Effects of Hand Training During the Aftereffect Period of Low-Frequency rTMS in Subacute Stroke Patients

Abstract

ObjectiveTo investigate the effects of hand training using low-frequency repetitive transcranial magnetic stimulation (rTMS) within the aftereffect period on hand function in patients with subacute stroke.MethodsThe subacute stroke patients with hand weaknesses were divided randomly into two groups. Patients in the intervention group underwent hand training within the aftereffect period, that is, immediately after receiving low-frequency rTMS treatment. Patients in the control group underwent hand training 2 hours after the low-frequency rTMS treatment. A manual function test (MFT) for ‘grasp and pinch’ and ‘hand activities’; a manual muscle test (MMT) for ‘grasp’, ‘release’, and ‘abductor pollicis brevis (APB)’; and the Modified Ashworth Scale for finger flexion were performed and measured before and immediately after combined therapy as well as 2 weeks after combined therapy.ResultsThirty-two patients with hand weakness were enrolled in this study. The intervention group patients showed more improvements in grasp MMT and MMT APB tested immediately after combined therapy. However, the changes in all measurements were not significantly different between the two groups 2 weeks after the combined therapy. In both groups, hand functions improved significantly immediately after combined therapy and 2 weeks after combined therapy.ConclusionHand training immediately after low-frequency rTMS showed more rapid improvement in the motor power of hands than hand training conducted 2 hours after low-frequency rTMS. Our results suggest that conducting hand training immediately after low-frequency rTMS could be an improved useful therapeutic option in subacute stroke patients.

Effect of Combined Therapy of Robot and Low-Frequency Repetitive Transcranial Magnetic Stimulation on Hemispatial Neglect in Stroke Patients

“…Thus, a higher ipsilesional excitability than the elevated ipsilesional excitability of the brain obtained through a single existing tool was induced. Second, the present study took advantage of the finding of a recent study which indicated that the second therapy of the combination therapy should be performed within 2 hours following the rTMS therapy to enhance the aftereffect and ultimately the efficacy of rTMS combined therapy by performing the robot therapy within 2 hours after the low-frequency rTMS therapy was completed [22]. Thus, the present study was conducted in a condition in which the increase in ipsilesional excitability of the brain and the suppression of the contralesional inter-hemisphere inhibition were maximized in comparison with other rTMS combined therapies targeting hemispatial neglect, through which the maximum treatment effect of the hemispatial neglect therapy was attempted to be achieved.…”

“…Patients in the combined group were treated with both rTMS therapy and robot therapy. To maximize the therapeutic effect in the combined group, the rTMS therapy was performed first and then the robot therapy was performed within 2 hours after the first therapy was completed which was the aftereffect period [22].…”