- The First Hospital of Jilin University
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参加基準
研究者は、適格基準と呼ばれる特定の説明に適合する人を探します。これらの基準のいくつかの例は、人の一般的な健康状態または以前の治療です。
適格基準
就学可能な年齢
- 大人
- 高齢者
健康ボランティアの受け入れ
いいえ
サンプリング方法
非確率サンプル
調査対象母集団
This study included adult patients with post-stroke hemiplegia and upper limb motor impairment receiving rehabilitation treatment.
説明
Inclusion Criteria: (1) first-ever ischemic or hemorrhagic stroke confirmed by computed tomography (CT) or magnetic resonance imaging (MRI); (2) post-stroke duration≤6 months; (3) aged between 20 and 80 years; (4) clinically diagnosed with unilateral upper extremity hemiparesis; (5) baseline active wrist extension≥20°, and active extension≥10° in the thumb and at least two additional fingers, as per the modified Constraint-Induced Movement Therapy (m-CIMT) criteria; (6) Brunnstrom stage of the affected upper extremity≥IV; (7) Modified Ashworth Scale (MAS) score of the wrist and finger flexors≤1+; (8) Mini-Mental State Examination (MMSE) score≥21 points; (9) sitting balance≥level 2; (10) had complete medical records documenting receipt of either repetitive peripheral magnetic stimulation (rPMS) priming combined with m-CIMT (experimental group) or m-CIMT alone (control group) for at least 4 consecutive weeks, with treatment sessions conducted once daily, 5 days per week; (11) no concurrent participation in other interventional studies or receipt of other neuromodulation therapies during the study period.
Exclusion Criteria:(1) severe pre-stroke neurological, orthopedic, or rheumatologic conditions affecting upper extremity function; (2) severe joint pain or contracture limiting wrist movement; (3) complications with severe cardiac, pulmonary, hepatic, renal, or infectious diseases; (4) history of epilepsy or seizure disorders; (5) presence of metal implants, cardiac pacemakers, or open wounds at the stimulation site; (6) severe visual impairment affecting task performance; (7) severe depression or psychiatric disorders; (8) pregnancy or lactation; (9) incomplete baseline or post-treatment assessment data.
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研究計画
このセクションでは、研究がどのように設計され、研究が何を測定しているかなど、研究計画の詳細を提供します。
研究はどのように設計されていますか？
デザインの詳細
コホートと介入
グループ/コホート |
介入・治療 |
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Experimental group
rPMS+m-CIMT
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rPMS was administered using a pulsed magnetic field stimulator (M-100 Ultimate, Shenzhen Yingchi Technology Co., Ltd., China) with a circular stimulation coil (OY120A, diameter 120 mm).
The patient was seated with the affected upper limb positioned on a treatment table, shoulder abducted to 90°, elbow flexed to 90°, forearm pronated, and wrist in a neutral position over the table edge.
The stimulation coil was placed over the motor point of the radial nerve, approximately 5-7 cm proximal to the wrist joint on the dorsal forearm.
The optimal stimulation site was determined by identifying the location that produced the most robust wrist extension movement when single pulses were delivered.
The intervention comprised restraint of the unaffected upper extremity and repetitive, task-oriented practice with the affected upper extremity using shaping techniques.
Functional tasks were selected from a standardized task database based on individual patient needs and baseline motor function.
Tasks were graded to be slightly above the patient's current ability level.
Each task was practiced for 30-120s per trial for 10 repetitions.
Therapists provided verbal encouragement, performance feedback, and physical guidance as needed.
The training intervention was 90min per session, once a day, 5 days a week, for 4 weeks.
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Control group
m-CIMT
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The intervention comprised restraint of the unaffected upper extremity and repetitive, task-oriented practice with the affected upper extremity using shaping techniques.
Functional tasks were selected from a standardized task database based on individual patient needs and baseline motor function.
Tasks were graded to be slightly above the patient's current ability level.
Each task was practiced for 30-120s per trial for 10 repetitions.
Therapists provided verbal encouragement, performance feedback, and physical guidance as needed.
The training intervention was 90min per session, once a day, 5 days a week, for 4 weeks.
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この研究は何を測定していますか？
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
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Fugl-Meyer Assessment for Upper Extremity
時間枠：At baseline and immediately after the 4-week intervention.
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A validated 33-item measure assessing motor impairment of the upper limb following stroke.
The FMA-UE evaluates reflex activity, voluntary movement control of the shoulder, elbow, forearm, wrist, and hand, as well as coordination and speed.
Each item is scored on a 3-point ordinal scale (0=cannot perform, 1=performs partially, 2=performs fully), with a total possible score of 66 points.
Higher scores indicate better motor function.
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At baseline and immediately after the 4-week intervention.
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二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
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FMA-UE Wrist Subscore
時間枠：At baseline and immediately after the 4-week intervention.
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This subscale consists of 5 items (items 19-23) assessing wrist stability, extension, flexion, circumduction, and coordination, with a maximum score of 10 points.
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At baseline and immediately after the 4-week intervention.
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Active Range of Motion (AROM) of Wrist Extension
時間枠：At baseline and immediately after the 4-week intervention.
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AROM was measured using a goniometer with standardized positioning: patient seated, shoulder abducted to 90°, elbow flexed to 90°, forearm pronated, and wrist positioned over the table edge.
The stationary arm of the goniometer was aligned with the lateral midline of the forearm, and the movable arm was aligned with the dorsal midline of the third metacarpal.
The axis was placed over the ulnar styloid process.
From a neutral starting position (0°), patients were instructed to actively extend the wrist as far as possible.
The measurement was repeated three times, and the average value was recorded.
Normal wrist extension AROM ranges from 0° to 70°.
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At baseline and immediately after the 4-week intervention.
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Surface Electromyography (sEMG) of Wrist Extensors
時間枠：At baseline and immediately after the 4-week intervention.
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sEMG was recorded from the paretic extensor carpi radialis (ECR) using a wireless system (SG-800B, Dinovo Medical Technology, China) with bipolar Ag/AgCl electrodes (inter-electrode distance: 20 mm).
Following SENIAM guidelines for electrode placement and standardized skin preparation, participants performed maximal voluntary isometric contraction (MVIC) of wrist extension against manual resistance, sustained for 5 seconds and repeated three times with 60-second rest intervals.
Signals were sampled at 2000Hz, band-pass filtered (20-450Hz), notch-filtered at 50Hz, and full-wave rectified.
sEMG outcomes included Average EMG amplitude (AEMG, μV) during the stable phase of MVIC (middle 3 seconds) and Root mean square (RMS, μV) amplitude.
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At baseline and immediately after the 4-week intervention.
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Wolf Motor Function Test (WMFT)
時間枠：At baseline and immediately after the 4-week intervention.
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The WMFT is a standardized, timed performance-based assessment consisting of 17 items: 15 timed functional tasks and 2 strength measures.
The timed tasks assess the ability to perform functional movements such as lifting cans, turning a key, and stacking checkers.
Performance is quantified by: (a) WMFT-Time: the time to complete each task (capped at 120 seconds), with lower scores indicating better performance; (b) WMFT-Score: a functional ability score rated on a 6-point ordinal scale (0=no use to 5=normal use), with a maximum total score of 75 points.
The grip strength item (Item 14) was measured using a Jamar dynamometer (Sammons Preston, USA) according to American Society of Hand Therapists (ASHT) standards, with the mean of three trials recorded.
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At baseline and immediately after the 4-week intervention.
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Motor Activity Log (MAL)
時間枠：At baseline and immediately after the 4-week intervention.
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The MAL is a structured interview assessing the patient's self-reported use of the affected upper limb in real-world activities.
The MAL consists of 30 standardized questions evaluating the amount of use (Amount of Use scale, AOU) and quality of movement (How Well scale, HW) during daily tasks.
Each item is scored on a 6-point scale (0-5), with total scores ranging from 0 to 150 for each subscale.
Higher scores indicate greater frequency and quality of affected limb use.
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At baseline and immediately after the 4-week intervention.
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Instrumental Activities of Daily Living (IADL) Scale
時間枠：At baseline and immediately after the 4-week intervention.
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The IADL scale assesses the ability to perform complex daily tasks requiring higher-level cognitive and motor function, including telephone use, shopping, food preparation, housekeeping, laundry, transportation, medication management, and financial management.
The scale consists of 8 items scored from 0 (unable) to 3 (independent), with a maximum score of 24 points.
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At baseline and immediately after the 4-week intervention.
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Barthel Index
時間枠：At baseline and immediately after the 4-week intervention.
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The BI is a widely used 10-item measure assessing basic activities of daily living, including bowel and bladder control, feeding, grooming, dressing, transfers, mobility, and stair climbing.
Total scores range from 0 to 100, with higher scores indicating greater independence.
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At baseline and immediately after the 4-week intervention.
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協力者と研究者
ここでは、この調査に関係する人々や組織を見つけることができます。
捜査官
- 主任研究者：Li Zhenlan, phD、The First Hospital of Jilin University
研究記録日
これらの日付は、ClinicalTrials.gov への研究記録と要約結果の提出の進捗状況を追跡します。研究記録と報告された結果は、国立医学図書館 (NLM) によって審査され、公開 Web サイトに掲載される前に、特定の品質管理基準を満たしていることが確認されます。
主要日程の研究
研究開始 (実際)
2022年1月1日
一次修了 (実際)
2024年5月31日
研究の完了 (実際)
2024年5月31日
試験登録日
最初に提出
2026年4月24日
QC基準を満たした最初の提出物
2026年4月24日
最初の投稿 (実際)
2026年4月30日
学習記録の更新
投稿された最後の更新 (実際)
2026年4月30日
QC基準を満たした最後の更新が送信されました
2026年4月24日
最終確認日
2026年4月1日
詳しくは
本研究に関する用語
個々の参加者データ (IPD) の計画
個々の参加者データ (IPD) を共有する予定はありますか?
いいえ
IPD プランの説明
Sharing individual participant data is restricted due to patient privacy protection, confidentiality requirements and institutional ethics committee regulations.
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