Effects and safety of combined rTMS and action observation for recovery of function in the upper extremities in stroke patients: A randomized controlled trial.
BACKGROUND
Repetitive transcranial magnetic stimulation (rTMS) modulates cortical excitability and facilitates motor learning to improve motor recovery after stroke. Action observation (AO) therapy effectively facilitates physical training for motor memory formation.


OBJECTIVE
To compare the effectiveness of rTMS alone with that of combined rTMS and AO for the functional recovery of upper extremity function in subacute stroke patients and to verify the safety of the interventions.


METHODS
The present study was a prospective, randomized controlled trial involving subacute unilateral stroke patients. In total, 22 patients were randomly assigned to 2 groups: the trial group (rTMS with AO) and the control group (rTMS alone). Both groups received 1 Hz rTMS (intensity: 120% of resting motor threshold; rMT) over the contralesional primary motor cortex for 20 minutes on 10 consecutive days. Trial group received rTMS while watching a video of 5 different complex hand movements. The functional parameters were the Brunnstrom stage, Fugl-Meyer assessment (FMA) score of the upper extremity, Manual Function Test (MFT) score, and grip power. The following motor evoked potential (MEP) parameters were recorded from the abductor pollicis brevis muscle: rMT, latency, and amplitude. Both parameters were measured before and after the 2 week intervention.


RESULTS
After the 2 week trial, the total FMA and MFT scores were significantly improved in both groups, but the MFT subscores of hand motor function and grip power were significantly improved in the combination therapy group only. In contrast, the changes (Δ) of FMA, MFT, grip power test, and MEP outcomes were not significantly different between the 2 groups. No adverse events or complications were reported.


CONCLUSIONS
Distal upper extremity function, as measured by MFT and grip power, was improved after rTMS and AO in combination. The combination of rTMS with AO may be applied safely to improve upper extremity function after stroke.
['Noh|Jun Soo|JS|', 'Lim|Ji Hoon|JH|', 'Choi|Tae Woong|TW|', 'Jang|Seung Gul|SG|', 'Pyun|Sung-Bom|SB|']
D000368:Aged D019054:Evoked Potentials, Motor D005260:Female D006429:Hemiplegia D006801:Humans D008297:Male D008875:Middle Aged D059167:Mirror Neurons D009043:Motor Activity D009044:Motor Cortex D010043:Outcome and Process Assessment, Health Care D020127:Recovery of Function D020521:Stroke D000071939:Stroke Rehabilitation D050781:Transcranial Magnetic Stimulation D034941:Upper Extremity D014796:Visual Perception
recovery of function stroke Transcranial magnetic stimulation hemiplegia stroke 
rehabilitation