Effects of repetitive transcranial magnetic stimulation of the unaffected hemisphere leg motor area in patients with subacute stroke and substantial leg impairment: A pilot study

Objective: To evaluate the effects of repetitive transcranial magnetic stimulation (rTMS) on mobility among patients with substantial leg impairment after subacute stroke. Design: Double-blinded, stratified, randomized trial involving a sham control group. Participants: Patients who developed unilateral hemiplegia after first-ever subacute stroke and underwent inpatient stroke rehabilitation. Methods: The 15-day intervention programme used in the present study included the application of rTMS (1 Hz, 15 min) over the leg motor area of the unaffected hemisphere, followed by 45 min physical therapy. Overall, 32 participants were randomly assigned to receive either real rTMS or sham stimulation. Clinical assessments, including the Postural Assessment Scale for Stroke Patients (PASS), balance subscale of the Performance Oriented Mobility Assessment (POMA-b), Fugl-Meyer Assessment, Barthel Index (BI), and Timed Up and Go test, were performed immediately before and after the intervention. Results: Both groups demonstrated significant improvements in all the test results over time. At the post-test assessment, the patients in the real rTMS group demonstrated greater improvements in the PASS, POMA, and BI scores than did the patients in the sham rTMS group. In addition, a significantly higher number of patients in the real rTMS group regained mobility at the post-test assessment compared with the corresponding number of patients in the sham rTMS group. Conclusion: Application of 1-Hz rTMS may improve mobility among patients with substantial leg impairment after subacute stroke.