Efficacy of paired associative stimulation combined with low-temperature thermoplastic orthosis in the treatment of post-stroke wrist flexor spasticity
DOI:
https://doi.org/10.54029/2025kveKeywords:
stroke, paired associative stimulation, transcranial magnetic stimulationtranscranial magnetic stimulation, peripheral nerve electrical stimulation, wrist flexor spasticityAbstract
Objective: This study aims to investigate the efficacy of Paired Associative Stimulation (PAS) integrated with Low-Temperature Thermoplastic Orthosis (LTTPO) on post-stroke wrist flexor spasticity.
Methods: This prospective randomized controlled study recruited 63 patients with post-stroke wrist flexor spasticity treated in the Neurology Department of our hospital from January 2022 to June 2023. The patients were randomly assigned in a ratio of 1:1 to receive either sham stimulation combined with LTTPO (control group) or PAS combined with low-temperature thermoplastic orthosis (study group) via a random number table, with 31 patients in the control group and 32 in the study group. The primary endpoints used to evaluate treatment efficacy were functional recovery—assessed by the Modified Ashworth Scale (MAS), Fugl-Meyer Assessment (FMA), Barthel Index (BI), and Visual Analog Scale (VAS)—and brain functional remodeling.
Results: At treatment completion, 4 weeks post-treatment, and 8 weeks post-treatment, PAS combined with LTTPO provided a significantly higher treatment effectiveness rate than LTTPO with sham stimulation. Patients receiving PAS exhibited significantly better functional recovery of wrist joint and pain mitigation than those with sham stimulation at the aforementioned time points, as evidenced by the lower MAS scores, higher Simplified FMA scores, and lower VAS pain scores. Both groups demonstrated improvements in BI scores over time, indicating enhanced functional independence. However, they also exhibited progressively worsening joint swelling. Despite these opposing trends, the differences between the two groups in both BI improvement and joint swelling were not statistically significant.
Conclusion: The integration of PAS combined with LTTPO offers a viable alternative managing post- stroke wrist flexor spasticity by significantly reducing wrist flexor spasticity, improving functional recovery, alleviating pain, and promoting neural remodeling.
