Rebeka Borba Costa Dos Santos1, Silvana Carla Barros Galvão1, Labibe Mara Pinel Frederico1, Nathália Serrano Lucena Amaral1, Maíra Izzadora Souza Carneiro1, Alberto Galvão de Moura Filho2, Daniele Piscitelli3, Kátia Monte-Silva4. 1. Applied Neuroscience Laboratory, Department of Physical Therapy, Avenida Jornalista Aníbal Fernandes s/n, Universidade Federal de Pernambuco, Cidade Universitária, Recife, Pernambuco, 50740-560, Brazil. 2. Laboratory of Kinesiology and Functional Assessment, Department of Physical Therapy, Avenida Jornalista Aníbal Fernandes s/n, Universidade Federal de Pernambuco, Cidade Universitária, Recife, Pernambuco, 50740-560, Brazil. 3. School of Physical and Occupational Therapy, McGill University, Montreal, Canada. 4. Applied Neuroscience Laboratory, Department of Physical Therapy, Avenida Jornalista Aníbal Fernandes s/n, Universidade Federal de Pernambuco, Cidade Universitária, Recife, Pernambuco, 50740-560, Brazil. monte.silvakk@gmail.com.
Abstract
OBJECTIVE:Repetitive Transcranial Magnetic Stimulation (rTMS) has been used to treat post-stroke upper limb spasticity (ULS) in addition to physiotherapy (PT). To determine whether rTMS associated with PT modulates cortical and spinal cord excitability as well as decreases ULS of post-stroke patients. METHODS:Twenty chronic patients were randomly assigned to either the intervention group-1 Hz rTMS on the unaffected hemisphere and PT, or control group-sham stimulation and PT, for ten sessions. Before and after sessions, ULS was measured using the modified Ashworth scale and cortical excitability using the output intensity of the magnetic stimulator (MSO). The spinal excitability was measured by the Hmax/Mmax ratio of the median nerve at baseline, at the end of treatment, and at the 4-week follow-up. RESULTS: The experimental group showed at the end of treatment an enhancement of cortical excitability, i.e., lower values of MSO, compared to control group (p = 0.044) and to baseline (p = 0.028). The experimental group showed a decreased spinal cord excitability at the 4-week follow-up compared to control group (p = 0.021). ULS decreased by the sixth session in the experimental group (p < 0.05). CONCLUSION: One-hertz rTMS associated with PT increased the unaffected hemisphere excitability, decreased spinal excitability, and reduced post-stroke ULS.
RCT Entities:
OBJECTIVE: Repetitive Transcranial Magnetic Stimulation (rTMS) has been used to treat post-stroke upper limb spasticity (ULS) in addition to physiotherapy (PT). To determine whether rTMS associated with PT modulates cortical and spinal cord excitability as well as decreases ULS of post-strokepatients. METHODS: Twenty chronic patients were randomly assigned to either the intervention group-1 Hz rTMS on the unaffected hemisphere and PT, or control group-sham stimulation and PT, for ten sessions. Before and after sessions, ULS was measured using the modified Ashworth scale and cortical excitability using the output intensity of the magnetic stimulator (MSO). The spinal excitability was measured by the Hmax/Mmax ratio of the median nerve at baseline, at the end of treatment, and at the 4-week follow-up. RESULTS: The experimental group showed at the end of treatment an enhancement of cortical excitability, i.e., lower values of MSO, compared to control group (p = 0.044) and to baseline (p = 0.028). The experimental group showed a decreased spinal cord excitability at the 4-week follow-up compared to control group (p = 0.021). ULS decreased by the sixth session in the experimental group (p < 0.05). CONCLUSION: One-hertz rTMS associated with PT increased the unaffected hemisphere excitability, decreased spinal excitability, and reduced post-stroke ULS.
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