Effectiveness of Repetitive Transcranial Magnetic Stimulation Combined with Visual Feedback Training in Improving Neuroplasticity and Lower Limb Function After Chronic Stroke

Abstract

Abstract Background After stroke, patients often experience lower limb motor deficits that interrupt their balance and gait functions and thereby lead to a high risk of falls. Sustained gait impairment can restrict participation in the activities listed in the International Classification of Functioning, Disability and Health model and poor quality of life. Repetitive transcranial magnetic stimulation (rTMS) and visual feedback training (VF) are key focuses in advanced rehabilitation medicine. The present study investigated the effectiveness of rTMS and VF training in improving lower limb motor performance, gait, and corticospinal excitability in patients with chronic stroke. Methods We recruited 30 patients with paretic legs at an average Brunnstrom stage of 3.7. The average time after the onset of stroke was 36.4 months. The patients were randomized into three groups: rTMS and VF, sham rTMS and VF, and sham rTMS and conventional rehabilitation groups. All participants underwent 50-minute intervention sessions three times per week for 4 weeks. The motor-evoked potential (MEP) of the tibialis anterior muscle, Berg Balance Scale (BBS) scores, Timed Up and Go (TUG) test scores, and Fugl–Meyer Assessment of Lower Extremity (FMA-LE) scores were determined before and after the intervention. Results The baseline characteristics were similar among the groups. After the intervention, the rTMS and VF group had improved MEP latency (Z = − 2.547, P = 0.011), TUG scores (Z = − 2.666, P = 0.008), and BBS scores (Z = − 2.539, P = 0.011). The sham rTMS and VF group had improved MEP latency (Z = − 2.207, P = 0.027) and TUG scores (Z = − 2.687, P = 0.052). The sham rTMS and conventional rehabilitation group had improved TUG scores (Z = − 2.537, P = 0.066). Conclusions rTMS and VF training may enhance the cortical excitability and walking ability of individuals with chronic stroke. However, future studies should use a larger study population and longer intervention time to validate this finding. Trial registration: This study was registered on the ClinicalTrials.gov Protocol Registration and Results System (ID:NCT03689491).