Effects of high-frequency repetitive transcranial magnetic stimulation combined with action observation and execution on upper extremity motor function in subacute stroke: a preliminary study
Keywords:
stroke, repetitive transcranial magnetic stimulation, action observation executionAbstract
Background: Objective: To investigate the effect of a combined high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) with action observation execution (AOE) on upper extremity motor function in subacute stroke.
Materials and Methods: Eight participants were randomly allocated to the experimental group (real HF-rTMS) or the control group (Sham-rTMS). All the participants also received 30 minutes of AOE training. The corticospinal excitability, which is represented by peak-to-peak motor evoked potential (MEP) amplitude of the lesioned hemisphere and the motor performance of the paretic hand from nine tasks of the Wolf Motor Function Test, was measured at baseline, immediately after 5 times HF-rTMS and AOE, and 1 week after the intervention.
Results: The lesioned MEP of the experimental group increased after HF-rTMS, and the effect was maintained for one week. In addition, their time to complete hand-to-table and lift significantly decreased after AOE training and was maintained for one week.
Conclusion: Five sessions of HF-rTMS followed by AOE training enhanced the paretic hand dexterity and persisted for at least one week.
References
Feigin VL, Brainin M, Norrving B, Martins S, Sacco RL, Hacke W, et al. World Stroke Organization (WSO): Global Stroke Fact Sheet 2022. Int J Stroke Off J Int Stroke Soc. 2022;17(1):18–29.
Shaker H, Fahmy EM, Honin AAN, Mohamed SS. Effect of mirror therapy on hand functions in Egyptian chronic stroke patients. Egypt J Neurol Psychiatry Neurosurg. 2020;56(1):96.
Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Executive summary: heart disease and stroke statistics--2014 update: a report from the American Heart Association. Circulation. 2014;129(3):399–410.
Tretriluxana J, Kantak S, Tretriluxana S, Wu AD, Fisher BE. Improvement in Paretic Arm Reach-to-Grasp following Low Frequency Repetitive Transcranial Magnetic Stimulation Depends on Object Size: A Pilot Study. Stroke Res Treat. 2015;2015:498169.
Zhang JJQ, Fong KNK, Welage N, Liu KPY. The Activation of the Mirror Neuron System during Action Observation and Action Execution with Mirror Visual Feedback in Stroke: A Systematic Review. Neural Plast. 2018;2018:2321045.
Pomeroy V, Aglioti SM, Mark VW, McFarland D, Stinear C, Wolf SL, et al. Neurological principles and rehabilitation of action disorders: rehabilitation interventions. Neurorehabil Neural Repair. 2011;25(5 Suppl):33S-43S.
Hari R, Forss N, Avikainen S, Kirveskari E, Salenius S, Rizzolatti G. Activation of human primary motor cortex during action observation: A neuromagnetic study. Proc Natl Acad Sci. 1998;95(25):15061–5.
Qi F, Nitsche MA, Ren X, Wang D, Wang L. Top-down and bottom-up stimulation techniques combined with action observation treatment in stroke rehabilitation: a perspective. Front Neurol. 2023;14:1156987.
Ke J, Zou X, Huang M, Huang Q, Li H, Zhou X. High-frequency rTMS with two different inter-train intervals improves upper limb motor function at the early stage of stroke. J Int Med Res. 2020;48(6):0300060520928737.
Vabalaite B, Petruseviciene L, Savickas R, Kubilius R, Ignatavicius P, Lendraitiene E. Effects of High-Frequency (HF) Repetitive Transcranial Magnetic Stimulation (rTMS) on Upper Extremity Motor Function in Stroke Patients: A Systematic Review. Medicina (Mex). 2021;57(11):1215.
Bhattacharjee S, Kashyap R, Abualait T, Annabel Chen SH, Yoo WK, Bashir S. The Role of Primary Motor Cortex: More Than Movement Execution. J Mot Behav. 2021;53(2):258–74.
Stoykov ME, Madhavan S. Motor Priming in Neurorehabilitation. J Neurol Phys Ther. 2015;39(1):33.
Woodbury M, Velozo CA, Thompson PA, Light K, Uswatte G, Taub E, et al. Measurement Structure of the Wolf Motor Function Test: Implications for Motor Control Theory. Neurorehabil Neural Repair. 2010;24(9):791–801.
Adhikari SP, Tretriluxana J, Chaiyawat P, Jalayondeja C. Enhanced Upper Extremity Functions with a Single Session of Action-Observation-Execution and Accelerated Skill Acquisition Program in Subacute Stroke. Stroke Res Treat. 2018;2018:1490692.
Lin K chung, Hsieh Y wei, Wu C yi, Chen C ling, Jang Y, Liu J sen. Minimal Detectable Change and Clinically Important Difference of the Wolf Motor Function Test in Stroke Patients. Neurorehabil Neural Repair. 2009;23(5):429–34.
Wang Q, Zhang D, Zhao YY, Hai H, Ma YW. Effects of high-frequency repetitive transcranial magnetic stimulation over the contralesional motor cortex on motor recovery in severe hemiplegic stroke: A randomized clinical trial. Brain Stimulat. 2020;13(4):979–86.
Du J, Yang F, Hu J, Hu J, Xu Q, Cong N, et al. Effects of high- and low-frequency repetitive transcranial magnetic stimulation on motor recovery in early stroke patients: Evidence from a randomized controlled trial with clinical, neurophysiological and functional imaging assessments. NeuroImage Clin. 2018;21:101620.
Fu J, Zeng M, Shen F, Cui Y, Zhu M, Gu X, et al. Effects of action observation therapy on upper extremity function, daily activities and motion evoked potential in cerebral infarction patients. Medicine (Baltimore). 2017;96(42):e8080.
Huerta PT, Volpe BT. Transcranial magnetic stimulation, synaptic plasticity and network oscillations. J NeuroEngineering Rehabil. 2009;6:7.
Stoykov ME, Madhavan S. Motor Priming in Neurorehabilitation. J Neurol Phys Ther JNPT. 2015;39(1):33.
Stefan K, Cohen LG, Duque J, Mazzocchio R, Celnik P, Sawaki L, et al. Formation of a Motor Memory by Action Observation. J Neurosci. 2005;25(41):9339–46.
Rungseethanakul S, Tretriluxana J, Piriyaprasarth P, Pakaprot N, Jitaree K, Tretriluxana S, et al. Task Oriented Training Activities Post Stroke Will Produce Measurable Alterations in Brain Plasticity Concurrent with Skill Improvement. Top Stroke Rehabil. 2022;29(4):241–54.
Choi H, Park D, Rha DW, Nam HS, Jo YJ, Kim DY. Kinematic analysis of movement patterns during a reach-and-grasp task in stroke patients. Front Neurol. 2023;14:1225425.
Kang N, Cauraugh JH. Force control in chronic stroke. Neurosci Biobehav Rev. 2015;52:38–48.
Downloads
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2025 The 11th International Physical Therapy Research Symposium 2025 (IPTRS 2025)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
