Motor Rehabilitation of Stroke Survivor using TMS – A Case Report

Introduction

There is a plethora of emerging evidence that Transcranial Magnetic Stimulation (TMS) can be used to treat many conditions beyond its typical uses for treating depression. Here at American TMS Clinics, we believe in staying at the forefront of emergent TMS research because there are countless people whose needs don’t quite fit the standard model of the FDA approved care. If there’s a chance we can help you, we work to examine the existing research and use it to target your treatment goals. 

A perfect example of our passion for doing treatment based on emergent, validated research on TMS is our work with Don. Don, like us, has a passion for researching and learning as much as he can about his condition and ways he can better manage his symptoms. He is a right-thalamic ischemic stroke survivor who was chronically struggling with Spasticity. Spasticity is a condition where certain muscles are continuously tight or stiff due to disrupted signals between the brain and spinal cord, making coordinated, smooth movement difficult.

Methods

After thorough research and understanding his goals in treatment, we determined a course of action that focused on all aspects of his condition. Combining TMS, Neurofeedback, and motor exercises, we began a holistic approach to helping Don regain control of his right arm. Linked at the bottom of this blog is the research we used to support our methodology¹²³.

By first stimulating his Left cerebellum and right motor cortex with a form of TMS called Theta Burst Stimulation (TBS), we induced a state of neuroplasticity in those areas. This gave us a window of flexibility to change the maladaptive, ingrained neural pathways that were causing irregular motor movement¹².

Then, using this window, we connected him to our wireless EEG cap and trained his brain, via Neurofeedback. This trained his brain to produce the frequencies that would allow him to consciously control his motor movements with greater precision³. Specifically, we targeted the motor strip (at Cz, C3, & C4) to increase low-beta, sensory motor rhythms (12hz-15hz) and to decrease theta (4hz-8hz) & high beta (roughly 20-35hz)³. These frequency bands are associated with efficient motor movement in the aforementioned brain regions of the motor strip³.

Between both locations of TBS and Neurofeedback training, we had Don complete motor exercises intermittently. These exercises challenged him to reach his arm and touch various dots on the wall, meanwhile concentrating his vision on a center dot. The purpose of this exercise was to train his ability to control his motor movements independent of visual stimuli, using only his internal representation of his bodily spatial awareness. This simultaneously worked to reduce the antagonism between his triceps and biceps, using the induced neuroplasticity.

Results

After just 4 weeks of TMS at 2-sessions-per week, Don saw drastic decreases in spasticity primarily for his biceps & triceps. His spasticity dropped by ~45% in the biceps, ~60% in the triceps, alongside moderate decreases in his shoulder. These scores translated to Don being able to complete movements that involved lifting his affected arm with less resistance and more ease, such as pressing a button or opening a door.

When asked about his symptoms in a follow-up a month later, Don reported that he is still reaping benefits from the treatment. He noted that he was now able to bear more weight on his affected arm and rely on it to complete tasks and saw no signs of these benefits receding. He remarked that thanks to our help he was “seeing very meaningful long-term improvements.”

Discussion/Conclusion

Don came into our clinic with a problem and an idea for how to fix it, and we helped him bring this into reality. Utilizing validated, peer-reviewed data, we determined a promising course of action. This resulted in Don significantly reducing his spasticity in his target areas. Considering that he only focused specifically on increasing mobility in his arm, and he only did 2 sessions per week for 4 weeks, we have reason to believe that targeting more motor movements and doing it for a longer period of time may produce even more significant results.

Here at American TMS clinics, because of how uniquely emergent our treatment methods are, we urge you to come in and talk with us if you want to try out TMS for your stroke, or even if you have treatment needs that don’t fit typical models of disorders. Many people have tried so many other things and nothing seemed to work until they joined our care. We can work with you to develop an individualized treatment plan tailored to your specific needs and reach for your treatment goals.

References 

1. Koch, G., Bonnì, S., Pellicciari, M. C., Casula, E. P., Mancuso, M., Cantone, M., … & Caltagirone, C. (2023). Intermittent theta-burst stimulation for stroke: Primary motor cortex versus cerebellar stimulation: A randomized sham-controlled trial. Stroke, 54(12), 3459–3468. https://doi.org/10.1161/STROKEAHA.123.044892
2. Li, X., Wang, C., Li, J., Chen, Y., & Zhang, T. (2023). Effects of intermittent theta burst stimulation on motor recovery in post-stroke patients: A systematic review and meta-analysis. Frontiers in Neuroscience, 17, 1272003. https://doi.org/10.3389/fnins.2023.1272003
3. Cuesta, F. J. S., González-Zamorano, Y., Moreno-Verdú, M., Vourvopoulos, A., Serrano, I. J., Del Castillo-Sobrino, M. D., Figueiredo, P., & Romero, J. P. (2024). Effects of motor imagery-based neurofeedback training after bilateral repetitive transcranial magnetic stimulation on post-stroke upper limb motor function: An exploratory crossover clinical trial. Journal of Rehabilitation Medicine, 56, jrm.v56.18253. https://doi.org/10.2340/jrm.v56.18253