Testing spasticity mechanisms in chronic stroke before and after intervention with contralesional motor cortex 1 Hz rTMS and physiotherapy.
Wala Mahmoud, Hans Hultborn, Jagoba Zuluaga and 4 others
PMID 37941036WHAT IT FOUND
After rTMS plus physiotherapy, chronic stroke patients had less reflex-mediated wrist stiffness and better arm scores.
Passive tissue stiffness did not change. Because both treatments were given together, rTMS alone cannot be credited.
Key findings
01After rTMS plus physiotherapy, wrist extension MAS scores changed from 1.47 to 1.25 on a 0 to 4 scale, and total arm MAS scores changed from 12.1 to 10.4 on a 0 to 70 scale.
02The hand-held dynamometer showed a significant reduction in reflex-mediated wrist torque, while passive stiffness did not change.
03Tests of spinal inhibitory circuits showed no significant change in post-activation depression, reciprocal inhibition, or presynaptic inhibition.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
There was no control or sham group, so time, natural recovery, and regular physiotherapy cannot be ruled out. Every patient received rTMS immediately followed by 50 minutes of personalized physiotherapy, so the contribution of either component cannot be separated. Patients were heterogeneous in lesion, time since stroke, and baseline impairment; some were included even without wrist spasticity. Three patients with severe wrist contractures were not measured with the hand-held dynamometer, and Wolf Motor Function Test was done only in 30 patients with sufficient residual arm ability. All measurements were performed by one experienced researcher and physiotherapist, who was also the first author. The correlation between FMA-UE change and post-activation depression change does not show that one caused the other.
Declared interests
Funding was provided by Deutscher Akademischer Austauschdienst, Bundesministerium für Bildung und Forschung, Brain2Move, and Universitätsklinikum Tübingen. The supplied text lists funders but does not provide author conflict-of-interest declarations.
The easy way to misread this
Do not conclude that rTMS alone reduced spasticity. Every patient also received 50 minutes of personalized physiotherapy after each rTMS session, and there was no sham or control group, so the study cannot separate rTMS effects from physiotherapy or time.