title: Primed Physical Therapy Enhances Recovery of Upper Limb Function in Chronic Stroke Patients.
abstract: BACKGROUND
  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.
authors.affiliation: University of Auckland, Auckland, New Zealand.
authors.forename: Suzanne J
authors.initials: SJ
authors.lastname: Ackerley
authors.affiliation: University of Auckland, Auckland, New Zealand.
authors.forename: Winston D
authors.initials: WD
authors.lastname: Byblow
authors.affiliation: University of Auckland, Auckland, New Zealand Auckland City Hospital, Auckland, New Zealand.
authors.forename: P Alan
authors.initials: PA
authors.lastname: Barber
authors.affiliation: University of Auckland, Auckland, New Zealand.
authors.forename: Hayley
authors.initials: H
authors.lastname: MacDonald
authors.affiliation: University of Auckland, Auckland, New Zealand.
authors.forename: Andrew
authors.initials: A
authors.lastname: McIntyre-Robinson
authors.affiliation: University of Auckland, Auckland, New Zealand c.stinear@auckland.ac.nz.
authors.forename: Cathy M
authors.initials: CM
authors.lastname: Stinear
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D004311:Double-Blind Method; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology*; D017063:Outcome Assessment, Health Care; D020127:Recovery of Function / Q000502:physiology*; D020521:Stroke / Q000503:physiopathology*; D000071939:Stroke Rehabilitation / Q000379:methods*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D034941:Upper Extremity / Q000503:physiopathology*; D055815:Young Adult
keywords: functional magnetic resonance imaging; stroke rehabilitation; theta burst stimulation; transcranial magnetic stimulation