# Rehabilitation Evaluation of Hemiplegic Patients with Anterior Circulation Cerebral Infarction Based on Cranial Magnetic Stimulation

Authors: Zhengde Tao; Gaofeng Rao; Shasha Wu; Yongqiang Lin; Jinqiao Wang; Zhirui Chen
Journal: Journal of Healthcare Engineering
 (2021)

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## Abstract

Cerebral infarction is a common cerebrovascular disease in clinical medicine. Cerebral infarction in the anterior circulation accounts for about 90% of cerebral infarction. Its treatment and rehabilitation has always been a research hotspot in the medical field. Functional retraining can enhance the afferent impulses received by receptors, make the plasticity development of cerebral cortex function, and improve the loss of function. Based on the patient’s individual condition, exercise therapy carries out the corresponding comprehensive functional training plan, which also includes the training of patients’ daily living ability, turning over, bridge exercise, trunk rotation, etc., in order to improve the motor function of patients. The other is psychotherapy, which can cause emotional fluctuations, depression, anxiety, and other negative emotions due to the occurrence of diseases. In the rehabilitation treatment, relevant personnel can conduct psychological counseling for patients through timely and effective communication, so as to better establish patients’ confidence in rehabilitation and improve the effect of rehabilitation treatment. The third is acupuncture treatment. Acupuncture is a traditional rehabilitation treatment in China. The rehabilitation effect of stroke has been proved by a large number of clinical practice. Acupuncture at Hegu, Quchi, Zusanli, and Taichong points can dredge channels and improve blood circulation. This paper mainly studies and analyzes the effect of behavior rehabilitation of hemiplegic patients with cerebral anterior circulation infarction treated by cranial magnetic stimulation. The rehabilitation treatment status of hemiplegic patients with anterior circulation cerebral infarction in a hospital was selected, and 100 cases were studied. Among them, 50 cases were treated with conventional rehabilitation therapy, and the other 50 cases were treated with cranial magnetic stimulation. The motor function, activities of daily living, and language expression ability of the two groups were compared for statistical analysis. After transcranial magnetic stimulation treatment, the abilities of the study group were better than those of the control group,P<0.05, with statistical significance. Based on the reliable experimental data, we can draw a conclusion that the treatment of cranial magnetic stimulation has a significant effect on the rehabilitation of hemiplegic patients with cerebral anterior circulation infarction, which is higher than the conventional treatment and rehabilitation methods, and can be popularized in clinical application.


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## Body

## 1. Introduction

With the aging of China’s population and the gradual improvement of the economic level, the incidence rate of cerebral infarction has increased year by year, showing a trend of younger age. Although the incidence of cerebral infarction presents a trend of younger age, the main force is the middle-aged and elderly people aged 50–75. Because of the increase of age, the aging of the body is accompanied by the decline of body function. After the onset of the disease, it will bring many consequences, such as death or hemiplegia, which will bring great pain to the patients themselves and their families, seriously reducing the quality of life of residents [1]. Cerebral infarction (CI) is due to a variety of factors; the blood supply to the brain is cut off, which induces cerebral ischemia and hypoxia death. The necrosis is irreversible [2]. The blood supply of the brain mainly comes from the internal carotid artery system and the vertebral basilar artery system. The internal carotid artery system mainly supplies blood to the eyes and the first three-fifths of the cerebral hemisphere. Therefore, it is also called precirculation. Cerebral infarction can be divided into anterior circulation ischemia and posterior circulation ischemia according to the location of infarction, and most of the infarction sites are anterior circulation, accounting for 80–90% of cerebral infarction. Some studies have pointed out that the anterior circulation vessels provide 60% of the total cerebral blood volume, so once the anterior circulation vessels narrow or occlude, it will have a very serious impact on the cerebral blood supply [3].Cerebral infarction is a common clinical brain disease, and its pathological factors can lead to irreversible necrosis of brain tissue. Statistics show that 80% of stroke cases are cerebral infarction, and the high incidence rate is also associated with high mortality and disability rate [4]. Cerebral infarction can cause many serious clinical symptoms, such as sudden fainting, hemiplegia, and aphasia [5]. Among them, hemiplegia refers to hemiplegia, which is mainly caused by the central nervous system damage caused by the blood supply disorder of cerebral infarction. Hemiplegia refers to the movement disorder of upper and lower limbs and facial muscles on the same side of the body in patients with cerebral infarction. Hemiplegia accounts for about 70% of patients with cerebral infarction, which is a very common clinical manifestation [6]. Severe patients have a great probability of disability, and most of them are with irreversible behavioral disabilities. Through some rehabilitation treatment, they can recover part of their mobility, but they are not as good as before, which is very painful to the patients themselves and their families. According to the degree of hemiplegia, it can be divided into different grades: mild: muscle strength is slightly weakened, causing slight inconvenience to the patient’s ability to move, and has little impact on the patient’s daily life. Incomplete paralysis has a large range; muscle strength is much lower than healthy, while total paralysis is the most serious, where muscle strength is almost completely lost, and paralyzed limbs are completely unable to move [7].Cerebral infarction is easy to cause disability and sudden death, but some patients’ condition has been effectively controlled after symptomatic treatment, but hemiplegia still exists. Some have language or physical behavior disorders, so their ability to move is limited or completely lost [8]. However, thanks to the development of current medical technology, the symptoms of hemiplegia caused by cerebral infarction can be relieved or cured after various stages of rehabilitation treatment [9]. It uses electromagnetic conversion. The charged coil generates a vertical magnetic field in the direction of current and generates a second current by irradiating the skin and skull, leaving the neurons in the cerebral cortex, affecting the activity of neurons in the brain, thereby affecting the mental activity of the brain, and affecting the function of local and remote cortex. The separation of cortical function, regional reorganization of cortical function, affects the release of a variety of neurotransmitters and gene expression levels. The advantages of rTMS are less trauma and pain, fewer side effects, repeatability, and being an easy operation. It has a very broad application prospect [10].


## 2. Algorithm Establishment

### 2.1. Statistical Methods of Rehabilitation Evaluation

Let the total mean of all the answers in the samplel of layer H be μ1h. The overall mean of all responses in sample 2 was μ2h. μh is the total mean value of H-layer sensitive problems, and μh is used as the reference value and μBh is the nonsensitive problem Bh layer. The total mean value of H is defined by the weighted mean value:(1)μ1h=P1×μh+1−P1×μBh,μ2h=P2×μh+1−P2×μBh.By solving the above equations, we get the following results:(2)μh=1−P2×μ1h−1−P1×μ2hP1−P2,μBh=P2×μ1h−P1×μ2hP2−P1.According toμh and μBh, the sample estimate of BH is(3)μ1h=1−P2×μ1h−1−P1×μ2hP1−P2,μBh=P2×μ1h−P1×μ2hP2−P1.Among them,(4)μ1h^=the sum of all rehabilitation assessment scores in sample1of levelHn1h,μ2h^=the sum of all rehabilitation assessment scores in sample1of levelHn2h.


### 2.2. Physical Principle of Transcranial Magnetic Stimulation Therapy

When a circular charged coil is used, a magnetic field will be induced around the coil when DC current is applied. The magnetic induction at the pointP at the distance r⟶ is as follows:(5)dB⟶=μ04πIdl⟶×r⟶r⟶3.AtP (x, Y, z), the time-varying magnetic field is(6)B⇀r,t=μrμ04π∮Itdl⇀×r⇀r⇀3=μ0It4π∮dl⇀×r⇀r⇀3=∇×A⇀.where μr is the relative permeability, μ0 is the permeability of vacuum, and its value is(7)μ0=4π×10−7N⋅A−2,and the permeability is μrμ0, Idl⟶ is the current element at a point P of the coil, and R⇀ is the vector of the current element pointing to the calculation point P (x, y, z). A⇀ denotes the magnetic vector potential at point P.(8)A⇀=μrμ0It4π∮dl⟶r⇀.According to Faraday’s electromagnetic induction theorem, a time-varying magnetic fieldB will produce an induced electric field E (R, t) in the space it passes through:(9)∇×Er,t=−∂Br,t∂t=−∂∇×A⇀∂t.Because ∇ × (∇·∂) = 0, by exchanging ∇ and ∂ positions, we can get the following results:(10)E⟶=−∂A⟶∂t−∇∅.For semi-infinite excitable tissue, the surface charge density can be neglected under ideal stimulation condition. The results are as follows:(11)E⟶=−∂A⟶∂t=−∂It∂turμ04π∮dl⟶r⟶.


### 2.3. Optimization of the Statistical Evaluation Method

When evaluating the rehabilitation of hemiplegia in patients with anterior circulation cerebral infarction, the established statistical model should be consistent with the specific indicators of patients. For example, aphasia caused by hemiplegia, that is, the patient’s brain language area, is damaged. At this time, the rehabilitation analysis of patients should not only stay in the assessment of the repair of the damaged brain area of patients, but also integrate the rehabilitation assessment value of patients with the combination of reality, the recovery of the actual language expression ability of patients, and the evaluation of their relatives. Only in this way can we better and more accurately evaluate and analyze the rehabilitation of patients. In addition to the scientific detection data of the repair of the damaged brain area as an index to judge the rehabilitation evaluation of the patients with cerebral infarction in the anterior circulation treated by cranial magnetic stimulation, the performance of the patients in real life (whether they can return to the previous daily life and work) should be added as an index to evaluate the rehabilitation of the patients. 100 patients with massive cerebral infarction in anterior circulation were randomly divided into study group and control group. Inclusion criteria were as follows: all patients being diagnosed as large area cerebral infarction of anterior circulation by CT or MRI, all clinical symptoms having met the diagnostic requirements of the recent domestic cerebrovascular academic conference, all patients having unilateral lesions, no limb deformity, first admitted to hospital for treatment, and the admission time not more than 7 days; exclusion criteria were as follows: for example, patients with transient cerebral hemorrhage accompanied by hematological diseases, elderly patients over 80 years old or patients with aphasia, unconsciousness and other symptoms, patients with cerebral infarction treatment history and severe sequelae, lactating or pregnant women, patients with organic diseases such as heart, kidney, and liver, and patients who received rehabilitation intervention before admission.


## 2.1. Statistical Methods of Rehabilitation Evaluation

Let the total mean of all the answers in the samplel of layer H be μ1h. The overall mean of all responses in sample 2 was μ2h. μh is the total mean value of H-layer sensitive problems, and μh is used as the reference value and μBh is the nonsensitive problem Bh layer. The total mean value of H is defined by the weighted mean value:(1)μ1h=P1×μh+1−P1×μBh,μ2h=P2×μh+1−P2×μBh.By solving the above equations, we get the following results:(2)μh=1−P2×μ1h−1−P1×μ2hP1−P2,μBh=P2×μ1h−P1×μ2hP2−P1.According toμh and μBh, the sample estimate of BH is(3)μ1h=1−P2×μ1h−1−P1×μ2hP1−P2,μBh=P2×μ1h−P1×μ2hP2−P1.Among them,(4)μ1h^=the sum of all rehabilitation assessment scores in sample1of levelHn1h,μ2h^=the sum of all rehabilitation assessment scores in sample1of levelHn2h.


## 2.2. Physical Principle of Transcranial Magnetic Stimulation Therapy

When a circular charged coil is used, a magnetic field will be induced around the coil when DC current is applied. The magnetic induction at the pointP at the distance r⟶ is as follows:(5)dB⟶=μ04πIdl⟶×r⟶r⟶3.AtP (x, Y, z), the time-varying magnetic field is(6)B⇀r,t=μrμ04π∮Itdl⇀×r⇀r⇀3=μ0It4π∮dl⇀×r⇀r⇀3=∇×A⇀.where μr is the relative permeability, μ0 is the permeability of vacuum, and its value is(7)μ0=4π×10−7N⋅A−2,and the permeability is μrμ0, Idl⟶ is the current element at a point P of the coil, and R⇀ is the vector of the current element pointing to the calculation point P (x, y, z). A⇀ denotes the magnetic vector potential at point P.(8)A⇀=μrμ0It4π∮dl⟶r⇀.According to Faraday’s electromagnetic induction theorem, a time-varying magnetic fieldB will produce an induced electric field E (R, t) in the space it passes through:(9)∇×Er,t=−∂Br,t∂t=−∂∇×A⇀∂t.Because ∇ × (∇·∂) = 0, by exchanging ∇ and ∂ positions, we can get the following results:(10)E⟶=−∂A⟶∂t−∇∅.For semi-infinite excitable tissue, the surface charge density can be neglected under ideal stimulation condition. The results are as follows:(11)E⟶=−∂A⟶∂t=−∂It∂turμ04π∮dl⟶r⟶.


## 2.3. Optimization of the Statistical Evaluation Method

When evaluating the rehabilitation of hemiplegia in patients with anterior circulation cerebral infarction, the established statistical model should be consistent with the specific indicators of patients. For example, aphasia caused by hemiplegia, that is, the patient’s brain language area, is damaged. At this time, the rehabilitation analysis of patients should not only stay in the assessment of the repair of the damaged brain area of patients, but also integrate the rehabilitation assessment value of patients with the combination of reality, the recovery of the actual language expression ability of patients, and the evaluation of their relatives. Only in this way can we better and more accurately evaluate and analyze the rehabilitation of patients. In addition to the scientific detection data of the repair of the damaged brain area as an index to judge the rehabilitation evaluation of the patients with cerebral infarction in the anterior circulation treated by cranial magnetic stimulation, the performance of the patients in real life (whether they can return to the previous daily life and work) should be added as an index to evaluate the rehabilitation of the patients. 100 patients with massive cerebral infarction in anterior circulation were randomly divided into study group and control group. Inclusion criteria were as follows: all patients being diagnosed as large area cerebral infarction of anterior circulation by CT or MRI, all clinical symptoms having met the diagnostic requirements of the recent domestic cerebrovascular academic conference, all patients having unilateral lesions, no limb deformity, first admitted to hospital for treatment, and the admission time not more than 7 days; exclusion criteria were as follows: for example, patients with transient cerebral hemorrhage accompanied by hematological diseases, elderly patients over 80 years old or patients with aphasia, unconsciousness and other symptoms, patients with cerebral infarction treatment history and severe sequelae, lactating or pregnant women, patients with organic diseases such as heart, kidney, and liver, and patients who received rehabilitation intervention before admission.


## 3. Modeling Method

### 3.1. Construction of the Grey Evaluation Matrix

With the help of grey system theory, this paper calculates the grey level of lower limb rehabilitation training evaluation samples and confirms the grey class through cluster analysis of whitening weight function and then constructs the lower limb rehabilitation training evaluation matrix. It is assumed that there arej evaluation indexes in the rehabilitation evaluation index system of hemiplegic patients. If there are i experts to evaluate the training result data, the evaluation data given by all experts are summarized. Establish sample matrix Dij:(12)Dij=d11⋯d1j⋮⋮⋮di1⋯dij.According to the specific situation of rehabilitation of patients with cerebral palsy, the assessment of grey classk was divided into five grades: excellent, good, average, poor, and very poor.ByDij and fkdij, calculate the grey evaluation coefficient of the evaluation index J, which belongs to class k, and record it as(13)njk=∑j=1pfkdij.Then, calculate the total grey evaluation coefficient and record it as(14)nj=∑j=15njk.Bynjk and nj, calculate the evaluation index J which belongs to the k-th grey class evaluation weight rjk for(15)rjk=njknj.The weightR is evaluated by grey system rjk which can get the grey evaluation weight matrix of all evaluation indexes, R = rjkj×5:(16)R=r11⋯r1k⋮⋱⋮rj1⋯rjk.


## 3.1. Construction of the Grey Evaluation Matrix

With the help of grey system theory, this paper calculates the grey level of lower limb rehabilitation training evaluation samples and confirms the grey class through cluster analysis of whitening weight function and then constructs the lower limb rehabilitation training evaluation matrix. It is assumed that there arej evaluation indexes in the rehabilitation evaluation index system of hemiplegic patients. If there are i experts to evaluate the training result data, the evaluation data given by all experts are summarized. Establish sample matrix Dij:(12)Dij=d11⋯d1j⋮⋮⋮di1⋯dij.According to the specific situation of rehabilitation of patients with cerebral palsy, the assessment of grey classk was divided into five grades: excellent, good, average, poor, and very poor.ByDij and fkdij, calculate the grey evaluation coefficient of the evaluation index J, which belongs to class k, and record it as(13)njk=∑j=1pfkdij.Then, calculate the total grey evaluation coefficient and record it as(14)nj=∑j=15njk.Bynjk and nj, calculate the evaluation index J which belongs to the k-th grey class evaluation weight rjk for(15)rjk=njknj.The weightR is evaluated by grey system rjk which can get the grey evaluation weight matrix of all evaluation indexes, R = rjkj×5:(16)R=r11⋯r1k⋮⋱⋮rj1⋯rjk.


## 4. Evaluation Results and Research

100 patients with cerebral infarction of anterior cerebral circulation were studied, 50 cases as control group and 50 cases as study group. In the study group, male : female = 25 : 25; the age was 45–74 years, with an average of 60.58 ± 6.78 years. In the control group, male: female = 24 : 26; age was 43–76 years, with an average of 61.34 ± 5.64 years (Table1). Inclusive criteria were as follows: complete data; normal cognition; patients with first cerebral infarction; no serious complications; good treatment compliance; patients with complete clinical data and complete data acquisition. Exclusion criteria were as follows: severe mental illness; infectious diseases; not cooperating with the researchers. The general data of the two groups were compared, P>0.05, with comparability shown in Table 2.Table 1
Basic information of patients in each group.
GroupNumber of casesAge (years)Course of disease (days)SexAffected sideManWomanLeftRightResearch group5060.58 ± 6.7816 ± 2.825252624Control group5061.34 ± 5.6416 ± 2.124262327Table 2
Comparison of motor function between the two groups.
GroupnBefore treatmentAfter treatmentResearch group5037.03 ± 6.9154.01 ± 7.98Control group5036.94 ± 7.3239.98 ± 7.95D—0.89255.9034R—0.46140.000The control group received routine treatment: in the early stage of treatment, the patients were asked to use and maintain the lateral position, try not to use the supine position, turn over regularly, and maintain a good limb position and when it is necessary to supine, lift up the shoulder, extend the upper limb, and place soft articles under the affected limb; when the patients are in the lateral position, they need to rotate the front wall and palm upward. After the patient’s vital signs are stable, massage the affected limbs twice a day, 15–20 minutes each time; first, carry out activities that need human assistance in bed, and gradually transition to independent activities, such as sitting up, getting out of bed, standing, and walking, to train the patients’ life skills such as dressing, eating, washing, and toileting, and to adjust the training intensity and time according to the patients’ rehabilitation. Repetitive transcranial magnetic stimulation (rTMS) was added to the study group. At the same time, tms8 coil was used to stimulate the motor corresponding area of the affected cerebral cortex. At present, scholars can conclude that rTMS can change or affect brain anatomy, normal neurophysiology, and pathophysiology by monitoring various instruments, including SPECT and PET for metabolism and TCD for blood flow velocity. Tzu Ching Chiang et al. reported that, stimulating the left motor cortex of healthy subjects for 20 minutes with an intensity of 1 Hz rTMS, the content of oxyhemoglobin in the cortex increased. However, the amount of oxyhemoglobin in the contralateral cortex was less than that in the stimulated side, and the change still persisted after 40 minutes of stopping stimulation. Conchauf et al. have reported that the use of 1 Hz subthreshold intensity rTMS in the right M1 region can increase the regional cerebral blood flow in the left s1m1 region in normal subjects. At the same time, it can also increase the contralateral regional cerebral blood flow in stroke patients.After treatment, the total score of Fugl–Meyer score in each group increased compared with that before treatment (P<0.01). Compared with the control group after treatment (Figure 1), the Fugl–Meyer score of the frequency of 5 Hz and 20 Hz after treatment was better than that of the control group (P=0.047 and P=0.032), while the Fugl–Meyer score of the frequency of 10 Hz after treatment was significantly higher than that of the control group (P=0.003). Humans are social animals, and the correct cognition of the world is the most basic requirement to integrate into the society. So the cognitive impairment of hemiplegic patients is the most important part in the process of rehabilitation, and the effective recovery of cognitive impairment is also the most important score point for hemiplegic rehabilitation score of patients with cerebral infarction.Figure 1
Fugl–Meyer score of cerebral infarction patients with hemiplegia and cognitive impairment.The rehabilitation of the patients themselves can be objectively known by scientific data, but the data stays on the figures. In this paper, a questionnaire survey on patients’ family members and their self-awareness was conducted, in order to investigate the patients’ satisfaction with the rehabilitation from the subjective cognition of patients and their families. Combining objective medical diagnosis with patient subjective emotional investigation can better evaluate the patient's recovery and improve the final level of treatment analysis. 50 questionnaires were distributed to the patients and their families in the 50 study groups. The questionnaire covers self-awareness, family evaluation, real-life performance, and so on. Set a 1–5 score system, and finally collect the questionnaire, and get the satisfaction degree through the comprehensive analysis and integration of data by the grey evaluation matrix proposed in this paper. 100 questionnaires were sent out (50 of them were patients and 50 of their corresponding family members), and 100 questionnaires were recovered with a recovery rate of 100%.By comparing Figures2 and 3, it is not difficult to draw a conclusion: most of the patients’ family members are very satisfied with the rehabilitation of the patients, but the patients’ own subjective cognition is not satisfied with their own rehabilitation. Because the patients’ family members are more tolerant of the patients, the patients have higher requirements for themselves. Some patients said that they did not recover as before, so they were not satisfied. Through the questionnaire in this paper, we can know that the recognition of patients is the most important, so the rehabilitation treatment of cerebral infarction patients with hemiplegia should be combined with appropriate psychological treatment, and the psychological dredging of patients themselves, which is a difficult problem to overcome at present. At the same time, the survey results also urge people to move forward and explore more effective rehabilitation treatment.Figure 2
Satisfaction degree of patients’ family members to rehabilitation effect.Figure 3
Patients’ satisfaction with rehabilitation self-cognition.


## 5. Conclusion

Cerebral infarction is a kind of cerebrovascular disease with high incidence in clinic, and cerebral infarction of anterior circulation accounts for 90% of cerebral infarction. After the onset, it is often accompanied by hemiplegia, aphasia, and other symptoms, which has a very serious impact on the normal life of patients. Scholars at home and abroad have done a lot of research on large area cerebral infarction of anterior cerebral circulation and have made some achievements, but at present, the rehabilitation treatment and prognosis evaluation of the disease system are less, especially in China, the rehabilitation treatment is not carried out for a long time, and there is a lack of systematic research results. In recent years, new studies have carried out a lot of discussions on various aspects of stroke rehabilitation. In recent years, with the establishment and use of “stroke unit,” the early treatment of patients with acute cerebral infarction is more standardized, and the disability rate of patients has decreased significantly. Modern medical research shows that if given active and effective rehabilitation treatment, it can effectively prolong the life of patients; more than 80% of patients can recover part of the function or symptoms, not only reducing mortality, but also improving the quality of life of patients. Traditional behavioral rehabilitation after hemiplegia has poor pertinence and lack of systematicness. So it is difficult to obtain a very significant rehabilitation effect. Hemiplegia after cerebral infarction has a great impact on the life of the patient. The family members of the patient often need to spend unimaginable energy and endurance to take care of the patient. Therefore, many family members of the patient cannot tolerate this disease. This also makes the rehabilitation of hemiplegia after cerebral infarction a key and difficult topic in the field of medical research. This study attempts to evaluate the effect of behavioral rehabilitation of patients with cerebral infarction after cranial magnetic stimulation. The results show that cranial magnetic stimulation can improve the rehabilitation effect of hemiplegia after cerebral infarction. There is no doubt that the rehabilitation of patients with cerebral infarction hemiplegia by cranial magnetic stimulation is superior to the traditional treatment. In this paper, a questionnaire survey was conducted among the patients with hemiplegia after cerebral infarction treated by transcranial magnetic stimulation (TMS) to evaluate and analyze the specific subjective satisfaction of TMS on the rehabilitation of the patients and the satisfaction of the patients’ family members. The results showed that most of the patients and their families were satisfied with the rehabilitation effect of the treatment. However, a small number of patients and their families are not satisfied with the effect of rehabilitation, which is the focus and significance of this paper’s rehabilitation evaluation and analysis. It shows that there is still room for progress and improvement in the treatment of cerebral infarction hemiplegia patients by cranial magnetic stimulation. We should keep up with the development of science and technology, improve medical means, and never stop the pace of progress.



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