Abstract
Objective
To assess the efficacy of inhibitory repetitive transcranial magnetic stimulation
(rTMS) for decreasing upper-limb muscle tone after chronic stroke.
Design
A randomized sham-controlled trial with a 4-week follow-up.
Setting
Research hospital.
Participants
Patients with stroke (N=20) with poststroke upper limb spasticity.
Interventions
The experimental group received rTMS to the primary motor cortex of the unaffected
side (1500 pulses; 1Hz; 90% of resting motor threshold for the first dorsal interosseous
muscle) in 10 sessions, 3d/wk, and physical therapy (PT). The control group received
sham stimulation and PT.
Main Outcome Measures
Modified Ashworth scale (MAS), upper-extremity Fugl-Meyer assessment, FIM, range of
motion, and stroke-specific quality-of-life scale. All outcomes were measured at baseline,
after treatment (postintervention), and at a 4-week follow-up. A clinically important
difference was defined as a reduction of ≥1 in the MAS score.
Results
Friedman test revealed that PT is efficient for significantly reducing the upper limb
spasticity of patients only when it is associated with rTMS. In the experimental group,
90% of the patients at postintervention and 55.5% at follow-up showed a decrease of
≥1 in the MAS score, representing clinically important differences. In the control
group, 30% of the patients at postintervention and 22.2% at follow-up experienced
clinically meaningful changes. There were no differences between the groups at any
time for any of the other outcome measures, indicating that both groups demonstrated
similar behaviors over time for all variables.
Conclusions
rTMS associated with PT can be beneficial in reducing poststroke spasticity. However,
more studies are needed to clarify the clinical changes underlying the reduction in
spasticity induced by noninvasive brain stimulations.
Keywords
List of abbreviations:
CID (clinically important difference), MAS (modified Ashworth scale), MT (rest motor threshold), rTMS (repetitive transcranial magnetic stimulation), SSQOL (stroke-specific quality-of-life scale), TMS (transcranial magnetic stimulation), UE-FMA (upper-extremity Fugl-Meyer assessment)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 14, 2013
Footnotes
No commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a benefit on the authors or on any organization with which the authors are associated.
Identification
Copyright
© 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
