Objective: To examine the effects of HF-rTMS with reach-to-grasp (RTG) training focusing on the movement amplitude

Background: Previous studies applied the HF-rTMS over primary motor area (M1) to compensate the thalamocortical pathway deficit for solving bradykinesia. However, the lasting effect is a limitation of one session, so the motor training is suggested to combine. The task specific training focusing on the movement amplitude is suitable for improving the bradykinesia Thus, it is important to examine the effects of one session of HF-rTMS with RTG training.

Methods: PD patients were allocated into two groups, the experimental group received HF-rTMS (600 pulses at 10Hz) over left M1 combined with RTG training and the control received HF-rTMS over left M1 combined with general upper limb exercises. They were evaluated motor-evoked-potential (MEP) amplitude, cortical silent period (CSP), reaction time (RT), and RTG action including total movement time (TMT), maximum transport velocity (Vmax), and maximum aperture (Amax) at pre-test, post training, post 1 day, and post 2 day. The four conditions for measuring RTG action included large non-barrier (LNB), large barrier (LB), small non-barrier (SNB), and small barrier (SB).

Results: Thirteen PD participated. Their Hoehn and Yahr scale were II and III. In experimental group, the MEP amplitude at post training and post 2 days showed significant greater when compared to the pre-test. Moreover, the CSP at post 2 days was significantly longer than that of the pre-test in experimental group. The RT in LNB significantly decreased when comparing between pre-test and post 1 day in both groups and significantly decreased when comparing between post-training and post 1 day in experimental group. TMT in all conditions showed no significant differences between the two groups. The Vmax in LB showed a significant difference between the two groups at post 1day. In experimental group, Vmax significantly increased when compared between post training and post 2 days. The Amax in all of conditions tended to increase in experimental group.

Conclusions: The RTG deficits could be improved by HF-rTMS combined with RTG training evidenced by the decreased RT, the increased Vmax and Amax. The directly stimulation over M1 may improve Vmax and Amax. The motor planning is adjusted by the focusing on movement amplitude.The finding is the suggested protocol to improve the bradykinesia of movement amplitude and could maintain for two days.

References: 1. Randhawa BK, Farley BG, and Boyd LA. Repetitive Transcranial Magnetic Stimulation Improves Handwriting in Parkinson’s Disease. Parkinson’s Dis. 2013. 2. Farley B.G, Koshland G.F. Training BIG to move faster: the application of the speed–amplitude relation as a rehabilitation strategy for people with Parkinson’s disease. Experimental brain research. 2005;167:462-67.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effects-of-high-frequency-repetitive-transcranial-magnetic-stimulation-hf-rtms-combined-with-task-specific-training-in-individuals-with-parkinsons-disease/