Article

The model of interhemispheric competition after stroke has been
established for the upper but not for the lower extremity. Repetitive
transcranial magnetic stimulation (rTMS) of the brain has been shown to modulate
cortical excitability. The purpose of this study was to investigate
the effects of rTMS followed by task-oriented training on cortical excitability
and walking performance in individuals with chronic stroke. METHODS: A total of
24 patients with average Fugl-Meyer lower limb scores of 17.88 +/- 5.27 and
average walking speeds of 63.81 +/- 18.25 cm/s were randomized into an
experimental group and a control group. Participants received rTMS (experimental
group) or sham rTMS (control group) followed by task-oriented training (30
minutes) for 10 sessions over 2 weeks. Repetitive TMS was applied at a 1-Hz
frequency over the leg area of the motor cortex of the unaffected hemisphere for
10 minutes. Outcomes, including motor-evoked potential (MEP), lower-extremity
Fugl-Meyer score, and gait performance, were measured before and after training.
RESULTS: Decreased interhemispheric asymmetry of the amplitude of the MEP was
noted after rTMS and task-oriented training. Improvement in spatial asymmetry of
gait was comparable with increased symmetry in interhemispheric excitability.
Motor control and walking ability were also significantly improved after rTMS and
task-oriented training. CONCLUSIONS: rTMS enhances the effect of task-oriented
training in those with chronic stroke, especially by increasing gait spatial
symmetry and corticomotor excitability symmetry.

Langue : ANGLAIS