Investigating feasibility of repetitive transcranial magnetic stimulation targeting upper limb spasticity- a case study
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Spasticity is one of the major disability that affects an individual and his caregivers’ lives in many ways. Spasticity is usually caused due to stroke, traumatic brain injury, multiple sclerosis to name a few. It occurs due to a lesion in the upper motor neuron complex that can range from mild stiffness to severe disability. Transcranial Magnetic Stimulation (TMS) is a non-invasive brain stimulation that are used to induce excitability in the motor cortex. This study aims to analyze the feasibility of repetitive TMS (rTMS) intervention for upper limb spasticity. The application of rTMS for spasticity has not been explored in depth. Hence, I investigated the feasibility of rTMS with two of the evaluation tools that are Modified Ashworth Scale (MAS) for spasticity and Dynamometer for muscle force. The single subject evaluation took place over a period of 4 weeks for 5 days in a week. After an rTMS intervention, post therapy evaluations were also performed. There was a decrease in MAS score (reduced spasticity) and an increase in the dynamometer readings (increased muscle force) from day 1 to day 21. There were fluctuations throughout the study that can be explained by the subject-specific fluctuations in the brain state. Therefore, determination of subject-specific dose-response was found necessary for rational dosing of rTMS intervention. A healthy gait analysis was also conducted to develop the protocol for evaluating lower limb spasticity in the future. This study used VICON-Nexus motion capture systems, Electromyography and Inertial Measurement Unit for the lower limb to quantify the changes in the gait pattern and gait phases. This gait study protocol can also be used in the future to analyze freezing of gait in Parkinson’s disease patients, for rehabilitation of patients with gait impairments due to stroke, Multiple Sclerosis and other Neurological conditions.