Effects of combining repetitive transcranial magnetic stimulation with treadmill training on gait performance in individuals with chronic stroke

INTERVENTION: Fourteen participants with chronic stroke were randomly assigned to experimental (n=8) or control group (n=6). Participants in both groups received treadmill training for 30 minitues, 3 times a week for 3 weeks. The treadmill training started with a 5 minutes warm up session walking at half of participant’s preferred speed. After warm up, the treadmill speed would be increased gradually until the maximum tolerable and safe speed of the participant has been reached. While training, a suspension system was used to ensure the safety of the participants, and a physiotherapist would be standing aside to ensure that the participants walked with good posture and appropriate weight transfer using verbal cues. Prior to each treadmill training session, the participants in the experimental group received real repetitive transcranial magnetic stimulation (rTMS) with 5Hz, 10s, 18 trains with total 900 pulses at 90% resting motor threshold for 15 minutes to the ipsilesional primary motor cortex of tibialis anterior (TA) muscle, and the control group received sham rTMS. CONDITION: stroke PRIMARY OUTCOME: gait velocity obtained from the GAITRite system, SECONDARY OUTCOME: lower extremity motor score of Fugl‐Meyer Assessment brain motor evoked potential (MEP) asymmetry calculated by using amplitude of MEP of both hemispheres obtained from MagStim 200 and the formula built by Brouwer et al., 2006. electromyography (EMG) of TA during walking electromyography (EMG) of rectus femoris (RF) during walking gait asymmetry index using formulas proposed by O'Sullivan et al, 2007 and Hsu et al., 2003 INCLUSION CRITERIA: (1) hemiparesis from a single stroke, (2) after stroke period more than 6 month. (3)able to walk independently for 10 meters with or without an assistive device. (4) Stable medical condition to allow participation in the testing protocol