Repetitive Transcranial Magnetic Stimulation on the Affected Hemisphere Enhances Hand Functional Recovery in Subacute Adult Stroke Patients: A Randomized Trial.

Yawen Yang,Wuwei Feng,Qing Xie,Jixian Wang,Wenxiu Pan,Chuanxin M Niu,Yang Liu,Xiaohui Song,Huijuan Pan

doi:10.3389/fnagi.2021.636184

Abstract

Objectives: Either motor training or repetitive transcranial magnetic stimulation (rTMS) could modulate the neural plasticity after stroke. Therefore, synchronizing the two interventions may optimize the efficiency of recovery. In the present study, we aim to investigate the effect of rTMS along with hand grip training on the neurobehavioral and hand functional recovery in one cohort of subacute stroke patients.Methods: Thirty-nine stroke patients were enrolled in a single-center, single-blinded, randomized clinical trial. We tested different intervention effects of rTMS and hand grip training (group A), rTMS alone (group B), and hand grip training alone (group C). For the rTMS-treated groups, patients received 10 consecutive sessions of 5-Hz stimulation over the affected hemisphere with 750 pulses. Jebsen–Taylor Hand Function Test (JTHFT), Fugl-Meyer assessment of upper extremity (FMA-UE), grip strength, modified Barthel index (mBI), and ipsilesional motor evoked potential (iMEP) latency were assessed and compared across the groups.Results: We found that only rTMS along with hand grip training group all improved in JTHFT, FMA-UE, grip strength, and mBI (p ≤ 0.01) compared with the baseline among the three groups. Furthermore, this study demonstrated that rTMS plus hand grip training had much better results in improvement of neurobehavioral outcomes compared to the rTMS alone- and hand grip training alone-treated patients (p < 0.05). However, no significant differences were detected in neurophysiologic outcome between intra-groups and inter-groups (p > 0.05).Conclusion: These proof-of-concept results suggested that rTMS alone with hand grip training was a unique approach to promote hand functional recovery in stroke patients. It provided important information to design a large-scale multi-center clinical trial to further demonstrate the efficiency of the combination of central and peripheral stimulation.Clinical Trial Registration: http://www.chictr.org.cn (#ChiCTR1900023443).

Highlights

Despite intensive neurorehabilitation efforts, hand- and fingerrelated functional abilities remain unsatisfactory following a neurological event
We aim to investigate the combined effect of high-frequency rTMS (HF-rTMS) and hand grip training on the impaired hand functional recovery in stroke survivors
Group C only showed significant difference in Jebsen–Taylor Hand Function Test (JTHFT) without writing and motor coordination (p < 0.05), which, as mentioned above, indicated that both rTMS only and rTMS with hand grip training were effective in improving hand function in stroke patients

Summary

Introduction

Hand- and fingerrelated functional abilities remain unsatisfactory following a neurological event. Studies demonstrated that 27% of stroke patients lose integral hand function due to hemiplegia (Fischer et al, 2007). Previous studies demonstrated that the establishment of neural plasticity after stroke is essential for the motor recovery (Hermann and Chopp, 2012). Motor training is capable of promoting neuroplasticity to attenuate the motor dysfunction in stroke patients (Kleim et al, 2003; Adkins et al, 2006). Hand grip training could be beneficial for the finger flexor and extensor tendon to recruit more motor units and improve the innervation and functional neuroplasticity, which played an important role in the motor recovery of stroke survivors (Murphy and Corbett, 2009). From the view of previous trials, hand functional training could regulate the neuronal excitatory input in the nerve reflex circuits and accelerate the process of reorganization of brain connectivity and neuroplasticity (Wolf et al, 2006; Buma et al, 2010)

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