Transcranial magnetic stimulation and muscle contraction to enhance stroke recovery: a randomized proof-of-principle and feasibility investigation.
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.
Pomeroy
Valerie M
VM
Centre for Rehabilitation and Ageing, Geriatric Medicine, St George's University of London, London, UK. v.pomeroy@sgul.ac.uk
Cloud
Geoffrey
G
Tallis
Raymond C
RC
Donaldson
Catherine
C
Nayak
Veena
V
Miller
Simon
S
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