Effects of navigated repetitive transcranial magnetic stimulation after stroke

Purpose: The purpose of this study was to test the effects o navigated repetitive transcranial magnetic stimulation, delivered in different modes, on motor impairments and functional limitations after stroke. Methods: The study sample included 42 patients (58.5 6 10.7 years; 26 males) who experienced a single unilateral stroke (1–12 months previously) in the area of the middle cerebral artery. Patients completed a course of conventional rehabilitation, together with 10 sessions of navigated repetitive transcranial magnetic stimulation or sham stimulation. Stimulation was scheduled five times a week over two consecutive weeks in an inpatient clinical setting. Patients were randomly assigned to one of four groups and received sham stimulation (n ¼ 10), low-frequency (1-Hz) stimulation of the nonaffected hemisphere (n ¼ 11), high-frequency (10-Hz) stimulation of the affected hemisphere (n ¼ 13), or sequential combination of low- and high-frequency stimulations (n ¼ 8). Participants were evaluated before and after stimulation with clinical tests, including the arm and hand section of the Fugl–Meyer Assessment Scale, modified Ashworth Scale of Muscle Spasticity, and Barthel Index of Activities of Daily Living. Results: Participants in the three groups receiving navigated repetitive transcranial magnetic stimulation showed improvements in arm and hand functions on the Fugl–Meyer Stroke Assessment Scale. Ashworth Scale of Muscle Spasticity and Barthel Index scores were significantly reduced in groups receiving low- or high-frequency stimulation alone. Conclusions: Including navigated repetitive transcranial magnetic stimulation in a conventional rehabilitation program positively influenced motor and functional recovery in study participants, demonstrating the clinical potential of the method. The results of this study will be used for designing a large-scale clinical trial.