High-frequency repetitive transcranial magnetic stimulation enhanced treadmill training effects on gait performance in individuals with chronic stroke: A double-blinded randomized controlled pilot trial

Background: Repetitive transcranial magnetic stimulation (rTMS) combined with treadmill training has been suggested to modulate corticomotor activity and improve gait performance in people with Parkinson's disease. Research question: It is unclear whether this combination therapy has a similar effect in people with stroke. The current study aimed to investigate whether high-frequency rTMS enhances the effects of subsequent treadmill training in individuals with chronic stroke. Methods: Fourteen participants meeting the selection criteria were randomly assigned to either the experimental (n = 8) or control (n = 6) group. The experimental group received 5 Hz rTMS prior to treadmill training three times per week for 3 weeks. The control group received sham rTMS before treadmill training. Walking speed, gait symmetry, corticomotor excitability, motor function of the lower extremities, and muscle activity during walking were measured before intervention, after intervention, and at 1-month follow-up. Results: The walking speed, spatial asymmetry of gait, and motor function of the lower extremities improved significantly in the experimental group, and these improvements exhibited significant differences in between-group comparisons. However, there was no significant difference in corticomotor excitability or brain asymmetry ratio after the intervention in each group. Significance: The current results revealed that applying 5 Hz high-frequency rTMS over the leg motor cortex in the affected hemisphere enhanced the effects of subsequent treadmill training on gait speed and spatial asymmetry in individuals with chronic stroke. Improvement in gait speed persisted for at least 1 month in individuals with chronic stroke.