Objective:

To evaluate whether mirror therapy combined with defecation motor imagery and repetitive transcranial magnetic stimulation (rTMS) improves bowel function and to explore associated cortical changes using EEG-derived event-related desynchronization (ERD).

Approach:

• Study Design: Single-center retrospective study involving 98 patients with frontal lobe infarction and Rome IV-defined constipation.
• Intervention: Forty-eight patients received mirror therapy, motor imagery, and rTMS in addition to routine rehabilitation; 50 received routine care alone.
• Outcomes Measured: Primary outcomes included Wexner Constipation Score, weekly bowel frequency, and PAC-QOL. EEG μ/β-band ERD during defecation motor imagery was quantified.
• Analysis: Between-group differences and correlations were analyzed.

Key Findings:

• The intervention group showed significantly greater improvement in Wexner score, bowel frequency, and PAC-QOL compared to controls (all P < 0.01; Cohen's d 0.60–0.82).
• Enhanced μ/β ERD was observed only in the intervention group.
• ERD changes correlated moderately with Wexner improvement (r = 0.56).

Interpretation:

EEG-derived ERD may serve as a candidate biomarker for bowel-focused neurorehabilitation.

Limitations:

• Retrospective study design limits causal inference.
• Single-center study may affect generalizability.
• EEG-derived ERD may not capture all aspects of cortical engagement.

Conclusion:

The study reports that the combination of mirror therapy, motor imagery, and rTMS may enhance bowel function in post-stroke patients.