Abstract
Repetitive transcranial magnetic stimulation (rTMS) has recently been demonstrated to improve motor function after stroke. However, no study has yet tested the synergetic effects of physical exercise on rTMS in clinical settings. We investigated the effect of a 6-session course of low frequency rTMS on contralesional primary motor cortex combined with range-of motion (ROM) exercise on paretic hand function in female stroke patients. This was a single-blind study of the effects of rTMS with or without ROM exercise in female hemiplegic patients after stroke. All patients underwent rTMS on the contralesional primary motor cortex for 15 minutes and ROM exercise on the paretic hand. The cortical excitability determined by the amplitude and latency of the motor evoked potential (MEP) was measured in both first dorsal interosseous (FDI) muscles. We also evaluated arm function using Box and Block, arm reach, 9-hole pegboard, power grip, and pinch grip force tests. The rTMS-induced MEP amplitude of the paretic side significantly increased whereas the non-paretic side showed a decrease through every session. However, the MEP latency significantly increased on the non-paretic hand at post-rTMS with exercise, but a tendency of decrement on paretic hand at same application. Motor function showed improvement in the 9-hole pegboard and arm reach tests at post-rTMS with exercise on the paretic side compared with the non-paretic side. A significant correlation was especially noted between motor function and MEP on the paretic side of stroke patients. Low frequency rTMS with ROM exercise improved hand function after stroke. This may, in part, result in additional rehabilitation in stroke patients.
Highlights
Patients after stroke commonly suffer from significant impairments including weakness, loss of voluntary motor control, and spasticity [1,2,3]
The present study provides the first direct demonstration that physical therapy combined with Repetitive transcranial magnetic stimulation (rTMS) can facilitate cortical excitability and motor recovery in stroke patients
This study was based on the hypotheses that inhibition of transcallosal inhibition (TCI) by rTMS would result in an increase in cortical excitability in the ipsilesional hemisphere and that range-of motion (ROM) exercise added to rTMS would accelerate increases in cortical excitability that would translate into a motor improvement
Summary
Patients after stroke commonly suffer from significant impairments including weakness, loss of voluntary motor control, and spasticity [1,2,3]. The Effect of Low Frequency Repetitive Transcranial Magnetic Stimulation Combined with Range of Motion Exercise on Paretic Hand Function in Female Patients after Stroke netic stimulation (rTMS) of the contralesional M1 reduces TCI, thereby disinhibiting ipsilesional hemisphere, and lead to enhanced excitability of the ipsilesional hemisphere [12,13,14,15]. We were interested in upper extremity motor function of chronic stroke patients after application of exercise and low frequency rTMS of the unaffected hemisphere to downregulate TCI. We examined whether ROM exercise combined with rTMS promotes functional improvement on paretic upper extremity and whether a change in cortical excitability is correlated with improvement of upper extremity reach and grasp in stroke patients
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
