Transcranial magnetic stimulation synchronized with maximal movement effort of the hemiplegic hand after stroke: A double-blinded controlled pilot study

Objective: The aim of this study was to evaluate the effects of transcranial magnetic stimulation synchronized with maximal effort to make a target movement in patients with chronic hemiplegia involving the hand. Design: Non-randomized double-blinded controlled trial. Subjects: Nine chronic patients with hemiplegia who were unable to fully extend the affected fingers following stroke. Methods: Patients were assigned to receive 100 pulses of active or sham transcranial magnetic stimulation of the affected hemisphere per session. Each active or sham pulse was delivered during maximal effort at thumb and finger extension as a target movement. A blinded rater assessed stroke impairments at baseline, immediately after, and one week after 4 weekly transcranial magnetic stimulation sessions. Motor evoked potential amplitudes were measured at each session. Results: All sessions were completed without adverse effects. Immediately after the fourth transcranial magnetic stimulation session, 4 of 5 patients in the active transcranial magnetic stimulation group (80%) had either reduced wrist flexor spasticity or improved manual performance; no such change occurred in the sham group (Fisher's exact test, p < 0.05). Effects persisted one week later. In the active transcranial magnetic stimulation group, 3 patients who showed an increase in motor evoked potential amplitudes all had improvement in clinical assessments. Conclusion: Transcranial magnetic stimulation synchronized with maximum effort to make a target movement improved hand motor function in patients with chronic hemiplegia.