title: Combining rTMS and Task-Oriented Training in the Rehabilitation of the Arm after Stroke: A Pilot Randomized Controlled Trial.
abstract: Introduction. Repetitive transcranial magnetic stimulation (rTMS) is a promising technique for promoting rehabilitation of arm function after stroke. The feasibility and impact of rTMS as an adjunct to traditional task-oriented training to improve arm function have not yet been demonstrated. Objective. Evaluate the feasibility of a randomized controlled trial aimed at determining the efficacy of rTMS as an adjunct to task-oriented therapy in facilitating restoration of arm function after stroke. Methods. Stratified block-randomized controlled trial set in the general community. Eleven stroke persons with mild to severe arm deficits were recruited and randomized to receive 8 sessions of real-rTMS or sham-rTMS followed by ninety minutes of arm tasks designed to improve function. Results. Medium to large, statistically significant effect sizes (0.49 to 1.63) were observed in both groups on several measures of arm function at the postintervention evaluation. Three out of four subjects in the real-TMS condition showed increased levels of corticomotor excitability after the first stimulation session. Conclusions. Preliminary evidence suggests that an rTMS protocol potent enough to induce transient increases in cortical excitability of the lesioned hemisphere is feasible but did not show promising results as an adjunct to task-specific training. This trial is registration with Clinical Trials.gov NCT00850408.
authors.affiliation: Division of Experimental Medicine, McGill University, 1110 Pine Avenue West, Montreal, QC, Canada ; School of Rehabilitation, Faculty of Medicine, Université de Montréal, C.P. 6128, Succursale Centre-Ville, Montreal, QC, Canada H3C 3J7 ; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 2275, Avenue Laurier Est, Montréal, QC, Canada H2H 2N8.
authors.forename: Johanne
authors.initials: J
authors.lastname: Higgins
authors.affiliation: Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, 687, Pine Avenue West, Montreal, QC, Canada H3A 1A1 ; Division of Geriatrics, Research Institute of the McGill University Health Centre, 687 Pine Avenue West, Montreal, QC, Canada H3A 1A1 ; The Allan Memorial Institute, P2.142, McGill University Health Centre, 1025 Pine Avenue West, Montreal, QC, Canada H3A 1A1.
authors.forename: Lisa
authors.initials: L
authors.lastname: Koski
authors.affiliation: Department of Neurology, Affiliated Foshan Hospital of Sun Yat-sen University, Foshan, Guangdong, China.
authors.forename: Haiqun
authors.initials: H
authors.lastname: Xie