Application of Transcranial Magnetic Stimulation in Balance and Walking Disorders in Stroke Patients

Stroke is characterized by high morbidity, mortality, and disability rates, severely impacting public health and safety. Organized stroke management can significantly reduce mortality and disability rates among stroke patients. Domestic experts have developed comprehensive recommendations for organized stroke management and reached a consensus: early intervention with appropriate intensity exercise prescriptions for patients with cerebral infarction can improve patient outcomes and reduce hospitalization time.

Balance and gait function in stroke survivors are of particular concern to patients and their families during rehabilitation treatment. Therefore, improving balance and gait function in stroke survivors has been a research hotspot for many years.

Advances in neuroscience, the application of various brain stimulation technologies, and the development of rehabilitation robots have brought many new therapeutic techniques to rehabilitation medicine. Among them, repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique that uses a magnetic (or electric) field to apply magnetic (or electric) signals at a constant frequency to the cerebral cortex, generating induced currents that modulate cortical excitability and influence brain metabolism and neural activity. Studies have shown that rTMS has a positive effect on the recovery of balance and gait function in stroke patients. This article will introduce research on the application of rTMS in improving balance and gait function in stroke patients.

Mechanisms of Balance and Walking Disorders

Previous studies have found that although many brain structures are involved in balance, the most commonly involved structures include the cerebellum, basal ganglia, thalamus, hippocampus, inferior parietal cortex, and frontal lobe areas. Although balance appears to be a whole-brain phenomenon, a number of structures play a key role in balance and may be associated with balance disorders. Some of these structures (namely the cerebellum, basal ganglia, and thalamus) have well-known roles in balance.

The Mechanism of Transcranial Magnetic Stimulation on Balance and Gait Disorders after Stroke

Transcranial magnetic stimulation (TMS) is a noninvasive strategy for modulating the excitability of cerebral cortical networks. Three types of TMS are currently in widespread use: single-pulse TMS, double-pulse TMS, and repetitive TMS.

Compared to the other two methods, repetitive TMS has been shown to induce significant modulations in cortical excitability, thereby impacting functional and behavioral performance. Repetitive TMS is a noninvasive, top-down, central nervous system modulation technique:

● Low-frequency (≤1 Hz) repetitive TMS inhibits local neuronal activity and reduces cortical excitability;

● High-frequency (>1 Hz) repetitive TMS increases cortical excitability.

Studies have shown that a three-week repetitive transcranial magnetic stimulation program can improve leg mobility, posture, and gait. Furthermore, studies have confirmed that the cerebellum is the brain region most closely associated with balance, and that cerebellar intermittent theta burst stimulation (CRB-iTBS) can strongly activate neural activity in the cerebellum. Other studies have found that combining CRB-iTBS with traditional exercise therapy is a powerful strategy for promoting gait and balance recovery in patients with ischemic stroke by successfully achieving cerebellar cortical reorganization.

Clinical Application of Repetitive Transcranial Magnetic Stimulation

According to relevant literature, repetitive transcranial magnetic stimulation (RTMS) is currently used to treat post-stroke balance and gait disorders, primarily targeting the cerebellum and dorsolateral prefrontal cortex. Furthermore, relevant research suggests that RTMS of trunk muscles has a certain effect on balance and gait in chronic stroke patients.

The rehabilitation of balance and walking function defects is a very important aspect of the rehabilitation process for stroke patients. It runs through every stage of the patient's rehabilitation treatment. The rehabilitation treatment team needs to carry out targeted rehabilitation treatment and guidance to help patients recover.

Based on traditional transcranial magnetic stimulation technology, Sunnyou Medical is equipped with an intelligent robotic system, combining visual imaging, medical image processing, positioning navigation, intelligent operating system and other technologies to ensure consistency in the treatment process and achieve standardized and standardized rehabilitation treatment.