The research progress on the improvement effect of repeated peripheral magnetic stimulation on upper limb and lower limb spasm after stroke_Journal of Biomedical Engineering

Authors：

XU Lijuan ¹ , YE Liang ¹ , JIA Jie ² ,  CHEN Shugeng ²

1. Rehabilitation Department, Hangzhou Linping Hospital of Traditional Chinese and Western Medicine, Hangzhou 310000, P. R. China;
2. Rehabilitation Department, Huashan Hospital, Fudan University, Shanghai 200040, P. R. China;

Corresponding author：

Keywords：

Repetitive peripheral magnetic stimulation; Stroke; Spasm

DOI：

10.7507/1001-5515.202411049

Video：

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Post-stroke spasticity, a common sequelae of upper motor neuron lesions, results in motor control deficits and pathological hypertonia that not only reduce patients’ activities of daily living but may also cause impairment of adaptive neuroplasticity. Repetitive peripheral magnetic stimulation (rPMS), as a novel non-invasive neuromodulation technique, demonstrates unique clinical potential through targeted modulation of electromagnetic coupling effects in the peripheral neuromuscular system. Although current international studies have validated the therapeutic potential of rPMS for spasticity, significant heterogeneity persists in elucidating its mechanisms of action, optimizing parameter protocols, and standardizing outcome assessment systems. This review innovatively synthesized recent randomized controlled trials (RCTs) and mechanistic evidence, systematically summarizing rPMS-mediated multidimensional intervention paradigms for upper- and lower-limb spasticity. It rigorously examined the correlations between stimulation frequency parameters (low-frequency vs. high-frequency), anatomical targeting (nerve trunk vs. motor point), and clinical outcomes including spasticity severity, motor function, and quality of life. Crucially, the analysis reveals that rPMS may ameliorate spasticity through dual mechanisms involving local neuroelectrophysiological modulation and central sensorimotor network reorganization, thereby providing a theoretical foundation for developing individualized rPMS clinical protocols and establishing precision treatment strategies.

1.	Kuriakose D, Xiao Z. Pathophysiology and treatment of stroke: Present status and future perspectives. Int J Mol Sci, 2020, 21(20): 7609.
2.	王陇德, 彭斌, 张鸿祺, 等. 《中国脑卒中防治报告2020》概要. 中国脑血管病杂志, 2022, 19(2): 136-144.
3.	Vaduganathan M, Mensah G A, Turco J V, et al. The global burden of cardiovascular diseases and risk: A compass for future health. J Am Coll Cardiol, 2022, 80(25): 2361-2371.
4.	Lundström E, Terént A, Borg J. Prevalence of disabling spasticity 1 year after first-ever stroke. Eur J Neurol, 2008, 15(6): 533-539.
5.	侯牧韶, 崔晓格, 刘子渤, 等. 肌骨超声技术在脑卒中后痉挛评估中的应用研究进展. 中华物理医学与康复杂志, 2024, 46(5): 460-463.
6.	Armstrong A W, Read C. Pathophysiology, clinical presentation, and treatment of psoriasis: A review. JAMA, 2020, 323(19): 1945-1960.
7.	Bates B, Choi J Y, Duncan P W, et al. Veterans affairs/department of defense clinical practice guideline for the management of adult stroke rehabilitation care: executive summary. Stroke, 2005, 36(9): 2049-2056.
8.	Gomez-Cuaresma L, Lucena-Anton D, Gonzalez-Medina G, et al. Effectiveness of stretching in post-stroke spasticity and range of motion: Systematic review and meta-analysis. J Pers Med, 2021, 11(11): 1074.
9.	程期琳, 胡昔权. 外周磁刺激治疗脑卒中患者上肢运动功能障碍的研究进展. 中国康复医学杂志, 2023, 38(6): 840-844.
10.	Wissel J, Verrier M, Simpson D M, et al. Post-stroke spasticity: predictors of early development and considerations for therapeutic intervention. PM R, 2015, 7(1): 60-67.
11.	Thibaut A, Chatelle C, Ziegler E, et al. Spasticity after stroke: physiology, assessment and treatment. Brain Inj, 2013, 27(10): 1093-1105.
12.	何伟, 韩伯军, 王庆广, 等. 体外冲击波作用于肌腹或肌肉-肌腱接合处对脑卒中患者下肢痉挛及步行能力的影响. 中华物理医学与康复杂志, 2023, 45(10): 904-908.
13.	Cabanas-Valdés R, Calvo-Sanz J, Urrùtia G, et al. The effectiveness of extracorporeal shock wave therapy to reduce lower limb spasticity in stroke patients: a systematic review and meta-analysis. Top Stroke Rehabil, 2020, 27(2): 137-157.
14.	Lin S, Sun Q, Wang H, et al. Influence of transcutaneous electrical nerve stimulation on spasticity, balance, and walking speed in stroke patients: A systematic review and meta-analysis. J Rehabil Med, 2018, 50(1): 3-7.
15.	Xu P, Huang Y, Wang J, et al. Repetitive transcranial magnetic stimulation as an alternative therapy for stroke with spasticity: a systematic review and meta-analysis. J Neurol, 2021, 268(11): 4013-4022.
16.	Salazar A P, Pinto C, Ruschel M J, et al. Effectiveness of static stretching positioning on post-stroke upper-limb spasticity and mobility: Systematic review with meta-analysis. Ann Phys Rehabil Med, 2019, 62(4): 274-282.
17.	Kinoshita S, Ikeda K, Hama M, et al. Repetitive peripheral magnetic stimulation combined with intensive physical therapy for gait disturbance after hemorrhagic stroke: an open-label case series. Int J Rehabil Res, 2020, 43(3): 235-239.
18.	Zschorlich V, Yamaguchi T, Schneider C. Editorial: The use of repetitive peripheral magnetic stimulation (rPMS) in neurological disorders and neurorehabilitation. Front Neurol, 2023, 14: 1324882.
19.	Aamir A, Girach A, Sarrigiannis P G, et al. Repetitive magnetic stimulation for the management of peripheral neuropathic pain: A systematic review. Adv Ther, 2020, 37(3): 998-1012.
20.	Fernandez-Lobera M, Morales M, Valls-Sole J. Repetitive peripheral magnetic stimulation for the assessment of wrist spasticity: reliability, validation and correlation with clinical measures. Disabil Rehabil, 2022, 44(18): 5257-5267.
21.	Jiang Y F, Zhang D, Zhang J, et al. A randomized controlled trial of repetitive peripheral magnetic stimulation applied in early subacute stroke: Effects on severe upper-limb impairment. Clin Rehabil, 2022, 36(5): 693-702.
22.	李阳, 陈树耿, 王传凯, 等. 重复外周磁刺激对脑卒中患者上肢痉挛和运动功能的即刻影响. 中国康复理论与实践, 2018, 24(12): 1376-1379.
23.	Struppler A, Angerer B, Gündisch C, 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, 157(1): 59-66.
24.	Werner C, Schrader M, Wernicke S, et al. Repetitive peripheral magnetic stimulation (rpMS) in combination with muscle stretch decreased the wrist and finger flexor muscle spasticity in chronic patients after CNS lesion. Int J Phys Med Rehabil, 2016, 4(4): 352.
25.	Qin Y, Liu X, Zhang Y, et al. Effects of transcranial combined with peripheral repetitive magnetic stimulation on limb spasticity and resting-state brain activity in stroke patients. Front Hum Neurosci, 2023, 17: 992424.
26.	Kamo T, Wada Y, Okamura M, et al. Repetitive peripheral magnetic stimulation for impairment and disability in people after stroke. Cochrane Database Syst Rev, 2022, 9(9): CD11968.
27.	Krewer C, Hartl S, Müller F, et al. Effects of repetitive peripheral magnetic stimulation on upper-limb spasticity and impairment in patients with spastic hemiparesis: a randomized, double-blind, sham-controlled study. Arch Phys Med Rehabil, 2014, 95(6): 1039-1047.
28.	孙藤方, 任梦婷, 杨琳, 等. 高压氧治疗联合重复外周磁刺激干预脑卒中患者踝运动功能和平衡能力的效果. 中国康复理论与实践, 2023, 29(8): 875-881.
29.	Ke J, Wei J, Zheng B, et al. Effect of high-frequency repetitive peripheral magnetic stimulation on motor performance in intracerebral haemorrhage: A clinical trial. J Stroke Cerebrovasc Dis, 2022, 31(7): 106446.
30.	Beaulieu L D, Massé-Alarie H, Brouwer B, et al. Noninvasive neurostimulation in chronic stroke: a double-blind randomized sham-controlled testing of clinical and corticomotor effects. Top Stroke Rehabil, 2015, 22(1): 8-17.
31.	Nevine El Nahas, Fatma Fathalla Kenawy, Eman Hamid Abd Eldayem, et al. Peripheral magnetic theta burst stimulation to muscles can effectively reduce spasticity: a randomized controlled trial. J Neuroeng Rehabil, 2022, 19(1): 5.
32.	Pan J X, Diao Y X, Peng H Y, et al. Effects of repetitive peripheral magnetic stimulation on spasticity evaluated with modified Ashworth scale/Ashworth scale in patients with spastic paralysis: A systematic review and meta-analysis. Front Neurol, 2022, 13: 997913.
33.	Sakai K, Yasufuku Y, Kamo T, et al. Repetitive peripheral magnetic stimulation for impairment and disability in people after stroke. Cochrane Database Syst Rev, 2019, 11(11): CD11968.
34.	Momosaki R, Yamada N, Ota E, et al. Repetitive peripheral magnetic stimulation for activities of daily living and functional ability in people after stroke. Cochrane Database Syst Rev, 2017, 6(6): CD11968.
35.	Ghandehari K, Ghandehari K, Saffarian-Toosi G, et al. Comparative interrater reliability of Asian Stroke Disability Scale, modified Rankin Scale and Barthel Index in patients with brain infarction. ARYA Atheroscler, 2012, 8(3): 153-157.
36.	Wissel J, Schelosky L D, Scott J, et al. Early development of spasticity following stroke: a prospective, observational trial. J Neurol, 2010, 257(7): 1067-1072.
37.	Pandyan A D, Gregoric M, Barnes M P, et al. Spasticity: clinical perceptions, neurological realities and meaningful measurement. Disabil Rehabil, 2005, 27(1-2): 2-6.
38.	Li S, Francisco G E, Rymer W Z. A new definition of poststroke spasticity and the interference of spasticity with motor recovery from acute to chronic stages. Neurorehabil Neural Repair, 2021, 35(7): 601-610.
39.	Guo X, Tang J, Crocher V, et al. Using sEMG signal frequency to evaluate post-stroke elbow spasticity. Annu Int Conf IEEE Eng Med Biol Soc, 2023, 2023: 1-4.
40.	Boulard C, Mathevon L, Arnaudeau L F, et al. Reliability of shear wave elastography and ultrasound measurement in children with unilateral spastic cerebral palsy. Ultrasound Med Biol, 2021, 47(5): 1204-1211.
41.	朱光跃, 陈思韵, 霍聪聪, 等. 外周联合中枢双靶磁刺激促进脑卒中运动功能障碍康复专家共识. 中国康复医学杂志, 2023, 38(7): 880-884.
42.	Fujimura K, Kagaya H, Itoh R, et al. Repetitive peripheral magnetic stimulation for preventing shoulder subluxation after stroke: a randomized controlled trial. Eur J Phys Rehabil Med, 2024, 60(2): 216-224.
43.	Asao A, Wada K, Nomura T, et al. Time course changes in corticospinal excitability during repetitive peripheral magnetic stimulation combined with motor imagery. Neurosci Lett, 2022, 771: 136427.
44.	Schabrun S M, Ridding M C, Galea M P, et al. Primary sensory and motor cortex excitability are co-modulated in response to peripheral electrical nerve stimulation. PLoS One, 2012, 7(12): e51298.
45.	Suputtitada A. Emerging theory of sensitization in post-stroke muscle spasticity. Front Rehabil Sci, 2023, 4: 1169087.
46.	Chen S, Li Y, Shu X, et al. Electroencephalography mu rhythm changes and decreased spasticity after repetitive peripheral magnetic stimulation in patients following stroke. Front Neurol, 2020, 11: 546599.
47.	Okudera Y, Matsunaga T, Sato M, et al. The impact of high-frequency magnetic stimulation of peripheral nerves: muscle hardness, venous blood flow, and motor function of upper extremity in healthy subjects. Biomed Res, 2015, 36(2): 81-87.
48.	刘浩, 贾延兵, 魏静, 等. 重复外周磁刺激在康复治疗中的应用及研究进展. 中国康复医学杂志, 2021, 36(5): 631-637.

1. Kuriakose D, Xiao Z. Pathophysiology and treatment of stroke: Present status and future perspectives. Int J Mol Sci, 2020, 21(20): 7609.
2. 王陇德, 彭斌, 张鸿祺, 等. 《中国脑卒中防治报告2020》概要. 中国脑血管病杂志, 2022, 19(2): 136-144.
3. Vaduganathan M, Mensah G A, Turco J V, et al. The global burden of cardiovascular diseases and risk: A compass for future health. J Am Coll Cardiol, 2022, 80(25): 2361-2371.
4. Lundström E, Terént A, Borg J. Prevalence of disabling spasticity 1 year after first-ever stroke. Eur J Neurol, 2008, 15(6): 533-539.
5. 侯牧韶, 崔晓格, 刘子渤, 等. 肌骨超声技术在脑卒中后痉挛评估中的应用研究进展. 中华物理医学与康复杂志, 2024, 46(5): 460-463.
6. Armstrong A W, Read C. Pathophysiology, clinical presentation, and treatment of psoriasis: A review. JAMA, 2020, 323(19): 1945-1960.
7. Bates B, Choi J Y, Duncan P W, et al. Veterans affairs/department of defense clinical practice guideline for the management of adult stroke rehabilitation care: executive summary. Stroke, 2005, 36(9): 2049-2056.
8. Gomez-Cuaresma L, Lucena-Anton D, Gonzalez-Medina G, et al. Effectiveness of stretching in post-stroke spasticity and range of motion: Systematic review and meta-analysis. J Pers Med, 2021, 11(11): 1074.
9. 程期琳, 胡昔权. 外周磁刺激治疗脑卒中患者上肢运动功能障碍的研究进展. 中国康复医学杂志, 2023, 38(6): 840-844.
10. Wissel J, Verrier M, Simpson D M, et al. Post-stroke spasticity: predictors of early development and considerations for therapeutic intervention. PM R, 2015, 7(1): 60-67.
11. Thibaut A, Chatelle C, Ziegler E, et al. Spasticity after stroke: physiology, assessment and treatment. Brain Inj, 2013, 27(10): 1093-1105.
12. 何伟, 韩伯军, 王庆广, 等. 体外冲击波作用于肌腹或肌肉-肌腱接合处对脑卒中患者下肢痉挛及步行能力的影响. 中华物理医学与康复杂志, 2023, 45(10): 904-908.
13. Cabanas-Valdés R, Calvo-Sanz J, Urrùtia G, et al. The effectiveness of extracorporeal shock wave therapy to reduce lower limb spasticity in stroke patients: a systematic review and meta-analysis. Top Stroke Rehabil, 2020, 27(2): 137-157.
14. Lin S, Sun Q, Wang H, et al. Influence of transcutaneous electrical nerve stimulation on spasticity, balance, and walking speed in stroke patients: A systematic review and meta-analysis. J Rehabil Med, 2018, 50(1): 3-7.
15. Xu P, Huang Y, Wang J, et al. Repetitive transcranial magnetic stimulation as an alternative therapy for stroke with spasticity: a systematic review and meta-analysis. J Neurol, 2021, 268(11): 4013-4022.
16. Salazar A P, Pinto C, Ruschel M J, et al. Effectiveness of static stretching positioning on post-stroke upper-limb spasticity and mobility: Systematic review with meta-analysis. Ann Phys Rehabil Med, 2019, 62(4): 274-282.
17. Kinoshita S, Ikeda K, Hama M, et al. Repetitive peripheral magnetic stimulation combined with intensive physical therapy for gait disturbance after hemorrhagic stroke: an open-label case series. Int J Rehabil Res, 2020, 43(3): 235-239.
18. Zschorlich V, Yamaguchi T, Schneider C. Editorial: The use of repetitive peripheral magnetic stimulation (rPMS) in neurological disorders and neurorehabilitation. Front Neurol, 2023, 14: 1324882.
19. Aamir A, Girach A, Sarrigiannis P G, et al. Repetitive magnetic stimulation for the management of peripheral neuropathic pain: A systematic review. Adv Ther, 2020, 37(3): 998-1012.
20. Fernandez-Lobera M, Morales M, Valls-Sole J. Repetitive peripheral magnetic stimulation for the assessment of wrist spasticity: reliability, validation and correlation with clinical measures. Disabil Rehabil, 2022, 44(18): 5257-5267.
21. Jiang Y F, Zhang D, Zhang J, et al. A randomized controlled trial of repetitive peripheral magnetic stimulation applied in early subacute stroke: Effects on severe upper-limb impairment. Clin Rehabil, 2022, 36(5): 693-702.
22. 李阳, 陈树耿, 王传凯, 等. 重复外周磁刺激对脑卒中患者上肢痉挛和运动功能的即刻影响. 中国康复理论与实践, 2018, 24(12): 1376-1379.
23. Struppler A, Angerer B, Gündisch C, 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, 157(1): 59-66.
24. Werner C, Schrader M, Wernicke S, et al. Repetitive peripheral magnetic stimulation (rpMS) in combination with muscle stretch decreased the wrist and finger flexor muscle spasticity in chronic patients after CNS lesion. Int J Phys Med Rehabil, 2016, 4(4): 352.
25. Qin Y, Liu X, Zhang Y, et al. Effects of transcranial combined with peripheral repetitive magnetic stimulation on limb spasticity and resting-state brain activity in stroke patients. Front Hum Neurosci, 2023, 17: 992424.
26. Kamo T, Wada Y, Okamura M, et al. Repetitive peripheral magnetic stimulation for impairment and disability in people after stroke. Cochrane Database Syst Rev, 2022, 9(9): CD11968.
27. Krewer C, Hartl S, Müller F, et al. Effects of repetitive peripheral magnetic stimulation on upper-limb spasticity and impairment in patients with spastic hemiparesis: a randomized, double-blind, sham-controlled study. Arch Phys Med Rehabil, 2014, 95(6): 1039-1047.
28. 孙藤方, 任梦婷, 杨琳, 等. 高压氧治疗联合重复外周磁刺激干预脑卒中患者踝运动功能和平衡能力的效果. 中国康复理论与实践, 2023, 29(8): 875-881.
29. Ke J, Wei J, Zheng B, et al. Effect of high-frequency repetitive peripheral magnetic stimulation on motor performance in intracerebral haemorrhage: A clinical trial. J Stroke Cerebrovasc Dis, 2022, 31(7): 106446.
30. Beaulieu L D, Massé-Alarie H, Brouwer B, et al. Noninvasive neurostimulation in chronic stroke: a double-blind randomized sham-controlled testing of clinical and corticomotor effects. Top Stroke Rehabil, 2015, 22(1): 8-17.
31. Nevine El Nahas, Fatma Fathalla Kenawy, Eman Hamid Abd Eldayem, et al. Peripheral magnetic theta burst stimulation to muscles can effectively reduce spasticity: a randomized controlled trial. J Neuroeng Rehabil, 2022, 19(1): 5.
32. Pan J X, Diao Y X, Peng H Y, et al. Effects of repetitive peripheral magnetic stimulation on spasticity evaluated with modified Ashworth scale/Ashworth scale in patients with spastic paralysis: A systematic review and meta-analysis. Front Neurol, 2022, 13: 997913.
33. Sakai K, Yasufuku Y, Kamo T, et al. Repetitive peripheral magnetic stimulation for impairment and disability in people after stroke. Cochrane Database Syst Rev, 2019, 11(11): CD11968.
34. Momosaki R, Yamada N, Ota E, et al. Repetitive peripheral magnetic stimulation for activities of daily living and functional ability in people after stroke. Cochrane Database Syst Rev, 2017, 6(6): CD11968.
35. Ghandehari K, Ghandehari K, Saffarian-Toosi G, et al. Comparative interrater reliability of Asian Stroke Disability Scale, modified Rankin Scale and Barthel Index in patients with brain infarction. ARYA Atheroscler, 2012, 8(3): 153-157.
36. Wissel J, Schelosky L D, Scott J, et al. Early development of spasticity following stroke: a prospective, observational trial. J Neurol, 2010, 257(7): 1067-1072.
37. Pandyan A D, Gregoric M, Barnes M P, et al. Spasticity: clinical perceptions, neurological realities and meaningful measurement. Disabil Rehabil, 2005, 27(1-2): 2-6.
38. Li S, Francisco G E, Rymer W Z. A new definition of poststroke spasticity and the interference of spasticity with motor recovery from acute to chronic stages. Neurorehabil Neural Repair, 2021, 35(7): 601-610.
39. Guo X, Tang J, Crocher V, et al. Using sEMG signal frequency to evaluate post-stroke elbow spasticity. Annu Int Conf IEEE Eng Med Biol Soc, 2023, 2023: 1-4.
40. Boulard C, Mathevon L, Arnaudeau L F, et al. Reliability of shear wave elastography and ultrasound measurement in children with unilateral spastic cerebral palsy. Ultrasound Med Biol, 2021, 47(5): 1204-1211.
41. 朱光跃, 陈思韵, 霍聪聪, 等. 外周联合中枢双靶磁刺激促进脑卒中运动功能障碍康复专家共识. 中国康复医学杂志, 2023, 38(7): 880-884.
42. Fujimura K, Kagaya H, Itoh R, et al. Repetitive peripheral magnetic stimulation for preventing shoulder subluxation after stroke: a randomized controlled trial. Eur J Phys Rehabil Med, 2024, 60(2): 216-224.
43. Asao A, Wada K, Nomura T, et al. Time course changes in corticospinal excitability during repetitive peripheral magnetic stimulation combined with motor imagery. Neurosci Lett, 2022, 771: 136427.
44. Schabrun S M, Ridding M C, Galea M P, et al. Primary sensory and motor cortex excitability are co-modulated in response to peripheral electrical nerve stimulation. PLoS One, 2012, 7(12): e51298.
45. Suputtitada A. Emerging theory of sensitization in post-stroke muscle spasticity. Front Rehabil Sci, 2023, 4: 1169087.
46. Chen S, Li Y, Shu X, et al. Electroencephalography mu rhythm changes and decreased spasticity after repetitive peripheral magnetic stimulation in patients following stroke. Front Neurol, 2020, 11: 546599.
47. Okudera Y, Matsunaga T, Sato M, et al. The impact of high-frequency magnetic stimulation of peripheral nerves: muscle hardness, venous blood flow, and motor function of upper extremity in healthy subjects. Biomed Res, 2015, 36(2): 81-87.
48. 刘浩, 贾延兵, 魏静, 等. 重复外周磁刺激在康复治疗中的应用及研究进展. 中国康复医学杂志, 2021, 36(5): 631-637.

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Latest ArticlesThe research progress on the improvement effect of repeated peripheral magnetic stimulation on upper limb and lower limb spasm after stroke

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