The Effect of Low Frequency Repetitive Transcranial Magnetic Stimulation Combined with Range of Motion Exercise on Paretic Hand Function in Female Patients after Stroke

Abstract

Repetitive transcranial magnetic\rstimulation (rTMS) has recently been demonstrated to improve motor function\rafter stroke. However, no study has yet tested the synergetic effects of\rphysical exercise on rTMS in clinical settings. We investigated the effect of a\r6-session course of low frequency rTMS on contralesional primary motor cortex\rcombined with range-of motion (ROM) exercise on paretic hand function in female\rstroke patients. This was a single-blind study of the effects of rTMS with or\rwithout ROM exercise in female hemiplegic patients after stroke. All patients underwent\rrTMS on the contralesional primary motor cortex for 15 minutes and ROM exercise\ron the paretic hand. The cortical excitability determined by the amplitude and\rlatency of the motor evoked potential (MEP) was measured in both first dorsal\rinterosseous (FDI) muscles. We also evaluated arm function using Box and Block,\rarm reach, 9-hole pegboard, power grip, and pinch grip force tests. The\rrTMS-induced MEP amplitude of the paretic side significantly increased whereas\rthe non-paretic side showed a decrease through every session. However, the MEP\rlatency significantly increased on the non-paretic hand at post-rTMS with exercise, but a\rtendency of decrement on paretic hand at same application. Motor function showed\rimprovement in the 9-hole pegboard and arm reach tests at post-rTMS with\rexercise on the paretic side compared with the non-paretic side. A significant\rcorrelation was especially noted between motor function and MEP on the paretic\rside of stroke patients. Low frequency rTMS with ROM exercise improved hand function after stroke. This may, in part,\rresult in additional rehabilitation in stroke patients.