Abstract
Objectives: The objective of this study was to explore the efficacy of cerebellar intermittent theta burst stimulation (iTBS) on the walking function of stroke patients.Methods: Stroke patients with walking dysfunction aged 25–80 years who had suffered their first unilateral stroke were included. A total of 36 patients [mean (SD) age, 53 (7.93) years; 10 women (28%)] were enrolled in the study. All participants received the same conventional physical therapy, including transfer, balance, and ambulation training, during admission for 50 min per day during 2 weeks (10 sessions). Every session was preceded by 3 min procedure of cerebellar iTBS applyed over the contralesional cerebellum in the intervention group or by a similar sham iTBS in control group. The groups were formed randomly and the baseline characteristics showed no significant difference. The primary outcome measure was Fugl–Meyer Assessment–Lower Extremity scores. Secondary outcomes included walking performance and corticospinal excitability. Measures were performed before the intervention beginning (T0), after the first (T1) and the second (T2) weeks.Results: The Fugl–Meyer Assessment for lower extremity scores slightly improved with time in both groups with no significant difference between the groups and over the time. The walking performance significantly improved with time and between group. Two-way mixed measures ANOVA showed that there was significant interaction between time and group in comfortable walking time (F2,68 = 6.5242, P = 0.0080, η2partial = 0.276, ε = 0.641), between-group comparisons revealed significant differences at T1 (P = 0.0072) and T2 (P = 0.0133). The statistical analysis of maximum walking time showed that there was significant interaction between time and groups (F2,68 = 5.4354, P = 0.0115, η2partial = 0.198, ε = 0.734). Compared with T0, the differences of maximum walking time between the two groups at T1 (P = 0.0227) and T2 (P = 0.0127) were statistically significant. However, both the Timed up and go test and functional ambulation category scale did not yield significant differences between groups (P > 0.05).Conclusion: Our results revealed that applying iTBS over the contralesional cerebellum paired with physical therapy could improve walking performance in patients after stroke, implying that cerebellar iTBS intervention may be a noninvasive strategy to promote walking function in these patients. This study was registered at ChiCTR, number ChiCTR1900026450.
Highlights
Stroke is the second most common cause of death worldwide and one of the leading causes of disability (Wang et al, 2014; Feigin et al, 2016)
This study was registered at ChiCTR, number ChiCTR1900026450
None of the differences between the groups were statistically significant (F = 1.8745, P = 0.1799, η2partial = 0.129) (Figure 3B). The results of this randomized, double-blind, sham-controlled clinical trial showed that in patients recovering from stroke, cerebellar intermittent theta burst stimulation plus physical therapy, compared to physical therapy alone, significantly improved walking performance, as reflected by the ten-meter walking test, comfortable walking time and maximum walking time after 1 and 2 weeks of stimulation
Summary
Stroke is the second most common cause of death worldwide and one of the leading causes of disability (Wang et al, 2014; Feigin et al, 2016). Even if patients are treated in time, they may still have disabilities, such as balance and walking limitations, spasms, dysphagia, and aphasia, which limit patients’ ability to carry out their daily activities and affect their quality of life (Winstein et al, 2016). Recovery of walking function is strongly demanded in stroke patients. Repetitive transcranial magnetic stimulation (rTMS) has been increasingly used to treat many neurological and neuropsychiatric disorders (Chen et al, 2019). Theta burst stimulation (TBS), a novel pattern of rTMS, saves time in the rehabilitation of motor function after stroke (Huang et al, 2005). Compared with conventional rTMS protocols, TBS provides major advantages due to its reduced administration time (Chung et al, 2015) and long-lasting effects with lower intensity stimulation (Cárdenas-Morales et al, 2010)
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