Abstract
Objective: To investigate the effects of low frequency transcranial magnetic stimulation (LF-rTMS) combined with motor imagery (MI) on upper limb motor function during stroke rehabilitation.Background: Hemiplegic upper extremity activity obstacle is a common movement disorder after stroke. Compared with a single intervention, sequential protocol or combination of several techniques has been proven to be better for alleviating motor function disorder. Non-invasive neuromodulation techniques such as repetitive transcranial magnetic stimulation (rTMS) and motor imagery (MI) have been verified to augment the efficacy of rehabilitation.Methods:Participants were randomly assigned to 2 intervention cohorts: (1) experimental group (rTMS+MI group) was applied at 1 Hz rTMS over the primary motor cortex of the contralesional hemisphere combined with audio-based MI; (2) control group (rTMS group) received the same therapeutic parameters of rTMS combined with audiotape-led relaxation. LF-rTMS protocol was conducted in 10 sessions over 2 weeks for 30 min. Functional measurements include Wolf Motor Function Test (WMFT), the Fugl-Meyer Assessment Upper Extremity (UE-FMA) subscore, the Box and Block Test (BBT), and the Modified Barthel index (MBI) were conducted at baseline, the second week (week 2) and the fourth week (week 4).Results: All assessments of upper limb function improved in both groups at weeks 2 and 4. In particular, significant differences were observed between two groups at end-intervention and after intervention (p < 0.05). In these findings, we saw greater changes of WMFT (p < 0.01), UE-FMA (p < 0.01), BBT (p < 0.01), and MBI (p < 0.001) scores in the experimental group.Conclusions: LF-rTMS combined with MI had a positive effect on motor function of upper limb and can be used for the rehabilitation of upper extremity motor recovery in stroke patients.
Highlights
Decreased mobility of hemiplegic upper limb is a common dyskinesia after stroke
Subjects were randomly assigned to two groups and 42 patients had finished the trial
Koyama et al combined NMES with Repetitive transcranial magnetic stimulation (rTMS) in patients with moderate to severe dysfunction after stroke, and they found that the combination protocol was more beneficial for recovery of stroke-induced motor function compared with the control group [34]
Summary
Decreased mobility of hemiplegic upper limb is a common dyskinesia after stroke. At present, clinical researchers have established a number of treatments to improve upper extremity motor function [1]. Compared with a single intervention, a combination approach of different techniques has been proven to be better for alleviating movement disorder [2]. Lots of trials have shown that movement function improvement after stroke can be enhanced by non-invasive brain stimulation techniques combined with conventional clinical practice [3,4,5,6]. Inhibition of contralateral primary motor cortex (M1) with 1 Hz rTMS may enhance hemispheric motor function This method has revealed efficacy in the stroke rehabilitation for adults they do not share the same models [8]. Hemiplegic upper extremity activity obstacle is a common movement disorder after stroke. Compared with a single intervention, sequential protocol or combination of several techniques has been proven to be better for alleviating motor function disorder. Non-invasive neuromodulation techniques such as repetitive transcranial magnetic stimulation (rTMS) and motor imagery (MI) have been verified to augment the efficacy of rehabilitation
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