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document
Theta burst stimulation in the rehabilitation of the upper limb : a semirandomized , placebo-controlled trial in chronic stroke patients . BACKGROUND Noninvasive cortical stimulation could represent an add-on treatment to enhance motor recovery after stroke . However , its clinical value , including anticipated size and duration of the treatment effects , remains largely unknown . OBJECTIVE The authors designed a small semi-randomized clinical trial to explore whether long-lasting clinically important gains can be achieved by adding theta burst stimulation ( TBS ) , a form of repetitive transcranial magnetic stimulation ( TMS ) , to a rehabilitation program for the hand . METHODS A total of 41 chronic stroke patients received excitatory TBS to the ipsilesional hemisphere or inhibitory TBS to the contralesional hemisphere in 2 centers ; each active group was compared with a group receiving sham TBS . TBS was followed by physical therapy for 10 working days . Patients and therapists were blinded to the type of TBS . Primary outcome measures ( 9-hole Peg Test [ 9HPT ] , Jebsen Taylor Test [ JTT ] , and grip and pinch-grip dynamometry ) were assessed 4 , 30 , and 90 days post treatment . The clinically important difference was defined as 10 % of the maximum score . RESULTS There were no differences between the active treatment and sham groups in any of the outcome measures . All patients achieved small sustainable improvements -- 9HPT , 5 % of maximum ( confidence interval [ CI ] = 3 % -7 % ) ; JTT , 5.7 % ( CI = 3 % -8 % ) ; and grip strength , 6 % ( CI = 2 % -10 % ) -- all below the defined clinically important level . CONCLUSIONS Cortical stimulation did not augment the gains from a late rehabilitation program . The effect size anticipated by the authors was overestimated . These results can improve the design of future work on therapeutic uses of TMS .
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Intervention_Physical
Theta burst stimulation
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Intervention_Physical
cortical stimulation
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Intervention_Physical
theta burst stimulation ( TBS )
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Intervention_Physical
transcranial magnetic stimulation ( TMS )
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Intervention_Physical
TBS
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Intervention_Physical
inhibitory TBS
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Intervention_Physical
sham TBS
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Intervention_Control
.
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Intervention_Physical
TBS
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Intervention_Physical
TBS
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Outcome_Physical
motor recovery
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Outcome_Physical
( 9-hole Peg Test [ 9HPT ] , Jebsen Taylor Test [ JTT ] , and grip and pinch-grip dynamometry ) were assessed
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Outcome_Physical
improvements -- 9HPT , 5 % of maximum
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Outcome_Physical
JTT
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Outcome_Physical
grip strength
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Participant_Condition
chronic stroke patients
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Participant_Condition
A total of
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Participant_Sample-size
41 chronic stroke patients
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Participant_Condition
received excitatory TBS to the ipsilesional hemisphere or inhibitory TBS to the contralesional hemisphere in 2 centers ;