Effect of Combined Therapy of Robot and Low-Frequency Repetitive Transcranial Magnetic Stimulation on Hemispatial Neglect in Stroke Patients

Abstract

Objective: To investigate the effect of upper limb rehabilitation combining robot with low-frequency repetitive transcranial magnetic stimulation (rTMS) on unilateral spatial neglect in stroke patients.

Methods: Patients who had hemispatial neglect after right hemisphere stroke were randomly divided into rTMS only group, robot only group, and combined group. All groups received conventional neglect therapy and additional treatment for each group. rTMS group received rTMS therapy. Robot group received robot therapy, while combined group received both therapies. The effect of therapy was assessed with Motor-Free Visual Perception Test-3 (MVPT-3), line bisection test, star cancellation test, Catherine Bergego Scale (CBS), Mini-Mental State Examination (MMSE), and the Korean version of Modified Barthel Index (K-MBI). These measurements were evaluated before and after treatment.

Results: For each group, 10 patients were recruited. There were no significant differences in baseline characteristics or initial values among the three groups. Two weeks after the therapy, all groups showed significant improvement in MVPT-3, line bisection test, star cancellation test, CBS, MMSE, and K-MBI. However, changes in measurements showed no significant differences among groups.

Conclusion: Treatment effect of the combined therapy of robotic therapy and low-frequency rTMS therapy for hemispatial neglect was not statistically different from that of each single treatment. Results of this study did not prove the superiority of any of the three treatments. Further study with large number of patients is needed to evaluate the superiority of these treatments.

Keywords: Perceptual disorders; Rehabilitation; Robotics; Stroke; Transcranial magnetic stimulation.

Fig. 1.

All groups received additional treatment. (A) The repetitive transcranial magnetic stimulation treatment was applied to the contralesional posterior parietal cortex at an intensity 95% motor thresholds and a frequency of 0.9 Hz. (B) During robot therapy, monitor was settled on the left side of patients to keep their attention to the left side.

Fig. 2.

Four game programs on the Neuro-X system (Apsun Inc., Seoul, Korea). (A) Archery game, (B) goalkeeper game, (C) dolphin & circus game, and (D) skateboard game.

Fig. 3.

The algorithm used for enrollment of subjects. MMSE, Mini-Mental State Examination; MMT, Manual Muscle Test; rTMS, repetitive transcranial magnetic stimulation.