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Post-stroke rehabilitation / spasticity treatment


In Germany there are 196,000 first-time and 66,000 repeated strokes (as of 2008) [1] , which, when extrapolated, means that every fifth German citizen is affected in the course of his life [2] . Ideally, in a stroke unit or surgery, the closed brain vessels (ischemic cerebral infarction) can be opened again or bleeding can be stopped in the case of a hemorrhagic stroke (cerebral hemorrhage) (phase A).


The location, extent and type of cerebral infarction decisively determine the success of the rehabilitation [3] . While early neurological rehabilitation (phase B) requires intensive medical treatment, the patient can already work "therapeutically" in the subsequent mobilization phase (phase C), which requires medical and nursing care.


Follow-up treatment (phase D) usually follows, which ideally ends in a professional reintegration (phase E). Finally, phase F is about permanent support, care and also “condition-preserving or symptom-relieving measures”. Unfortunately, even one year after a stroke, more than 60% of the surviving patients still need therapy, aids or care.


Treatment of spasticity by PEMF

Many stroke patients remain partially or completely paralyzed after a stroke (hemiparesis). This affects not only the extremities, but also the facial muscles - with the result that speaking, chewing and swallowing are impeded. Around a quarter of patients (19% [4] / 38% [5] / 21.7% [6] / 42.6% [7] / 41.6% [8] ) develop after about 3 - 6 Months of spasticity, which are based on pathologically tense muscles. The resulting painful restrictions on movement manifest themselves primarily at the joints (subluxations) and often persist permanently.


Although spasticity primarily requires physiotherapy treatment, physical measures that counteract hardening of the muscles or contractions are of considerable importance. Provided that increased blood flow can counteract muscle hardening and thus reduce contraction pain [9] , [10] , the use of PEMF special frequency and pulse forms is an important supportive measure in rehabilitation.


Because their use leads to an enlargement of the arterioles diameter, which obviously remains at least 3 hours after an application [11] , [12] . For example, using NIRP (near infrared red remission pletysmography) - a diagnostic system with which the volume pulse of the microvessels can be measured - a QRS treatment can be used to demonstrate a clear vasodilation with an increase in the microcirculation in the periphery [13] , An important side aspect may also be an increased outflow of metabolic metabolites, which leads to a reversal of the very low tissue pH - and there is therefore no longer any reason for the pain receptors in the muscles to "fire" more [14] .


Study situation QRS in the treatment of hemiparesis / spasticity

In an Apoplex study (double-blind, randomized), 52 stroke patients with hemiparesis for the usual drug-assisted physiotherapy and occupational therapy were treated with the QRS 101 for 28 days (twice a day for 15 minutes). There was a significant improvement in the treatment group compared to the placebo group. This manifested itself in improved mobility, a reduction in pain (3-4 pain scales), reduced spasticity and an increase in muscle strength. The people treated with QRS also expressed greater overall well-being [15] .


PEMF can have a positive effect on early stroke damage

Several animal experiments have shown that the rapid demise of nerve cells in the closer region of acute stroke can be prevented with PEMF. If, for example, 10 minutes after the stroke event (rabbit) not only reopens the closed cerebral artery, but also a PEMF is used, the feared brain edema decreases by 65% ​​compared to the comparison group. At the same time, neuronal cell death is reduced by 69% [16] .


Also in mice that had been artificially provoked to stroke and who were treated with PEMF twice a day for 21 days 30 to 45 minutes after the event, the infarct area was 26% smaller than in the untreated control group [17] - which also is associated with a significant decrease in the inflammatory reaction that normally takes place there.


The authors conclude that PEMF could be an important adjunctive therapy for stroke patients. A further study with apoplex mice also showed that PEMF increased the formation of so-called “survival proteins”, while the pro-apoptosis proteins, as those that trigger cell death, did the same decreases [18] .



Even if the fewest stroke victims have the opportunity to receive an accompanying PEMF treatment in acute therapy in order to keep the extent and the dreaded cell death as small as possible, it is astonishing what therapy potential is basically available. In later rehabilitation, when it comes to the treatment of paralysis and the associated spasticity, PEMF of certain power spectra (frequency / pulse shape) can at least reduce pain, weaken muscle contractions and improve mobility. The QRS 101 system in particular has provided clear proof of effectiveness.


[1] Heuschmann PU et al. Stroke frequency and care for stroke patients in Germany. Act Neurol 2010; 37: 333-340

[2] Seshadri S et a. The lifetime risk of stroke: Estimates from the Framingham Study. Stroke 2006; 37: 345-50.

[3] Knecht K, Hesse S, Oster P. Rehabilitation after stroke. Dtsch. Arzteblatt Int 2011; 108 (36): 600-6

[4] Sommerfeld DE et al. Spasticity after stroke. Its occurrence and association with motor impairments and acitivity limitation. Stroke 2004; 35 (1): 134-9

[5] Watkins CL et al. Prevalence of spasticity post stroke. Clin Rehabil 2002; 16: 515-522

[6] Wissel J, Manack A, Brainin M. Toward on epidemiology of poststroke spasticity. Neurology 2013; 80 (3): 13-19.

[7] Urban PP et al. Occurence and clinical predictors of spasticity after ischemic stroke. Stroke 2010: 41 (9). 2016-20

[8] Dajpratham P et al. Prevalence and management of poststroke spasticity in Thai stroke patients: a multicenter study. J Med Assoc Thai 2009; 92 (10): 1354-60

[9] Bartysheva TT et a. The first use of external counterpulsation for the rehabilitation treatment of post-stroke patients. Zh Nevrol Psikhiatr in SS Korsakova 2009; 109 (6): 38-40

[10] Dhindsa MS et al. Mjscle spasticity associated with reduced wohle-leg perfusion in peson with spinal cord injury. J Spinal Cort Med 2011; 34 (6): 594-9

[11] Bragin DE et al. Increases in microvascular perfusion and tissue oxygenation via pulsed electromagnetic fields in the healthy rat brain. J Neurosurg 2015; 122 (5): 1239-47

[12] Smith TL, Wong-Gibbons D, Maultsby J. Microcirculatory effects of pulsed electromagnetic fields. J Orthop Res 2004; 22 (1): 80-4

[13] Krauss M, Grohmann G. Measurement of peripheral circulatory parameters with the non-invasive NIRP method with pulsed magnetic field therapy with the Quantronic resonance system Salut. Medical time naturopathy 1997; 38- (7): 491-502

[14] Mense S. Muscle pain. Mechanisms and clinical significance. Dtsch. Ärzteblat Int. 2008; 105 (2): 214-9

[15] Schaberl B. Effect of low-frequency pulsating magnetic fields on the stroke-related hemipares. Diploma thesis at Sigmund Freud State Hospital, Neurological Dept. Graz.

[16] Grant G, Cadossi R, Steinberg G. Protection against focal cerebral ischemia following exposure to a pulsed electromagnetic field. Bioelectromagnetics 1994; 15 (3): 205-16

[17] Pena-Philippides JC et al. Effect of pulsed electromagnetic field (PEMF) on infarct size and inflammation after cerebral ischemia in mice. Transl Stroke Res 2014; 5 (4): 491-500

[18] Umukhsaikhan E et al. Neuroprotective effect of low frequency-pulsed electromagnetic fields in ischemic stroke. Appl Biochem Biotechnol 2017; 181 (4): 1360-1371