• Seiji Etoh, Tomokazu Noma, Keiko Ikeda, Yuiko Jonoshita, Atsuko Ogata, Shuji Matsumoto, Megumi Shimodozono, and Kazumi Kawahira.
• Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences3930-7 Makizono-cho, Kagoshima 899-6603, Japan. etohs@m2.kufm.kagoshima-u.ac.jp.
• J Rehabil Med. 2013 Sep 1; 45 (9): 843-7.

ObjectiveTo investigate whether multiple sessions of 1-Hz repetitive transcranial magnetic stimulation (rTMS) facilitates the effect of repetitive facilitation exercises on hemiplegic upper-limb function in chronic stroke patients.DesignRandomized double-blinded crossover study.PatientsEighteen patients with hemiplegia of the upper limb.MethodsPatients were assigned to 2 groups: a motor-before-sham rTMS group, which performed motor rTMS sessions for 2 weeks followed by sham rTMS sessions for 2 weeks; or a motor-following-sham rTMS group, which performed sham rTMS sessions for 2 weeks followed by motor rTMS sessions for 2 weeks. Patients received 1-Hz rTMS to the unaffected motor cortex for 4 min and performed repetitive facilitation exercises for 40 min during motor rTMS sessions. The Fugl-Meyer Assessment, Action Research Arm Test (ARAT) and Simple Test for Evaluating Hand Function were used to evaluate upper-limb function. The Modified Ashworth Scale and F-wave were measured to evaluate spasticity.ResultsMotor function improved significantly during the motor, but not sham, rTMS sessions. ARAT score gains were 1.5 (0-4.0) (median, interquartile range) during the motor rTMS session, and 0 (-0.8-1.8) during the sham rTMS session (p = 0.04). Spasticity did not significantly change during either session.ConclusionMultiple sessions of 1-Hz rTMS facilitated the effects of repetitive facilitation exercises in improving motor function of the affected upper limb, but did not change spasticity.

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