Immediate Effect of Repetitive Peripheral Magnetic Stimulation in Hemiplegic Patients with Arm Paresis: A Pilot Study


  • Peeraya Ruthiraphong Department of Rehabilitation Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
  • Thachapim Sukhumvada Department of Rehabilitation Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
  • Parit Wongphaet 2Department of Rehabilitation Medicine, Samrong General Hospital, Samutprakan, Thailand


magnetic stimulation, hemiparesis, upper extremity


Objectives: To compare the immediate effects of repetitive peripheral magnetic stimulation (rPMS) on upper extremity (UE) function of hemiplegic patients with different severity.

Study design: Experimental pilot study.

Setting: Rehabilitation Center at Ramathibodi Hospital, Mahidol University, Thailand.

Subjects: Thirteen participants (10 males and 3 females) with subacute to chronic UE paresis due to central nervous system lesion.

Methods: Each subject received one session of 12 minutes rPMS equally distributed over six hemiparetic shoulder-arm muscles (supraspinatus, infraspinatus, deltoid, biceps, triceps and pectoralis major). The train of stimulation was delivered to the affected arm with a figure eight coil at approximately 120% intensity of motor threshold at 20 Hz frequency in pulses of 4 seconds on alternating with 4 seconds of rest. Motor functions were assessed with upper extremity Fugl-Meyer motor (UE-FMA) scale, modified Ashworth Scale (MAS), and arm reach test (ART) before and then again 5 minutes after the stimulation. Patients with UE- FMA score of 16 or lower and those with score more than 16 were classified as more-severe and less-severe respectively. Statistical analysis was made comparing the difference between before and after of UE-FMA score, MAS, and ART of each group.

Results: The mean (SD) of UE-FMA score before and after rPMS stimulation were 21.6 (10.5) and 23.3 (8.9), respectively. Wilcoxon matched-pairs test confirmed that the results reached statistical significance (p = 0.018). The median (Q1-Q3) UE-FMA score before and after the stimulation in more-severe paresis group were 12.5 (9.3 to 13.3) and 16.0 (11.8 to 17.3), respectively. Wilcoxon matched-pairs test confirmed significant between group statistical difference (p = 0.027). The median (Q1-Q3) of UE-FMA score of the less-severe group before and after stimulation were 32.0 (24.0 to 35.0) and 32.0 (25.0 to 35.0), respectively. This difference has not reached significant level (p = 0.317). Analysis of the MAS and the ART, however, did not show any significances between groups.

Conclusion: The rPMS over six hemiparetic shoulder-arm muscles could result in immediate improvement of motor function in patients with severe upper extremity paresis, but not spasticity or arm and reach test.

Keywords: magnetic stimulation, hemiparesis, upper extremity


Download data is not yet available.


Lawrence ES, Coshall C, Dundas R, Stewart J, Rudd AG, Howard R, et al. Estimates of the prevalence of acute stroke impairments and disability in a multiethnic population.Stroke. 2001;32:1279-84.

Selzer M, Clarke S, Cohen L, Duncan P, Gage F. Textbook of neural repair and rehabilitation, vol. 2. Cambridge: Cambridge University Press; 2006.

Krewer C, Hartl S, Müller F, Koenig E. Effects of repetitive peripheral magnetic stimulation on upper-limb spasticity and impairment in patients with spastic hemiparesis: a randomized, double-blind, sham-controlled study. Arch Phys Med Rehabil. 2014;95:1039-47.

Hatem SM, Saussez G, Della Faille M, Prist V, Zhang X, Dispa D, et al. Rehabilitation of motor function after stroke: A multiple systematic review focused on techniques to stimulate upper extremity recovery. Front Hum Neurosci. 2016;10:442. doi: 10.3389/fnhum.2016.00442.

McArthur KS, Quinn TJ, Higgins P, Langhorne P. Post-acute care and secondary prevention after ischaemic stroke. BMJ. 2011;342: d2083. doi:10.1136/bmj.d2083.

Beaulieu LD, Schneider C. Effects of repetitive peripheral magnetic stimulation on normal or impaired motor control: a review. Neurophysiol Clin. 2013;43:251-60.

Struppler A, Havel P, Muller-Barna P. Facilitation of skilled finger movements by repetitive peripheral magnetic stimulation (RPMS) - a new approach in central paresis. NeuroRehabilitation. 2003; 18:69-82.

Marz-Loose H, Siemes H. [Repetitive peripheral magnetic stimulation. Treatment option for spasticity?]. Der Nervenarzt. 2009;80:1489-95.

Sakai K, Yasufuku Y, Kamo T, Ota E, Momosaki R. Repetitive peripheral magnetic stimulation for impairment and disability in people after stroke. Cochrane Database of Syst Rev 2019;11(11):Cd011968.

Flamand VH, Schneider C. Noninvasive and painless magnetic stimulation of nerves improved brain motor function and mobility in a cerebral palsy case. Arch Phys Med Rehabil. 2014;95:1984-90.

Struppler A, Angerer B, Gündisch C, Havel P. Modulatory effect of repetitive peripheral magnetic stimulation on skeletal muscle tone in healthy subjects: stabilization of the elbow joint. Exp Brain Res. 2004;157:59-66.

Struppler A, Binkofski F, Angerer B, Bernhardt M, Spiegel S, Drzezga A, et al. A fronto-parietal network is mediating improvement of motor function related to repetitive peripheral magnetic stimulation: a PET-H2O15 study. Neuroimage 2007;36 Suppl 2: T174-86.

Houwink A, Nijland RH, Geurts AC, Kwakkel G. Functional recovery of the paretic upper limb after stroke: who regains hand capacity? Arch Phys Med Rehabil. 2013;94:839-44.

Havel P, Struppler A. First steps in functional magnetic stimulation (FMS)-movements of forearm and fingers induced by closed-loop controlled FMS. Acta Physiol Pharmacol Bulg. 2001;26:185-8.

Bernhardt M, Angerer B, Buss M, Struppler A. Neural observer based spasticity quantification during therapeutic muscle stimulation. Conf Proc IEEE Eng Med Biol Soc. 2006;2006:4897-900. doi: 10.1109/IEMBS.2006.260122.

Gladstone DJ, Danells CJ, Black SE. The Fugl-Meyer assessment of motor recovery after stroke: A critical review of its measurement properties. Neurorehabil Neural Repair. 2002;16:232-40.

Kim H, Her J, Ko J, Park D-s, Woo J-H, You Y, et al. Reliability, Concurrent validity, and responsiveness of the Fugl-Meyer Assessment (FMA) for hemiplegic patients. J Phys Ther Sci. 2012; 24:893-9.

Gregson JM, Leathley M, Moore AP, Sharma AK, Smith TL, Watkins CL. Reliability of the tone assessment scale and the modified ashworth scale as clinical tools for assessing poststroke spasticity. Arch Phys Med Rehabil. 1999;80:1013-6.

Meseguer-Henarejos AB, Sánchez-Meca J, López-Pina JA, Carles-Hernández R. Inter- and intra-rater reliability of the Modified Ashworth Scale: A systematic review and meta-analysis. Eur J Phys Rehabil Med. 2018;54:576-90.

Woytowicz EJ, Rietschel JC, Goodman RN, Conroy SS, Sorkin JD, Whitall J, et al. Determining levels of upper extremity movement impairment by applying a cluster analysis to the Fugl-Meyer Assessment of the upper extremity in chronic stroke. Arch Phys Med Rehabil. 2017;98:456-62.

Amengual JL, Valero-Cabré A, de las Heras MV, Rojo N, Froudist-Walsh S, Ripollés P, et al. A prognostic value of cortically induced motor evoked activity by TMS in chronic stroke: caveats from a revealing single clinical case. BMC Neurol. 2012;12:35. doi: 10.1186/1471-2377-12-35.

Stinear CM, Barber PA, Smale PR, Coxon JP, Fleming MK, Byblow WD. Functional potential in chronic stroke patients depends on corticospinal tract integrity. Brain. 2007;130(Pt 1): 170-80.

Perez MA, Cohen LG. The corticospinal system and transcranial magnetic stimulation in stroke. Top Stroke Rehabil. 2009;16:254-69.

Potter-Baker KA, Varnerin NM, Cunningham DA, Roelle SM, Sankarasubramanian V, Bonnett CE, et al. Influence of corticospinal tracts from higher order motor cortices on recruitment curve properties in stroke. Front Neurosci. 2016;10:79. doi: 10.3389/fnins. 2016.00079.

Buetefisch CM, Revill KP, Haut MW, Kowalski GM, Wischnewski M, Pifer M, et al. Abnormally reduced primary motor cortex output is related to impaired hand function in chronic stroke. J Neurophysiol. 2018;120:1680-94.

Bradnam LV, Stinear CM, Barber PA, Byblow WD. Contralesional hemisphere control of the proximal paretic upper limb following stroke. Cereb cortex. 2012;22:2662-71.

Edwardson MA, Ding L, Park C, Lane CJ, Nelsen MA, Wolf SL, et al. Reduced upper limb recovery in subcortical stroke patients with small prior radiographic stroke. Front Neurol. 2019;10:454. doi: 10.3389/fneur.2019.00454.

Shelton FN, Reding MJ. Effect of lesion location on upper limb motor recovery after stroke. Stroke. 2001;32:107-12.

Hackshaw A. Small studies: strengths and limitations. Eur Respir J. 2008;32:1141-3.






Original Article