title: Transcranial magnetic stimulation synchronized with maximal movement effort of the hemiplegic hand after stroke: a double-blinded controlled pilot study.
abstract: OBJECTIVE
  The aim of this study was to evaluate the effects of transcranial magnetic stimulation synchronized with maximal effort to make a target movement in patients with chronic hemiplegia involving the hand.
  
  
  METHODS
  Non-randomized double-blinded controlled trial.
  
  
  METHODS
  Nine chronic patients with hemiplegia who were unable to fully extend the affected fingers following stroke.
  
  
  METHODS
  Patients were assigned to receive 100 pulses of active or sham transcranial magnetic stimulation of the affected hemisphere per session. Each active or sham pulse was delivered during maximal effort at thumb and finger extension as a target movement. A blinded rater assessed stroke impairments at baseline, immediately after, and one week after 4 weekly transcranial magnetic stimulation sessions. Motor evoked potential amplitudes were measured at each session.
  
  
  RESULTS
  All sessions were completed without adverse effects. Immediately after the fourth transcranial magnetic stimulation session, 4 of 5 patients in the active transcranial magnetic stimulation group (80%) had either reduced wrist flexor spasticity or improved manual performance; no such change occurred in the sham group (Fisher's exact test, p < 0.05). Effects persisted one week later. In the active transcranial magnetic stimulation group, 3 patients who showed an increase in motor evoked potential amplitudes all had improvement in clinical assessments.
  
  
  CONCLUSIONS
  Transcranial magnetic stimulation synchronized with maximum effort to make a target movement improved hand motor function in patients with chronic hemiplegia.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan. s-izumi@mail.tains.tohoku.ac.jp
authors.forename: Shin-Ichi
authors.initials: S
authors.lastname: Izumi
authors.forename: Takeo
authors.initials: T
authors.lastname: Kondo
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Shindo
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D004311:Double-Blind Method; D005260:Female; D006225:Hand / Q000503:physiopathology; D018737:Hand Strength / Q000502:physiology; D006429:Hemiplegia / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D050781:Transcranial Magnetic Stimulation / Q000379:methods