Repetitive transcranial magnetic
stimulation (rTMS) has recently been demonstrated to improve motor function
after stroke. However, no study has yet tested the synergetic effects of
physical exercise on rTMS in clinical settings. We investigated the effect of a
6-session course of low frequency rTMS on contralesional primary motor cortex
combined with range-of motion (ROM) exercise on paretic hand function in female
stroke patients. This was a single-blind study of the effects of rTMS with or
without ROM exercise in female hemiplegic patients after stroke. All patients underwent
rTMS on the contralesional primary motor cortex for 15 minutes and ROM exercise
on the paretic hand. The cortical excitability determined by the amplitude and
latency of the motor evoked potential (MEP) was measured in both first dorsal
interosseous (FDI) muscles. We also evaluated arm function using Box and Block,
arm reach, 9-hole pegboard, power grip, and pinch grip force tests. The
rTMS-induced MEP amplitude of the paretic side significantly increased whereas
the non-paretic side showed a decrease through every session. However, the MEP
latency significantly increased on the non-paretic hand at post-rTMS with exercise, but a
tendency of decrement on paretic hand at same application. Motor function showed
improvement in the 9-hole pegboard and arm reach tests at post-rTMS with
exercise on the paretic side compared with the non-paretic side. A significant
correlation was especially noted between motor function and MEP on the paretic
side of stroke patients. Low frequency rTMS with ROM exercise improved hand function after stroke. This may, in part,
result in additional rehabilitation in stroke patients.
Cite this paper
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