Effects of transcranial magnetic stimulation on the performance of the activities of daily living and attention function after stroke: a randomized controlled trial

Abstract

Objective: We aimed to interrogate the effects of transcranial magnetic stimulation (TMS) on the performance in activities of daily living (ADL) and attention function after stroke. Design: Randomized controlled trial. Setting: Inpatient rehabilitation hospital. Subjects: We randomized 62 stroke patients with attention dysfunction who were randomly assigned into two groups, and two dropped out from each group. The TMS group ( n = 29) and a sham group ( n = 29), whose mean (SD) was 58.12 (6.72) years. A total of 33 (56.9%) patients had right hemisphere lesion while the rest 25 (43.1%) patients had left hemisphere lesion. Interventions: Patients in the TMS group received 10 Hz, 700 pulses of TMS, while those in the sham group received sham TMS for four weeks. All the participants underwent comprehensive cognitive training. Main measures: At baseline, and end of the four-week treatment, the performance in the activities of daily living was assessed by Functional Independence Measure (FIM). On the other side, attention dysfunction was screened by Mini-Mental State Examination (MMSE), while the attention function was assessed by the Trail Making Test-A (TMT-A), Digit Symbol Test (DST) and Digital Span Test (DS). Results: Our data showed a significant difference in the post-treatment gains in motor of Functional Independence Measure (13.00 SD 1.69 vs 4.21 SD 2.96), cognition of Functional Independence Measure (4.69 SD 1.56 vs 1.52 SD 1.02), total of Functional Independence Measure (17.69 SD 2.36 vs 5.72 SD 3.12), Mini-Mental State Examination (3.07 SD 1.36 vs 1.21 SD 0.62), time taken in Trail Making Test-A (96.67 SD 25.18 vs 44.28 SD 19.45), errors number in Trail Making Test-A (2.72 SD 1.03 vs 0.86 SD 1.03), Digit Symbol Test (3.76 SD 1.09 vs 0.76 SD 0.87) or Digital Span Test (1.69 SD 0.54 vs 0.90 SD 0.72) between the TMS group and the sham group ( P < 0.05). Conclusions: Taken together, we demonstrate that TMS improves the performance in the activities of daily living and attention function in patients with stroke.

The Effect of Non-Invasive Brain Stimulation (NIBS) on Attention and Memory Function in Stroke Rehabilitation Patients: A Systematic Review and Meta-Analysis

“…The reason for choosing DLPFC was that all studies indicated that DLPFC was an important site in cognitive function. Some studies have shown that DLPFC is associated with WM [32,36,40], is an important part of the Default mode network [33], is a hub of attentional function [32], and plays an important part in the central executive network (CEN), which is responsible for high-level cognitive functions such as control of attention and WM [34]. Except for the study by Hosseinzadeh et al [41], excitatory stimulation of the frontal lobe was selected in tDCS studies [37][38][39].…”

“…Of these, all patients received rehabilitation regardless of the intervention group or control group. In rTMS, five studies combined cognitive rehabilitation and cognitive training [32][33][34][35][36]. Yin et al [34] and Lu et al [35] combined computer-assisted cognitive training in all patients [34,35].…”

“…Two studies reported on executive function. Liu et al [32] reported that 10 Hz stimulation applied to the left DLPFC had significant improvement which was observed in all of the neuropsychological test categories compared to the control group [32]. Li et al [33] applied 5 Hz stimulation on the left DLPFC with cognitive improvements observed both in the intervention and control groups, while the rTMS group got more significant improvement [33].…”

Novel Advances to Post-Stroke Aphasia Pharmacology and Rehabilitation

“…Transcranial magnetic stimulation is a non-invasive and painless form of therapy, widely used in the neurorehabilitation in post-stroke patients [100][101][102]104]. TMS is based on generating a magnetic pulse that induces power in various regions of the cerebral cortex.…”

Using Fractional Amplitude of Low-Frequency Fluctuations and Functional Connectivity in Patients With Post-stroke Cognitive Impairment for a Simulated Stimulation Program

“…rTMS is a non-invasive and relatively safe technique that has been used in cognition impairment (Fisicaro et al, 2019). Several studies have shown the efficacy of TMS in improving cognition function in patients with PSCI (Liu et al, 2020;Tsai et al, 2020). They found that rTMS can improve attention, memory, executive and overall cognitive function after stroke (Hara et al, 2021).…”