Effectiveness of Transcranial Magnetic Stimulation Combined With OT for Upper Limb Function Among Stroke Patients

This study aimed to examine the effectiveness of transcranial magnetic stimulation (TMS) combined with OT in improving upper extremity (UE) function in stroke patients. Stroke remains the leading cause of long-term disability, with UE impairments severely limiting quality of life. TMS enhances UE function by modulating neuronal activity. OT improves UE function, supporting functional recovery. Our research aims to examine the effectiveness of combining TMS with OT to improve UE recovery in stroke patients. PRISMA guidelines were adhered to for this review. Searches were conducted through MEDLINE, PubMed, and CINAHL, using the search string ‘transcranial magnetic stimulation’ AND (stroke OR paralysis) AND (‘occupational therapy’ OR ‘physical therapy’), yielding 670 citations. Titles and abstracts were screened with inclusion/exclusion criteria, producing 87 articles for full-text review. After applying refined criteria, four RCTs met the final inclusion. Following AJOT guidelines, data extraction, and quality assessment were completed. Four studies reported positive outcomes. Abo et al. (2014) found that the low frequency rTMS + OT group (NEURO) and CIMT groups significantly improved UE function, with the NEURO group showing superior gains. Chen et al. (2020) demonstrated significant improvements in UE function, with the Functional Magnetic Stimulation + OT group achieving more significant gains than the Low-Frequency Repetitive Transcranial Magnetic Stimulation + OT control group. Shim and Lee (2023) observed improved UE function, with high-frequency rTMS combined with motor learning vs. sham group. Lastly, Wang et al. (2021) reported the active HD transcranial burst electrostimulation combined with OT group experienced more significant improvements in UE function than sham group. These studies underscore the potential of varied neuromodulation and motor training approaches in enhancing post-stroke UE recovery when combined with magnetic stimulation.

References

Wang, S. M. S., Huang, Y. J., Chen, J. J. J., Wu, C. W., Chen, C. A., Lin, C. W., ... & Peng, C. W. (2021). Designing and pilot testing a novel high-definition transcranial burst electrostimulation device for neurorehabilitation. Journal of neural engineering, 18(5), 056030.

Shim, J., & Lee, S. (2023). Effects of High-Frequency Repetitive Transcranial Magnetic Stimulation Combined with Motor Learning on Motor Function and Grip Force of the Upper Limbs and Activities of Daily Living in Patients with a Subacute Stroke. International Journal of Environmental Research and Public Health, 20(12), 6093.

Chen, X., Liu, X., Cui, Y., Xu, G., Liu, L., Zhang, X., ... & Li, Z. (2020). Efficacy of functional magnetic stimulation in improving upper extremity function after stroke: A randomized, single-blind, controlled study. Journal of International Medical Research, 48(6), 0300060520927881.

Abo, M., Kakuda, W., Momosaki, R., Harashima, H., Kojima, M., Watanabe, S., ... & Sasanuma, J. (2014). Randomized, multicenter, comparative study of NEURO versus CIMT in poststroke patients with upper limb hemiparesis: the NEURO-VERIFY Study. International Journal of Stroke, 9(5), 607–612.