Thesis (M.Sc.) - Cairo University - Faculty of Physical Therapy - Department of Physical Therapy for Neuromuscular and Neurosurgery

Background:Repetitive transcranial magnetic stimulation (rTMS) changes the excitability of the motor cortex and thereby has the potential to enhance motor recovery after stroke.Task oriented training is an interventional method that has proved effective in restoration of abnormal patterns in both the damaged hemisphere and the contralateral hemisphere. Objectives: The purpose of this study is to evaluate the efficacy of bilateral rTMS as an adjunct to task-oriented training in facilitating restoration of upper limb function after stroke. Methods: A total of 40 first time stroke patients with upper limb motor deficits were randomly allocated into four equal groups; bilateral group, which received five daily sessions of 5-Hz ipsilesional rTMS (facilitatory) and 1-Hz contralesional rTMS(inhibitory), , stimulatory group, which recieved five daily sessions of 5-Hz ipsilesional rTMS (facilitatory),inhibitory group, which received five daily sessions of1-Hz ipsilesional rTMS (inhibitory) and control group, which recieved sham rTMS stimulation.Task oriented training (TOT) was given immediately following each session. TOT sessions then continued for one month at 3 sessions per week. Outcome measures included the Fugl-Meyer Upper Extremity assessment, the Wolf Motor Function Test and Modified Ashworth Scale, which were assessed at baseline (pretest) and after rTMS treatment (post one) and after one month of task oriented training (post two), as well as MEP amplitudes assesed at baseline (pre test) and after (post test) rTMS treatment

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