Effects of strengthening exercise integrated repetitive transcranial magnetic stimulation on motor function recovery in subacute stroke patients: A randomized controlled trial
Available accessResearch articleFirst published online May, 2017
Effects of strengthening exercise integrated repetitive transcranial magnetic stimulation on motor function recovery in subacute stroke patients: A randomized controlled trial
To investigate the effects of strengthening exercise integrated repetitive transcranial magnetic stimulation (rTMS) on motor function recovery in subacute stroke patients.
SUBJECTS AND METHODS:
Thirty subacute stroke patients were randomly assigned to three groups: an ankle strengthening exercise group (group I), ankle strengthening exercise integrated rTMS group (group II), or an rTMS group (control group (CG)). Study subjects received therapy five days per week for eight weeks. Motor-evoked potential testing, peak torque at the ankle joint, and 10 m walk test were performed before and after the eight-week treatment period.
RESULTS:
Subjects in group II showed significantly higher amplitude of MEP, plantarflexor and dorsiflexor of peak torque, 10 m walk test than groups I and CG (p < 0.05). Subjects in groups I and II differed significantly in the pre- and post-test for all variables, (p < 0.05). In the CG group, the pre- and post-test scores for the amplitude of MEP, dorsiflexor, and 10-walk test differed significantly (p < 0.05).
CONCLUSIONS:
Strengthening exercise integrated rTMS has positive effects on motor function recovery in subacute stroke patients.
JongbloedL. Prediction of function after stroke: A critical review. Stroke (1986); 17(4): 765-776.
2.
OlneySJ. Hemiparetic gait following stroke, part I: characteristics. Gait Posture (1996); 4(2): 136-148.
3.
MitchellAJ, ShuklaD, AjumalHA et al. The mini-mental state examination as a diagnostic and screening test for delirium: Systematic review and meta-analysis. Gen Hosp Psychiatry (2014); 36(6): 627-633.
4.
LeQ, QuY, TaoY et al. Effects of repetitive transcranial magnetic stimulation on hand function recovery and excitability of the motor cortex after stroke: A meta-analysis. Am J Phys Med Rehabili (2014); 93(5): 422-430.
5.
SasakiN, MizutaniS, KakudaW et al. Comparison of the effects of high and low frequency repetitive transcranial magnetic stimulation on upper limb hemiparesis in the early phase of stroke. J Stroke Cerebrovasc Dis (2013); 22(4): 413-418.
6.
BerardelliA, InqhilleriM, RothwellJC et al. Facilitation of muscle evoked responses after repetitive cortical stimulation in man. Exp Brain Res (1998); 122(1): 79-84.
7.
MizunoK, TsujiT, TakebayashiT et al. Prism adaptation therapy enhances rehabilitation of stroke patients with unilateral spatial neglect: A randomized, controlled trial. Neurorehabil Neural Repair (2011); 25: 711-720.
8.
FolsteinMF, FolsteinSE, McHughPR. `Mini-mental state', A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res (1975); 12(3): 189-198.
9.
KhedrEM, FetohNA. Short- and long-term effect of rTMS on motor function recovery after ischemic stroke. Restor Neurol Neurosci (2010); 28(4): 545-559.
10.
LivingstonSC, IngersollCD. Intra-rater reliability of a transcranial magnetic stimulation technique to obtain motor evoked potentials. Int J Neurosci (2008); 118(2): 239-256.
11.
HartmannA, KnolsR, MurerK et al. Reproducibility of an isokinetic strength-testing protocol of the knee and ankle in older adults. Gerontology (2009); 55(3): 259-268.
12.
GreenJ, ForsterA, YoungJ. Reliability of gait speed measured by a timed walking test in patients one year after stroke. Clin Rehabil (2002); 16(3): 306-14.
13.
BatesKA, RodgerJ. Repetitive transcranial magnetic stimulation for stroke rehabilitation-potential therapy or misplaced hope? Restorative Neurology & Neuroscience (2015); 33(4): 557-569.
14.
FregniF, BoggioPS, ValleAC et al. A sham controlled trial of a 5 day course of repetitive transcranial magnetic stimulation of the unaffected hemisphere in stroke patients. Stroke (2006); 37(8): 2115-2122.
15.
PeinemannA, ReimerB, LoerC et al. Long-lasting increase in corticospinal excitability after 1800 pulses of subthreshold 5 Hz repetitive TMS to the primary motor cortex. Clin Neurophysiol (2004); 115(7): 1519-1526.
16.
WassermannEM. Side effects of repetitive transcranial magnetic stimulation. Depress Anxiety (2000); 12(3): 124-129.
17.
HendricksHT, PasmanJW, van LimbeekJ et al. Motor evoked potentials of the lower extremity in predicting motor recovery and ambulation after stroke: A cohort study. Arch Phys Med Rehabil (2003); 84(9): 1373-1379.
18.
MallyJ, DinyaE. Recovery of motor disability and spasticity in post-stroke after repetitive transcranial magnetic stimulation. Brain Res Bull (2008); 76(4): 388-395.
19.
MillsKR, KimiskidisV. Cortical and spinal mechanism of facillitation to brain stimulation. Muscle Nerve (1996); 19: 953-958.
20.
RossiniPM, CarmiaM, ZarolaF. Mechanisms nervous propagation along central motor pathways: Non-invasive evaluation in healthy subjects and in patients with neurological disease. Neurosurg (1987); 20: 183-191.
21.
TrompettoC, AssiniA, BuccolieriA et al. Motor recovery following stroke: A transcranial magnetic stimulation study. Clinical Neurophysiol (2000); 111: 1860-1867.
22.
RossiniPM, BarkerAT, BerardelliA et al. Non-invasive electrical and magnetic stimulation of the brain, spinal cord and roots: Basic principles and procedures for routine clinical application. Report of an IFCN committee. Electroencephalogr Clin Neurophysiol (1994); 91(2): 79-92.
23.
PomeroyVM, CloudG, TallisRC et al. Transcranial magnetic stimulation and muscle contraction to enhance stroke recovery: A randomized proof of principle and feasibility investigation. Neurorehabil Neural Repair (2007); 21(6): 509-517.
24.
DafotakisM, GrefkesC, EickhoffSB et al. Effects of rTMS on grip force control following subcortical stroke. Exp Neurol (2008); 211(2): 407-412.
25.
CakarE, AkyuzG, DurmusO et al. The relationships of motor-evoked potentials to hand dexterity, motor function, and spasticity in chronic stroke patients: A transcranial magnetic stimulation study. Acta Neurol Belg2016 Apr 1. [Epub ahead of print]
26.
ChieffoR, De PrezzoS, HoudayerE et al. Deep repetitive transcranial magnetic stimulation with H-coil on lower limb motor function in chronic stroke: A pilot study. Arch Phys Med Rehabil (2014); 95(6): 1141-1147.
27.
RastgooM, NaghdiS, NakhostinAN. Effects of repetitive transcranial magnetic stimulation on lower extremity spasticity and motor function in stroke patients. Disabil Rehabil (2016); 38(19): 1918-1926.
28.
NaghdiS, AnsariNN, RastgooM et al. A pilot study on the effects of low frequency repetitive transcranial magnetic stimulation on lower extremity spasticity and motor neuron excitability in patients after stroke. J Bodyw Mov Ther (2015); 19(4): 616-23.
