Combination therapy with repetitive facilitative exercise program and botulinum toxin type A to improve motor function for the upper-limb spastic paresis in chronic stroke: A randomized controlled trial.

STUDY DESIGN: An open-label, randomized, controlled, observer-blinded trial. INTRODUCTION: Repetitive facilitative exercise (RFE) is a movement therapy to recover from hemiparesis after stroke. However, improvement is inhibited by spasticity. Recently, botulinum toxin type A (BoNT-A) injection has been shown to reduce spasticity. PURPOSE: To examine the combined effect of an RFE program and BoNT-A treatment on upper-limb spastic paresis in chronic stroke. METHODS: Forty chronic stroke inpatients with upper-limb spastic paresis (Brunnstrom stage ≥III and Modified Ashworth Scale [MAS] score ≥1) were enrolled. Subjects were randomized into 2 groups of 20 each and received 4 weeks of treatment. The intervention group received RFE and BoNT-A injection; the control group underwent RFE only. Assessments were performed at baseline and at study conclusion. The primary outcome was change in Fugl-Meyer Assessment score for the upper extremity (FMA). The Action Research Arm Test (ARAT), active range of motion, Box and Block Test, and MAS were also evaluated. RESULTS: All participants completed this study. After 4 weeks, the intervention group evidenced a significantly greater increase in FMA score (median 11.0 [range 4-20]) than the control group (median 3.0 [range 0-9]) (P < .01, r = 0.79); as well as improvements in the other measures such as ARAT (median 12.5 [range 4-22] vs 7 [0-13]) (P < .01, r = 0.6), and MAS in the elbow flexors (median -1.5 [range -2 to 0] vs -1 [-2 to 0]) (P < .01, r = 0.45). DISCUSSION: A high degree of repetitive volitional movement induced by the facilitative technique with concomitant control of spasticity by BoNT-A injection might increase efficiency of motor learning with continuous movement of the affected upper-limb. CONCLUSIONS: The combination of RFE and BoNT-A for spastic paresis might be more effective than RFE alone to improve upper-limb motor function and to lessen impairment in chronic stroke.

Use of an arm weight-bearing combined with upper-limb reaching apparatus to facilitate motor paralysis recovery in an incomplete spinal cord injury patient: a single case report.

[Purpose] Training using an arm weight-bearing device combined with upper-limb reaching apparatus to facilitate motor paralysis recovery, named the "Reaching Robot", as well as Repetitive Facilitation Exercise were applied to a patient with severe impairment of the shoulder and elbow due to incomplete spinal cord injury and the effects were examined. [Subjects and Methods] A 66-year-old man with incomplete spinal cord injury participated in an upper extremity rehabilitation program involving a Reaching Robot. The program was comprised of active motor suspension, continuous low amplitude neuromuscular electrical stimulation and functional vibratory stimulation, as well as Repetitive Facilitation Exercise combined with continuous low amplitude neuromuscular electrical stimulation. This protocol used a crossover design following an A1-B1-A2-B2. "A" consisted of 2 weeks of Repetitive Facilitation Exercise, and "B" consisted of 2 weeks of Reaching Robot training. [Results] Improvements were observed after all sessions. Active range of motion for shoulder flexion improved after 2 weeks of Reaching Robot sessions only. There were no adverse events. [Conclusion] Reaching Robot training for severe paretic upper-extremity after incomplete spinal cord injury was a safe and effective treatment. Reaching Robot training may be useful for rehabilitation of paretic upper-extremity after incomplete spinal cord injury.

Outcomes of repetitive facilitation exercises in convalescent patients after stroke with impaired health status.

OBJECTIVE: To investigate the impact of stroke on health status and the effects of repetitive facilitation exercises (RFEs) for convalescent patients after stroke. METHODS: The study was a prospective observational study of patients enrolled in an RFE programme. Between April 2008 and March 2012, 468 patients with stroke were enrolled in an intensive, comprehensive RFE programme. Patients participated in this interdisciplinary programme for 12 weeks, for an average of 5 hours per week. Before and immediately after the programme, several measures of rehabilitation outcomes and health-related quality-of-life were evaluated. RESULTS: At baseline, most patients (95.4%) had modified Rankin scale scores of 3-5. Their health-related quality-of-life was significantly impaired, with physical and mental component summary scores on the Short Form 36-item questionnaire (SF-36) of 30.7 and 35.8, respectively. After the RFE programme, all outcome measures improved significantly. CONCLUSIONS: The results demonstrate that convalescent patients after stroke may benefit substantially from RFE programmes in stroke rehabilitation centres, even when patients have impaired health status or high levels of healthcare utilization. Thus, an RFE programme is a simple yet highly effective means to improve rehabilitation outcomes and health-related quality-of-life, with a relatively low dropout rate.

Effects of repetitive facilitative exercise with neuromuscular electrical stimulation, vibratory stimulation and repetitive transcranial magnetic stimulation of the hemiplegic hand in chronic stroke patients.

AIM: Repetitive facilitative exercise (RFE) is a developed approach to the rehabilitation of hemiplegia. RFE can be integrated with neuromuscular electrical stimulation (NMES), direct application of vibratory stimulation (DAVS) and repetitive transcranial magnetic stimulation (rTMS). The aims of the present study were to retrospectively compare the effects of RFE and NMES, DAVS with those of RFE and rTMS, and to determine the maximal effect of the combination of RFE with NMES, DAVS, rTMS and pharmacological treatments in stroke patients. SUBJECTS AND METHODS: Thirty-three stroke patients were enrolled and divided into three groups: 15 who received RFE with rTMS (4 min) (TMS4 alone), 9 who received RFE with NMES, DAVS (NMES, DAVS alone) and 9 who received RFE with NMES, DAVS and rTMS (10 min) (rTMS10 + NMES, DAVS). The subjects performed the Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT) before and after the 2-week session. The 18 patients in the NMES, DAVS alone and rTMS10 + NMES, DAVS group underwent the intervention for 4 weeks. RESULT: There were no significant differences in the increases in the FMA, ARAT scores in the three groups. The FMA or ARAT scores in the NMES, DAVS alone and the rTMS10 + NMES, DAVS group were increased significantly. The FMA and ARAT scores were significantly improved after 4 weeks in the NMES, DAVS alone group. DISCUSSION: RFE with NMES, DAVS may be more effective than RFE with rTMS for the recovery of upper-limb function. Patients who received RFE with NMES, DAVS and pharmacological treatments showed significant functional recovery.

Repetitive facilitative exercise under continuous electrical stimulation for severe arm impairment after sub-acute stroke: a randomized controlled pilot study.

OBJECTIVE: To investigate the effectiveness of repetitive facilitative exercise (RFE) under surface neuromuscular electrical stimulation (NMES) in patients with post-stroke hemiplegia. METHODS: This randomized, controlled, observer-blinded, pilot trial randomized 27 adults with severe arm impairment [Fugl-Meyer Arm scale (FMA) ≤ 20] due to stroke of 3-13 weeks duration into three groups and provided treatment on a 4-week, 40 minutes/day, 5 days/week schedule. The RFE-under-NMES group were given 100-150 repetitions of standardized movements of shoulder, elbow and wrist joints of their affected arm with concurrent low-amplitude NMES for each corresponding musculature. The RFE group was given the same exercise regimen but without NMES. The control group was treated with a conventional arm rehabilitation programme without NMES. FMA was assessed at baseline and 4 weeks. RESULTS: All 27 participants (nine in each group) completed the trial. At 4 weeks, the RFE-under-NMES group evidenced significantly greater improvement compared with the control group on the FMA (p = 0.003), but not with the RFE group (p = 0.092). The RFE group showed improvement compared with the control group, but it was not significant (p = 0.199). CONCLUSIONS: RFE under NMES is feasible in clinical settings and may be more effective than conventional rehabilitation in lessening arm impairment after sub-acute stroke.

Repetitive facilitative exercise under continuous electrical stimulation for recovery of pure motor isolated hand palsy after infarction of the "hand knob" area: A case report.

PURPOSE: Pure motor isolated hand palsy (PMIHP) following infarction of the "hand knob" area is a rare entity in stroke. PMIHP usually recovers within the first few days, but there are rare cases where patients do not recover rapidly. Herein, we report a case of residual PMIHP in which repetitive facilitative exercise under concurrent low-amplitude continuous neuromuscular electrical stimulation ("RFE-under-cNMES") was introduced to improve hand function. CASE DESCRIPTION: A 65-year-old man with PMIHP (30 days after onset) participated in a rehabilitation program involving RFE-under-cNMES. This protocol followed an A1-B1-A2-B2 schedule, where the "A"-period consisted of RFE-under-cNMES ("A1," 2 weeks; "A2," 1 week), and the "B"-period consisted of 1-week conventional rehabilitation. OUTCOMES: The 5-week intervention promoted not only recovery from paralysis (8 points by the Fugl-Meyer Assessment), but also the ability to manipulate objects (13 points by the Action Research Arm test) and increased the subjective use of the affected upper limb during activities of daily living (2.88 points by the Motor Activity Log). Changes that exceeded the minimal clinically important difference occurred only in the RFE-under-cNMES period. CONCLUSIONS: The patient had improved outcomes. Further studies are required to determine the possibility of RFE-under-cNMES relieving motor paralysis in patients with PMIHP who do not recover rapidly.

Acute effects of a single warm-water bath on serum adiponectin and leptin levels in healthy men: a pilot study.

To preliminarily assess the acute effects of a single warm-water bath (WWB) on serum adipokine activity, we measured serum adiponectin, leptin and other metabolic profiles before, immediately after and 30 minutes after WWB in seven healthy male volunteers (mean age, 39.7 ± 6.0 years; mean body mass index, 21.6 ± 1.8 kg/m(2)). The subjects were immersed in tap water at 41°C for 10 minutes. Two weeks later, the same subjects underwent a single WWB with a bath additive that included inorganic salts and carbon dioxide (WWB with ISCO(2)) by the same protocol as for the first WWB. Leptin levels significantly increased immediately after WWB with tap water and ISCO(2) (both P < 0.05), and remained significantly higher than those at baseline even 30 minutes after WWB with tap water (P < 0.05). Adiponectin levels showed a slight, but not significant, increase both immediately after and 30 minutes after WWB with tap water or ISCO(2). Some parameters, such as serum total cholesterol, red blood cell count, hemoglobin and hematocrit significantly increased immediately after WWB with tap water or ISCO(2) (all P < 0.05), but they all returned to the baseline levels 30 minutes after bathing under both conditions. The sublingual temperature rose significantly after 10 minutes of WWB with tap water (0.96 ± 0.16°C relative to baseline, P < 0.01) and after the same duration of WWB with ISCO(2) (1.24 ± 0.34°C relative to baseline, P < 0.01). These findings suggest that a single WWB at 41°C for 10 minutes may modulate leptin and adiponectin profiles in healthy men.

Effect of cilostazol administration on cerebral hemodynamics and rehabilitation outcomes in poststroke patients.

PRIMARY OBJECTIVE: Cilostazol is an antiplatelet agent that inhibits phosphodiesterase III in platelets and the vascular endothelium. We assessed the effects of cilostazol on human cerebral hemodynamics and rehabilitation outcomes. RESEARCH DESIGN: Prospective, consecutive, observational trial with pretreatment and posttreatment evaluations. EXPERIMENTAL INTERVENTIONS: Cilostazol (200 mg/day) administered for 8 weeks. METHODS AND PROCEDURES: Cerebral blood flow at rest, cerebrovascular reserve capacity, and rehabilitation outcomes (Brunnstrom stage, Barthel index score, modified Rankin Scale score, and Mini-Mental State Examination score) were measured in 104 poststroke patients with an average age ± standard deviation of 60.8 ± 9.2 years. MAIN OUTCOMES AND RESULTS: The cerebral blood flow increased by 23.8% on the affected side of the brain and by 16.9% on the nonaffected side. The cerebrovascular reserve capacity increased by 19.0% on the affected side of the brain and by 13.3% on the nonaffected side. Improvements were observed in the Brunnstrom stage, Barthel index score, modified Rankin Scale score, and Mini-Mental State Examination score. CONCLUSIONS: Cilostazol appeared to have beneficial effects in poststroke patients with cerebral ischemia and might improve cerebral circulation and rehabilitation outcome.

Effects of intensive repetition of a new facilitation technique on motor functional recovery of the hemiplegic upper limb and hand.

OBJECTIVE: To study the effects on the hemiplegic upper limb of repetitive facilitation exercises (RFEs) using a novel facilitation technique, in which the patient's intention to move the hemiplegic upper limb or finger was followed by realization of the movement using multiple sensory stimulations. METHODS: Twenty-three stroke patients were enrolled in a cross-over study in which 2-week RFE sessions (100 repetitions each of five-to-eight types of facilitation exercise per day) were alternated with 2-week conventional rehabilitation (CR) sessions, for a total of four sessions. Treatments were begun with the 2-week RFE session in one group and the 2-week CR session in the second group. RESULTS: After the first 2-week RFE session, both groups showed improvements in the Brunnstrom stages of the upper limb and the hand, in contrast to the small improvements observed during the first CR session. The Simple Test for Evaluating Hand Function (STEF) score, which evaluates the ability of manipulating objects, in both groups improved during both sessions. After the second 2-week RFE and CR sessions, both groups showed little further improvement except in the STEF score. CONCLUSION: The novel RFEs promoted the functional recovery of the hemiplegic upper limb and hand to a greater extent than the CR sessions.

Beneficial effects of footbaths in controlling spasticity after stroke.

Footbaths are considered to provide beneficial thermal therapy for post-stroke patients with spasticity, but their anti-spastic effects have not been investigated comprehensively. The present study aimed to evaluate alterations in motor-neuron excitability using F-wave parameters in post-stroke patients with spastic hemiplegia. Subjects' legs below the knee joint were immersed in water at 41 degrees C and F-wave recordings were made over the abductor hallucis muscle before, immediately after, and 30 min after thermal treatment. Antidromic stimulation was performed on the tibial nerve at the ankle. Measurements included F-wave amplitude, F-wave/M-response ratio, changes in modified Ashworth scale (MAS), body temperature and surface-skin temperature. The mean values of both F-wave parameters were higher on the affected side before footbath treatment. In post-stroke patients, the mean values of F-wave parameters were significantly reduced after footbath treatment (P < 0.01). The anti-spastic effects of footbath treatment were indicated by decreased F-wave parameters, in parallel with decreases in MAS. Body temperature was significantly increased both immediately after, and 30 min following footbath treatment in both groups, which appeared to play an important role in decreased spasticity. Surface-skin temperature increased immediately after footbath treatment in both groups and returned to baseline 30 min later. These findings demonstrate that the use of footbaths is an effective nonpharmacological anti-spastic treatment that might facilitate stroke rehabilitation.

The angiotensin II type 1 receptor antagonist olmesartan preserves cerebral blood flow and cerebrovascular reserve capacity, and accelerates rehabilitative outcomes in hypertensive patients with a history of stroke.

We aimed to determine the effects of angiotensin II receptor blocker on cerebral hemodynamics and rehabilitative outcome. Sixteen hypertensive patients with a history of stroke received 10-20 mg olmesartan daily for eight weeks. Blood pressure decreased after treatment compared with the baseline, whereas cerebral blood flow (CBF) values of the affected and nonaffected sides increased. The results of the cerebrovascular reserve capacity were also statistically increased in the affected side. Improvements were observed in three rehabilitative outcome parameters. These findings suggest that olmesartan has beneficial effects in hypertensive patients with stroke and impaired CBF autoregulation, and might improve cerebral circulation and rehabilitative outcome.

Examining procedural consolidation with visuomotor learning in the lower limb.

To investigate the effects of interference tasks in the early stages of motor learning, we used a computerized motor skill analyzer (CMSA) for the lower limb that evaluates the accuracy and speed of movements in tracking tasks. Forty-five healthy subjects were randomly divided into three groups: a control group without an interference task, a mirror image interference group, and a point symmetry interference group. The practice and measurement of motor-learning trials were carried out as follows: (1) 10 practice trials followed by 10 measurement trials in the morning of the first day. (2) 10 measurement trials 6-7 awake hours after the first measurement. (3) 10 measurement trials on the morning of day 2. In the learning interference groups, 10 trials of the mirror image or point symmetry task were performed immediately after the first measurement. Although motor skills of the control group improved, those of the learning interference groups did not. This suggests that a second task performed immediately after the first task interferes with the consolidation of motor skill learning demanding complex visuomotor transformation.

Salivary secretion and occlusal force in patients with unilateral cerebral stroke.

The purpose of this study was to investigate salivary secretion in unilateral cerebral stroke patients, including the effects of masticatory forces. We compared the volumes of unstimulated and acid-stimulated saliva between 30 patients with unilateral cerebral stroke and 30 age-matched healthy subjects. The volume of whole-mouth salivary secretion was measured by the modified cotton swab method. Occlusal forces were measured with an occlusal force meter in patients/subjects, in groups with normal teeth and dentures, respectively. The volume of unstimulated saliva in stroke patients was significantly lower than that in controls. For subjects with normal teeth, the volume of acid-stimulated saliva and the occlusal force on the hemiplegic side in stroke patients were significantly lower than those in control subjects. For those with dentures, while the volume of unstimulated saliva in stroke patients was significantly lower than that in controls, there were no significant differences in occlusal forces between the two groups. These results suggest that salivary secretion might be reduced in cerebral stroke patients, which might be caused partly by an inability to generate sufficient masticatory force, and which, in turn, might lead to a reduced masticatory-parotid reflex and consequent disuse atrophy of the salivary glands.

Addition of an anabolic steroid to strength training promotes muscle strength in the nonparetic lower limb of poststroke hemiplegia patients.

In this prospective observer-blinded open-label nonrandomized controlled trial, 25 inpatients with hemiplegia 1-8 months after stroke were assigned to an anabolic androgenic steroid (AAS; n = 14) or a control (n = 11) group: the former received 100 mg metenolone enanthate by intramuscular injection once a week for 6 weeks along with rehabilitation therapy including muscle strength training of the nonparetic lower limb, which consisted of 100 repetitions of isokinetic reciprocal knee extension/flexion (60 degrees /s) on a dynamometer once a day for 5 days a week over 6 weeks, and the latter received rehabilitation therapy alone. The maximal peak torque of the nonparetic lower limb, including the isokinetic (60 degrees /s, 120 degrees /s, and 180 degrees /s), isotonic, and isometric muscle strength of knee extension/flexion, measured every 2 weeks, was compared with the baseline values. Significant increases in peak torque were seen at 2 weeks in 9 of the 10 conditions and at 6 weeks in 8 of the 10 conditions tested for the AAS group but in only 1 and 5 conditions for the control group, respectively. While no contraindications for AAS were encountered, the combination of AAS and muscle strength training tended to have a positive effect on muscle strength after stroke.

Stroke patient with mirror movement of the affected hand due to an ipsilateral motor pathway confirmed by transcranial magnetic stimulation: a case report.

A stroke patient with right hemiplegia and mirror movement underwent transcranial magnetic stimulation (TMS) and somatosensory-evoked potential (SEP) testing. The motor-evoked potentials (MEPs) of both abductor pollicis brevis muscles after stimulating the unaffected right hemisphere showed similar latencies, and were potentially produced by corticospinal tracts from the same motor cortex. N(20) responses of SEPs were recorded at C(4)' after contralateral stimulation of the unaffected left median nerve, but not stimulation of the affected right median nerve. The mirror movements and motor recovery might have utilized an ipsilateral motor pathway between the unaffected hemisphere and the affected hand.

Anti-spastic effects of the direct application of vibratory stimuli to the spastic muscles of hemiplegic limbs in post-stroke patients.

OBJECTIVE: To investigate whether the direct application of vibratory stimuli inhibits spasticity and improves motor function in the hemiplegic upper limbs of post-stroke patients. DESIGN: Prospective pilot study. SETTING: University hospital rehabilitation centre. SUBJECTS: Fourteen post-stroke patients (mean age = 57.3 years; SD = 19.1 years). INTERVENTIONS: A hand and forearm stimulation device and an upper-arm stimulation device, consisting of vibrators, a wooden frame and a cloth strap, applied to the upper limbs of subjects. MAIN MEASURES: The modified Ashworth scale (MAS) score, F-wave parameters and motor-function parameters (finger tapping, active range of motion and the simple test for evaluating hand function). RESULTS: Subjects showed significant and potentially durable improvements in MAS score (p < 0.01), F-wave parameters (p < 0.01) and motor-function parameters (p < 0.05). The MAS score, F-wave parameters and motor-function parameters dropped below the baseline values after vibratory stimulation. The MAS score and F-wave parameters remained significantly below the baseline 30 minutes after stimulation. CONCLUSIONS: The direct application of vibratory stimuli is an effective non-pharmacological anti-spastic treatment that could facilitate stroke rehabilitation. These results provide good evidence of potential short-term benefits of anti-spastic vibratory therapy in post-stroke patients in terms of decreased muscle tonus and improved motor function.

Effect of the angiotensin II type 1 receptor antagonist olmesartan on cerebral hemodynamics and rehabilitation outcomes in hypertensive post-stroke patients.

PRIMARY OBJECTIVE: In patients with severe hypertension, chronic heart failure or history of stroke, the lower limit of cerebral blood flow (CBF) autoregulation is shifted to a higher blood pressure (BP) than in healthy subjects. This study investigated the effects of the angiotensin II receptor blocker (ARB) olmesartan on human cerebral haemodynamics and rehabilitation outcomes. RESEARCH DESIGN: Open treatment trial with pre-treatment and post-treatment evaluations. EXPERIMENTAL INTERVENTIONS: Olmesartan (10-20 mg) administered daily for 8 weeks. METHODS AND PROCEDURES: The 24-hour BP, clinical BP, CBF at rest, cerebrovascular reserve capacity (CRC) and rehabilitation outcomes (Brunnstrom stage, Barthel index and Mini-Mental State Examination [MMSE] score) were measured in 44 post-stroke patients with hypertension (62.2 +/- 10.7 years). MAIN OUTCOMES AND RESULTS: The systemic BP decreased after treatment compared with baseline. The CBF increased by 11.2% on the affected side and by 8.9% on the non-affected side of the brain and the CRC also increased on both sides. Improvements were observed in the Brunnstrom stage, Barthel index and MMSE score. CONCLUSIONS: This study suggest that olmesartan has beneficial effects in post-stroke patients with hypertension and impaired CBF autoregulation and provides important information necessary to design future more definitive studies.

Use of calcitonin to prevent complex regional pain syndrome type I in severe hemiplegic patients after stroke.

PURPOSE: To evaluate the effects of calcitonin in preventing complex regional pain syndrome type I (CRPS) in patients with severe hemiplegia following stroke. METHODS: In this observer-blinded, controlled study comparison with historical controls between April 2003 and May 2004, subjects comprised consecutive patients with post-stroke hemiplegia admitted between June 2004 and September 2005, with any upper limb or finger graded as Brunnstrom stage (BrST) III or below. One group was administered intramuscular injection of 20 units of elcatonin (EL) (Asu(1-7) eel calcitonin) weekly from immediately after admission to discharge, together with rehabilitation therapy. The control group received rehabilitation therapy alone. Patients were observed during the in-hospital rehabilitation period. The main outcome measure was onset of CRPS. RESULTS: Incidence of CRPS in all patients with post-stroke hemiplegia during the control period was about 8.2%, similar to recent studies. Limited to serious hemiplegic patients graded as BrST III or below, incidence of CRPS was significantly lower in the EL group (12.5%) than in controls (57.1%). No significant differences in patient background were seen between groups. CRPS was completely prevented when EL injection was started 6 weeks after stroke. CONCLUSION: Intramuscular calcitonin appears to suppress onset of CRPS after stroke, particularly when started early after stroke.

Effect of theta burst stimulation over the human sensorimotor cortex on motor and somatosensory evoked potentials.

OBJECTIVE: To study the after-effect of theta burst stimulation (TBS) over the left sensorimotor cortex on the size of somatosensory as well as motor evoked potentials evoked from both hemispheres in healthy human subjects. METHODS: We used a continuous TBS paradigm for 40 s (600 pulses) in which a burst of 3 transcranial magnetic stimuli at 50 Hz is repeated at 5 Hz [Huang YZ, Edwards MJ, Rounis E, Bhatia KP, Rothwell JC. Theta burst stimulation of the human motor cortex. Neuron 2005;45:201-6]. Somatosensory evoked potentials (SEPs) following electrical stimulation of right or left median nerve and motor evoked potentials (MEPs) in the right or left first dorsal interosseous (FDI) muscles were recorded before and after TBS over the left motor cortex (M1) or a point 2 cm posterior to left M1. RESULTS: Amplitudes of P25/N33 (parietal components) following right median nerve stimulation were significantly increased for at least 53 min after TBS over the left M1, whereas this component was suppressed for 13 min after TBS over a point 2 cm posterior. MEPs in right as well as left FDI muscles were suppressed with a similar time course after TBS over the left M1. CONCLUSIONS: A single-session of TBS over the sensorimotor cortex can induce a short-lasting change in the size of ipsilateral cortical components of SEPs as well as MEPs evoked from both hemispheres. SIGNIFICANCE: TBS is an interventional tool that can induce rapid reorganization within cortical somatosensory as well as motor networks in humans.

Functional vibratory stimulation on the hand facilitates voluntary movements of a hemiplegic upper limb in a patient with stroke.

The use of a new device consisting of a small vibrator to deliver functional vibratory stimulation (FVS) to the arm resulted in improvements of flexion of the hemiparetic shoulder in a man with thalamic bleeding. FVS delivered to the palm enabled the patient to repeat flexing his hemiparetic shoulder to manipulate objects with his hand. The functions of the patient's hemiparetic shoulder and fingers improved after treatments using FVS for 1 month. We examined whether FVS of the hemiplegic upper limb could facilitate voluntary movements of the limb by increasing the excitability of the motor cortex or the spinal motor neurons using somatosensory-evoked potentials, transcranial magnetic stimulation, F-wave, and single photon emission computed tomography. Our results did not detect an increase of excitability in the motor cortex or in spinal motor neurons by FVS.