Repetitive Transcranial Magnetic Stimulation May Benefit Motor Recovery
Repetitive Transcranial Magnetic Stimulation May Benefit Motor Recovery After Incomplete Spinal Cord Injury: A Case Study Foreman, J. , Masel, B. MD Transitional Learning Center • Galveston, Texas Background Motor impairments following an incomplete spinal cord injury can have devastating effects on daily living. Tasks that were originally habitual can become much more difficult or even impossible. The rehabilitation of motor function can help restore the ability to complete tasks for eating and bathing without assistance and significantly increase an individual’s quality of life. Discussion and Conclusion f. MRI data shows less cortical blood flow when performing hand movement task after hfr. TMS intervention This intervention concluded with notable improvements in finger dexterity and strength and the functional gains were fully retained 2 weeks after the initial 10 sessions and remained 9 weeks after the 15 th session. Transcranial magnetic stimulation (TMS) is a non-invasive technique used to modulate the excitability of discrete cortical areas using electromagnetic induction. High frequency repetitive TMS (hfr. TMS) utilizes a series of stimuli applied at 5 Hz to increase neural excitability and activate the impaired afferent motor pathways. Functional magnetic resonance imaging (f. MRI) can be used to observe the changes in cortical activation after the application of r. TMS. We believe that r. TMS significantly increased the efficacy of OT and the results were not solely a result of OT, because similar gains were not observed during previous occupational therapy without r. TMS. This modality for activating motor pathways has a great deal of potential for assisting motor recovery in the clinical setting for individuals with incomplete spinal cord injuries. And because of the necessity for high quality rehabilitation for muscle control, the capabilities of hfr. TMS need to be continually explored and considered for i. SCI rehab. The condensed locality and decreased intensity of cortical activation shown by the BOLD f. MRI data may infer more efficient muscle activation via M 1 after hfr. TMS and OT. Less blood flow, meaning less energy and effort, was required for this patient to produce identical hand movements. f. MRI before hfr. TMS Objective Assess changes of functional hand movement and cortical activity after applying high frequency r. TMS to the primary motor cortex after an i. SCI High frequency r. TMS appears to be a beneficial tool for aiding the recovery of motor function when used to supplement OT. Stimulating the primary motor cortex may enhance the ability of descending motor pathways to traverse the injured spinal area and reach the target muscle. f. MRI after hfr. TMS Future research of hfr. TMS should explore the efficacy of suprathreshold stimulation as well as compare the benefit of OT with r. TMS to OT without r. TMS. Results Grip strength increased from 0 lbs to 6. 3 lbs over the first two weeks of TMS and OT Patient’s ability to partially adduct and abduct her thumb from a neutral position increased notably. This allowed her to ‘click’ a pen, which was not previously possible. Experimental Design Subject Thirty-five-year-old female functional quadriplegic Injury result of incomplete C 5 -C 6 SCI 15 years prior Presented negligible hand function except for moderate wrist movement Cortical blood flow induced by hand movement decreased and area of cortical activation condensed to more focal area of M 1. Measures Functional grip strength and finger dexterity f. MRI of cortical activation during finger movement Neuronavigated r. TMS apparatus Acknowledgements Intervention Ten hfr. TMS and OT sessions over two weeks Two week break Five hfr. TMS and OT sessions over one week Stimulation consisted of 300 stimuli applied intermittently at 5 Hz. Applied to right Pollicis Brevis area of M 1 at 90% of resting motor threshold. r. TMS followed immediately by Occupational Therapy focused on hand control. Moody Endowment 3 D model of MRI for neuronavigation Magnetic field representation and EMG display Bibliography Demirtas-Tatlidede, A. , Vahabzadeh-Hagh, A. , Bernabeu, M. , Tormos, J. , Pascual-Leone, A. (2012). Noninvasive brain stimulation in traumatic brain injury. J Head Trauma Rehabil. 27, 274 -292.
- Slides: 1