Effects of High-Frequency (HF) Repetitive Transcranial Magnetic Stimulation (rTMS) on Upper Extremity Motor Function in Stroke Patients: A Systematic Review

Background and Objectives: Repetitive transcranial magnetic stimulation (rTMS) is being widely used for treating upper extremity paresis after stroke, however, evidence of applying high-frequency rTMS (HF-rTMS) on the ipsilesional hemisphere for upper extremity motor recovery remains limited. This systematic review aimed to investigate the effect of high-frequency repetitive transcranial magnetic stimulation for upper extremity motor function recovery after a first-time ischaemic stroke. Materials and Methods: This systematic review was prepared according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. A comprehensive literature search was performed to identify all studies published before 12 February 2021. The search was performed on the following databases: PubMed, Ovid, The Cochrane Library. Results: A total of 6440 studies were found in the databases and four trials were included in the review. Three of the studies were randomized control trials (RCT), and one was a pseudo-RCT. Three of the studies showed good methodological quality and one study was rated as excellent. Fugl-Meyer Assessment (FMA) was performed in three out of four studies and the score significantly increased in the HF-rTMS treatment group compared with sham stimulation in all trials. Other measures used in the studies were handgrip strength, shoulder abduction, Motricity Index, Wolf Motor Function Test (WMFT), and Box and Block, although these tests did not show unanimous results. Overall, all four studies conveyed significantly better results in at least one test that was performed for hand motor function evaluation in a 10 Hz stimulation group while none of the tests showed any advantage for sham stimulation groups. Two studies reported headache as an adverse event (six patients in total). Conclusion: The overall results showed that HF-rTMS may increase impaired upper extremity motor function better than sham stimulation in stroke patients.

Effect of Different Physical Therapy Programs on Renal Transplant Recipients' Physical Activity, Grip Strength, and Psychoemotional Status and the Associations Between These Indices

The aim of this study was to evaluate the effect of different physical therapy programs on physical activity, grip strength, and psychoemotional status of individuals who had undergone renal transplant and to determine the associations between these indices. The study included 32 individuals who had undergone renal transplant; the subjects were distributed into 2 groups, each consisting of 16 individuals. Group 1 received a physical therapy program involving aerobic exercises, and group 2 received a physical therapy program involving Pilates exercises. During the study, physical activity was evaluated using the long version of the International Physical Activity Questionnaire. Grip strength in the hands was evaluated with a dynamometer. Psychoemotional status was evaluated by applying the Hospital Anxiety and Depression Scale. To evaluate the effectiveness of physical therapy programs, we assessed changes in physical activity, grip strength, and psychoemotional status, and the associations between these indices. The evaluation of changes in physical activity, grip strength, and psychoemotional status when applying different physical therapy programs showed a significant change in these indices in both groups. The study also showed that both physical therapy programs had equal effect on the analyzed indices. The evaluation of the association between physical activity and grip strength showed a direct weak correlation between physical activity and grip strength in the left and right hands, a moderate inverse correlation between the level of physical activity and the severity of anxiety, and an inverse correlation between time after renal transplant and the severity of anxiety. In addition, we found a direct strong correlation between physical activity and its other domains and an inverse correlation between physical activity and the duration of sitting (min/wk).