Effects of High-Frequency Repetitive Transcranial Magnetic Stimulation Combined with Motor Learning on Motor Function and Grip Force of the Upper Limbs and Activities of Daily Living in Patients with a Subacute Stroke.

Abstract

Functional paralysis of the upper extremities occurs in >70% of all patients after having a stroke, and >60% showed decreased hand dexterity. A total of 30 patients with a subacute stroke were randomly allocated to either high-frequency repetitive transcranial magnetic stimulation combined with motor learning (n = 14) or sham repetitive transcranial magnetic stimulation combined with motor learning (n = 16). High-frequency repetitive transcranial magnetic stimulation combined with the motor learning group was conducted for 20 min (10 min of high-frequency repetitive transcranial magnetic stimulation and 10 min of motor learning) three times a week for 4 weeks. The sham repetitive transcranial magnetic stimulation combined with the motor learning group received 12 20-min sessions (10 min of sham repetitive transcranial magnetic stimulation and 10 min of motor learning). This was held three times a week for 4 weeks. Upper-limb function (Fugl-Meyer Assessment of the Upper Limbs) and upper-limb dexterity (box and block tests) concerning upper-limb motor function and grip force (hand grip dynamometer), and activities of daily living (Korean version of the modified Barthel index), were measured pre- and post-intervention. In both groups, there were significant improvements in the upper-limb motor function, grip force, and activities of daily living (p < 0.05). Regarding grip force, the high-frequency repetitive transcranial magnetic stimulation combined with the motor learning group improved significantly compared to the sham repetitive transcranial magnetic stimulation combined with the motor learning group (p < 0.05). However, except for grip force, there were no significant differences in the upper-limb motor function or activities of daily living between the groups. These findings suggest that high-frequency repetitive transcranial magnetic stimulation combined with motor learning is more likely to improve grip force than motor learning alone.