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The Impact of Repetitive Transcranial Magnetic Stimulation on Affected and Unaffected Sides of a Child With Hemiplegic Cerebral Palsy Publisher Pubmed



Parvin S1, 2 ; Mehdinezhad M3 ; Taghiloo A4 ; Nourian R5 ; Mirbagheri MM1, 2, 6
Authors
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Authors Affiliations
  1. 1. Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Neural Engineering Research Center, Noorafshar Hospital, Tehran, Iran
  3. 3. Department of Occupational Therapy, Noorafshar Hospital, Tehran, Iran
  4. 4. Day Hospital, Tehran, Iran
  5. 5. Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
  6. 6. Department of Physical Medicine and Rehabilitation, Northwestern University, United States

Source: Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society# EMBS Published:2018


Abstract

The purpose of this study was to investigate the therapeutic effects of neuro-navigated repetitive transcranial magnetic stimulation (rTMS) combined with occupational therapy (OT) on gait impairment of a child (male, age: 13.2) with spastic hemiplegic cerebral palsy (CP). The treatment included 4 days a week of rTMS sessions for 3 weeks and 4 days of rTMS and OT sessions per week for 3 weeks. Transcranial magnetic stimulation (TMS) was used to evaluate corticospinal tract (CST) activities and H-reflex test was used to assess reflex hyper-excitability. Common clinical tests demonstrate the clinical status of the patient. Evaluations were performed in 4 time steps: baseline, 3 weeks after the beginning of the treatment, at the end of the treatment, and 1 month after the end of the treatment. The patient did not receive any specific treatment after the end of the treatment up to the follow up evaluations. The tests' results were compared between the affected and unaffected legs of the patient. Four parameters of the TMS test were calculated (motor evoked potential (MEP) latency, MEP peak-to-peak amplitude, cortical silent period (cSP), and stimulation intensity). These parameters were all improved for the affected side and cSP improved for the unaffected side, but MEP p-p amplitude and intensity got worse slightly for the unaffected side. Recruitment curves of H response and M-wave of the H-reflex test for both sides were obtained. Improvements could be seen after the treatment for both sides. Max H response on max M-wave (H/M) and H response latency got better after the treatment for both sides. Walking speed for self and fast velocity, timed up and go, and walking endurance improved during and after the treatment. All the improvements persisted after one month of the end of the treatment in the follow up evaluations. These findings indicate that rTMS combined with OT can have effective and long-lasting impact on neuromuscular impairments in spastic CP children. © 2018 IEEE.