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      The Effect of Repetitive Transcranial Magnetic Stimulation on Lower-Limb Motor Ability in Stroke Patients: A Systematic Review

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          Abstract

          Repetitive transcranial magnetic stimulation (rTMS) is fundamental in inducing neuroplastic changes and promoting brain function restoration. Nevertheless, evidence based on the systematic assessment of the implication of rTMS in stroke patients is inadequate. This study aimed to evaluate the value of rTMS in the treatment of lower-limb motor dysfunction in stroke patients via gait characteristics. The electronic literature search was performed in ScienceDirect, Google Scholar, and PubMed databases using “repetitive transcranial magnetic stimulation,” “gait,” and “stroke” between 2000 and 2020. By screening all the identified studies, a total of 10 studies covering 257 stroke patients were included by matching the inclusion criteria, involving both rTMS with high (≥5 Hz) and low frequency (<5 Hz). Despite the limited study number and relatively high risk of bias, the results of this review primarily confirmed the enhancing effects of rTMS on the lower-limb motor ability (e.g., gait and balance) of stroke patients. In addition, 15- to 20-min course of rTMS for 2 to 3 weeks was found to be the most common setting, and 1 Hz and 10 Hz were the most commonly used low and high frequencies, respectively. These results might have significant clinical applications for patients with weakened lower-limb mobility after a stroke. Nevertheless, more rigorous studies in this field are much warranted.

          Systematic Review Registration: https://inplasy.com/, identifier INPLASY202180079.

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          The influence of gender and age on disability following ischemic stroke: the Framingham study.

          Margaret Kelly-Hayes, Alexa S Beiser, Carlos Kase … (2007)
          The magnitude of disability among elderly stroke survivors is substantial. There have been few community-based estimates of the contribution gender and older age make to stroke-related disability and outcome. Using the original Framingham Study cohort, we documented gender-specific neurological deficits and disability differences in stroke survivors at six months post-stroke. Logistic regression analyses were performed to estimate odds ratios, comparing men and women, and adjusting for age, and age and stroke subtype. Age and gender-matched controls were then compared to distinguish stroke-related disability from disability associated with general aging. Results showed that almost half (43%) of all elderly stroke survivors in the cohort had moderate to severe neurological deficits. In the crude analyses, women were more dependent in ADLs (33.9% vs 15.6%), less likely to walk unassisted (40.3% vs 17.8%), and living in nursing homes (34.9 % vs 13.3%). After adjusting for age and stroke subtype, it was older age that accounted for the severity of disability. When compared to age and gender-matched controls, stroke cases were significantly more disabled in all domains studied. In this elderly cohort, more women experienced initial strokes and were more disabled at 6 months post-stroke than men. However, older age at stroke onset, not gender or stroke subtype, was associated with greater disability. Health care providers need to understand that strokes occur later in life for women and that because of age, women are at greater risk for disability and institutionalization.
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            Gait asymmetry in community-ambulating stroke survivors.

            Iwona Parafianowicz, Heather Patterson, Valerie Closson … (2008)
            To determine the prevalence and severity of asymmetry among independently ambulating stroke survivors and to establish the association between velocity and asymmetry. Descriptive analysis. Research gait laboratory in a Canadian hospital. Community-dwelling, independently ambulating participants (N=54) with chronic stroke. Not applicable. Overground gait velocity, symmetry ratios for temporal and spatial step parameters, and motor impairment of the foot and leg. Spatiotemporal parameters were collected with a pressure-sensitive mat. Motor impairment was measured clinically with the Chedoke-McMaster Stroke Assessment. Thirty (55.5%) participants showed statistically significant temporal asymmetry and 18 (33.3%) exhibited statistically significant spatial asymmetry. Preferred velocity was negatively associated with temporal asymmetry (r=-.583, df=52, P<.001) but not spatial asymmetry (r=-.146, df=52, P=.29). Temporal asymmetry was also associated with motor recovery of the leg (r=-.644, df=35, P<.001) and foot (r=-.628, df=35, P<.001). The results of the current study illustrate that temporal asymmetry can be found in many independently ambulating stroke patients. The work highlights the need for a standard assessment of poststroke gait symmetry in light of the complex relationship with motor impairment and velocity.
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              A sham stimulation-controlled trial of rTMS of the unaffected hemisphere in stroke patients.

              Marco Marcolin, Sergio Rigonatti, J. Neto … (2005)
              The authors investigated the use of slow-frequency repetitive transcranial magnetic stimulation (rTMS) to the unaffected hemisphere to decrease interhemispheric inhibition of the lesioned hemisphere and improve motor function in patients within 12 months of a stroke. Patients showed a significant decrease in simple and choice reaction time and improved performance of the Purdue Pegboard test with their affected hand after rTMS of the motor cortex in the intact hemisphere as compared with sham rTMS.
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                Author and article information

                Contributors
                Journal
                Journal ID (nlm-ta): Front Hum Neurosci
                Journal ID (iso-abbrev): Front Hum Neurosci
                Journal ID (publisher-id): Front. Hum. Neurosci.
                Title: Frontiers in Human Neuroscience
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 1662-5161
                Publication date (Electronic): 01 September 2021
                Publication date Collection: 2021
                Volume: 15
                Electronic Location Identifier: 620573
                Affiliations
                [1] 1Faculty of Sports Science, Ningbo University , Ningbo, China
                [2] 2Doctoral School of Safety and Security Sciences, Obuda University , Budapest, Hungary
                [3] 3Faculty of Engineering , University of Szeged, Szeged, Hungary
                Author notes

                Edited by: Taiar Redha, Université de Reims Champagne-Ardenne, France

                Reviewed by: Nejc Sarabon, University of Primorska, Slovenia; Massimo Venturelli, University of Verona, Italy; Sanjay Kumar, Oxford Brookes University, United Kingdom

                *Correspondence: Yaodong Gu guyaodong@ 123456nbu.edu.cn

                This article was submitted to Motor Neuroscience, a section of the journal Frontiers in Human Neuroscience

                Article
                DOI: 10.3389/fnhum.2021.620573
                PMC ID: 8442991
                PubMed ID: 34539362
                SO-VID: 12b9fdd0-64ca-4aca-a6b4-273d54d88938
                Copyright © Copyright © 2021 Fan, Song, Cen, Yu, Bíró and Gu.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 01 September 2020
                Date accepted : 12 August 2021
                Page count
                Figures: 2, Tables: 3, Equations: 0, References: 33, Pages: 8, Words: 5621
                Categories
                Subject: Human Neuroscience
                Subject: Systematic Review

                ScienceOpen disciplines: Neurosciences
                Keywords: stroke,systematic review,walking,balance,repetitive transcranial magnetic stimulation
                Data availability:
                ScienceOpen disciplines: Neurosciences
                Keywords: stroke, systematic review, walking, balance, repetitive transcranial magnetic stimulation

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