The Combining rTMS With Visual Feedback Training for Patients With Stroke
Condition: Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      After stroke, patients often experience motor deficits that interrupt normal lower extremity
      movement and gait function. Recent developments in neuroimaging have focus on the reasons why
      some patients recover well while some do poorly. However, there is still no consensus on the
      exact mechanisms involved in regaining the functions after rehabilitation. Application of
      repetitive transcranial magnetic stimulation (rTMS) to facilitate neural plasticity during
      stroke treatment has recently gained considerable attention. The possible mechanism through
      which rTMS acts is based on the interhemispheric competition (IHC) model, which explains that
      patients with stroke experience alterations in cortical excitability and exhibit abnormally
      high interhemispheric inhibition from the unaffected hemisphere to the affected hemisphere.
      The visual feedback training can improve postural control and enhance motor performance.
      Several rTMS studies have evaluated the lower extremity dysfunction following stroke, but few
      studies have explored the efficacy of applying rTMS on the lower extremities. We expect the
      study can help us to further exploration of the change of clinical function and cortical
      excitability following rTMS and visual feedback training in subjects with stroke. In
      addition, the results of this project will be provided for further rehabilitation programs in
      people with stroke.
    

Detailed description: 
      Objective: To investigate the effects of combining rTMS with visual feedback training to
      improve movements in the paretic lower limb and gait performance.

      Methods: Thirty patients with monohemispheric after ischemic stroke will recruited and
      randomized into 3 groups. The group 1 received a 10-minute rTMS intervention then a 30-minute
      visual feedback training. The group 2 received a 10-minute sham rTMS intervention then a
      30-minute visual feedback training. The group 3 received a 10-minute sham rTMS intervention
      then a 30-minute traditional rehabilitation training. All subjects received treatments 3
      times a week for 4 weeks. The performance was assessed by a blinded assessor for two times
      (baseline and after 4 weeks). The outcome measures included Motor evoked potential (MEP),
      Fugl-Meyer Assessment-Lower Limb section(FMA-LE),Motor Assessment Score(MAS), Berg Balance
      Test (BBS),Time Up and Go (TUG), and Modified Barthel Index for ADL ability. Collected data
      will be analyzed with ANOVA test by SPSS version 20.0, and alpha level was set at 0.05. The
      hypothesis is combining rTMS with visual feedback training has positive effects on lower limb
      and gait performance among patients with stroke.
    

Intervention name(s): rTMS; visual feedback training; traditional rehabilitation
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): The EMG measured the MEPs of the anterior tibialis in response to the TMS delivered using a Magstim Rapid2 stimulator (Magstim Co, Ltd, Carmarthenshire, Wales, UK) with a 70-mm figure-8 coil (maximum power, 2.2 T) over the contralateral M1. The intensity was initially set at 100% of the machine output (MO) to determine the optimal stimulation site (hotspot). The hotspot was marked on the scalp with oil ink and recorded as x, y, in centimeters from the vertex (cz). The participants received real rTMS or sham rTMS, respectively (1 Hz, 10 min), which was before a 30-minute visual feedback training and/or traditional rehabilitation training.; Game-based visual feedback training system and software.The system was designed to enable the subjects to perform ankle movements in multiple axes.; 30 min traditional rehabilitation. The traditional rehabilitation programs included balance training, postural training, muscle strengthening, ambulation training and etc..
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Randomized
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: rTMS; visual feedback; gait