Abstract
It has been recently demonstrated high frequency repetitive transcranial magnetic stimulation (HF-rTMS) can improve motor function after stroke. However, there is no study that tested the synergetic effects of physical therapy to HF-rTMS in clinical settings. We therefore investigated the effect of physical healthy exercise (PHE) on paretic arm combined with HF-rTMS in stroke patients. All patients underwent HF-rTMS on contralesional hemisphere for 15 minutes and PHE on paretic arm. The cortical excitability by the amplitude and latency of motor evoked potential (MEP) were measured. We also evaluated arm function using Box and Block, arm reach, 9-hole pegboard, and grip force tests. We found for the first time significant differences of MEP between pre- and post-intervention. HF-rTMS with PHE had a tendency to induce a decrease in MEP amplitude on the nonparetic hand whereas it led to an increment in MEP amplitude in the paretic hand. In particular, the Box and Block, power grip, and arm reach tests showed improvement through every session. Furthermore, motor function and MEP were correlated especially on paretic side. These results indicate PHE with HF-rTMS partially improves arm function after stroke which may support additional effect to rehabilitation in stroke patients.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Takeuchi, N. et al. Inhibition of the unaffected motor cortex by 1 Hz repetitive transcranical magnetic stimulation enhances motor performance and training effect of the paretic hand in patients with chronic stroke. J. Rehabil. Med. 40, 298–303 2008.
Kakuda, W. et al. Low-frequency rTMS combined with intensive occuoational therapy for upper limb hemiparesis after brain tumour resection. Brain Inj. 24, 1505–1510 2010.
Malcolm, M. P. et al. Repetitive transcranial magnetic stimulation as an adjunct to constraint-induced therapy: an exploratory randomized controlled trial. Am. J. Phys. Med. Rehabil. 86, 707–715 2007.
Kim, J. H. et al. A pilot study on the effect of functional electrical stimulation of stroke patients in a sitting position on balance and activities of daily living. J. Phys. Ther. Sci. 25, 1097–1101 2013.
Lee, W. D., Lee, J. U. & Kim, J. Differences in amplitude of functional electrical stimulation between the paretic and nonparetic sides of hemiplegic stroke patients. Toxicol. Environ. Health. Sci. 5, 82–85 2013.
Patten, C., Lexell, J. & Brown, H. E. Weakness and strength training in persons with poststroke hemiplegia: rationale, method, and efficacy. J. Rehabil. Res. Dev. 41, 293–312 2004.
Kim, J. H. et al. Waveform analysis of the brachial-ankle pulse wave velocity in hemiplegic stroke patients and healthy volunteers: a pilot study. J. Phys. Ther. Sci. 26, 501–504 2014.
Pak, S. & Patten, C. Strengthening to promote functional recovery poststroke: an evidence-based review. Top. Stroke Rehabil. 15, 177–199 2008.
Hendricks, H. T. et al. Motor recovery after stroke: a systematic review of the literature. Arch. Phys. Med. Rehabil. 83, 1629–1637 2002.
Hofgren, C. et al. Recovery after stroke: cognition, ADL function and return to work. Acta Neurol. Scand. 115, 73–80 2007.
Lincoln, N. B., Parry, R. H. & Vass, C. D. Randomized, controlled trial to evaluate increased intensity of physiotherapy treatment of arm function after stroke. Stroke. 30, 573–579 1999.
Sunderland, A. et al. Enhanced physical therapy improves recovery of arm function after stroke. A randomised controlled trial. J. Neurol. Neurosurg. Psychiatry. 55, 530–535 1992.
Feys, H. M. et al. Effect of a therapeutic intervention for the hemiplegic upper limb in the acute phase after stroke: a single blind, randomized, controlled multicenter trial. Stroke. 29, 785–792 1998.
Kim, M. Y. et al. The effect of low frequency repetitive transcranial magnetic stimulation combined with range of motion exercise on paretic hand function in female patients after stroke. Neurosci. Med. 4, 77–83 2013.
Kim, M. et al. Reliability of dynamic muscle performance in the hemiparetic upper limb. J. Neurol. Phys. Ther. 29, 9–17 2005.
Lomarev, M. P. et al. Safety study of high-frequency tanscranial magnetic stimulation in patients with chronic stroke. Clin. Neurophysiol. 118, 2072–2075 2007.
Gerloff, C. et al. Inhibitory influence of the ipsilateral motor cortex on responses to stimulation of the human cortex and pyramidal tract. J. Physiol. 510, 249–259 1998.
Murase, N. et al. Influence of interhemispheric interactions on motor function in chronic stroke. Ann. Neurol. 55, 400–409 2004.
Ward, N. S. & Cohen, L. G. Mechanisms underlying recovery of motor function after stroke. Arch. Neurol. 61, 1844–1848 2004.
Takeuchi, N. et al. Repetitive transcranial magnetic stimulation over bilateral hemispheres enhances motor function and training effect of paretic hand in patients after stroke. J. Rehabil. Med. 41, 1049–1054 2009.
Fregni, F. et al. A sham-controlled trial of a 5-day course of repetitive transcranial magnetic stimulation of the unaffected hemisphere in stroke patients. Stroke. 37, 2115–2122 2006.
Peinemann, A. et al. Long-lasting increase in corticospinal excitability after 1800 pulses of subthreshold 5 Hz repetitive TMS to the primary motor cortex. Clin. Neurophysiol. 115, 1519–1526 2004.
Butler, A. J. & Wolf, S. L. Putting the brain on the map: use of transcranial magnetic stimulation to assess and induce cortical plasticity of upper-extremity movement. Phys. Ther. 87, 719–736 2007.
Takeuchi, N. et al. Repetitive transcranical magnetic stimulation of contralesional primary motor cortex improves hand function after stroke. Stroke. 36, 2681–2686 2005.
Kim, Y. H. et al. Repetitive transcranial magnetic stimulation-induced corticomotor excitability and associated motor skill acquisition in chronic stroke. Stroke. 37, 1471–1476 2006.
Indovina, I. & Sanes, J. N. On somatotopic representation centers for finger movements in human primary motor cortex and supplementary motor area. Neuroimage. 13, 1027–1034 2001.
Allendorfer, J. B., Storrs, J. M. & Szaflarski, J. P. Changes in white matter integrity follow excitatory rTMS treatment of post-stroke aphasia. Restor. Neurol. Neurosci. 30, 103–113 2012.
Khedr, E. M. & Fetoh, N. A. Short-and long-term effect of rTMS on motor function recovery after ischemic stroke. Restor. Neurol. Neurosci. 28, 545–559 2010.
Lee, E. Y. & Kim, I. S. Development plan of health impact assessments in Korea. Toxicol. Environ. Health. Sci. 6, 225–232 2014.
Ku, S. K. et al. Effects of polycan on calcium bioavailability in two different rat models of osteoporosis. Toxicol. Environ. Health. Sci. 7, 35–42 2015.
Bagyinszky, E. et al. Diagnostic methods and biomarkers for Alzheimer’s disease. Toxicol. Environ. Health. Sci. 6, 133–147 2014.
Rossini, P. M. 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. Electroence phalogr. Clin. Neurophysiol. 91, 79–92 1994.
Silverman, I. E., Restrepo, L. & Mathews, G. C. Poststroke seizures. Arch. Neurol. 59, 195–201 2002.
Rossi, S. et al. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin. Neurophysiol. 120, 2008–2039 2009.
Wassermann, E. M. Risk and safety of repetitive transcranial magnetic stimulation: report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation, June 5-7, 1996. Electroencephalogr. Clin. Neurophysiol. 108, 1–16 1998.
Prashantha, D. K. et al. Evaluation of the motor cortical excitability changes after ischemic stroke. Ann. Indian Acad. Neurol. 16, 394–397 2013.
Pizzi, A. et al. Prognostic value of motor evoked potentials in motor function recovery of upper limb after stroke. J. Rehabil. Med. 41, 654–660 2009.
Hendricks, H. T. et al. Analysis of recovery processes after stroke by means of transcranial magnetic stimulation. J. Clin. Neurophysiol. 20, 188–195 2003.
Binkofski, F. et al. Recovery of motor functions following hemiparetic stroke: a clinical and magnetic resonance-morphometric study. Cerebrovasc. Dis. 11, 273–281 2001.
Platz, T. et al. Reliability and validity of arm function assessment with standardized guidelines for the Fugl-Meyer Test, Action Research Arm Test and Box and Block Test: a multicentre study. Clin. Rehabil. 19, 404–411 2005.
Canny, M. L., Thompson, J. M. & Wheeler, M. J. Reli-ability of the box and block test of manual dexterity for use with patients with fibromyalgia. Am. J. Occup. Ther. 63, 506–510 2009.
Smith, Y. A., Hong, E. & Presson, C. Normative and validation studies of the Nine-hole Peg Test with children. Percep. Mot. Skills. 90, 823–843 2000.
Bellace, J. V. et al. Validity of the Dexter Evaluation System's Jamar dynamometer attachment for assessment of hand grip strength in a normal population. J. Hand Ther. 13, 46–51 2000.
Mathiowetz, V. et al. Adult norms for the Box and Block Test of manual dexterity. Am. J. Occup. Ther. 39, 386–391 1985.
Smith, J. et al. Effect of scapular protraction and retraction on isometric shoulder elevation strength. Arch. Phys. Med. Rehabil. 83, 367–370 2002.
Schenkman, M. et al. Measures of shoulder protraction and thoracolumbar rotation. J. Orthop. Sports Phys. Ther. 25, 329–335 1997.
Author information
Authors and Affiliations
Corresponding author
Additional information
These authors contributed equally to this work.
Rights and permissions
About this article
Cite this article
Kim, MY., Park, BS. & Kim, J. Effects of high frequency repetitive transcranial magnetic stimulation with physical healthy exercise in stroke. Toxicol. Environ. Health Sci. 7, 160–170 (2015). https://doi.org/10.1007/s13530-015-0234-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13530-015-0234-0