Abstract 152: The Contrastim Stroke Study: Improving Hand and Arm Function After Stroke With Combined Non-Invasive Brain Stimulation and Task-Oriented Therapy - A Pilot Study

Abstract

Objective: To determine whether neuro-navigated 1hz rTMS targeted to the non-lesioned hemisphere (NLH) combined with task-oriented occupational therapy (OT) can improve motor function of arm and hand in patients with subacute stroke. Methods: 30 patients (3-9 months post-stroke) were randomly assigned to sham (n=10) or active 1hz rTMS (n=20) targeted to the wrist extensor representation in the NLH. Patients completed 3 visits per week for 6 weeks that included: 20min pre-functional OT, neuro-navigated 1hz rTMS or sham, and 60 min upper-limb task-oriented OT. Patients returned for 1 week, 1 month, and 6 month follow-up visits. Groups were well matched at baseline but there was a trend toward more severe impairment in the active treatment group on the Upper Extremity Fugl Meyer (UEFM) (23.8±10.2, active; 31.5±15.3, sham: p=0.11). Results: Patients receiving active rTMS prior to OT made significantly greater gains on the UEFM by 6 months post-intervention than patients receiving sham stimulation (change in UEFM 14.4 ± 10.0 vs. 4.1 ± 5.5; p=0.013). On ANOVA differences were significant for group, time and group x time (F=5.73, df=2, p=0.006). Individuals receiving active rTMS were significantly more likely to exceed the published minimal clinical important difference (MCID) on the UEFM at 6 months post (88% vs. 38%, p = 0.002). Similar trends at 1 week and 1 month post were not statistically significant. Ceiling effects were unlikely. Conclusion: These findings suggest neuro-navigated 1hz rTMS paired with task-oriented OT is more likely to promote clinically important improvements than OT alone. Of note is the finding that significant improvements in impairment were seen 6 months following therapy, suggesting non-invasive brain stimulation as an adjuvant to therapy promotes lasting motor improvement.