Article

OBJECTIVE: To assess the efficacy of inhibitory repetitive transcranial magnetic
stimulation (rTMS) for decreasing upper-limb muscle tone after chronic stroke.
DESIGN: A randomized sham-controlled trial with a 4-week follow-up. SETTING:
Research hospital. PARTICIPANTS: Patients with stroke (N=20) with poststroke
upper limb spasticity. INTERVENTIONS: The experimental group received rTMS to the
primary motor cortex of the unaffected side (1500 pulses; 1Hz; 90% of resting
motor threshold for the first dorsal interosseous muscle) in 10 sessions, 3d/wk,
and physical therapy (PT). The control group received sham stimulation and PT.
MAIN OUTCOME MEASURES: Modified Ashworth scale (MAS), upper-extremity Fugl-Meyer
assessment, FIM, range of motion, and stroke-specific quality-of-life scale. All
outcomes were measured at baseline, after treatment (postintervention), and at a
4-week follow-up. A clinically important difference was defined as a reduction of
>/=1 in the MAS score. RESULTS: Friedman test revealed that PT is efficient for
significantly reducing the upper limb spasticity of patients only when it is
associated with rTMS. In the experimental group, 90% of the patients at
postintervention and 55.5% at follow-up showed a decrease of >/=1 in the MAS
score, representing clinically important differences. In the control group, 30%
of the patients at postintervention and 22.2% at follow-up experienced clinically
meaningful changes. There were no differences between the groups at any time for
any of the other outcome measures, indicating that both groups demonstrated
similar behaviors over time for all variables. CONCLUSIONS: rTMS associated with
PT can be beneficial in reducing poststroke spasticity. However, more studies are
needed to clarify the clinical changes underlying the reduction in spasticity
induced by noninvasive brain stimulations.
CI - Copyright (c) 2014 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS