EFFECT OF COMBINED PHYSIOTHERAPY WITH PERIPHERAL REPETITIVE MAGNETIC STIMULATION ON BALANCE AND GAIT AFTER TRAUMATIC BRAIN INJURY: CASE STUDY

M. Kim¹, J. Kim², J. Kim³

Background: Traumatic brain injury (TBI) causes a broad range of structural damage and functional deficits and there are no standardized protocols in physiotherapy at present. Only few Isolated repetitive transcranial and peripheral magnetic stimulation (TMS and PMS) studies have been performed in TBI patients with motor impairment. However, they suggested TMS and PMS could enhance recovery after TBI. If provided in combination, magnetic stimulation and physiotherapy may be synergistic and be beneficial.

Purpose: This study aimed to explore the effect of combined therapy of Neurodevelopmental treatment (NDT) and repetitive PMS (rPMS) on balance and gait functions after TBI and to give a mere contribution to establishment of the treatment protocols in TBI rehabilitation.

Methods: This study is a case report on a male Emirati, middle aged man with right sided hemiplegia from TBI by a traffic accident 23 years ago. He was physically independent in most of lower extremity involved activities of daily life including gait, however, had continuously experienced falls averagely 2 times a month from lack of coordination and impaired standing balance. He had a spasticity on distal extremities (Modified Ashworth scale G 1) with generalized right sided weakness. HF-rPMS has been administered on muscles in the trunk, upper extremity, and lower extremity according to the daily goal based on NDT throughout 1 hour’s physiotherapy session (NDT+rPMS). Total 12 sessions have been delivered on a weekly basis for 3 months. Berg balance scale, trunk impairment scale, functional reach test, and gait speed were measured at baseline and after 12 sessions of NDT+rPMS.

Results: At baseline, berg balance scale (BBS) was 41 over 56 that implied the patient had a risk of fall, trunk impairment scale (TIS) was 12 over 24 that showed impairment in dynamic balance and coordination, and gait speed was 1.00 m/s. After 12 sessions of NDT+rPMS, gait and balance function has been improved. BBS has increased (52/56), TIS has increased (22/24), functional reach test has improved (25cm) on the right, and gait speed has increased (1.18m/s).

Conclusion(s): Combined therapy of NDT and rPMS could be synergistic and beneficial in TBI patients to improve gait and balance functions even in the chronic stage. In order to reach definitive conclusions, randomized controlled studies with larger patient samples, improved design and setup are necessary to verify initial findings of the study.

Implications: PMS is more feasible application in real life clinical usage than TMS without adverse side effects. PMS combined neurorehabilitation in TBI has positive potentials in our findings. Further investigation should be considered to establish the treatment protocols of PMS combined physiotherapy.

Funding, acknowledgements: No funding to declare.

Keywords: Traumatic brain injury, Neurodevelopmental treatment, Peripheral magnetic stimulation

Topic: Disability & rehabilitation

Did this work require ethics approval? No

Institution: N/A

Committee: N/A

Reason: This is a case study to develop protocols in practice. Written consent was taken from the participant.