Combining rTMS and task-oriented training to enhance arm function after stroke.
Prof Johanne HIGGINSa, Dr Lisa KOSKIb
a École de Réadaptation, Université de Montréal; Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), b Division of Clinical Epidemiology & Division of Geriatrics, Research Institute of the McGill University Health Centre
Objective: Repetitive transcranial magnetic stimulation (rTMS) is a promising technique for enhancing rehabilitation of upper extremity function after stroke. The objective of this study is to evaluate the feasibility of conducting a randomized controlled trial aimed at determining the efficacy of rTMS as an adjunct to task-oriented therapy in facilitating restoration of arm and hand function after stroke.
Methods: Eleven individuals living in the community (Montreal, Canada) with mild to severe arm deficits following a stroke were recruited and randomized. The experimental intervention consisted in a session of real-rTMS immediately followed by ninety minutes of arm and hand functional tasks designed to improve function. The control intervention involved a session of sham-rTMS followed by ninety minutes of arm and hand functional tasks. Subjects in both groups attended sessions twice weekly for four weeks. The main outcome measures were: The Box and Block Test (BBT), the Wolf Motor Function Test (WMFT), the Stroke Impact Scale (SIS) and neurophysiological measures.
Results: Medium to large, statistically significant effect sizes (0.49 to 1.63) were observed in both groups on the BBT, the SIS and the functional score of the WMFT at the post-intervention evaluation. Three out of four subjects in the real-TMS condition showed an increase in baseline levels of corticomotor excitability after the first stimulation session.
Conclusion: It is possible to conduct a study comprising two ninety-minute therapy sessions weekly for arm function. However, preliminary evidence suggests that an rTMS protocol potent enough to induce transient increases in cortical excitability of the lesioned hemisphere did not show promising results as an adjunct to task-oriented training for improving upper extremity function.
Reference: Higgins J, Koski LM, Xie H. Combining rTMS and task-oriented training in the rehabilitation of the arm after stroke: a pilot randomized controlled trial. Stroke Research and Treatment 539146. PMCID: PMC3865731. 2013.
Keywords : Stroke, Transcranial Magnetic Stimulation, upper extremity