The Effect of Low Frequency Repetitive Transcranial Magnetic Stimulation Combined with Range of Motion Exercise on Paretic Hand Function in Female Patients after Stroke

Copyright © 2013 Mee-Young Kim et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 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 in-creased on the non-paretic hand at post-rTMS with exercise, but a tendency of decrement on paretic hand at same ap-plication. Motor function showed improvement in the 9-hole pegboard and arm reach tests at post-rTMS with exercis