title: High-frequency rTMS applied over bilateral leg motor areas combined with mobility training for gait disturbance after stroke: a preliminary study.
abstract: OBJECTIVE
  A double cone coil enables delivery of magnetic stimulation to leg motor areas and modulates neural activities of the areas. It is expected that combined application of facilitatory rTMS with the coil and physical therapy would improve walking function after stroke. The purpose of this study is to clarify the clinical effect of an in-patient protocol featuring rTMS with a double cone coil and mobility training for gait disturbance after stroke.
  
  
  METHODS
  Nineteen post-stroke hemiparetic patients with gait disturbance were studied (aged 56.2 ± 11.9 years). During the 13-day hospitalization, each patient received 20 sessions of high-frequency rTMS and mobility training featuring treadmill training. In one rTMS session, 2000 pulses of 10-Hz rTMS were delivered over bilateral leg motor areas using the double cone coil. Walking velocity, Physiological Cost Index (PCI) and Timed Up and Go Test (TUG) were evaluated on the day of admission and discharge.
  
  
  RESULTS
  The protocol was completed without any adverse effects in all patients. The combination treatment significantly increased walking velocity (p < 0.05) and decreased PCI (p < 0.05), decreased the performance time for TUG (p < 0.05).
  
  
  CONCLUSIONS
  The protocol featuring high-frequency rTMS and mobility training is safe and feasible and can improve walking function after stroke.
authors.affiliation: Department of Rehabilitation Medicine, Jikei University School of Medicine , Nishi-Shimbashi, Minato-Ku, Tokyo, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Kakuda
authors.forename: Masahiro
authors.initials: M
authors.lastname: Abo
authors.forename: Shu
authors.initials: S
authors.lastname: Watanabe
authors.forename: Ryo
authors.initials: R
authors.lastname: Momosaki
authors.forename: Gentaro
authors.initials: G
authors.lastname: Hashimoto
authors.forename: Yasuhide
authors.initials: Y
authors.lastname: Nakayama
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kiyama
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Yoshida
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D020233:Gait Disorders, Neurologic / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007866:Leg / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D026741:Physical Therapy Modalities; D020521:Stroke / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D050781:Transcranial Magnetic Stimulation / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome; D016138:Walking