2012 Annual Conference

Foreman, Jack & Forshee, Claudia

Transitional Learning Center - Galveston, Texas

Repetitive Transcranial Magnetic Stimulation (rTMS) is a precise non-invasive method of modulating cortical excitability and thus presents potential application to the rehabilitation of patients with impaired motor function. Patients who have suffered traumatic brain injuries often experience deficiencies in motor function. The use of Physical Therapy (PT) to rehabilitate movement has yielded significant improvements in patients’ motor control and thus quality of life. Increasing the excitability of the corticomotor area with high-frequency rTMS primes the motor pathway, increasing muscle excitability and thus increases the efficacy of physical therapy. 

Study assessed preformance of a 51 year-old white male 30 years after sustaining a traumatic brain injury due to a car collision.

This study analyzed motor function and gait performance of a 51 year-old white male 30 years after sustaining a traumatic brain injury due to a car collision. Baseline performance of lower extremity spasticity and range of motion, and gait was measured before starting rTMS sessions and performance was re-evaluated after 2 and 4 weeks of treatment. Treatment consisted of 10 daily high-frequency rTMS sessions over the first 2 weeks and 8 rTMS sessions over the course of the second 2 weeks. The rTMS was immediately followed by 45 min sessions of PT focused on stretching and strengthening the lower extremities and aspects of functional gait. Over-ground and treadmill exercises were conducted with verbal and manual cues and with the use of assistive devices, such as single-point canes and orthotics. 

Gait parameters measured using GAITRite system. Spasticity measured using Tardieu scale at sign of first catch.

Notable improvements were seen in multiple aspects of the patient’s gait when measured by the GAITRite system. Assessment of ambulation without assistive devices and minimal balance assistance showed an increase in velocity by 109% (8.6 m/s at baseline, and 18 m/s after 4 weeks of treatment) and an increase of step length of the affected leg (right) by 22.89 cm (-0.04 at baseline).  Improvement in step length of the affected leg decreased the step differential from 19.65cm to 1.27cm. Additionally, lower extremity spasticity improved by 7 degrees in the right leg and 16 degrees in the left leg according to the Tardieu scale at sign of first catch. 

Overall, the patient exhibited obvious improvements in motor control and gait. His ability to ambulate without use of a wheelchair greatly improved as did his general degree of safety and quality of life. The patient had undergone PT for an extended period of time prior to the rTMS, which suggests that rTMS had a positive affect on the state of the patient’s motor function beyond that seen with PT alone. Because the rTMS was focused directly on the motor cortex, this treatment would benefit patients with impaired motor function not necessarily caused by brain injury. Other treatable conditions include Parkinson’s disease, incomplete spinal cord injuries and stroke. The prevalence of these movement disorders in the population requires the most efficient treatment regiments possible and rTMS may prove to be a powerful tool for achieving high-quality rehabilitation.

Other treatable conditions include Parkinson’s disease, incomplete spinal cord injuries and stroke. The prevalence of these movement disorders in the population requires the most efficient treatment regiments possible and rTMS may prove to be a powerful tool for achieving high-quality rehabilitation.