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Peer-reviewedCC BY 4.0Frontiers in Neurology

Repetitive transcranial magnetic stimulation paired with a 3D-printed ankle-foot orthosis for ankle-foot dysfunction among older adults following subacute stroke: clinical findings and exploratory neurophysiological analyses

  • Yuting Zhang1
  • Hehe Chen1
  • Rui Xu1
  • Lingyu Zhu1
  • Siyuan Song2
  • Weixin Zhu1
  1. 1Jinhua Municipal Central Hospital, Jinhua
  2. 2Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine
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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.

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Cite

BibTeXRIS
BibTeX
@article{zhang2026repetitive,
  title = {{Repetitive transcranial magnetic stimulation paired with a 3D-printed ankle-foot orthosis for ankle-foot dysfunction among older adults following subacute stroke: clinical findings and exploratory neurophysiological analyses}},
  author = {Yuting Zhang and Hehe Chen and Rui Xu and Lingyu Zhu and Siyuan Song and Weixin Zhu},
  journal = {Frontiers in Neurology},
  year = {2026},
  month = oct,
  doi = {10.3389/fneur.2026.1859162},
  url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1859162/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Repetitive transcranial magnetic stimulation paired with a 3D-printed ankle-foot orthosis for ankle-foot dysfunction among older adults following subacute stroke: clinical findings and exploratory neurophysiological analyses
AU  - Yuting Zhang
AU  - Hehe Chen
AU  - Rui Xu
AU  - Lingyu Zhu
AU  - Siyuan Song
AU  - Weixin Zhu
PY  - 2026
DA  - 2026/10/13
JO  - Frontiers in Neurology
DO  - 10.3389/fneur.2026.1859162
UR  - https://www.frontiersin.org/articles/10.3389/fneur.2026.1859162/full
AB  - 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.
SN  - 1664-2295
ER  -