Effects of concomitant neuromuscular electrical stimulation during repetitive transcranial magnetic stimulation before repetitive facilitation exercise on the hemiparetic hand

Repetitive transcranial magnetic stimulation (rTMS) and Repetitive facilitative exercise (RFE) improves motor impairment after stroke. To investigate whether neuromuscular electrical stimulation (NMES) can facilitate the effects of rTMS and RFE on the function of the hemiparetic hand in stroke patie...

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Bibliographic Details
Published in:	NeuroRehabilitation (Reading, Mass.) Vol. 45; no. 3; p. 323
Main Authors:	Etoh, Seiji, Kawamura, Kentaro, Tomonaga, Kei, Miura, Seiji, Harada, Shizuyo, Noma, Tomokazu, Kikuno, Satomi, Ueno, Makoto, Miyata, Ryuji, Shimodozono, Megumi
Format:	Journal Article
Language:	English
Published:	Netherlands 01-01-2019
Subjects:	Adult Aged Combined Modality Therapy - methods Combined Modality Therapy - trends Cross-Over Studies Double-Blind Method Electric Stimulation Therapy - methods Electric Stimulation Therapy - trends Exercise Therapy - methods Exercise Therapy - trends Female Hand - physiopathology Humans Male Middle Aged Paresis - physiopathology Paresis - rehabilitation Random Allocation Stroke - complications Stroke Rehabilitation - methods Stroke Rehabilitation - trends Transcranial Direct Current Stimulation - methods Transcranial Direct Current Stimulation - trends Transcranial Magnetic Stimulation - methods Transcranial Magnetic Stimulation - trends Treatment Outcome stroke Neuromuscular electrical stimulation repetitive facilitative exercise hemiparesis repetitive transcranial magnetic stimulation
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Summary:	Repetitive transcranial magnetic stimulation (rTMS) and Repetitive facilitative exercise (RFE) improves motor impairment after stroke. To investigate whether neuromuscular electrical stimulation (NMES) can facilitate the effects of rTMS and RFE on the function of the hemiparetic hand in stroke patients. This randomized double-blinded crossover study divided 20 patients with hemiparesis into two groups and provided treatment for 4 weeks at 5 days/week. NMES-before-sham group and NMES-following-sham group performed NMES sessions and sham NMES sessions for each 2 weeks. Patients received NMES or sham NMES for the affected extensor muscle concurrently with 1 Hz rTMS for the unaffected motor cortex for 10 min and performed RFE for 60 min. The Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), Box and Block Test (BBT) and Modified Ashworth Scale (MAS) were used for evaluation. FMA and ARAT improved significantly during both sessions. The gains in the BBT during an NMES session were significantly greater than those during a sham NMES session. MAS for the wrist and finger significantly decreased only during an NMES session. NMES combined with rTMS might facilitate, at least in part, the beneficial effects of RFE on motor function and spasticity of the affected upper limb.
ISSN:	1878-6448
DOI:	10.3233/NRE-192800