rTMS Over Dorsolateral Prefrontal Cortex Augments Dual‐Task Training for Mobility, Balance and Cognition in Sub‐Acute Stroke: A Randomized Controlled Trial

OBJECTIVE: To evaluate the effects of adding repetitive transcranial magnetic stimulation (rTMS) to dorsolateral prefrontal cortex (DLPFC) with dual-task (DT) exercise on DT mobility, balance and cognitive performance in individuals with sub-acute stroke. METHODS: Thirty sub-acute stroke patients [age, mean (SD) = 59.2 (7.9) years] were randomly assigned to the experimental group (N = 15), or the sham stimulation group (N = 15). 5 Hz rTMS (90% resting motor threshold, 1200 pulses/session) or sham stimulation was applied to the ipsilesional DLPFC, 1 session/day, 5 days/week for 2 weeks, followed by dual-task training. Two mobility tests [10 m walking and timed-up-and-go (TUG) test] and two cognitive tasks (serial 3 subtractions and verbal fluency) were assessed separately [that is, single-task (ST) condition] and concurrently (i.e., DT condition) before and after the intervention. RESULTS: The experimental group had greater improvement in TUG time under both ST and DT conditions (p < 0.05), while the step length of the paretic leg during the 10 m walking test of the experimental group only showed better improvement under ST condition and in DT condition when performed with serial 3 subtractions task. Cadence changes did not reach significance in any DT condition. Greater increment in the DT cognitive performance was observed only when verbal fluency task performed with 10 m walking test in the experimental group. The experimental group had better gain in Montreal cognitive assessment, Mini balance evaluation systems test, and Activities-specific balance confidence scores than controls. DISCUSSION: The 2-week rTMS to DLPFC combined with DT training augments DT walking performance, and improves balance and cognitive function in mild to moderate motor and cognitive impairment individuals with sub-acute stroke. IMPLICATIONS OF PHYSIOTHERAPY PRACTICE: This combined intervention is a feasible, effective strategy to improve real-world mobility in sub-acute stroke rehabilitation. TRIAL REGISTRATION: Chinese Clinical Trial Registry platform (www.chictr.org.cn), with the registration number ChiCTR2200066237.