Effect of Transcranial Magnetic Stimulation on Recovery of Upper Limb Among Stroke Survivors
| Status: | Active, not recruiting |
|---|---|
| Conditions: | Neurology |
| Therapuetic Areas: | Neurology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 8/10/2018 |
| Start Date: | February 2013 |
| End Date: | December 2019 |
Effect of Transcranial Magnetic Stimulation on Motor Recovery of Upper Limb Among Stroke Survivors: Pilot Study
Approximately two thirds of stroke survivors have profoundly impaired function of the upper
limb. Currently the main stay of the treatment for upper limb motor function is
rehabilitation therapy focusing on repetitive and skillful task practice (task-oriented
therapy) which has been shown to induce substantial functional reorganization in the
undamaged motor cortex and functional recovery. In spite of rehabilitation therapy,
functional recovery of arm and hand function is limited to one third of stroke survivors and
there is a great need for adjunct treatment to current practice. Repetitive Transcranial
Magnetic Stimulation (rTMS) is a noninvasive means of stimulating nerve cells in superficial
areas of the brain and emerging as a novel method of modulating cortical excitability and
promoting functional recovery after stroke. There have been studies using rTMS to improve
motor function after stroke. However, whether 1Hz rTMS can enhance the effect of the
task-oriented therapy on upper limb function after stroke has not been investigated. In this
pilot proposal, we intend to investigate the feasibility of 1Hz rTMS on unaffected hemisphere
as an adjunct to task-oriented therapy to improve upper limb motor function among stroke
patients. The information obtained from this pilot study will provide a platform for the
future randomized control trials combining the rTMS and task-oriented therapy to enhance
motor recovery among stroke survivors.
limb. Currently the main stay of the treatment for upper limb motor function is
rehabilitation therapy focusing on repetitive and skillful task practice (task-oriented
therapy) which has been shown to induce substantial functional reorganization in the
undamaged motor cortex and functional recovery. In spite of rehabilitation therapy,
functional recovery of arm and hand function is limited to one third of stroke survivors and
there is a great need for adjunct treatment to current practice. Repetitive Transcranial
Magnetic Stimulation (rTMS) is a noninvasive means of stimulating nerve cells in superficial
areas of the brain and emerging as a novel method of modulating cortical excitability and
promoting functional recovery after stroke. There have been studies using rTMS to improve
motor function after stroke. However, whether 1Hz rTMS can enhance the effect of the
task-oriented therapy on upper limb function after stroke has not been investigated. In this
pilot proposal, we intend to investigate the feasibility of 1Hz rTMS on unaffected hemisphere
as an adjunct to task-oriented therapy to improve upper limb motor function among stroke
patients. The information obtained from this pilot study will provide a platform for the
future randomized control trials combining the rTMS and task-oriented therapy to enhance
motor recovery among stroke survivors.
See above.
Inclusion Criteria:
--≥18 years of age
- Ability to give informed consent
- An unilateral ischemic stroke of onset 6-36 months prior to the study
- No other known brain abnormalities by medical history or by MRI
- Affected upper limb function of score 2-6 in Chedoke Arm and Hand Inventory
- Enrolled or planned to be enrolled in occupational therapy at Kessler Institute for
Rehabilitation as an outpatient
Exclusion Criteria:
- More than one stroke (Transient Ischemic Attack not a reason for exclusion)
Neurological conditions other than stroke (brain tumor, Parkinson's disease, etc)
- History of epilepsy or unprovoked seizures
- Family history of epilepsy (father, mother, children, siblings with diagnosis of
epilepsy)
- Implanted medical devices (pacemakers, defibrillators, medical pump, implanted brain
stimulator, aneurysm clip, carotid or cerebral stents, central venous catheter,
cochlear implant, internal hearing aids)
- Damaged skin or skull of head
- Excessive spasticity of upper limb as indicated by Modified Ashworth Spasticity Scale
>2/4
- Recent injection of antispastic medications (Botulinum toxin, phenol) of the last 3
months or scheduled such injection during the study period
- Severe sensory deficits as measured by a score of 2 on item 8 of the National
Institute of Health (NIH) stroke scale
- Severe aphasia as measured by a score of ≥2 on item 9 of NIH stroke scale
- Being determined to be medically unstable by a physician
- Being pregnant or trying to become pregnant
- Past or current alcohol abuse, illicit drug use, or significant mental illness
(schizophrenia, major depression, manic disorders)
- Working with metal currently or in the past
- Tattoo with metal based ink on the head or neck
- Unable to answer the questionnaires in the consent form correctly
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