Effects of low-frequency repetitive transcranial magnetic stimulation and neuromuscular electrical stimulation on upper extremity motor recovery in the early period after stroke: a preliminary study

Abstract

LF-rTMS with or without NMES seems to facilitate the motor recovery in the paretic hand of patients with acute/subacute ischemic stroke. TMS or the combination of TMS + NMES may be a promising additional therapy in upper limb motor training. Further studies with larger numbers of patients are needed to establish their effectiveness in upper limb motor rehabilitation of stroke.

Neurotechnology-aided interventions for upper limb motor rehabilitation in severe chronic stroke

“…The results show a pre-post treatment improvement on average of 4.3 FM points. Tosun et al (2017) showed in a larger group of stroke patients that low frequency repetitive TMS alone and with neuromuscular electrical stimulation of wrist extensors significantly enhance motor recovery in the paretic hand more than conventional therapy.…”

“…Here, 11 studies reporting muscular electrical stimulation effectiveness for stroke upper limb rehabilitation were selected (Dorsch et al , 2014; Kim et al , 2014; Quandt and Hummel, 2014; Knutson et al , 2015 a , b ; Liu et al , 2015; Vafadar et al , 2015; Wilson et al , 2016; Carda et al , 2017; Eraifej et al , 2017; Schick et al , 2017), and seven where muscular electrical stimulation was used in combination with other treatments (Koyama et al , 2014; Lee et al , 2015; Sattler et al , 2015, Jang et al , 2016; Kim et al , 2016; Rong et al , 2017; Tosun et al , 2017) (Table 1). In almost all of these studies, the muscular electrical stimulation elicits a movement and only in few cases, it is used solely for sensory stimulation (Wilson et al , 2016).…”

“…Its use in stroke rehabilitation was initiated more than 10 years ago (Hummel et al , 2005; Khedr et al , 2005; Hummel and Cohen, 2006), and its efficacy is still under investigation with several studies conducted in the past 3 years. We included evidence from 19 publications, where brain stimulation is used alone (Fusco et al , 2014; Lefaucheur et al , 2014; O’Shea et al , 2014; Plow and Machado, 2014; Elsner et al , 2015; Tretriluxana et al , 2015; Allman et al , 2016; Chang et al , 2016; D'Agata et al , 2016; Del Felice et al , 2016; Ilić et al , 2016; Kubis, 2016; Levy et al , 2016; Rocha et al , 2016; Triccas et al , 2016; Cho et al , 2017; Figlewski et al , 2017; Koh et al , 2017; Lefaucheur et al , 2017), and 10 studies (Koyama et al , 2014; Ang et al , 2015 b ; Kasashima-Shindo et al , 2015; Sattler et al , 2015; Triccas et al , 2015 a , b ; Di Lazzaro et al , 2016; Straudi et al , 2016; Simonetti et al , 2017; Tosun et al , 2017) where brain stimulation is used in combination with other interventions (Table 1).…”

“…For this reason, we review post-stroke upper limb rehabilitation based on the combination of neurotechnologies. Twelve papers were selected (Koyama et al , 2014; Ang et al , 2015 b ; Kasashima-Shindo et al , 2015; Lee et al , 2015; Sattler et al , 2015; Triccas et al , 2015 a , b ; Di Lazzaro et al , 2016; Straudi et al , 2016; Rong et al , 2017; Simonetti et al , 2017; Tosun et al , 2017) (Table 1).…”

Repetitive transcranial magnetic stimulation in combination with neuromuscular electrical stimulation for treatment of post-stroke dysphagia

“…It appears that the combination of rTMS with other recovery approaches, such as drugs, pharyngeal electrical stimulation, NMES, conventional rehabilitation, and task-oriented mirror therapy, achieves better therapeutic effects. 22–25…”