Effects of concomitant neuromuscular electrical stimulation during repetitive transcranial magnetic stimulation before repetitive facilitation exercise on the hemiparetic hand

Article type: Research Article

Authors: Etoh, Seiji^{a; *} | Kawamura, Kentaro^a | Tomonaga, Kei^a | Miura, Seiji^a | Harada, Shizuyo^a | Noma, Tomokazu^b | Kikuno, Satomi^a | Ueno, Makoto^a | Miyata, Ryuji^a | Shimodozono, Megumi^a

Affiliations: [a] Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan | [b] Department of Rehabilitation, Faculty of Health Science, Nihon Fukushi University, Aichi, Japan

Correspondence: [*] Address for correspondence: Seiji Etoh, Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima-city, Kagoshima, 890-8520, Japan. Tel.: +81 99 275 5339; Fax: +81 99 275 1273; E-mail: etohs@m2.kufm.kagoshima-u.ac.jp.

Abstract: BACKGROUND:Repetitive transcranial magnetic stimulation (rTMS) and Repetitive facilitative exercise (RFE) improves motor impairment after stroke. OBJECTIVE:To investigate whether neuromuscular electrical stimulation (NMES) can facilitate the effects of rTMS and RFE on the function of the hemiparetic hand in stroke patients. METHODS:This randomized double-blinded crossover study divided 20 patients with hemiparesis into two groups and provided treatment for 4 weeks at 5 days/week. NMES-before-sham group and NMES-following-sham group performed NMES sessions and sham NMES sessions for each 2 weeks. Patients received NMES or sham NMES for the affected extensor muscle concurrently with 1 Hz rTMS for the unaffected motor cortex for 10 min and performed RFE for 60 min. The Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), Box and Block Test (BBT) and Modified Ashworth Scale (MAS) were used for evaluation. RESULTS:FMA and ARAT improved significantly during both sessions. The gains in the BBT during an NMES session were significantly greater than those during a sham NMES session. MAS for the wrist and finger significantly decreased only during an NMES session. CONCLUSIONS:NMES combined with rTMS might facilitate, at least in part, the beneficial effects of RFE on motor function and spasticity of the affected upper limb.

Keywords: Neuromuscular electrical stimulation, hemiparesis, repetitive facilitative exercise, repetitive transcranial magnetic stimulation, stroke

DOI: 10.3233/NRE-192800

Journal: NeuroRehabilitation, vol. 45, no. 3, pp. 323-329, 2019