Journal of Rehabilitation Medicine 51-11 | Page 41

Inflammatory cytokine levels after post-stroke ELF-EMF
cent evidence suggests that inflammatory reactions can
be also neuroprotective. Ischaemic inflammatory events
(the activation of glial cells, production of number
of destructive mediators including pro-inflammatory
cytokines, and infiltration of monocytes into the brain)
have been shown to contribute to brain injury, but, on
the other hand, activated inflammatory cells can partici-
pate in tissue remodelling following brain damage (6).
Early post-stroke physical therapy, including the
use of extremely low frequency electromagnetic field
(ELF-EMF) treatment, is beneficial in restoring the
patient after stroke, mainly due to anti-inflammatory,
regenerative, and analgesic actions. Moreover, the
beneficial effect of ELF-EMF is to promote cell pro-
liferation, protein synthesis, ion transport and changes
in cellular signal transmission (7).
The impact of ELF-EMF on biological systems is, ho-
wever, unclear. Our previous study indicated that ELF-
EMF treatment results in the activation of antioxidant
enzymes and increases the level of neurotrophic factors
in vivo in post-stroke patients, probably as a result of the
impact of ELF-EMF on gene expression (8, 9).
One potential target for ELF-EMF treatment is the
immune system. Several studies indicate that ELF-
EMF regulates the activity of immune cells (10, 11).
Experimental data indicate that, in both animals and
humans, several inflammatory cytokines (i.e. IL-1, IL-
6, and TNF-α) are associated with stroke severity, and
thus have a direct impact on the plasticity processes
occurring after stroke (12).
The aim of this study was to investigate the effect of
ELF-EMF treatment on the molecular mechanism of
inflammatory cytokine activity in post-stroke patients.
MATERIAL AND METHODS
Subject selection and rehabilitation protocol
A total of 48 post-stroke patients were enrolled in the study.
Patients were hospitalized in the Neurorehabilitation Ward, III
General Hospital in Lodz, Poland. The clinical and demographic
characteristics of the patients are shown in Table I. The cerebral
ischaemic event in each patient was documented by computer
tomography (CT) scan of the brain. Neurological and CT findings
were interpreted by 2 or more independent experienced neurolo-
gists. All patients were diagnosed with ischaemic stroke. Patients
with other types of stroke were excluded. Other exclusion criteria
were: patients with neurological illness other than stroke; chronic
or significant acute inflammatory factors; and/or dementia.
All patients received a rehabilitation programme of aerobic
exercise, as described below. Participants were randomly
divided into 2 groups: an ELF-EMF group (n = 25), who were
additionally rehabilitated with ELF-EMF treatment, and a non-
ELF-EMF group (n = 23).
Both groups have been used in our previous studies, in which
we tested gene expression of neurotrophic factor, antioxidant
and nitric oxide synthesis enzymes (8, 9, 13), because of same
techniques were not been available at that time.
855
Table I. Characteristics of the study groups
Characteristics
Demographics
Age, mean (SD)
Sex, male/female, %
Living alone, %
Vascular risk, %
Hypertension
Diabetes
Dyslipidaemia
BMI ≥ 30
Concomitant medications, %
Antidepressants
Acetylsalicylicacid
NSAID
Stroke characteristics, mean (SD)
Weeks since stroke
NIHSS scores
Activities of daily living
Lesion location, n
Anterior
Posterior
Intermediate
Lesion side, n
Left
Right
Control
n  = 23 Study group
n  = 25
p-value
44.8 (7.7)
48/52
32.1 48.0 (8.0)
60/40
34.2
0.84
0.27
0.59
97.3
31.4
78.8
21 98.5
39.2
72.2
34
0.07
0.21
0.7
0.78
29
70
25 34
65
27
0.5
0.42
0.8
3.9 (0.6)
5.4 (2.9)
8.89 (2.87) 3.2 (0.4)
4.9 (3.1)
9.95 (2.35)
0.22
3
7
13 5
6
14
15
8 13
12
BMI: body mass index; SD: standard deviation; NIHSS: National Institutes of
Health Stroke Scale; NSAID: non-steroidioal anti-inflammatory drugs.
In both the groups, the patients received a rehabilitation pro-
gramme provided by a physiotherapist, every day for a period of
4 weeks with weekend breaks. The rehabilitation programme in
post-stroke rehabilitation consisted of 15 min of psychotherapy,
60 min neurophysiological session in the morning (30 min of
shaping techniques and 30 min of repetitive task practice or
balance) and 30 min aerobic training (2–3 times a day for 10 min
at 60 min intervals). Neurophysiological rehabilitation consisted
mainly of functional rehabilitation shaping techniques and repe-
titive task practice designed to intensively use the affected upper
and lower limbs. The shaping techniques included activities
based on activities of daily living. However, training time was
individually modified depending on the improvement in motor
function of the affected limbs, if necessary. The rehabilitation
programme in the control group consisted of a 60 min session
in the morning (30 min of shaping techniques and 30 min of
balance training), 30 min aerobic training (2–3 times a day for
10 min at 60 min intervals) and 30 min muscle strengthening
exercises. The range of physical effort during the rehabilitation
programmes in both groups of patients was between 13 and 14
according to Borg scale (moderate effort).
Fig. 1. Schematic diagram of extremely low frequency electromagnetic
field (ELF-EMF) treatment device.
J Rehabil Med 51, 2019