Effects and safety of combined rTMS and action observation for recovery of function in the upper extremities in stroke patients: A randomized controlled trial

Jun Soo Noh, Ji Hoon Lim, Tae Woong Choi, Seung Gul Jang, Sung Bom Pyun

Research output: Contribution to journalArticlepeer-review

23 Citations (Scopus)


Background: Repetitive transcranial magnetic stimulation (rTMS) modulates cortical excitability and facilitates motor learning to improve motor recovery after stroke. Action observation (AO) therapy effectively facilitates physical training for motor memory formation. Objective: To compare the effectiveness of rTMS alone with that of combined rTMS and AO for the functional recovery of upper extremity function in subacute stroke patients and to verify the safety of the interventions. Methods: The present study was a prospective, randomized controlled trial involving subacute unilateral stroke patients. In total, 22 patients were randomly assigned to 2 groups: the trial group (rTMS with AO) and the control group (rTMS alone). Both groups received 1 Hz rTMS (intensity: 120% of resting motor threshold; rMT) over the contralesional primary motor cortex for 20 minutes on 10 consecutive days. Trial group received rTMS while watching a video of 5 different complex hand movements. The functional parameters were the Brunnstrom stage, Fugl-Meyer assessment (FMA) score of the upper extremity, Manual Function Test (MFT) score, and grip power. The following motor evoked potential (MEP) parameters were recorded from the abductor pollicis brevis muscle: rMT, latency, and amplitude. Both parameters were measured before and after the 2 week intervention. Results: After the 2 week trial, the total FMA and MFT scores were significantly improved in both groups, but the MFT subscores of hand motor function and grip power were significantly improved in the combination therapy group only. In contrast, the changes (δ) of FMA, MFT, grip power test, and MEP outcomes were not significantly different between the 2 groups. No adverse events or complications were reported. Conclusions: Distal upper extremity function, as measured by MFT and grip power, was improved after rTMS and AO in combination. The combination of rTMS with AO may be applied safely to improve upper extremity function after stroke.

Original languageEnglish
Pages (from-to)219-230
Number of pages12
JournalRestorative Neurology and Neuroscience
Issue number3
Publication statusPublished - 2019

Bibliographical note

Funding Information:
No potential conflict of interests relevant to this article were reported. This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. 2019R1A2C2003020).

Publisher Copyright:
© 2019 - IOS Press and the authors. All rights reserved.


  • Transcranial magnetic stimulation
  • hemiplegia
  • recovery of function
  • stroke
  • stroke rehabilitation

ASJC Scopus subject areas

  • Neurology
  • Developmental Neuroscience
  • Clinical Neurology


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