Effective method of combining rTMS and motor training in stroke patients

Enhanced therapeutic effects of repetitive transcranial magnetic stimulation (rTMS) on the motor function of stroke patients when provided in combination with motor training have been reported. The objective of this study was to determine the most effective method for combining rTMS and motor training in stroke patients.Fourteen stroke patients were enrolled. All patients participated in two randomly arranged intervention sessions, each of which incorporated a differently combined rTMS and motor training method. With an interleaved combination method (ICM), an rTMS train and a short period of motor training were interleaved and repeated. With a preconditioning combination method (PCM), rTMS trains were applied as preconditioning, followed by repeated blocks of motor training. The total rTMS pulses and total duration of motor training were the same in both sessions.Performance of a sequential finger motor task improved significantly after both the ICM and PCM interventions: movement accuracy increased and movement time decreased. The PCM-associated improvements were significantly greater than the ICM-associated improvements. Performance in the Purdue Pegboard Test and Nine-Hole Peg Test also improved significantly after both interventions but without a significant difference between the two interventions. Cortical excitability improved after both the ICM and PCM interventions but without a significant difference between the two.In combining rTMS and motor training, preconditioning with rTMS followed by motor training is more effective than interleaving the rTMS and motor training to facilitate the motor performance of stroke patients.