Effects of Repetitive Transcranial Magnetic Stimulation Therapy on Lower Extremity Motor Development in Stroke Patients
Condition: Neurological Rehabilitation; Stroke; Lower Extremity Problem; Quality of Life
MeSH terms: Stroke
Study type: Interventional

Summary: 
      The aim of our study is to investigate the effects of rTMS applications at different current
      frequencies (low frequency / intermittent (intermittent) theta burst (iTBS)) in stroke
      patients on lower extremity motor development, physical function and quality of life, and to
      compare the effectiveness of these modalities.
    

Detailed description: 
      Stroke is the second leading cause of mortality in adults and is the main cause of long-term
      disability. Functional limitations that develop in the post-stroke period affect the quality
      of life and activities of daily living of the patients. The main purpose of stroke
      rehabilitation is to increase the quality of life by adopting multidimensional approaches
      that aim to reach the maximum level of independence in the physical, functional,
      psychological and social health areas of the patients.

      Thanks to the neuroplasticity mechanisms that develop in the brain in the post-stroke period,
      it is aimed to activate the cortical areas directly affected by the stroke by creating new
      connections in the neuronal networks. With increased activation, clinical motor recovery
      occurs. Conventional therapy methods are an important tool for motor recovery, however, the
      effects of treatment outcomes are often limited, especially when applied to chronic patients.
      In recent years, there is a need for more effective approaches on neuroplasticity mechanisms
      in stroke rehabilitation. Repetitive transcranial magnetic stimulation (rTMS) is an
      innovative approach applied in this field. With the application of repetitive transcranial
      magnetic stimulation (rTMS), it is aimed to modulate plasticity and restore the normal
      activity pattern.

      Repetitive transcranial magnetic stimulation (rTMS) is a painless non-invasive technique
      widely used in clinical routine practice to modulate the neural excitability of the human
      brain. High frequency rTMS (>5 Hz) increases neural activity (long term potentiation), while
      low frequency (1 Hz) rTMS decreases neural activity (long term depression). Theta burst
      excitation (TBS), on the other hand, is a undulating form.

      Several systematic reviews have evaluated the efficacy and safety of rTMS for various
      functional and psychological outcomes in people after stroke. In the literature, rTMS is used
      in patients with acute, subacute and chronic stroke to improve upper and lower extremity
      functions, as well as in the rehabilitation of dysphagia and aphasia.

      The aim of our study is to investigate the effects of rTMS applications at different current
      frequencies (low frequency / intermittent (intermittent) theta burst (iTBS)) on patients with
      stroke on lower extremity motor development, physical function and quality of life, and to
      compare the effectiveness of these modalities.
    

Intervention name(s): Low Frequency rTMS Protocol; Intermittent Theta Burst Stimulation (iTBS) Protocol; Sham rTMS Protocol
Intervention type(s): Device; Device; Device
Intervention description(s): It was planned to apply 1 Hz low-frequency inhibition protocol to the primary motor cortex foot area in the non-lesional hemisphere, 5 days a week for 2 weeks, for a total of 10 sessions.
After the daily rTMS session, it was planned to apply a conventional rehabilitation therapy for 60 minutes to all patients for 6 weeks (Exercise program consisting of joint range of motion exercises, strengthening exercises, balance exercises and neurophysiological exercises (Brunstroom exercises) for 45 minutes and 15 minutes of NMES application in the presence of an experienced physiotherapist).; It was planned to apply 50 Hz high-frequency stimulation protocol to the primary motor cortex foot area in the ipsilesional hemisphere, 5 days a week for 2 weeks, for a total of 10 sessions.
After the daily rTBS session, it was planned to apply a conventional rehabilitation therapy for 60 minutes to all patients for 6 weeks (Exercise program consisting of joint range of motion exercises, strengthening exercises, balance exercises and neurophysiological exercises (Brunstroom exercises) for 45 minutes and 15 minutes of NMES application in the presence of an experienced physiotherapist).; It was planned to apply daily sham rTMS to the motor extremity area of the primary motor cortex along a 10 cm thick wood for 10 sessions.
After the daily sham rTMS session, it was planned to apply a conventional rehabilitation therapy for 60 minutes to all patients for 6 weeks (Exercise program consisting of joint range of motion exercises, strengthening exercises, balance exercises and neurophysiological exercises (Brunstroom exercises) for 45 minutes and 15 minutes of NMES application in the presence of an experienced physiotherapist).
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Repetitive Transcranial Magnetic Stimulation; Hemiplegia; Neurological Rehabilitation