Improvements in hand function in adults with chronic tetraplegia following a multi-day 10Hz rTMS intervention combined with repetitive task practice

J Neurol Phys Ther, 2015 · DOI: 10.1097/NPT.0000000000000062 · Published: January 1, 2015

Spinal Cord Injury Neurology Rehabilitation

Simple Explanation

This study investigates whether using brain stimulation (rTMS) along with hand exercises can improve hand function in people with spinal cord injuries. Participants with tetraplegia and healthy individuals received both real and sham rTMS combined with repetitive hand exercises. The study measured hand function and brain activity before and after the interventions to see if rTMS enhanced the benefits of exercise.

Study Duration

2 weeks

Participants

11 participants with chronic tetraplegia and 10 neurologically healthy participants

Evidence Level

Level 2: Randomized crossover design

Key Findings

1
rTMS combined with repetitive task practice (RTP) showed larger improvements in hand function compared to sham rTMS with RTP.
2
The combination of rTMS and RTP resulted in clinically meaningful improvements in hand function, as measured by the Jebsen-Taylor Hand Function Test.
3
There was evidence of inter-manual transfer of training effects, with improvements observed in the non-trained hand.

Research Summary

The study assessed the effects of 10Hz rTMS combined with repetitive task practice (RTP) on hand function in individuals with tetraplegia and neurologically healthy participants. Results indicated that rTMS+RTP was associated with larger effect sizes for improvement in hand function compared to sham-rTMS+RTP, particularly in the trained hand. The findings suggest that rTMS may be a valuable adjunct to RTP for improving hand function in persons with tetraplegia, warranting further investigation into optimal stimulation parameters.

Practical Implications

Enhanced Rehabilitation

rTMS can be integrated into rehabilitation programs to potentially augment the effects of repetitive task practice in improving hand function for individuals with tetraplegia.

Personalized Therapy

Further research should focus on identifying the optimal rTMS parameters (frequency, intensity, duration) to maximize individual responses and tailor treatment approaches.

Inter-manual transfer

Rehabilitation programs should incorporate strategies to encourage inter-manual transfer of skills, as this study demonstrated improvements in the non-trained hand.

Study Limitations

1
The use of biceps brachii as reference for calculating rTMS stimulator frequency could have resulted in insufficient excitation in the corticospinal pathway's projection to the thenar muscles
2
Allowing individuals to perform self-paced RTP could have resulted in differences in training intensity.
3
The lack of effects in the neurologically healthy group could suggest that the dose of rTMS stimulation was insufficient to induce changes in cortical excitability in that group.

Your Feedback

Was this summary helpful?

Back to Spinal Cord Injury