Exploring the experiences of stroke patients treated with transcranial magnetic stimulation for upper limb recovery: a qualitative study

Abstract

Background: Transcranial magnetic stimulation (TMS) treatments have shown promise in improving arm recovery in stroke patients. Currently, little is known about patients’ experiences with TMS treatment, and this lack of knowledge may affect optimal implementation in clinical practice. The aim of this explorative study was to gain insight in the perceived effects and experiences of the design and delivery of a TMS treatment for upper limb recovery from the perspectives of stroke patients. Methods: This qualitative study was conducted as part of a randomized controlled trial (RCT) in a specialized rehabilitation center. Data were collected through face-to-face semi-structured interviews with 13 stroke patients who completed a 10-day TMS intervention for upper limb recovery. The interviews were recorded, transcribed verbatim and analyzed using thematic analysis. Results: The major themes that emerged from the patients’ feedback were the following: positive experiences of the treatment (experienced physical effects, comfort, therapeutic relationship, receiving information, learning about the brain, no burden of added rTMS treatment session, no unpleasant aspects), concerns (effects of stimulation of the brain, equipment, logistics), general experience of recovery, experienced psychological effects (grateful, sense of purpose, recovery as extra motivation to exercise, disappointment and hope of group allocation), and motivation to participate (personal benefit and cognitions, altruism). Important components related to the positive experience of the design and delivery of the treatment included comfort (i.e. moment of relaxation) and the sensation of a painless treatment without side-effects. Key concerns included uncertainty and anxiety about possible negative consequences and group allocation. Conclusions: This study demonstrates that TMS is well accepted by stroke patients with an upper limb paresis. Besides the expectation of a therapeutic benefit, the patients reported various psychological effects. Positive experiences, such as the provision of a short moment of relaxation each day, could have practical implications for clinical stroke rehabilitation settings aimed at improving patient satisfaction. Explanation about and feedback from routine motor recovery progression monitoring at fixed times post-stroke is also valued by patients. Negative emotions may be limited or avoided by transparent and recurrent information delivery in future trials. Trial registration: NL5952 Registered November 28, 2016.

Chronic Gq activation of ventral hippocampal neurons and astrocytes differentially affects memory and behavior

“…Recently, many studies have investigated the role of direct brain modulation for the treatment and prevention of disease (Johnson et al, 2013; Gauthier et al 2022), though the identity of the perturbed cells remains relatively unknown. For instance, stimulation of brain cells via transmagnetic stimulation (TMS), which is an approved therapy for treatment-resistant MDD, has promising therapeutic value when applied to AD, PD, stroke, schizophrenia, and MS (Weiler et al 2020; Brys et al 2016; van Lieshout et al 2020; Cole et al 2015; Nasios et al 2018). However, understanding how to restore brain patterns through a cell-type specific and targeted manner remains elusive, especially when used for the treatment of brain diseases.…”