Effects of combining rTMs and augmented reality gait adaptive training on walking function of patients with stroke based on three-dimensional gait analysis and sEMG: a randomized controlled trial

Abstract

Background: Augmented reality gait adaptive training (ARGAT) and repetitive transcranial magnetic stimulation (rTMS) have both demonstrated efficacy in improving lower limb motor function in survivors of stroke.

Purpose: To investigate the effects of combining rTMS and ARGAT on motor function in survivors of stroke.

Methods: The experimental group received a combination of rTMS and ARGAT, while the control group received ARGAT alone. The interventions comprised a total of 20 sessions, conducted over four weeks with five consecutive daily sessions. Outcome measures included three-dimensional gait analysis (3DGA), surface electromyography (sEMG), Fugl-Meyer assessment for the lower extremity (FMA-LE), and the Berg Balance Scale (BBS).

Results: Following the intervention, both groups showed significant improvements in walking speed, symmetry index, affected step length, affected stride length, FMA-LE, and BBS scores (p < .05). Furthermore, the experimental group demonstrated greater improvements in walking speed (F = 4.58, p = .040), cadence (F = 5.67, p = .023), affected step length (F = 5.79, p = .022), affected stride length (F = 4.84, p = .035), FMA-LE (Z = 2.43, p = .019), and BBS (F = 4.76, p = .036) compared to the control group. The experimental group demonstrated a significant improvement in the co-contraction index (CCI) of the knee joint (F = 14.88, p < .001), a change not observed in the control group (F = 2.16, p = .151). However, neither group showed significant alterations in CCI of the ankle joint (F = 1.58, p = .218), step width (F = 0.24, p = .630), unaffected step length (F = 0.22, p = .641), or unaffected stride length (F = 2.99, p = .093).

Conclusion: The combination of low-frequency rTMS and ARGAT demonstrated superior effects on motor function recovery compared to ARGAT alone in survivors of stroke.

Keywords: Repetitive transcranial magnetic stimulation; augmented reality gait adaptive training; stroke; walking function.