Effects of High-Frequency rTMS Combined with Virtual Reality Balance Training in Patients with Hemiplegia After Stroke

Yuanyuan TANG; Sainan WANG; Aoran YANG

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Yuanyuan TANG, Sainan WANG, Aoran YANG. Effects of High-Frequency rTMS Combined with Virtual Reality Balance Training in Patients with Hemiplegia After Stroke[J]. Journal of Kunming Medical University.

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Yuanyuan TANG, Sainan WANG, Aoran YANG. Effects of High-Frequency rTMS Combined with Virtual Reality Balance Training in Patients with Hemiplegia After Stroke[J]. Journal of Kunming Medical University.

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Effects of High-Frequency rTMS Combined with Virtual Reality Balance Training in Patients with Hemiplegia After Stroke

1.
Department of Rehabilitation，Kunshan Rehabilitation Hospital，Kunshan Jiangsu 215314
2.
Rehabilitation Department pital Affiliated to Capital Medical University，Beijing 100000，China

Received Date: 2026-01-09

Abstract

Abstract

Objective To explore the effects of high-frequency repetitive transcranial magnetic stimulation （rTMS） combined with virtual reality balance training on postural control and falls efficacy in patients with hemiplegia after stroke. Methods A total of 216 patients with post-stroke hemiplegia admitted to Kunshan Rehabilitation Hospital from May 2023 to April 2025 were enrolled. They were divided into four groups by random number table method: routine intervention group （routine intervention）, high-frequency rTMS group （high-frequency rTMS intervention）, balance training group （virtual reality balance training）, and combined training group （high-frequency rTMS combined with virtual reality balance training）, with 54 patients in each group. An assessor-single-blind design was used to reduce measurement bias. Repeated-measures analysis of variance （or mixed-effects models） was employed to compare outcomes—including postural control [Berg Balance Scale （BBS）, Fugl-Meyer Assessment （FMA）], fall efficacy [Modified Fall Efficacy Scale （MFES）], walking ability [Functional Ambulation Category （FAC）], compliance [Exercise Adherence Questionnaire （EAQ）], adverse events, and fall rates—among the four groups before and after the intervention. Results After intervention, the BBS and FMA scores increased in all four groups: The scores in the high-frequency rTMS group and balance training group were higher than those in the routine intervention group （P < 0.05）, and the scores in the combined training group were higher than those in the routine intervention group, the high-frequency rTMS group, and the balance training group （P < 0.05）. There was a group-by-time interaction for BBS scores among the four groups （P < 0.05）, whereas no group-by-time interaction was observed for FMA scoresamong the four groups （P > 0.05）. After intervention, the MFES scores increased in all four groups. The scores in the high-frequency rTMS group and balance training group were higher than those in the routine intervention group （P < 0.05）, and the scores in the combined training group were higher than those in the routine intervention group, the high-frequency rTMS group, and the balance training group （P < 0.05）. Group-by-time interactions were found for all dimensions of the MFES （indoor activity, outdoor activity, and household activity） among the four groups （P < 0.05）.After intervention, there was a statistically significant difference in the distribution of walking function （FAC grades） among the four groups （H = 22.364, P < 0.001）. Post hoc pairwise comparisons using the Mann-Whitney U test （with a corrected significance level of α = 0.0083） revealed that walking function in the high-frequency rTMS group and the balance training group was superior to that in the routine intervention group （P < 0.0083）, and walking function in the combined training group was superior to that in the routine intervention group, the high-frequency rTMS group, and the balance training group （P < 0.0083）. After intervention, the EAQ scores of the four groups were increased. The scores in the high-frequency rTMS group and balance training group were higher than those in the routine intervention group （P < 0.05）, and the scores in the combined training group were higher than those in the routine intervention group, the high-frequency rTMS group, and the balance training group （P < 0.05）. Group-by-time interactions were observed for all dimensions of the EAQ （exercise intensity, time, frequency, and precautions） among the four groups （P < 0.05）.There was no significant difference in the incidence of adverse reactions among the four groups （P > 0.05）. The fall rate and injurious fall rate in the high-frequency rTMS group, balance training group, and combined training group were all lower than those in the routine intervention group （P < 0.05）. Moreover, the fall rate and injurious fall rate in the combined training group were lower than those in the routine intervention group （P < 0.05）. Conclusion Both high-frequency rTMS and virtual reality balance training, when applied alone, are superior to routine rehabilitation intervention. Their combination has a significant synergistic effect, which can more effectively improve balance function, motor function, and fall-related efficacy in patients with post-stroke hemiplegia, enhance independent walking ability and treatment compliance, reduce the long-term risks of falls and injurious falls, and has a favorable safety profile.
- High-frequency rTMS,
- Virtual reality balance training,
- Post-stroke,
- Hemiplegia,
- Postural control,
- Falls efficacy

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