Effects Of RTMS Synchronized With Hand Grip Training On Hand Function In Post-stroke Patients

Objective To investigate the effects of repetitive transcranial magnetic stimulation(rTMS)synchronized with hand grip training on recovery of hand function and motor evoked potential(MEP)latency of primary motor cortex(M1)in the affected hemisphere in post-stroke patients.Methods A total of 39 stroke patients with a duration of 1 to 6 months were recruited for the randomized,single-blinded and controlled trial.All subjects were randomly divided into the rTMS_R+hand grip training group(n=12),the passive rTMS group(n=14),and the control group(n=13).The stimulation parameters were 5 Hz,ipsilesional M1(i M1),100%RMT(resting motor threshold,RMT),and 750 pulses.The treatment time was once a day,5 days a week for 2 weeks.Participants were evaluated with Fugl-Meyer Assessment of Upper Limb(FMA-UL),Jebsen-Taylor Hand Function Test(JTHFT),grip strength,and Modified Barthel Index(MBI)and MEP latency of i M1 at baseline and post-intervention.Results The results of assessments showed that there were no statistical differences between the three groups at baseline(p>0.05).Two weeks after the interventions,the assessments of FMA-UL,JTHFT,grip strength,and MBI were all improved when compared with baseline(p≤0.01).Except for grip strength,the passive rTMS group also enhanced in the whole behavioral outcomes after treatments(p<0.05).However,the control group merely had statistical differences in JTHFT(total),JTHFT(without writing),JTHFT-motor coordination and MBI(p<0.05).The changes of MEP latency of i M1 between baseline and post-intervention of the three groups were no statistical differences(p>0.05).Compared to the control group,rTMS_R+hand grip training group displayed more excellent changes in the FMA-UL and JTHFT(p<0.05).Moreover,rTMS_R+hand grip training group had more significant enhancement in FMA-UL when compared with the passive rTMS group(p<0.05).Besides,no significant differences were found between changes in grip strength,MBI and MEP latency of i M1 after different interventions.Conclusions The results highlight that rTMS_Rsynchronized with hand grip training is optimal to recover arm and hand function.And it suggest that it is a more promising intervention strategy for post-stroke patients.