title: rTMS combined with task-oriented training to improve symmetry of interhemispheric corticomotor excitability and gait performance after stroke: a randomized trial.
abstract: BACKGROUND
  The model of interhemispheric competition after stroke has been established for the upper but not for the lower extremity. Repetitive transcranial magnetic stimulation (rTMS) of the brain has been shown to modulate cortical excitability.
  
  
  OBJECTIVE
  The purpose of this study was to investigate the effects of rTMS followed by task-oriented training on cortical excitability and walking performance in individuals with chronic stroke.
  
  
  METHODS
  A total of 24 patients with average Fugl-Meyer lower limb scores of 17.88 ± 5.27 and average walking speeds of 63.81 ± 18.25 cm/s were randomized into an experimental group and a control group. Participants received rTMS (experimental group) or sham rTMS (control group) followed by task-oriented training (30 minutes) for 10 sessions over 2 weeks. Repetitive TMS was applied at a 1-Hz frequency over the leg area of the motor cortex of the unaffected hemisphere for 10 minutes. Outcomes, including motor-evoked potential (MEP), lower-extremity Fugl-Meyer score, and gait performance, were measured before and after training.
  
  
  RESULTS
  Decreased interhemispheric asymmetry of the amplitude of the MEP was noted after rTMS and task-oriented training. Improvement in spatial asymmetry of gait was comparable with increased symmetry in interhemispheric excitability. Motor control and walking ability were also significantly improved after rTMS and task-oriented training.
  
  
  CONCLUSIONS
  rTMS enhances the effect of task-oriented training in those with chronic stroke, especially by increasing gait spatial symmetry and corticomotor excitability symmetry.
authors.affiliation: National Yang-Ming University, Taipei, Taiwan.
authors.forename: Ray-Yau
authors.initials: RY
authors.lastname: Wang
authors.forename: Hsin-Yuan
authors.initials: HY
authors.lastname: Tseng
authors.forename: Kwong-Kum
authors.initials: KK
authors.lastname: Liao
authors.forename: Chung-Jen
authors.initials: CJ
authors.lastname: Wang
authors.forename: Kuan-Lin
authors.initials: KL
authors.lastname: Lai
authors.forename: Yea-Ru
authors.initials: YR
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D019054:Evoked Potentials, Motor / Q000502:physiology; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology*; D010291:Paresis / Q000209:etiology / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D020521:Stroke / Q000150:complications / Q000473:pathology; D000071939:Stroke Rehabilitation; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology