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Repetitive Transcranial Magnetic Stimulation as an Adjunct to Constraint-Induced Therapy: An Exploratory Randomized Controlled Trial

Malcolm, Matthew P. PhD; Triggs, William J. MD; Light, Kathye E. PhD; Gonzalez Rothi, Leslie J. PhD; Wu, Sam PhD; Reid, Kimberly MS; Nadeau, Stephen E. MD

American Journal of Physical Medicine & Rehabilitation: September 2007 - Volume 86 - Issue 9 - pp 707-715
doi: 10.1097/PHM.0b013e31813e0de0
Research Article: Hemiparesis

Malcolm MP, Triggs WJ, Light KE, Gonzalez Rothi LJ, Wu S, Reid K, Nadeau SE: Repetitive transcranial magnetic stimulation as an adjunct to constraint-induced therapy: an exploratory randomized controlled trial. Am J Phys Med Rehabil 2007;86:707–715.

Objective: To test the potential adjuvant effect of repetitive transcranial magnetic stimulation (rTMS) on motor learning in a group of stroke survivors undergoing constraint-induced therapy (CIT) for upper-limb hemiparesis.

Design: This was a prospective randomized, double-blind, sham-controlled, parallel group study. Nineteen individuals, one or more years poststroke, were randomized to either a rTMS + CIT (n = 9) or a sham rTMS + CIT (n = 10) group and participated in the 2-wk intervention.

Results: Regardless of group assignment, participants demonstrated significant gains on the primary outcome measures: the Wolf Motor Function Test (WMFT) and the Motor Activity Log (MAL)–Amount of Use, and on secondary outcome measures including the Box and Block Test (BBT) and the MAL–How Well. Participants receiving rTMS failed to show differential improvement on either primary outcome measure.

Conclusions: Although this study provided further evidence that even relatively brief sessions of CIT can have a substantial effect, it provided no support for adjuvant use of rTMS.

From the Department of Occupational Therapy and NeuroRehabilitation Research Laboratory, Colorado State University, Fort Collins, Colorado (MPM); Department of Neurology, University of Florida, Gainesville, Florida (WJT, LJGR, SEN); Brain Rehabilitation Research Center, VAMC, Gainesville, Florida (WJT, LJGR, SW, SEN); Department of Physical Therapy, University of Florida, Gainesville, Florida (KEL); Rehabilitation Outcomes Research Center, VAMC, Gainesville, Florida (SW, KR); Geriatric Research, Education and Clinical Center, VAMC, Gainesville, Florida (SEN); and Department of Biostatistics, University of Florida, Gainesville, Florida (SW).

All correspondence and requests for reprints should be addressed to Dr. William J. Triggs, Department of Neurology, L3-100 McKnight Brain Institute, Newell Drive, University of Florida, Gainesville, FL 32610.

This material is based on work supported by the Office of Academic Affairs and by the Rehabilitation Research and Development Service (grant F2182C to Leslie J. Gonzalez Rothi) of the Department of Veterans Affairs.

© 2007 Lippincott Williams & Wilkins, Inc.