Theta burst stimulation in the rehabilitation of the upper limb: A semirandomized, placebo-controlled trial in chronic stroke patients

P. Talelli, A. Wallace, M. Dileone, D. Hoad, B. Cheeran, R. Oliver, M. Vandenbos, U. Hammerbeck, K. Barratt, C. Gillini, G. Musumeci, M.-H. Boudrias, G.C. Cloud, J. Ball, J.F. Marsden, N.S. Ward, V. Di Lazzaro, R.G. Greenwood, J.C. Rothwell

Research output: Contribution to journalArticlepeer-review


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.
Original languageEnglish
Pages (from-to)976-987
Number of pages11
JournalNeurorehabilitation and Neural Repair
Issue number8
Publication statusPublished - 12 Mar 2012


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