Effects of neuromodulation interventions combined with robot-assisted gait training on lower extremity motor function
Haiping Huang1, Beisi Zheng1, Xinyi Su1
1The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
Background:
The combination of neuromodulation interventions with robot-assisted gait training (RAGT) for enhancing lower limb motor function recovery in stroke patients remains contentious.
Objective:
This study aims to investigate the effects of neuromodulation combined with RAGT on patients with lower limb motor dysfunction following a stroke and to analyze the optimal combined treatment strategies.
Methods:
A systematic search was conducted across PubMed, Web of Science, Cochrane Library, Embase, CNKI, VIP, Wanfang, and SinoMed databases. Two independent researchers performed literature screening, data extraction, and bias assessment. After data integration, the Cochrane risk of bias tool and PEDro scale were used to evaluate study quality. Data were analyzed using RevMan 5.4.1 and Stata 18.0 software, and the GRADE system was employed to assess evidence quality. Results are expressed as mean differences (MD) with 95 % confidence intervals (CI).
Results:
Eleven studies involving 445 stroke patients were included. Meta-analysis indicated that neuromodulation (acupuncture, tDCS, rTMS) combined with RAGT significantly improved FMA-LE scores ,BBS scores ,and 6MWT distances compared to RAGT alone, with no significant difference in FAC scores .In the order of FMA-LE , FAC , and BBS ,SUCRA results show: rTMS+RAGT (98.6 %) > acupuncture+RAGT (67.5 %) > RAGT (23.0 %) > DCS+RAGT (10.9 %); acupuncture+RAGT (89.1 %) > rTMS+RAGT (72.0 %) > tDCS+RAGT (34.3 %) > RAGT (4.6 %); acupuncture+RAGT (83.4 %) > rTMS+RAGT (83.2 %) > RAGT (26.0 %) > tDCS+RAGT (7.4 %).
Conclusion:
Neuromodulation interventions (rTMS, tDCS, acupuncture) combined with RAGT can significantly enhance lower limb motor function in stroke patients. Acupuncture or rTMS combined with RAGT may represent the optimal strategy.
