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Mirror therapy combined with defecation motor imagery and repetitive transcranial magnetic stimulation improves
1Rehabilitation Medicine Department, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China.
Background:
Post-stroke constipation is prevalent after frontal lobe infarction and may reflect disrupted cortical-autonomic regulation. Neurorehabilitation strategies targeting cortical plasticity may offer therapeutic benefit.
Objective:
To evaluate whether mirror therapy combined with defecation motor imagery and repetitive transcranial magnetic stimulation (rTMS) improves bowel function, and to explore associated cortical changes using EEG-derived event-related desynchronization (ERD).
Methods:
In this single-center retrospective study, 98 patients with frontal lobe infarction and Rome IV-defined constipation were analyzed. Forty-eight received mirror therapy + motor imagery + rTMS in addition to routine rehabilitation, and 50 received routine care alone. Primary outcomes included Wexner Constipation Score, weekly bowel frequency, and PAC-QOL. EEG μ/β-band ERD during defecation motor imagery was quantified. Between-group differences and correlations were analyzed.
Results:
After 8 weeks, the intervention group showed significantly greater improvement in Wexner score, bowel frequency, and PAC-QOL compared with controls (all P < 0.01; Cohen's d 0.60-0.82). Enhanced μ/β ERD was observed only in the intervention group. ERD changes correlated moderately with Wexner improvement (r = 0.56).
Conclusions:
Combined mirror therapy, motor imagery, and rTMS were associated with improved bowel function and increased task-related cortical activation. EEG-derived ERD may serve as a candidate biomarker for bowel-focused neurorehabilitation.
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