Effects of Repetitive Peripheral Magnetic Stimulation on Upper-Limb Spasticity and Impairment in Patients With Spastic Hemiparesis: A Randomized, Double-Blind, Sham-Controlled Study

doi:10.1016/j.apmr.2014.02.003

Archives of Physical Medicine and Rehabilitation

Volume 95, Issue 6, June 2014, Pages 1039-1047

Presented in part to the German Society for Clinical Neurophysiology and Movement Disorders Society, October 1–4, 2008, Göttingen, Germany; and to the German Society for Clinical Neurophysiology and Functional Imaging, March 18–20, 2010, Halle (Saale), Germany.

https://doi.org/10.1016/j.apmr.2014.02.003 Get rights and content

Abstract

Objective

To investigate short-term and long-term effects of repetitive peripheral magnetic stimulation (rpMS) on spasticity and motor function.

Design

Monocentric, randomized, double-blind, sham-controlled trial.

Setting

Neurologic rehabilitation hospital.

Participants

Patients (N=66) with severe hemiparesis and mild to moderate spasticity resulting from a stroke or a traumatic brain injury. The average time ± SD since injury for the intervention groups was 26±71 weeks or 37±82 weeks.

Interventions

rpMS for 20 minutes or sham stimulation with subsequent occupational therapy for 20 minutes, 2 times a day, over a 2-week period.

Main Outcome Measures

Modified Tardieu Scale and Fugl-Meyer Assessment (arm score), assessed before therapy, at the end of the 2-week treatment period, and 2 weeks after study treatment. Additionally, the Tardieu Scale was assessed after the first and before the third therapy session to determine any short-term effects.

Results

Spasticity (Tardieu >0) was present in 83% of wrist flexors, 62% of elbow flexors, 44% of elbow extensors, and 10% of wrist extensors. Compared with the sham stimulation group, the rpMS group showed short-term effects on spasticity for wrist flexors (P=.048), and long-term effects for elbow extensors (P<.045). Arm motor function (rpMS group: median 5 [4–27]; sham group: median 4 [4–9]) did not significantly change over the study period in either group, whereas rpMS had a positive effect on sensory function.

Conclusions

Therapy with rpMS increases sensory function in patients with severe limb paresis. The magnetic stimulation, however, has limited effect on spasticity and no effect on motor function.

Section snippets

Methods

This investigation was a randomized, double-blind, sham-controlled study, conducted at a neurologic rehabilitation hospital.

Results

During the 1-year study period (April 2007 to April 2008), 66 patients were included in the study. Three patients were removed from the analysis (2 had changes in antispastic medication, 1 legal representative refused study participation before the first therapy). The flowchart for the patients’ flow through the study is illustrated in figure 2. The clinical and baseline characteristics of the patients in the 2 treatment groups were not significantly different. Values are summarized in tables 1

Discussion

This is the first double-blind, randomized controlled study investigating the effects of rpMS compared with sham stimulation that focuses on spasticity and motor function in the paretic upper extremity. We analyzed data as intention to treat and as PP. Both types of analyses did not allow for global verification of our stated hypotheses.

From the investigated 4 muscle groups (flexors and extensors of wrist and elbow), only the wrist flexors showed significant differences between the 2

Conclusions

The application of 2 weeks of rpMS or sham stimulation to the paretic upper extremity twice a day combined with additional occupational therapy had no effect on motor function of severely affected hemiparetic patients. The effect of rpMS on spasticity in patients with mild to moderate spasticity was only limited; that is, there were only short-term effects (after the first rpMS session) in the wrist flexors and long-term effects (after the 2-wk intervention period) in the elbow extensors. rpMS

Suppliers

a.
Cambridge Electronic Design Limited, Unit 4, Science Park, Milton Rd, Cambridge, CB4 0FE, UK.
b.
MAG & More GmbH, Geisenhausenerstrasse 11A, 81379 Munich, Germany.
c.
SPSS Inc, 233 S Wacker Dr, 11th Fl, Chicago, IL 60606.

Acknowledgments

We thank Silke Heller, MSc, and Olaf Krapp for assessing the Tardieu Scale, Christian Blechschmidt and colleagues for performing rpMS and sham stimulation sessions, Stella Peitzker, MSc, and colleagues for administering occupational therapies and assessing FM, Magdalena Schröder for her help with randomization.

References (24)

V. Dietz et al.
Spastic movement disorder: impaired reflex function and altered muscle mechanics
Lancet Neurol
(2007)
P. Krause et al.
Repetitive magnetic and functional electrical stimulation reduce spastic tone increase in patients with spinal cord injury
Suppl Clin Neurophysiol
(2003)
E.M. Wassermann
Risk and safety of repetitive transcranial magnetic stimulation: report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation, June 5–7, 1996
Electroencephalogr Clin Neurophysiol
(1998)
S. Paolucci et al.
Poststroke depression and its role in rehabilitation of inpatients
Arch Phys Med Rehabil
(1999)
S. Malhotra et al.
A randomized controlled trial of surface neuromuscular electrical stimulation applied early after acute stroke: effects on wrist pain, spasticity and contractures
Clin Rehabil
(2013)
A. Thibaut et al.
Spasticity after stroke: physiology, assessment and treatment
Brain Inj
(2013)
K.S. Sunnerhagen et al.
Assessing and treating functional impairment in poststroke spasticity
Neurology
(2013)
Struppler A, Angerer B, Havel P. Modulation of sensorimotor performances and cognition abilities induced by...
A. Struppler et al.
Facilitation of skilled finger movements by repetitive peripheral magnetic stimulation (RPMS)—a new approach in central paresis
NeuroRehabilitation
(2003)
A. Struppler et al.
Modulatory effect of repetitive peripheral magnetic stimulation on skeletal muscle tone in healthy subjects: stabilization of the elbow joint
Exp Brain Res
(2004)

J.H. Burridge et al.

Theoretical and methodological considerations in the measurement of spasticity

Disabil Rehabil

(2005)

E. Patrick et al.

The Tardieu Scale differentiates contracture from spasticity whereas the Ashworth Scale is confounded by it

Clin Rehabil

(2006)

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Effects of repetitive peripheral magnetic stimulation for the upper limb after stroke: Meta-analysis of randomized controlled trials
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Repetitive peripheral magnetic stimulation (rPMS) can stimulate profound neuromuscular tissues painlessly to evoke action potentials in motor axons and induce muscle contraction for treating neurological conditions. It has been increasingly used in stroke rehabilitation as an easy-to-administer approach for therapeutic neuromodulation.
We performed this meta-analysis of randomized controlled trials to systematically evaluate the effects of rPMS for the upper limb in patients with stroke, including motor impairment, muscle spasticity, muscle strength, and activity limitation outcomes.
The meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. PubMed, EMBASE, Web of Science, Cochrane Library, and Physiotherapy Evidence Database (PEDro) were searched for articles published before June 2022. Forest plots were employed to estimate the pooled results of the included studies, and the I² statistical analysis was used to identify the source of heterogeneity. Publication bias was examined by Egger’s regression tests or visual inspection of the funnel plots.
The database searches yielded 1052 potential eligible literature; of them, five randomized controlled trials met the eligible criteria, involving a total of 188 participants. Patients in the rPMS group showed better improvement in motor impairment as measured by the FM-UE (MD: 5.39 [95% CI, 4.26 to 6.52]; P < 0.001; I² = 0%) compared with the control group. Among the secondary outcomes, no difference was found in the improvement of muscle spasticity (SMD: 0.36 [95% CI, −0.05 to 0.77]; P = 0.08; I² = 41%). There was a significant difference in the proximal (SMD: 0.58 [95% CI, 0.10 to 1.06]; P = 0.02; I² = 0%) but not the distal muscle strength (SMD: 1.18 [95% CI, −1.00 to 3.36]; P = 0.29; I² = 93%). Moreover, the activity limitation outcomes were significantly improved with rPMS intervention (SMD: 0.59 [95% CI, 0.08 to 1.10]; P = 0.02; I² = 0%).
This meta-analysis showed that rPMS might improve upper limb motor impairment, proximal muscle strength, and activity limitation outcomes but not muscle spasticity and distal strength in patients after stroke. Due to the limited number of studies, further randomized clinical trials are still warranted for more accurate interpretation and clinical recommendation.
Effect of high-frequency repetitive peripheral magnetic stimulation on motor performance in intracerebral haemorrhage: A clinical trial
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The aim of the randomized, double-blind, sham-controlled trial was to explore the efficacy and safety of HF-rPMS synchronosly applied to the axilla (stimulating the brachial plexus) and the popliteal fossa (stimulating the tibial nerve and common peroneal nerve) in patients with intracerebral hemorrhage on rehabilitation of motor functions.
Patients with intracerebral haemorrhage in the early period were recruited and randomly assigned to the HF-rPMS group or the sham rPMS group. The two synchrous coils of magnetic stimulation in the two groups were respectively applied to the axilla and the popliteal fossa of the affected limb. But the sham group received the ineffective rPMS and only heard the sound as occured in the HF-rPMS group. Clinical outcomes included the change of Fugl-Meyer Assessment (FMA) scale and Medical Research Council (MRC) scale before and after HF-rPMS.
Of 76 eligible patients, 30 were included and only 26 patients completed this study. The diferences on the improvement of the upper extremity FMA (P=0.012), the lower extremity FMA (P=0.001), the proximal MRC of upper extremity (p = 0.043), the proximal MRC of lower extremity (p= 0.004) and the distal MRC scores of lower extremity (p= 0.008) between the the HF-rPMS group and sham rPMS group were statistically signifcant.
Synchrous HF-rPMS intervention at the axilla and the popliteal fossa significantly improved motor function and proximal muscle strength of upper and lower limb of patients in acute or early subacute phase of intracerebral hemorrhage.
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Original articleEffects of Repetitive Peripheral Magnetic Stimulation on Upper-Limb Spasticity and Impairment in Patients With Spastic Hemiparesis: A Randomized, Double-Blind, Sham-Controlled Study

Abstract

Objective

Design

Setting

Participants

Interventions

Main Outcome Measures

Results

Conclusions

Section snippets

Methods

Results

Discussion

Conclusions

Suppliers

Acknowledgments

Lancet Neurol

Suppl Clin Neurophysiol

Electroencephalogr Clin Neurophysiol

Arch Phys Med Rehabil

A randomized controlled trial of surface neuromuscular electrical stimulation applied early after acute stroke: effects on wrist pain, spasticity and contractures

Clin Rehabil

Spasticity after stroke: physiology, assessment and treatment

Brain Inj

Assessing and treating functional impairment in poststroke spasticity

Neurology

Facilitation of skilled finger movements by repetitive peripheral magnetic stimulation (RPMS)—a new approach in central paresis

NeuroRehabilitation

Modulatory effect of repetitive peripheral magnetic stimulation on skeletal muscle tone in healthy subjects: stabilization of the elbow joint

Exp Brain Res

Theoretical and methodological considerations in the measurement of spasticity

Disabil Rehabil

The Tardieu Scale differentiates contracture from spasticity whereas the Ashworth Scale is confounded by it

Clin Rehabil

Original article
Effects of Repetitive Peripheral Magnetic Stimulation on Upper-Limb Spasticity and Impairment in Patients With Spastic Hemiparesis: A Randomized, Double-Blind, Sham-Controlled Study