Effects of Repetitive Transcranial Magnetic Stimulation on Gait and Postural Control Ability of Patients with Executive Dysfunction after Stroke

Abstract

Objective: To assess the effects of repetitive transcranial magnetic stimulation (rTMS) on the gait and postural control ability of patients with executive dysfunction (ED) after stroke. Methods: A total of 18 patients with ED after stroke were randomly assigned into two groups, including an experimental group and a sham group. Patients in both groups received routine rehabilitation therapy, and patients in the experimental group underwent rTMS on the left dorsolateral prefrontal cortex (DLPFC) for 2 weeks (5 HZ, 80%MT, 1200 pulses). In the sham group, patients experienced sham stimulation treatment, in which the coil was placed vertically with the head. Before and after treatment, patients in both groups were subjected to Montreal cognitive assessment (MoCA) scoring, Fugl–Meyer assessment of lower extremity (L-FMA), Stroop color-word test (SCWT), gait analysis, foot plantar pressure test, 10-m walking test (10MWT), Berg balance scale (BBS), and timed up and go test (TUGT). In the SCWT, it was attempted to record the time of each card (SCWT-T), the correct number (SCWT-C), Stroop interference effect-time (SIE-T), and SIE correct count (SIE-C). The TUGT was categorized into four stages: getting up (GT), walking straight (WT), turning around (TT), and sitting down (ST), in which the total time of TUGT was calculated. Results: After two weeks of treatment, the evaluation indexes were improved in the two groups, some of which were statistically significant. In the experimental group, SCWT-T, SIE-T, SIE-C, GT, WT, TT, ST, and TUGT were significantly improved after treatment (p < 0.05). SCWT-C, L-FMA score, 10MWT, GT, WT, stride length, step width, foot plantar pressure, pressure center curve, and activities of daily living were not statistically different from those before treatment (p > 0.05). After treatment, SCWT-T, SIE-C, SIE-T, BBS score, TT, and ST in the experimental group were significantly shorter than those before treatment, with statistical differences (p < 0.05). Compared with the sham group, SCWT-C, L-FMA score, 10MWT, GT, WT, TUGT, stride length, step width, foot plantar pressure, pressure center curve, and motor skills were not significantly improved (p > 0.05). Conclusion: It was revealed that post-stroke rTMS treatment of patients with ED could improve executive function, improve postural control function, and reduce the risk of falling. In addition, rTMS of DLPFC could be a therapeutic target for improving postural control ability and reducing the risk of falling.

High-Frequency Repetitive Transcranial Magnetic Stimulation (HF-rTMS) on Overall Cognition in patients with Post-Stroke Cognitive Impairment: A Systematic Review and Meta-analysis

“…After further review of titles and abstracts, 88 studies were reserved. Finally, 61 studies 14–74 were included after a review of the full text. Figure 1 shows the literature screening process.…”

“…Of these 61 studies, a total of 28 studies 14,18–21,23–25,30–32,34,35,37,39–41,47,49,51,52,54,57,59,66,69,73,74 used a frequency of 10 Hz for HF-rTMS, 13 studies 15,22,26,29,33,38,44,45,61,65,67,68,71 used 5 Hz, and the others used 2–50 Hz. The resting motor threshold (MT) is the minimum intensity of TMS stimulation of a fully relaxed muscle that elicits an electromyograph response of at least 50 μV with a probability of 50%.…”

“…The resting motor threshold (MT) is the minimum intensity of TMS stimulation of a fully relaxed muscle that elicits an electromyograph response of at least 50 μV with a probability of 50%. A total of 52 studies 14–19,21–27,29–36,38,39,41,42,44,45,47–50,52–57,59–71,73,74 had HF-rTMS stimulation intensities ranging from 80%MT to 120%MT, two studies 28,72 reported the magnetic induction intensity of 3 mT and 14 ± 4 mT, respectively, and seven studies 20,37,40,43,46,51,58 did not report this information. A total of 50 studies 14–19,21–27,29–42,44–49,52–57,59–61,66–71,73,74 had stimulation sites in the dorsolateral prefrontal cortex (DLPFC); five studies 28,50,62–64 in the temporal lobe, the frontal lobe, and the occipital lobe; three studies in temporal lobe and frontal lobe, 43 prefrontal cortex (PFC), 20 and the primary motor cortex (M1), 51 respectively.…”

“…A total of 52 studies 14–19,21–27,29–36,38,39,41,42,44,45,47–50,52–57,59–71,73,74 had HF-rTMS stimulation intensities ranging from 80%MT to 120%MT, two studies 28,72 reported the magnetic induction intensity of 3 mT and 14 ± 4 mT, respectively, and seven studies 20,37,40,43,46,51,58 did not report this information. A total of 50 studies 14–19,21–27,29–42,44–49,52–57,59–61,66–71,73,74 had stimulation sites in the dorsolateral prefrontal cortex (DLPFC); five studies 28,50,62–64 in the temporal lobe, the frontal lobe, and the occipital lobe; three studies in temporal lobe and frontal lobe, 43 prefrontal cortex (PFC), 20 and the primary motor cortex (M1), 51 respectively. A total of 59 studies 15–72,74 had intervention durations of 2–8 wks, one study 73 at 12 wks, and one study 14 did not report this information.…”

The immediate effects of iTBS on the muscle activation pattern under challenging balance conditions in the patients with chronic low back pain: A preliminary study

“…Intermittent theta burst stimulation (iTBS), which is a special mode of repetitive transcranial magnetic stimulation, has been demonstrated to regulate the excitability of the cerebral cortex and induce plastic changes in the cortex ( Lowe et al, 2018 ). One study found that rTMS over the DLPFC could improve the postural control ability by in patients after stroke ( Yu et al, 2022 ). After the intervention of iTBS on the left DLPFC, the performance during working memory tasks in healthy participants was improved by increasing the theta connectivity between the frontal and parietal regions ( Hoy et al, 2016 ).…”