Article

Recovery of upper limb function is important for regaining
independence after stroke. OBJECTIVE: To test the effects of priming upper limb
physical therapy with intermittent theta burst stimulation (iTBS), a form of
noninvasive brain stimulation. METHODS: Eighteen adults with first-ever chronic
monohemispheric subcortical stroke participated in this randomized, controlled,
triple-blinded trial. Intervention consisted of priming with real or sham iTBS to
the ipsilesional primary motor cortex immediately before 45 minutes of upper limb
physical therapy, daily for 10 days. Changes in upper limb function (Action
Research Arm Test [ARAT]), upper limb impairment (Fugl-Meyer Scale), and
corticomotor excitability, were assessed before, during, and immediately, 1 month
and 3 months after the intervention. Functional magnetic resonance images were
acquired before and at one month after the intervention. RESULTS: Improvements in
ARAT were observed after the intervention period when therapy was primed with
real iTBS, but not sham, and were maintained at 1 month. These improvements were
not apparent halfway through the intervention, indicating a dose effect.
Improvements in ARAT at 1 month were related to balancing of corticomotor
excitability and an increase in ipsilesional premotor cortex activation during
paretic hand grip. CONCLUSIONS: Two weeks of iTBS-primed therapy improves upper
limb function at the chronic stage of stroke, for at least 1 month
postintervention, whereas therapy alone may not be sufficient to alter function.
This indicates a potential role for iTBS as an adjuvant to therapy delivered at
the chronic stage.
CI - (c) The Author(s) 2015.

Langue : ANGLAIS