title: Transcranial magnetic stimulation and muscle contraction to enhance stroke recovery: a randomized proof-of-principle and feasibility investigation.
abstract: 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.
  
  
  METHODS
  n = 27, mean age 75 years, mean 27 days after middle cerebral artery infarct (24 subjects completed outcome measures).
  
  
  METHODS
  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.
  
  
  METHODS
  (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.
  
  
  RESULTS
  frequency of motor-evoked potentials in biceps and triceps, muscle function (torque about elbow), and purposeful movement (Action Research Arm Test).
  
  
  METHODS
  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.
authors.affiliation: Centre for Rehabilitation and Ageing, Geriatric Medicine, St George's University of London, London, UK. v.pomeroy@sgul.ac.uk
authors.forename: Valerie M
authors.initials: VM
authors.lastname: Pomeroy
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Cloud
authors.forename: Raymond C
authors.initials: RC
authors.lastname: Tallis
authors.forename: Catherine
authors.initials: C
authors.lastname: Donaldson
authors.forename: Veena
authors.initials: V
authors.lastname: Nayak
authors.forename: Simon
authors.initials: S
authors.lastname: Miller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D019054:Evoked Potentials, Motor; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009068:Movement; D009119:Muscle Contraction; D026741:Physical Therapy Modalities; D020127:Recovery of Function; D020521:Stroke / Q000628:therapy*; D000071939:Stroke Rehabilitation; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome