ABSTRACT
Objectives: Stroke is the leading cause of long-term disability. Hand motor impairment resulting from chronic stroke may have extensive physical, psychological, economical, and social implications despite available rehabilitative treatments. The best time to start treatment for stroke is in sub-acute period. Repetitive Transcranial Magnetic Stimulation [rTMS] is a method of stimulating and augmenting the neurophysiology of the motor cortex in order to promote the neuroplastic changes that are associated with motor recovery. The purpose of this study was to compare the effects of repetitive transcranial magnetic stimulation protocols plus routine rehabilitation on hand motor functions and hand corticomotor excitability in stroke patients with hemiplegia with pure routine rehabilitation programs.
Methods: This study was a randomized clinical trial which was performed on 24 patients with hemiplegia who were randomly divided in to three groups: received high frequency rTMS, received rehabilitation program with low frequency rTMSl, who were given only routine rehabilitation programs. The treatment was performed for 10 sessions, three times pre-post test and follow-up about neurophysiological contralesional hemisphere evaluations using record of MEP wave indices by single pulse TMS, and assessing functional wolf test and hand grip power of disabled hand by dynamometer.
Results: The results demonstrated that the rest MEP threshold reduction in experimental group which received high frequency magnetic stimulation was not statistically significant [P=0.387]. There was significant reduction for active MEP threshold in the within group [P=0.031]. Also there were statistically significant between obtained results from WOLF test and grip test.
Discussion: According to the results, it seems that Hf rTMS combined with routine physiotherapy can significantly improve hand functions and brain neurophysiology via specifically increase of contralesional corticomotor excitability in sever stroke patients. It indicated the role of neuroplasticity in nonlesioned hemisphere; but the hypothesis of movement improvement related cognitive balance can't be eliminated by exploring powerful approved effect of Hf rTMS on mood regulation.