Hyun Gyu Cha

Effects of repetitive transcranial magnetic stimulation on arm function and decreasing unilateral spatial neglect in subacute stroke: A randomized controlled trial

Objective: The objective of this study is to investigate the effect of repetitive transcranial magnetic stimulation (rTMS) on the functional recovery of stroke patients with unilateral neglect. Design: Randomized controlled experimental study. Setting: Outpatient rehabilitation hospital. Subjects: Thirty patients with stroke were randomly assigned to two groups: an rTMS group (experimental) and a control group. Interventions: Stroke patients in the experimental group underwent comprehensive rehabilitation therapy and rTMS. Stroke patients in the control group underwent sham therapy and comprehensive rehabilitation therapy. Participants in both groups received therapy 5 days per week for 4 weeks. Main measures: Line bisection, Albert, Box and block and Grip strength tests were assessed before and after the four-week therapy period. Results: A significant difference in the post-training gains in Line bisection (16.53 SD 9.78 vs. 3.60 SD 5.02), Albert (14.13 SD 4.92 vs. 3.26 SD 2.01), Box and block (15.06 SD 9.68 vs. 6.93 SD 7.52), and Grip strength tests (3.60 SD 2.66 vs 0.80 SD 1.26) was observed between the experimental group and the control group (P<0.05). In addition, the effect size for gains in the experimental and control groups was very strong in AT, BBT (effect size=2.15, 0.77 respectively). Conclusion: We conclude that rTMS might be effective in improvement in reduction of the unilateral neglect and motor function.

Therapeutic Efficacy of Low Frequency Transcranial Magnetic Stimulation in Conjunction with Mirror Therapy for Sub-acute Stroke Patients

The purpose of the current study was to investigate the effect of repetitive transcranial magnetic stimulation (rTMS) in conjunction with mirror therapy on the balance function of patients with sub-acute stroke hemiparesis. This study was conducted with 36 subjects who were diagnosed with a hemiparesis due to stroke. Participants in the experimental (19 members) and control groups (17 members) received rTMS and sham rTMS during 10 minute sessions each, which were carried out five days per week for four weeks. This was followed by the mirror therapy over 30 minute sessions, which were carried out five days per week for four weeks. Motor recovery was assessed by balance index, dynamic limits of stability, Berg balance scale, and time up go test. The change values of the balance index (?2.06 ± 1.99 versus ?0.41 ± 1.11), dynamic limits of stability (3.68 ± 2.71 versus 1.17 ± 2.38), and time up go test (?7.05 ± 5.64 score versus ?3.35 ± 5.30 score) were significantly higher in the experimental group than in the control group ( p < 0.05). At post-test, balance index (4.08 ± 1.14 versus 5.09 ± 1.04), dynamic limits of stability (13.75 ± 0.60 versus 11.73 ± 3.53), and time up go test (23.89 ± 4.51 versus 28.82 ± 3.07) were significantly higher in the experimental group than in the control group ( p ＜ 0.05). In the experimental group, significant differences were found in the pre- and post-test scores for the balance index, dynamic limits of stability, Berg balance scale, and time up go test ( p ＜ 0.01). In the control group, a significant difference was observed between the pre- and post-test only for the Berg balance scale and time up go test ( p ＜ 0.05). These findings demonstrate that the application of 1㎐ rTMS in conjunction with mirror therapy can be helpful in improving the balance function of patients with sub-acute stroke hemiparesis, and this may be used as a practical adjunct to routine rehabilitation therapy.

Effects of strengthening exercise integrated repetitive transcranial magnetic stimulation on motor function recovery in subacute stroke patients: A randomized controlled trial

OBJECTIVE To investigate the effects of strengthening exercise integrated repetitive transcranial magnetic stimulation (rTMS) on motor function recovery in subacute stroke patients. SUBJECTS AND METHODS Thirty subacute stroke patients were randomly assigned to three groups: an ankle strengthening exercise group (group I), ankle strengthening exercise integrated rTMS group (group II), or an rTMS group (control group (CG)). Study subjects received therapy five days per week for eight weeks. Motor-evoked potential testing, peak torque at the ankle joint, and 10 m walk test were performed before and after the eight-week treatment period. RESULTS Subjects in group II showed significantly higher amplitude of MEP, plantarflexor and dorsiflexor of peak torque, 10 m walk test than groups I and CG (p < 0.05). Subjects in groups I and II differed significantly in the pre- and post-test for all variables, (p < 0.05). In the CG group, the pre- and post-test scores for the amplitude of MEP, dorsiflexor, and 10-walk test differed significantly (p < 0.05). CONCLUSIONS Strengthening exercise integrated rTMS has positive effects on motor function recovery in subacute stroke patients.

Effect of high-frequency repetitive transcranial magnetic stimulation on motor cortical excitability and sensory nerve conduction velocity in subacute-stage incomplete spinal cord injury patients.

[Purpose] The aim of the present study was to determine whether repetitive transcranial magnetic stimulation can improve sensory recovery of the lower extremities in subacute-stage spinal cord injury patients. [Subjects and Methods] This study was conducted on 20 subjects with diagnosed paraplegia due to spinal cord injury. These 20 subjects were allocated to an experimental group of 10 subjects that underwent active repetitive transcranial magnetic stimulation or to a control group of 10 subjects that underwent sham repetitive transcranial magnetic stimulation. The SCI patients in the experimental group underwent active repetitive transcranial magnetic stimulation and conventional rehabilitation therapy, whereas the spinal cord injury patients in the control group underwent sham repetitive transcranial magnetic stimulation and conventional rehabilitation therapy. Participants in both groups received therapy five days per week for six-weeks. Latency, amplitude, and sensory nerve conduction velocity were assessed before and after the six week therapy period. [Results] A significant intergroup difference was observed for posttreatment velocity gains, but no significant intergroup difference was observed for amplitude or latency. [Conclusion] repetitive transcranial magnetic stimulation may be improve sensory recovery of the lower extremities in subacute-stage spinal cord injury patients.

Effects of trunk stabilization exercise on the local muscle activity and balance ability of normal subjects

[Purpose] The purpose of this study was to investigate the effects of trunk stabilization exercise on the transvers abdominalis (TA) and internal oblique (IO) muscle activity and balance ability of normal subjects. [Subjects and Methods] Forty healthy male subjects without orthopedic history of the lower extremity were selected for the present study. The experimental group received a hollowing exercise, curl-up and bridging exercise. The control group received a pelvic tilting exercise in the sitting position for the same period of time. [Results] Significant differences in the post-training gains in Balance index, TA, IO were observed between the experimental group and the control group. [Conclusion] The trunk stabilization exercise improved the balance ability and increased the activity of the TA and IO muscle.

The Effect of Low-Frequency (1 Hz) rTMS on the Cerebellar Cortex in Patients with Ataxia After a Posterior Circulation Stroke : Randomized Control Trial

To assess the Safety, feasibility, and efficacy of low-frequency repetitive transcranial magnetic stimulation (rTMS) applied to the cerebellum in patients with acute posterior circulation stroke. Thirty ataxic patients with acute posterior circulation stroke were randomized to experimental (EG = 15) and control groups (CG = 15). All subjects received a 30-minute mirror therapy in common, which consisted of lower limb strengthening exercises and balance enhancement program related to functional tasks. During this intervention, mirrors were placed on the front and side walls to provide visual feedback about their movement. EG applied 1HZ real rTMS for 15 minutes to the cerebellum before mirror treatment and sham rTMS for CG. Intervention was performed once a day, five times a week for four weeks. Static balance test, Wisconsin gait scale, 6 minute walk test (6MWT) and time up go test (TUG) were performed before and after the intervention. At post-test, Static balance test (98.53.68 ± 6.94 versus 110.53 ± 16.83), Wisconsin gait scale (25.61 ± 4.86 versus 29.54 ± 5.82), 6 minute walk test (181.47 ± 34.52 versus 165.72 ± 35.63), time up go test (24.47 ± 4.55 versus 28.93 ± 3.13) was a significant difference in the experimental group than in the control group (p < 0.05). There was a significant difference between the pre-test and post-test scores for all variables in both groups (p < 0.01). The results of this study show that 1 Hz rTMS application to the cerebellum is safe and feasible and may have beneficial effects on the balance function of stroke patients with posterior circulation dysfunction.

The effects of horse riding simulation exercise with blindfolding on healthy subjects’ balance and gait

[Purpose] The study was conducted to determine the effect of horse riding simulation combined with blindfolding on healthy individuals’ balance and gait. [Subjects and Methods] Thirty subjects were randomly divided into an experimental group (n=15) and a control group (n=15). The subjects in the experimental group covered their eyes using a blindfold, climbed onto a horse riding simulator, and performed the horse riding simulation exercise. The control group took part in the horse riding exercises without a blindfold. All of the subjects performed the 20 minutes long exercise once a day, five times a week, over a four-week period. [Results] The experimental group showed significant improvement in static balance, dynamic balance, velocity, and cadence compared to pre-intervention measurements. In addition, the control group showed significant improvement in static balance, dynamic balance, single support, and cadence compared to pre-intervention measurements. Significant differences in post-training gains in static balance, dynamic balance, and cadence were observed between the experimental group and the control group. [Conclusion] Subjects that performed horse riding simulation exercise after blindfolding showed significant improvements in balance and cadence compared to the control group.

The effects of sitting with the right leg crossed on the trunk length and pelvic torsion of healthy individuals

[Purpose] The purpose of this study was to determine the effects on the trunk length and pelvic torsion of healthy individuals that arise from crossing the right leg while sitting. [Subjects and Methods] The subjects in this study were 30 healthy individuals consisting of 18 males and 12 females. The subjects were instructed to sit on a chair, the height of which was adjustable, so that their knee and hip joints were bent at 90°. For the study, they sat stripped to the waist, with the back and hips bare. They were then instructed to perform a one-leg-crossed sitting posture by placing the right leg on the top of the left knee. A spinal posture test was performed to measure the subjects’ trunk length and pelvic torsion by using a three-dimensional image-based spinal diagnostic system. [Results] The results of the three-dimensional spine examination showed statistically significant decreases in trunk length and pelvic torsion after the one-leg-crossed sitting posture. [Conclusion] In this study, the right leg-crossed sitting posture led to a decrease in the right trunk length with time and, in terms of pelvic torsion, increased the posterior rotation of the right pelvis when compared with the left pelvis.