Front Neurol. 2026 Oct 13;17:1859162. doi: 10.3389/fneur.2026.1859162. eCollection 2026.
ABSTRACT
OBJECTIVE: This work evaluated clinical effects of repetitive transcranial magnetic stimulation (rTMS) plus custom-made 3D-printed ankle-foot orthosis (AFO) for older adults living with post-stroke ankle-foot impairment. Neurophysiological assessments were also carried out for exploratory purposes, drawing exclusively on indirect physiological readouts.
MATERIALS AND METHODS: Sixty older participants with ankle-foot dysfunction after subacute stroke were randomized into three parallel groups: conventional-only rehabilitation, 3D-printed AFO therapy, and combined rTMS-AFO intervention (n = 20 per group). Evaluations including ankle active range-of-motion (AROM), resting motor threshold (RMT), integrated surface electromyography (iEMG), Clinical Spasticity Index (CSI), Fugl-Meyer Assessment of the Lower Extremity (FMA-LE), Berg Balance Scale (BBS), and 10-Metre Walking Test (10MWT) were performed at baseline and four-week post-intervention time-point.
RESULTS: Noticeable within-group functional improvements emerged in all three study arms upon completion of treatment (p < 0.001). Participants assigned to combined therapy achieved greater functional improvements compared with those receiving standalone 3D-printed-AFO or conventional rehabilitation (p < 0.05). The conventional rehabilitation group produced the weakest magnitude of functional recovery across measured endpoints.
CONCLUSION: Compared with single-modality rehabilitation approaches, adding rTMS to 3D-printed AFO therapy brought measurable improvements in ankle mobility, muscle recruitment, balance and walking performance. These clinical benefits occurred alongside elevated excitability within the ipsilesional corticospinal tract. Explanations regarding sensorimotor integration and afferent-efferent circuit regulation should be regarded as exploratory hypotheses because direct neural measurements were not obtained in this investigation. Further independent research is needed to test these mechanistic assumptions.
PMID:42947694 | PMC:PMC13710023 | DOI:10.3389/fneur.2026.1859162