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Effects of Repetitive Transcranial Magnetic Stimulation on Walking and Balance Function after Stroke: A Systematic Review and Meta-Analysis

Li, Yi, MD; Fan, Jingjing, MS; Yang, Jingyi, MS; He, Chengqi, PhD; Li, Shasha, PhD

American Journal of Physical Medicine & Rehabilitation: November 2018 - Volume 97 - Issue 11 - p 773–781
doi: 10.1097/PHM.0000000000000948
Original Research Articles CME Article . 2018 Series . Number 11

Objective The aim of this study was to investigate the effects of repetitive transcranial magnetic stimulation (rTMS) on walking and balance function in patients with stroke.

Design MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, CENTRAL, and the Physiotherapy Evidence Database were comprehensively searched for randomized controlled trials published through March 2017 that investigated the effects of rTMS on lower limb function. Main outcomes included walking speed, balance function, motor function, and cortical excitability.

Results Nine studies were included. The meta-analysis revealed a significant effect of rTMS on walking speed (standardized mean difference, 0.64; 95% confidence interval [CI], 0.32–0.95), particularly ipsilesional stimulation (standardized mean difference, 0.80; 95% CI, 0.36–1.24). No significant effects were found for balance function (standardized mean difference, 0.10; 95% CI, −0.26 to 0.45), motor function (mean difference, 0.50, 95% CI: −0.68 to 1.68), or cortical excitability (motor-evoked potentials of the affected hemisphere: mean difference, 0.21 mV; 95% CI, −0.11 to 0.54; motor-evoked potentials of the unaffected hemisphere: mean difference, 0.09 mV; 95% CI, −0.16 to −0.02).

Conclusion These results suggest that rTMS, particularly ipsilesional stimulation, significantly improves walking speed. Future studies with larger sample sizes and an adequate follow-up period are required to further understand the effects of rTMS on lower limb function and its relationship with changes in cortical excitability with the help of functional neuroimaging techniques.

To Claim CME Credits Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME

CME Objectives Upon completion of this article, the reader should be able to: 1) Understand the potential neurophysiologic effects of rTMS; 2) Appreciate the potential benefits of rTMS on stroke recovery; and 3) Identify indications for including rTMS in a stroke rehabilitation program.

Level Advanced

Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

From the Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China (YL, JF, JY, CH); Key Laboratory of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China (YL, JF, JY, CH); and Department of Psychiatry and Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (SL).

All correspondence should be addressed to: Chengqi He, PhD, Department of Rehabilitation Medicine, West China Hospital, Sichuan University, No. 37 Guo-xue-xiang St, Chengdu, Sichuan, People's Republic of China; and Shasha Li, PhD, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th St, Charlestown, MA 02129.

Supported by the National Natural Science Foundation of China (no. 81000852 and 81301677), the American Heart Association Award (no. 17POST32530004), and the Supporting Project of Science & Technology of Sichuan Province of China (no. 2012SZ0140).

Yi Li is in training.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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