Ann Rehabil Med.  2022 Dec;46(6):275-283. 10.5535/arm.22058.

Effect of Low Frequency Cerebellar Repetitive Transcranial Magnetic Stimulation on Balance Impairment in Patients With Cerebral Infarction

• Im NG
• Oh KR
• Kim Mg
• Lee Y
• Lim NN
• Cho TH
• Ryu SR
• Yoon SR

• KMID: 2537158
• DOI: http://doi.org/10.5535/arm.22058

Abstract

Objective
To investigate the effect of low frequency cerebellar repetitive transcranial magnetic stimulation (rTMS) on balance impairment in patients with cerebral infarction.
Methods
Thirty-two patients were randomly divided into two groups: rTMS group (n=16) and control (n=16). In the rTMS group, treatment was performed five times per week for 2 weeks (10 sessions), and in the control group, a sham coil was used with the sound and sensation of scalp similar to the rTMS coil. Patients in both groups underwent a conventional rehabilitation program. Berg Balance Scale (BBS) was used as the primary outcome measurement. Timed Up and Go test (TUG), 10-m walk test (10mWT), and Activity-specific Balance Confidence scale (ABC) were used as the secondary outcome measurement. All scales were measured at baseline (T0), after 10 sessions of rTMS (T1), and at 4 weeks after treatment completion (T2) by therapists with over 5 years of clinical experience.
Results
There were significant improvements between T0 and T1, and between T0 and T2, for all assessed items in the rTMS group. Whereas there were significant improvements between T0 and T1, and between T0 and T2, for the BBS and 10mWT in the control group. TUG (-4.87±5.05 vs. -0.50±2.97 seconds) and ABC score (8.10±8.33 vs. 0.16±0.97) were observed significant differences in comparison of the changes from T0 to T1 between the two group. BBS score (4.40±3.66 vs. 1.88±3.14), TUG (-4.87±4.56 vs. -0.62±2.96 seconds) and ABC score (8.22±7.70 vs. -0.09±0.86) differed significantly from T0 to T2 between the two groups.
Conclusion
Our findings suggest that low-frequency cerebellar rTMS is helpful for improving balance in patients with cerebral infarction, and maybe a beneficial treatment for these patients.

Keyword

Repetitive transcranial magnetic stimulation (rTMS); Stroke; Balance

Figure

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  Fig. 1. Study flowchart. rTMS, repetitive transcranial magnetic stimulation; PCA, posterior cerebral artery.

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  Fig. 2. Cerebellar repetitive transcranial magnetic stimulation. The coil of the machine used for treatment was placed 2 cm below and 2 cm lateral to the inion by targeting the cerebellar hemisphere contralateral to the site of cerebral infarction. The photo was posted with the consent of the patient.

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  Fig. 3. Results of the comparison of the changes from T0 to T1 between the two groups: (A) BBS, (B) TUG, (C) 10mWT, and (D) ABC. rTMS, repetitive transcranial magnetic stimulation; BBS, Berg Balance Scale; TUG, Timed Up and Go test; 10mWT, 10-m walk test; ABC, Activity-specific Balance Confidence scale; T0, baseline; T1, 10 sessions after treatment. *p<0.05 comparison between rTMS group and control group by repeated-measures ANOVA.

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  Fig. 4. Results of the comparison of the changes from T0 to T2 between the two groups: (A) BBS, (B) TUG, (C) 10mWT, and (D) ABC. rTMS, repetitive transcranial magnetic stimulation; BBS, Berg Balance Scale; TUG, Timed Up and Go test; 10mWT, 10-m walk test; ABC, Activity-specific Balance Confidence scale; T0, baseline; T1, 10 sessions after treatment. *p<0.05 comparison between rTMS group and control group by repeated-measures ANOVA.

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