Augmented efficacy of intermittent theta burst stimulation on the virtual reality-based cycling training for upper limb function in patients with stroke: a double-blinded, randomized controlled trial

Journal of NeuroEngineering and Rehabilitation

Hsieh-Ching Chen¹  Yu-Hsin Chen²  Chung-Yao Chen³  Ying-Zu Huang⁴  Ching-Yi Wu⁵  Chia-Ling Chen⁶  Keh-chung Lin⁷ 

[1] Department of Industrial and Management, National Taipei University of Technology, Taipei, Taiwan;Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan;Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan;Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan;Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan;Neuroscience Research Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taiwan;Institute of Cognitive Neuroscience, National Central University, Taoyuan, Taiwan;Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan;Department of Occupational Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan;Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan;Graduate Institute of Early Intervention, Chang Gung University, Taoyuan, Taiwan;School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan;Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan;

关键词: Theta burst stimulation;    Virtual reality;    Stroke;    Upper limb;    Motor function;    Rehabilitation;   

DOI  :  10.1186/s12984-021-00885-5

来源: Springer

【 摘 要 】

BackgroundVirtual reality and arm cycling have been reported as effective treatments for improving upper limb motor recovery in patients with stroke. Intermittent theta burst stimulation (iTBS) can increase ipsilesional cortical excitability, and has been increasingly used in patients with stroke. However, few studies examined the augmented effect of iTBS on neurorehabilitation program. In this study, we investigated the augmented effect of iTBS on virtual reality-based cycling training (VCT) for upper limb function in patients with stroke.MethodsIn this randomized controlled trial, 23 patients with stroke were recruited. Each patient received either 15 sessions of iTBS or sham stimulation in addition to VCT on the same day. Outcome measures were assessed before and after the intervention. Primary outcome measures for the improvement of upper limb motor function and spasticity were Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and Modified Ashworth Scale Upper-Extremity (MAS-UE). Secondary outcome measures for activity and participation were Action Research Arm Test (ARAT), Nine Hole Peg Test (NHPT), Box and Block Test (BBT) and Motor Activity Log (MAL), and Stroke Impact Scale (SIS). Wilcoxon signed-rank tests were performed to evaluate the effectiveness after the intervention and Mann–Whitney U tests were conducted to compare the therapeutic effects between two groups.ResultsAt post-treatment, both groups showed significant improvement in FMA-UE and ARAT, while only the iTBS + VCT group demonstrated significant improvement in MAS-UE, BBT, NHPT, MAL and SIS. The Mann–Whitney U tests revealed that the iTBS + VCT group has presented greater improvement than the sham group significantly in MAS-UE, MAL-AOU and SIS. However, there were no significant differences in the changes of the FMA-UE, ARAT, BBT, NHPT and MAL-QOM between groups.ConclusionsIntermittent TBS showed augmented efficacy on VCT for reducing spasticity, increasing actual use of the affected upper limb, and improving participation in daily life in stroke patients. This study provided an integrated innovative intervention, which may be a promising therapy to improve upper limb function recovery in stroke rehabilitation. However, this study has a small sample size, and thus a further larger-scale study is warranted to confirm the treatment efficacy.Trial registration This trial was registered under ClinicalTrials.gov ID No. NCT03350087, retrospectively registered, on November 22, 2017

【 授权许可】

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