Repetitive Transcranial Magnetic Stimulation on the Affected Hemisphere Enhances Hand Functional Recovery in Subacute Adult Stroke Patients: A Randomized Trial.
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2021-01
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Objectives: Either motor training or repetitive transcranial magnetic stimulation (rTMS) could modulate the neural plasticity after stroke. Therefore, synchronizing the two interventions may optimize the efficiency of recovery. In the present study, we aim to investigate the effect of rTMS along with hand grip training on the neurobehavioral and hand functional recovery in one cohort of subacute stroke patients. Methods: Thirty-nine stroke patients were enrolled in a single-center, single-blinded, randomized clinical trial. We tested different intervention effects of rTMS and hand grip training (group A), rTMS alone (group B), and hand grip training alone (group C). For the rTMS-treated groups, patients received 10 consecutive sessions of 5-Hz stimulation over the affected hemisphere with 750 pulses. Jebsen-Taylor Hand Function Test (JTHFT), Fugl-Meyer assessment of upper extremity (FMA-UE), grip strength, modified Barthel index (mBI), and ipsilesional motor evoked potential (iMEP) latency were assessed and compared across the groups. Results: We found that only rTMS along with hand grip training group all improved in JTHFT, FMA-UE, grip strength, and mBI (p ≤ 0.01) compared with the baseline among the three groups. Furthermore, this study demonstrated that rTMS plus hand grip training had much better results in improvement of neurobehavioral outcomes compared to the rTMS alone- and hand grip training alone-treated patients (p < 0.05). However, no significant differences were detected in neurophysiologic outcome between intra-groups and inter-groups (p > 0.05). Conclusion: These proof-of-concept results suggested that rTMS alone with hand grip training was a unique approach to promote hand functional recovery in stroke patients. It provided important information to design a large-scale multi-center clinical trial to further demonstrate the efficiency of the combination of central and peripheral stimulation. Clinical Trial Registration: http://www.chictr.org.cn (#ChiCTR1900023443).
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Yang, Yawen, Huijuan Pan, Wenxiu Pan, Yang Liu, Xiaohui Song, Chuanxin M Niu, Wuwei Feng, Jixian Wang, et al. (2021). Repetitive Transcranial Magnetic Stimulation on the Affected Hemisphere Enhances Hand Functional Recovery in Subacute Adult Stroke Patients: A Randomized Trial. Frontiers in aging neuroscience, 13. p. 636184. 10.3389/fnagi.2021.636184 Retrieved from https://hdl.handle.net/10161/34022.
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Wuwei Feng
Wayne Feng is the Chief of Division of Stroke & Vascular Neurology, Medical Director of Duke Comprehensive Stroke Center, and Tenured Profess of Neurology and Biomedical Engineering at Duke University School of Medicine. Dr. Feng is a board-certified vascular neurologist as well as a physician scientist. His research portfolios include developing imaging biomarker for post-stroke motor outcomes prediction, and use of non-invasive brain stimulation tools, such as, transcranial direct current stimulation (tDCS), vagus nerve stimulation, low intensity focused ultrasound and transcranial light stimulation to enhance post-stroke recovery. His research has been actively funded by the National Institute of Health (NIH), the American Heart Association/American Stroke Association (AHA/ASA) and other various sources. He is currently leading an NIH funded 8.9 million U01 12-center, phase II study called TRANSPORT 2 (TRANScranial direct current stimulation for POst-stroke motor Recovery – a phase II sTudy) – on the NINDS funded stroke trial network.
Dr. Feng has published over 150 peer reviewed manuscripts (H index of 36), including two manuscripts featured on the cover page of brain stimulation journal, and one manuscript featured on Journal of Neuroscience. He co-edited - “Cerebral Venous System in Acute and Chronic Brain Injuries” book. He served as the associate editor for Translational Stroke Research from 2019 to 2021(IF=7.0). Dr. Feng received several prestigious awards for his research work in stroke and stroke recovery including the FIRST “Rehabilitation Award” from the American Heart Association/American Stroke Association in 2015, “Franz Gerstenbrand Award” from World Federation of Neurorehabilitation (WFNR) in 2016, Arthur Guyton New Investigator Award, Consortium for Southeastern Hypertension Control (COSEHC) in 2016 and “Clinical Investigator Award” from the Society of Chinese American Physician Entrepreneur (SCAPE). Currently, he is the Section Chair of Neural Repair & Rehabilitation, the American Academy of Neurology. He leads the global mentoring program for the WFNR.
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