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Aims/Background: Knee hyperextension during walking is a common clinical concern in stroke patients that worsens lower limb dysfunction and reduces quality of life. This condition is commonly managed through repetitive transcranial magnetic stimulation (rTMS) and lower limb rehabilitation robots. This study aims to explore the therapeutic effect of combining rTMS with lower limb rehabilitation robots on knee hyperextension in stroke patients. Methods: This retrospective study included 158 stroke patients who underwent rehabilitation treatment in the Department of Rehabilitation Medicine, Shanghai Tianyou Hospital between January 2024 and May 2025. Based on the treatment, the patients were divided into a rTMS group, a lower limb rehabilitation robot (UGO) group, and a repetitive transcranial magnetic stimulation combined with lower limb rehabilitation robot (rTMS+UGO) group. Brunnstrom staging and knee hyperextension angle were applied to evaluate lower limb motor recovery and knee joint alignment. The lower limb motor function was assessed with the Fugl-Meyer Assessment for Lower Extremity (FMA-LE) score, and balance was examined using the Berg balance scales. The modified Barthel Index (MBI) was used to evaluate activities of daily living. Quadriceps and hamstring co-contraction patterns were assessed using surface electromyography and isokinetic muscle strength testing. Results: After 4 weeks of treatment, the Brunnstrom stage, FMA-LE, Berg score, and MBI score were significantly higher in all three groups compared with before treatment (p < 0.05). The therapeutic effect in the combined-treatment (rTMS+UGO) group was significantly better than that observed in the rTMS and UGO groups (p < 0.05). The knee hyperextension angle decreased over time in all three groups. However, after 4 weeks, the knee hyperextension angle was significantly lower in the rTMS+UGO group than in the rTMS and UGO groups (p < 0.05). Isokinetic muscle strength testing showed that, after 4 weeks of treatment, peak torque (PT), peak torque relative to body weight (PT/W), and total work (TW) during knee extension were significantly higher in all three groups (p < 0.05), with the greatest improvement observed in the combined-treatment group (p < 0.05). Surface electromyography findings showed that average electromyographic (AEMG) of the affected vastus medialis and rectus femoris was higher (p < 0.05) whereas AEMG of the affected hamstring muscles and gastrocnemius was substantially lower after treatment in the three groups (p < 0.05). Additionally, these therapeutic effects were more pronounced in the combined-treatment group than in the other two groups (p < 0.05). Conclusion: Both rTMS and lower limb rehabilitation robotics can reduce knee hyperextension in stroke patients with hemiplegia to a certain extent. However, their combination demonstrates a more pronounced therapeutic effect, substantially improving lower limb motor function and enhancing the stability of the knee joint.
Wang et al. (Fri,) studied this question.