ABSTRACT
BACKGROUND AND PURPOSE: Numerous studies have shown that repetitive transcranial magnetic stimulation (rTMS) over the primary motor cortex (M1) may improve motor function of the affected hand after stroke. The effects of 1 Hz rTMS applied over the contralesional dorsal premotor cortex (PMd) on hand function and cortical neurophysiology in subacute stroke were examined. METHODS: Ten subacute stroke patients with mild hand motor impairment were enrolled in a prospective, double-blind, randomized, placebo-controlled, crossover study with two intervention sessions. 1 Hz rTMS was applied over the contralesional PMd (real rTMS, 900 pulses at 110% of the motor threshold; sham rTMS, 900 pulses at 0% of the motor threshold). Tests of hand function (Jebsen-Taylor hand function test, box and block test) and neurophysiological evaluations (resting motor threshold, motor evoked potentials, cortical silent period, ipsilateral silent period) were obtained from both hands and hemispheres prior to (baseline) and after each treatment. RESULTS: Hand function tests revealed significant improvement of motor function of the affected but not of the unaffected hand after real rTMS only. Neither intervention changed the neurophysiological measures in comparison to baseline. CONCLUSION: One hertz rTMS over the contralesional PMd improves motor function of the affected hand in subacute stroke. The PMd may be a novel rTMS target to treat motor impairment after stroke.
Subject(s)
Hand/physiopathology , Motor Cortex/physiopathology , Neural Inhibition , Stroke/therapy , Transcranial Magnetic Stimulation/methods , Aged , Aged, 80 and over , Cross-Over Studies , Double-Blind Method , Female , Humans , Male , Middle Aged , Prospective Studies , Treatment OutcomeABSTRACT
Stroke induces structural and functional changes within the cortical motor network of both hemispheres. Repetitive transcranial magnetic stimulation modulates the excitability of the motor cortex and thereby may facilitate motor function and/or recovery of motor function after stroke. Based on a systematic literature search we identified 33 placebo-controlled trials which examined the effectiveness of repetitive transcranial magnetic stimulation in the treatment of impaired hand function following stroke. Despite limitations, the majority of the studies referred to the interhemispheric competition model after stroke to apply repetitive transcranial magnetic stimulation. In a comparative approach, methodology and effectiveness of (a) inhibition of the unaffected hemisphere, (b) facilitation of the affected hemisphere and (c) combined application of repetitive transcranial magnetic stimulation over the affected and unaffected hemispheres to treat impaired hand function after stroke are presented. Problems and limitations of repetitive transcranial magnetic stimulation in stroke rehabilitation are discussed and visions for future clinical research are presented.
Subject(s)
Movement/physiology , Stroke Rehabilitation , Transcranial Magnetic Stimulation/methods , Upper Extremity/physiology , Clinical Trials as Topic , Functional Laterality/physiology , Hand/physiology , Humans , Neuronal Plasticity , Randomized Controlled Trials as Topic , Recovery of Function/physiologyABSTRACT
The diagnosis of intensive care unit acquired weakness (ICUAW) in the setting of neurological rehabilitation is steadily increasing. This is due to the fact that the intensive care of patients with sepsis or after cardiac or abdominal surgery is improving. A longer duration of respiratory weaning and comorbidities frequently complicate rehabilitation. Clinically, patients present with a flaccid (tetra) paresis and electrophysiological studies have shown axonal damage. Besides involvement of peripheral nerves, muscle can also be affected (critical illness myopathy) leading to ICUAW with inconstant myopathic damage patterns found by electrophysiological testing. Mixed forms can also be found. A specific therapy for ICUAW is not available. Early mobilization to be initiated on the intensive care unit and commencing neurological rehabilitation improve the outcome of ICUAW. This review highlights the current literature regarding the etiology and diagnosis of ICUAW. Furthermore, studies about rehabilitation and outcome of ICUAW are discussed.
