| Author: | Hai, Yip Kuen Eddie |
| Title: | Priming effects of repetitive transcranial magnetic stimulation (rTMS) with motor training on a hemiplegic upper limb in patients with chronic stroke |
| Advisors: | Fong, Kenneth (RS) |
| Degree: | DHSc |
| Year: | 2022 |
| Subject: | Cerebrovascular disease -- Patients -- Rehabilitation Magnetic brain stimulation Motor learning Hong Kong Polytechnic University -- Dissertations |
| Department: | Faculty of Health and Social Sciences |
| Pages: | xii, 90 pages : color illustrations |
| Language: | English |
| Abstract: | Objective: Previous evidence has shown that both low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) and continuous theta-burst stimulation (cTBS) to the contralesional motor cortex induce long-term depression in the hemisphere, reducing interhemispheric inhibition and hence providing a priming effect to conventional rehabilitation training in promoting hemiplegic upper limb motor recovery in stroke patients. Therefore, this study was conducted to investigate and compare the priming effects of LF-rTMS and cTBS, applied immediately prior to motor training using rehabilitation robots on the hemiplegic upper limb, to aid the recovery of patients with chronic stroke. Methods: This was a single-blinded randomized controlled trial which consisted of three groups: an LF-rTMS group, a cTBS group, and a sham-stimulation group. Each group received 10 sessions of stimulation over the contralesional motor cortex, followed with 30 minutes of robotic training using the ArmMotus M2 Gen on the hemiparetic upper limb. The LF-rTMS group received the rTMS at 1Hz for 10 minutes, with a total of 600 pulses in one single train, and the cTBS group received continuous stimulation, at a burst of 3 pulses at 50Hz and repeated at 5Hz for a total of 40 seconds, also with a total of 600 pulses. The sham group received sham stimulation. Patients were blinded to the stimulation. Outcome measures were made using the Fugl-Meyer Assessment: Upper Extremity (FMA-UE) to measure the motor recovery, and the Action Research Arm Tests (ARAT) to measure the laboratory arm functions, at four time points: baseline, the middle of the intervention (5th session), the end of the intervention (10th session), and one month after completion of the intervention. Results: Twenty-four patients ultimately were recruited and analysed. A significant interaction effect between time and group was found in the FMA-UE scores for both the LF-rTMS and the cTBS groups. Continuous improvement was also shown in the change scores from the middle to the end of the intervention in both the LF group and the cTBS group, but not in the sham group. Both the LF-rTMS and cTBS groups showed significant differences in their FMA-UE scores compared with the sham group, whereas no significant difference between the two groups was found. A carryover effect could not be seen for any of the groups at the one-month follow-up. No significant findings could be seen in the ARAT. Conclusions: Both the LF-rTMS and the cTBS were able to induce long-term depressive effects to the contralesional M1, and those effects were timed just before robotic training to enhance hemiplegic upper limb motor recovery but not the laboratory arm functions. That priming effect did not happen with the sham stimulation. A treatment course of 10 sessions induced more optimal benefits than five sessions did. However, there was no difference between the priming effects from the two modes of stimulation, compared with the sham. Notably, the use of cTBS is considered preferable to the LF-rTMS in this scenario because it is shorter in duration and more cost-effective. |
| Rights: | All rights reserved |
| Access: | restricted access |
Files in This Item:
| File | Description | Size | Format | |
|---|---|---|---|---|
| 6687.pdf | For All Users (off-campus access for PolyU Staff & Students only) | 5.62 MB | Adobe PDF | View/Open |
Copyright Undertaking
As a bona fide Library user, I declare that:
- I will abide by the rules and legal ordinances governing copyright regarding the use of the Database.
- I will use the Database for the purpose of my research or private study only and not for circulation or further reproduction or any other purpose.
- I agree to indemnify and hold the University harmless from and against any loss, damage, cost, liability or expenses arising from copyright infringement or unauthorized usage.
By downloading any item(s) listed above, you acknowledge that you have read and understood the copyright undertaking as stated above, and agree to be bound by all of its terms.
Please use this identifier to cite or link to this item:
https://theses.lib.polyu.edu.hk/handle/200/12255