title: Does inhibitory repetitive transcranial magnetic stimulation augment functional task practice to improve arm recovery in chronic stroke?
abstract: Introduction. Restoration of upper extremity (UE) functional use remains a challenge for individuals following stroke. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive modality that modulates cortical excitability and is being explored as a means to potentially ameliorate these deficits. The purpose of this study was to evaluate, in the presence of chronic stroke, the effects of low-frequency rTMS to the contralesional hemisphere as an adjuvant to functional task practice (FTP), to improve UE functional ability. Methods. Twenty-two individuals with chronic stroke and subsequent moderate UE deficits were randomized to receive 16 sessions (4 times/week for 4 weeks) of either real-rTMS or sham-rTMS followed by 1-hour of paretic UE FTP. Results. No differences in UE outcomes were revealed between the real-rTMS and sham-rTMS intervention groups. After adjusting for baseline differences, no differences were revealed in contralesional cortical excitability postintervention. In a secondary analysis, data pooled across both groups revealed small, but statistically significant, improvements in UE behavioral measures. Conclusions. rTMS did not augment changes in UE motor ability in this population of individuals with chronic stroke. The chronicity of our participant cohort and their degree of UE motor impairment may have contributed to inability to produce marked effects using rTMS.
authors.affiliation: Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, P.O. Box 100154, Gainesville, FL 32610-0154, USA ; Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA.
authors.forename: Dorian K
authors.identifier: 0000-0002-9751-0298
authors.initials: DK
authors.lastname: Rose
authors.affiliation: Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, P.O. Box 100154, Gainesville, FL 32610-0154, USA ; Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA ; Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA ; Department of Neurology, University of Florida, Gainesville, FL, USA.
authors.forename: Carolynn
authors.identifier: 0000-0002-9948-0045
authors.initials: C
authors.lastname: Patten
authors.affiliation: Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA ; Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA.
authors.forename: Theresa E
authors.initials: TE
authors.lastname: McGuirk
authors.affiliation: Department of Biostatistics & Children's Oncology Group, University of Florida, Gainesville, FL, USA.
authors.forename: Xiaomin
authors.identifier: 0000-0001-6798-2668
authors.initials: X
authors.lastname: Lu
authors.affiliation: Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA ; Department of Neurology, University of Florida, Gainesville, FL, USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Triggs