This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Pomeroy, V. M. Articles by Miller, S. Search for Related Content PubMed PubMed Citation Articles by Pomeroy, V. M. Articles by Miller, S. Pubmed/NCBI databases Medline Plus Health Information Stroke Social Bookmarking                         What's this?

Transcranial Magnetic Stimulation and Muscle Contraction to Enhance Stroke Recovery: A Randomized Proof-of-Principle and Feasibility Investigation

Centre for Rehabilitation and Ageing, Geriatric Medicine, St George's University of London, London, UK, v.pomeroy{at}sgul.ac.uk

Geoffrey Cloud

St George's Healthcare NHS Trust, London, UK

Raymond C. Tallis, F Med Sci

University of Manchester, Manchester, UK

Catherine Donaldson, MSc

Centre for Rehabilitation and Ageing, Geriatric Medicine, St George's University of London, London, UK

Veena Nayak

Centre for Rehabilitation and Ageing, Geriatric Medicine, St George's University of London, London, UK

Simon Miller, DPhil

Centre for Rehabilitation and Ageing, Geriatric Medicine, St George's University of London, London, UK, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne, UK

Objective. To explore the efficacy of repetitive transcranial magnetic stimulation (rTMS) and voluntary muscle contraction (VMC) to improve corticospinal transmission, muscle function, and purposeful movement early after stroke. Methods. Factorial 2 x 2 randomized single-blind trial. Subjects: n = 27, mean age 75 years, mean 27 days after middle cerebral artery infarct (24 subjects completed outcome measures). Procedure: after baseline measurement (day 1), subjects were randomized to 1 of 4 groups. Treatment was given for the next 8 working days, and outcome was measured on day 10. Interventions: (a) Real-rTMS + RealVMC, (b) Real-rTMS + PlaceboVMC, (c) Placebo-rTMS + RealVMC, and (d) Placebo-rTMS + PlaceboVMC. Real-rTMS consisted of 200 1-Hz stimuli at 120% motor threshold in 5 blocks of 40 separated by 3 minutes delivered to the lesioned hemisphere. Placebo-rTMS used a dummy coil. In RealVMC, the paretic elbow was repeatedly flexed/extended for 5 minutes. In PlaceboVMC, subjects viewed pairs of drawings of upper limbs and reported their likeness. Outcomes: frequency of motor-evoked potentials in biceps and triceps, muscle function (torque about elbow), and purposeful movement (Action Research Arm Test). Analysis: group mean changes (outcome — baseline) were compared. Results. In the Real-rTMS + RealVMC group, motor-evoked potential frequency increased 14% for biceps and 20% for triceps, whereas in the Placebo-rTMS + PlaceboVMC group, it decreased 12% for biceps and 6% for triceps. For other groups, there were changes of intermediate values. No meaningful differences were found for secondary outcomes. Conclusions . A positive trend for motor-evoked potential frequency was found for Real-rTMS + RealVMC, whereas a negative trend for motor-evoked potential frequency was found for Placebo-rTMS + PlaceboVMC.

Key Words: Stroke • Rehabilitation • Physical therapy • Motor function • Movement

References

• Pomeroy VM, Tallis RC Need to focus research in stroke rehabilitation. Lancet. 2000;355:836-837.[CrossRef][Medline] [Order article via Infotrieve]
• Hummelsheim H., Hauptmann B., Neumann S. Influence of physiotherapeutic facilitation techniques on motor evoked potentials in centrally paretic hand extensor muscles. Electroencephalogr Clin Neurophysiol. 1997;97:18-28.[Medline] [Order article via Infotrieve]
• Hummelsheim H., Hauptmann B. Transcranial magnetic stimulation and motor rehabilitation. Electroencephalogr Clin Neurophysiol. 1999;13(suppl 51):221-232.
• Butefisch CM, Khurana V., Kopylev L., Cohen LG Enhancing encoding of a motor memory in the primary motor cortex by cortical stimulation. J Neurophysiol. 2004;91:2110-2116.[Abstract/Free Full Text]
• Bestmann S., Baudewig J., Siebner HR, Rothwell JC, Frahm J. Functional MRI of the immediate impact of transcranial magnetic stimulation on cortical and subcortical motor circuits. Eur J Neurosci. 2004; 19:1950-1962.[CrossRef]
• Lee L., Siebner HR, Rowe JB, et al. Acute remapping within the motor system induced by low-frequency repetitive transcranial magnetic stimulation. J Neurosci. 2003;23:5308-5318.[Abstract/Free Full Text]
• Khedr EM, Ahmed MA, Fathy N., Rothwell JC Therapeutic trial of repetitive transcranial magnetic stimulation after acute ischemic stroke. Neurology. 2005;65:466-468.[Abstract/Free Full Text]
• Mansur CG, Fregni F., Boggio PS, et al. A sham stimulation-controlled trial of rTMS of the unaffected hemisphere in stroke patients. Neurology. 2005;64:1802-1804.[Abstract/Free Full Text]
• Takeuchi N., Chuma T., Matsuo Y., Watanabe I., Ikoma K. Repetitive transcranial magnetic stimulation of contralesional primary motor cortex improves hand function after stroke. Stroke. 2005;36:2681-2686.[Abstract/Free Full Text]
• Jin X., Xiaowei W., Wang J., et al. Effect of transcranial magnetic stimulation on rehabilitation of motor function in patients with cerebral infarction. Natl Med J China. 2002;82:534-537.
• Dean CM, Shepherd RB Task-related training improves performance of seated reaching tasks after stroke: a randomized controlled trial. Stroke. 1997;28:722-728.[Abstract/Free Full Text]
• Wassermann EM Safety and side-effects of transcranial magnetic stimulation and repetitive transcranial magnetic stimulation. In: Pascual-Leone A, Davey NJ, Rothwell J, Wassermann EM, Puri BK, eds. Handbook of Transcranial Magnetic Stimulation. London: Arnold; 2002:39-49.
• Johnson SW, Lynn PA, Miller S., Reed GA Miniature skin mounted preamplifiers for measurement of surface electromyographic potentials. Med Biol Eng Comput. 1977;15:710-711.[CrossRef][Medline] [Order article via Infotrieve]
• Lyle RC A performance test for assessment of upper limb function in physical rehabilitation treatment and research. Int J Rehabil Res. 1981;4:483-492.[Medline] [Order article via Infotrieve]
• Chen R., Gerloff C., Classen J., Hallett M., Cohen LG Safety of different inter-train intervals for repetitive transcranial magnetic stimulation and recommendations for safe ranges of stimulation parameters. Electroencephalogr Clin Neurophysiol. 1997;105:415-421.[CrossRef][Medline] [Order article via Infotrieve]
• Anand S., Hotson J. Transcranial magnetic stimulation: neurophysiological applications and safety. Brain Cogn. 2002;50:366-386.[CrossRef][Medline] [Order article via Infotrieve]
• Siebner HR, Mentschel C., Auer C., Lehner C., Conrad B. Repetitive transcranial magnetic stimulation causes a short-term increase in the duration of the cortical silent period in patients with Parkinson's disease. Neurosci Lett. 2000;284:147-150.[CrossRef][Medline] [Order article via Infotrieve]
• Edwards DJ, Thickbroom GW, Byrnes ML, Ghosh S., Mastaglia FL Reduced corticomotor excitability with cyclic passive movement: a study using transcranial magnetic stimulation. Hum Move Sci. 2002; 21:533-540.
• Gandy M., Johnson SW, Lynn PA, Reed GA, Miller S. Acquisition and analysis of electromyographic data associated with dynamic movements of the arm. Med Biol Eng Comput. 1980;18:57-64.[CrossRef][Medline] [Order article via Infotrieve]
• Hendricks HT, Zwarts MJ, Plat EF, van Limbeek J. Systematic review for the early prediction of motor and functional outcome after stroke by using motor-evoked potentials. Arch Phys Med Rehabil. 2002;83:1303-1308.[CrossRef][Medline] [Order article via Infotrieve]
• Stinear CM, Byblow WD Impaired modulation of corticospinal excitability following subthreshold rTMS in focal hand dystonia. Hum Move Sci. 2004;23:527-538.
• Fregni F., Boggio PS, Valle AC, 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;37:2115-2122.[Abstract/Free Full Text]
• Lang N., Siebner HR, Ernst D., et al. Preconditioning with transcranial direct current stimulation sensitizes the motor cortex to rapid-rate transcranial magnetic stimulation and controls the direction of after-effects. Biol Psychiatry. 2004;56:634-639.[CrossRef][Medline] [Order article via Infotrieve]
• Gangitano M., Valero-Cabre A., Tormos JM, Mottaghy FM, Romero JR, Pascual-Leone A. Modulation of input-output curves by low and high frequency repetitive transcranial magnetic stimulation of the motor cortex. Clin Neurophysiol. 2002;113:1249-1257.[CrossRef][Medline] [Order article via Infotrieve]
• Maeda F., Keenan JP, Tormos JM, Topka H., Pascual-Leone A. Interindividual variability of the modulatory effects of repetitive transcranial magnetic stimulation on cortical excitability. Exp Brain Res. 2000;133:425-430.[CrossRef][Medline] [Order article via Infotrieve]
• Siebner HR, Lang N., Rizzo V., et al. Preconditioning of low-frequency repetitive transcranial magnetic stimulation with transcranial direct current stimulation: evidence for homeostatic plasticity in the human motor cortex. J Neurosci. 2004;24:3379-3379.[Abstract/Free Full Text]
• Liepert J., Restemeyer C., Kucinski T., Zittel S., Weiller C. Motor strokes: the lesion location determines motor excitability changes. Stroke. 2005;36:2648-2653.[Abstract/Free Full Text]
• Wagner T., Fregni F., Eden U., et al. Transcranial magnetic stimulation and stroke: a computer-based human model study. Neuroimage. 2006;30:857-870.[CrossRef][Medline] [Order article via Infotrieve]

This version was published on December 1, 2007

Neurorehabilitation and Neural Repair, Vol. 21, No. 6, 509-517 (2007)
DOI: 10.1177/1545968307300418


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				E. B. Plow, J. R. Carey, R. J. Nudo, and A. Pascual-Leone Invasive Cortical Stimulation to Promote Recovery of Function After Stroke: A Critical Appraisal Stroke, May 1, 2009; 40(5): 1926 - 1931. [Abstract] [Full Text] [PDF]

				B. H. Dobkin Progressive Staging of Pilot Studies to Improve Phase III Trials for Motor Interventions Neurorehabil Neural Repair, March 1, 2009; 23(3): 197 - 206. [Abstract] [PDF]

				R. L. Harvey, C. J. Winstein, and for the Everest Trial Group Design for the Everest Randomized Trial of Cortical Stimulation and Rehabilitation for Arm Function Following Stroke Neurorehabil Neural Repair, January 1, 2009; 23(1): 32 - 44. [Abstract] [PDF]

This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Pomeroy, V. M. Articles by Miller, S. Search for Related Content PubMed PubMed Citation Articles by Pomeroy, V. M. Articles by Miller, S. Pubmed/NCBI databases Medline Plus Health Information Stroke Social Bookmarking                         What's this?