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dc.contributorFaculty of Health and Social Sciencesen_US
dc.contributor.advisorFong, Kenneth (RS)en_US
dc.creatorHai, Yip Kuen Eddie-
dc.publisherHong Kong Polytechnic Universityen_US
dc.rightsAll rights reserveden_US
dc.titlePriming effects of repetitive transcranial magnetic stimulation (rTMS) with motor training on a hemiplegic upper limb in patients with chronic strokeen_US
dcterms.abstractObjective: 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.en_US
dcterms.abstractMethods: 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.en_US
dcterms.abstractResults: 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.en_US
dcterms.abstractConclusions: 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.en_US
dcterms.extentxii, 90 pages : color illustrationsen_US
dcterms.isPartOfPolyU Electronic Thesesen_US
dcterms.educationalLevelAll Doctorateen_US
dcterms.LCSHCerebrovascular disease -- Patients -- Rehabilitationen_US
dcterms.LCSHMagnetic brain stimulationen_US
dcterms.LCSHMotor learningen_US
dcterms.LCSHHong Kong Polytechnic University -- Dissertationsen_US
dcterms.accessRightsrestricted accessen_US

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