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Evaluation of contralateral limb cross education and high-frequency repetitive transcranial magnetic stimulation on functional indices of the affected upper limb in subacute phase of stroke
Rezaei K, Kordi Yoosefinejad A, Moslemi Haghighi F, Razeghi M
Stroke Research and Treatment 2023 Dec 19(4387667):Epub
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: No. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Stroke is one of the causes of long-term morbidity. Despite rehabilitation strategies, most survivors live with motor deficits in the upper limbs. OBJECTIVES:. The aim of the study was to compare the effect of contralateral cross education (CE) and high-frequency repetitive magnetic stimulation (HF-rTMS) on the function of upper extremity in subacute phase of stroke. METHODS: Forty patients were randomly assigned into 4 groups. Group "A"received physical therapy (PT) for 10 sessions, 3 times per week. Group "B"received PT and HF-rTMS as follows: stimulation of 20 Hz for 5 s, intertrain interval for 50 s, 20 trains, 2000 pulses at 90% resting motor threshold, and conventional PT. Group "C"was treated with CE and PT. In group "D,"HF-rTMS, CE, and PT were administered. RESULTS: Significant differences were found in the Fugl-Meyer scale between "A"and "C"(p = 0.01), "A"and "D"(p = 0.02), and "B"and "C"groups (p = 0.01). In the box-block test, there were significant differences between "A"and "B"(p = 0.01), "A"and "C"(p < 0.001), "B"and "D"(p = 0.001), and "B"and "C"groups (p = 0.01). Statistical differences were observed in grip strength between "A"and "B"(p = 0.01) and "A"and "C"groups (p = 0.02). CONCLUSIONS: It is suggested that clinicians select the therapeutic methods in line with their expected goal. When the goal is to improve upper extremity function, CE plus PT could be more effective than HF-rTMS plus PT. Also, CE plus PT and HF-rTMS plus PT were more effective than CE plus HF-rTMS plus PT at improving grip strength. Therefore, combining several methods would not always lead to better results.

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