5 Hz repetitive transcranial magnetic stimulation over the ipsilesional sensory cortex enhances motor learning after stroke

Sonia M Brodie, Sean Meehan, Michael R Borich, Lara A Boyd, Sonia M Brodie, Sean Meehan, Michael R Borich, Lara A Boyd

Abstract

Sensory feedback is critical for motor learning, and thus to neurorehabilitation after stroke. Whether enhancing sensory feedback by applying excitatory repetitive transcranial magnetic stimulation (rTMS) over the ipsilesional primary sensory cortex (IL-S1) might enhance motor learning in chronic stroke has yet to be investigated. The present study investigated the effects of 5 Hz rTMS over IL-S1 paired with skilled motor practice on motor learning, hemiparetic cutaneous somatosensation, and motor function. Individuals with unilateral chronic stroke were pseudo-randomly divided into either Active or Sham 5 Hz rTMS groups (n = 11/group). Following stimulation, both groups practiced a Serial Tracking Task (STT) with the hemiparetic arm; this was repeated for 5 days. Performance on the STT was quantified by response time, peak velocity, and cumulative distance tracked at baseline, during the 5 days of practice, and at a no-rTMS retention test. Cutaneous somatosensation was measured using two-point discrimination. Standardized sensorimotor tests were performed to assess whether the effects might generalize to impact hemiparetic arm function. The active 5 Hz rTMS + training group demonstrated significantly greater improvements in STT performance {response time [F (1, 286.04) = 13.016, p < 0.0005], peak velocity [F (1, 285.95) = 4.111, p = 0.044], and cumulative distance [F (1, 285.92) = 4.076, p = 0.044]} and cutaneous somatosensation [F (1, 21.15) = 8.793, p = 0.007] across all sessions compared to the sham rTMS + training group. Measures of upper extremity motor function were not significantly different for either group. Our preliminary results suggest that, when paired with motor practice, 5 Hz rTMS over IL-S1 enhances motor learning related change in individuals with chronic stroke, potentially as a consequence of improved cutaneous somatosensation, however no improvement in general upper extremity function was observed.

Keywords: hemiparesis; motor learning; primary sensory cortex; repetitive transcranial magnetic stimulation; stroke; upper extremity.

Figures

Figure 1
Figure 1
(A) Experimental overview. At the baseline session on day 1, STT performance was assessed along with RMT, 2PD, WMFT, and Box & Blocks performance. Five sessions of rTMS paired with STT practice were completed on separate days (days 2–6). A delayed no-rTMS retention test was administered on a separate day 7 to assess motor learning; all baseline measures were re-assessed. (B) Example of target locations in BrainSight™ for M1 and S1. (C) Schematic of the experimental motor learning task, the STT, showing the adapted mouse, a sample progression of targets and illustration of a path of movements between 2 targets. STT, Serial Tracking Task; RMT, Resting Motor Threshold; 2PD, 2 Point Discrimination; WMFT, Wolf Motor Function Test; rTMS, repetitive Transcranial Magnetic Stimulation.
Figure 2
Figure 2
(A) Serial tracking task (STT) mean performance values across all 7 days of the experiment for the Active and Sham groups. A significant Group * Day interaction was observed for (i) Response Time, (ii) Peak Velocity and (iii) Cumulative Distance tracked (p ≤ 0.044). (B) Change scores from baseline to retention for the Active and Sham groups. Negative change scores reflect performance improvements from baseline to retention, as reflected by reduced response times, lower peak velocities and less cumulative distance traveled, respectively. A significant Group * Day interaction was observed for Response Time (i; *p = 0.011), but not for Peak Velocity (ii; p = 0.122) or Cumulative Distance tracked (iii; p = 0.081). Error bars are s.e.m.
Figure 3
Figure 3
Individual thresholds for 2-point discrimination at baseline and retention, by stimulation type. Lower values indicate better somatosensory discrimination (i.e., less distance between stimulation points). Solid lines indicate first time participation, dashed lines indicate second time (crossed over) participation. (n = 8 Active; 10 Sham). *p = 0.007.
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/3968757/bin/fnhum-08-00143-g0004.jpg

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