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Huang G, Wang H, Zhao W, Qian Y, Yao Y, Zhang L, Chen Y, Song L, Yang J, Liu Z, Su B, Sun L. Effects of the intermittent theta burst stimulation on gait, balance and lower limbs motor function in stroke: study protocol for a double-blind randomised controlled trial with multimodal neuroimaging assessments. BMJ Open 2024; 14:e082019. [PMID: 39107014 PMCID: PMC11308910 DOI: 10.1136/bmjopen-2023-082019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 06/03/2024] [Indexed: 08/09/2024] Open
Abstract
INTRODUCTION Approximately, 50% of stroke survivors experience impaired walking ability 6 months after conventional rehabilitation and standard care. However, compared with upper limb motor function, research on lower limbs rehabilitation through non-invasive neuromodulation like repetitive transcranial magnetic stimulation (rTMS) has received less attention. Limited evidence exists regarding the effectiveness of intermittent theta-burst stimulation (iTBS), an optimised rTMS modality, on lower limbs rehabilitation after stroke. This study aims to evaluate the effects of iTBS on gait, balance and lower limbs motor function in stroke recovery while also exploring the underlying neural mechanisms using longitudinal analysis of multimodal neuroimaging data. METHODS AND ANALYSIS In this double-blinded randomised controlled trial, a total of 46 patients who had a stroke will be randomly assigned in a 1:1 ratio to receive either 15 sessions of leg motor area iTBS consisting of 600 pulses or sham stimulation over the course of 3 weeks. Additionally, conventional rehabilitation therapy will be administered following the (sham) iTBS intervention. The primary outcome measure will be the 10 m walking test. Secondary outcomes include the Fugl-Meyer assessment of the lower extremity, Timed Up and Go Test, Functional Ambulation Category Scale, Berg Balance Scale, modified Barthel Index, Mini-Mental State Examination, montreal cognitive assessment, tecnobody balance assessment encompassing both static and dynamic stability evaluations, surface electromyography recording muscle activation of the lower limbs, three-dimensional gait analysis focusing on temporal and spatial parameters as well as ground reaction force measurements, corticomotor excitability tests including resting motor threshold, motor evoked potential and recruitment curves and multimodal functional MRI scanning. Outcome measures will be collected prior to and after the intervention period with follow-up at 3 weeks. ETHICS AND DISSEMINATION The study has received approval from the Medical Research Ethics Committee of Wuxi Mental Health Center/Wuxi Central Rehabilitation Hospital (no. WXMHCCIRB2023LLky078). Results will be disseminated through peer-reviewed journals and scientific conferences. TRIAL REGISTRATION NUMBER ChiCTR2300077431.
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Affiliation(s)
- Guilan Huang
- Department of Rehabilitation, Wuxi Central Rehabilitation Hospital, The Affiliated Mental Health Center of Jiangnan University, Wuxi, China
| | - Hewei Wang
- Department of Rehabilitation, Huashan Hospital Fudan University, Shanghai, China
| | - WeiWei Zhao
- Department of Rehabilitation, Wuxi Central Rehabilitation Hospital, The Affiliated Mental Health Center of Jiangnan University, Wuxi, China
| | - Yao Qian
- Department of Rehabilitation, Wuxi Central Rehabilitation Hospital, The Affiliated Mental Health Center of Jiangnan University, Wuxi, China
| | - Yu Yao
- Department of Rehabilitation, Wuxi Central Rehabilitation Hospital, The Affiliated Mental Health Center of Jiangnan University, Wuxi, China
| | - Li Zhang
- Department of Rehabilitation, Wuxi Central Rehabilitation Hospital, The Affiliated Mental Health Center of Jiangnan University, Wuxi, China
| | - Yating Chen
- Department of Rehabilitation, Wuxi Central Rehabilitation Hospital, The Affiliated Mental Health Center of Jiangnan University, Wuxi, China
| | - Lianxin Song
- Department of Rehabilitation, Wuxi Central Rehabilitation Hospital, The Affiliated Mental Health Center of Jiangnan University, Wuxi, China
| | - Jinyu Yang
- Department of Rehabilitation, Wuxi Central Rehabilitation Hospital, The Affiliated Mental Health Center of Jiangnan University, Wuxi, China
| | - Zhichao Liu
- Department of Rehabilitation, Huashan Hospital Fudan University, Shanghai, China
| | - Bin Su
- Department of Rehabilitation, Wuxi Central Rehabilitation Hospital, The Affiliated Mental Health Center of Jiangnan University, Wuxi, China
| | - Limin Sun
- Department of Rehabilitation, Huashan Hospital Fudan University, Shanghai, China
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Zhu PA, Li ZL, Lu QQ, Nie YY, Liu H, Kiernan E, Yuan J, Zhang LJ, Bao X. Can cerebellar theta-burst stimulation improve balance function and gait in stroke patients? A randomized controlled trial. Eur J Phys Rehabil Med 2024; 60:391-399. [PMID: 38577727 PMCID: PMC11255874 DOI: 10.23736/s1973-9087.24.08307-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/09/2024] [Accepted: 03/11/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND The cerebellum is a key structure involved in balance and motor control, and has become a new stimulation target in brain regulation technology. Interference theta-burst simulation (iTBS) is a novel simulation mode of repetitive transcranial magnetic simulation. However, the impact of cerebellar iTBS on balance function and gait in stroke patients is still unknown. AIM The aim of this study was to determine whether cerebellar iTBS can improve function, particularly balance and gait, in patients with post-stroke hemiplegia. DESIGN This study is a randomized, double-blind, sham controlled clinical trial. SETTING The study was carried out at the Department of Rehabilitation Medicine in a general hospital. POPULATION Patients with stroke with first unilateral lesions were enrolled in the study. METHODS Thirty-six patients were randomly assigned to the cerebellar iTBS group or sham stimulation group. The cerebellar iTBS or pseudo stimulation site is the ipsilateral cerebellum on the paralyzed side, which is completed just before daily physical therapy. The study was conducted five times a week for two consecutive weeks. All patients were assessed before the intervention (T0) and at the end of 2 weeks of treatment (T1), respectively. The primary outcome was the Berg Balance Scale (BBS), while secondary outcome measures included the Fugl Meyer Lower Limb Assessment Scale (FMA-LE), timed up and go (TUG), Barthel Index (BI), and gait analysis. RESULTS After 2 weeks of intervention, the BBS, FMA-LE, TUG, and BI score in both the iTBS group and the sham group were significantly improved compared to the baseline (all P<0.05). Also, there was a significant gait parameter improvement including the cadence, stride length, velocity, step length compared to the baseline (P<0.05) in the iTBS group, but only significant improvement in cadence was identified in the sham group (P<0.05). Intergroup comparison showed that the BBS (P<0.001), FMA-LE (P<0.001), and BI (P=0.002) in the iTBS group were significantly higher than those in the sham group, and the TUG in the iTBS was significantly lower than that in the sham group (P=0.002). In addition, there were significant differences in cadence (P=0.029), strip length (P=0.046), gain velocity (P=0.002), and step length of affected lower limb (P=0.024) between the iTBS group and the sham iTBS group. CONCLUSIONS Physical therapy is able to improve the functional recovery in hemiplegic patients after stroke, but the cerebellar iTBS can facilitate and accelerate the recovery, particularly the balance function and gait. Cerebellar iTBS could be an efficient and facilitative treatment for patients with stroke. CLINICAL REHABILITATION IMPACT Cerebellar iTBS provides a convenient and efficient treatment modality for functional recovery of patients with stroke, especially balance function and gait.
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Affiliation(s)
- Ping-An Zhu
- Department of Rehabilitation Medicine, Yuebei People's Hospital, Shaoguan, China
| | - Zhi-Liang Li
- Department of Rehabilitation Medicine, Yuebei People's Hospital, Shaoguan, China
| | - Qi-Qi Lu
- Department of Rehabilitation Medicine, Yuebei People's Hospital, Shaoguan, China
| | - Ying-Ying Nie
- Department of Rehabilitation Medicine, Yuebei People's Hospital, Shaoguan, China
| | - Howe Liu
- Physical Therapy Department, Louisiana State University Health Science Center, New Orleans, LA, USA
| | - Erica Kiernan
- Service of Physical Therapy, Allen College, Waterloo, IA, USA
| | - Jia Yuan
- Department of Rehabilitation Medicine, Guangdong Hospital of Integrated Traditional Chinese and Western Medicine, Guangdong, China
| | - Lin-Jian Zhang
- Department of Rehabilitation Medicine, Yuebei People's Hospital, Shaoguan, China
| | - Xiao Bao
- Department of Rehabilitation Medicine, Yuebei People's Hospital, Shaoguan, China -
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Guo G, Wang Y, Xu X, Lu K, Zhu X, Gu Y, Yang G, Yao F, Fang M. Effectiveness of Yijinjing exercise in the treatment of early-stage knee osteoarthritis: a randomized controlled trial protocol. BMJ Open 2024; 14:e074508. [PMID: 38453194 PMCID: PMC10921529 DOI: 10.1136/bmjopen-2023-074508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 01/11/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION Knee osteoarthritis (KOA) is still a challenging degenerative joint disease with high morbidity and disease burden. Early-stage KOA, the focus of this study, could present a Window of Opportunity to arrest the disease process and reduce the disease burden. Yijinjing exercise is an important part of physical and psychological therapies in Traditional Chinese Exercise and may be an effective treatment. However, there is no clinical efficacy assessment of Yijinjing exercise for patients with early-stage KOA. Therefore, we designed a randomised controlled trial to evaluate the effectiveness of Yijinjing exercise on patients with early-stage KOA. METHODS AND ANALYSIS This is a parallel-design, two-arm, analyst assessor-blinded, randomised controlled trial. In total, 60 patients with early-stage KOA will be recruited and randomly assigned to the Yijinjing exercise group (n=30) and health education group (n=30) at a ratio of 1:1, receiving 12 weeks of Yijinjing exercise or health education accordingly. The primary outcome will be measured with the Western Ontario and McMaster Universities Osteoarthritis Index, and the secondary outcomes will include the Visual Analogue Scale, Short-Form 36 Item Health Survey Questionnaire, Beck Depression Inventory, Perceived Stress Scale, Berg Balance Scale, and Gait Analysis for a comprehensive assessment. Outcome measures are collected at baseline, at 12 week ending intervention and at the 12 week, 24 week and 48 week ending follow-up. The primay time point will be 12 weeks postintervention. Adverse events will be recorded for safety assessment. ETHICS AND DISSEMINATION This study has been approved by the ethical application of the Shanghai Municipal Hospital of Traditional Chinese Medicine Ethics Committee (2021SHL-KY-78). TRIAL REGISTRATION NUMBER ChiCTR2200065178.
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Affiliation(s)
- Guangxin Guo
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yihang Wang
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiruo Xu
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Kaiqiu Lu
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xuanying Zhu
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yijia Gu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Guangpu Yang
- School of Basic Medical Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fei Yao
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Min Fang
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Wang X, Cao J, Zhao Q, Chen M, Luo J, Wang H, Yu L, Tsui KL, Zhao Y. Identifying sensors-based parameters associated with fall risk in community-dwelling older adults: an investigation and interpretation of discriminatory parameters. BMC Geriatr 2024; 24:125. [PMID: 38302872 PMCID: PMC10836006 DOI: 10.1186/s12877-024-04723-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 01/18/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Falls pose a severe threat to the health of older adults worldwide. Determining gait and kinematic parameters that are related to an increased risk of falls is essential for developing effective intervention and fall prevention strategies. This study aimed to investigate the discriminatory parameter, which lay an important basis for developing effective clinical screening tools for identifying high-fall-risk older adults. METHODS Forty-one individuals aged 65 years and above living in the community participated in this study. The older adults were classified as high-fall-risk and low-fall-risk individuals based on their BBS scores. The participants wore an inertial measurement unit (IMU) while conducting the Timed Up and Go (TUG) test. Simultaneously, a depth camera acquired images of the participants' movements during the experiment. After segmenting the data according to subtasks, 142 parameters were extracted from the sensor-based data. A t-test or Mann-Whitney U test was performed on the parameters for distinguishing older adults at high risk of falling. The logistic regression was used to further quantify the role of different parameters in identifying high-fall-risk individuals. Furthermore, we conducted an ablation experiment to explore the complementary information offered by the two sensors. RESULTS Fifteen participants were defined as high-fall-risk individuals, while twenty-six were defined as low-fall-risk individuals. 17 parameters were tested for significance with p-values less than 0.05. Some of these parameters, such as the usage of walking assistance, maximum angular velocity around the yaw axis during turn-to-sit, and step length, exhibit the greatest discriminatory abilities in identifying high-fall-risk individuals. Additionally, combining features from both devices for fall risk assessment resulted in a higher AUC of 0.882 compared to using each device separately. CONCLUSIONS Utilizing different types of sensors can offer more comprehensive information. Interpreting parameters to physiology provides deeper insights into the identification of high-fall-risk individuals. High-fall-risk individuals typically exhibited a cautious gait, such as larger step width and shorter step length during walking. Besides, we identified some abnormal gait patterns of high-fall-risk individuals compared to low-fall-risk individuals, such as less knee flexion and a tendency to tilt the pelvis forward during turning.
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Affiliation(s)
- Xuan Wang
- Intelligent Sensing and Proactive Health Research Center, School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Junjie Cao
- Intelligent Sensing and Proactive Health Research Center, School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Qizheng Zhao
- Intelligent Sensing and Proactive Health Research Center, School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Manting Chen
- Intelligent Sensing and Proactive Health Research Center, School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Jiajia Luo
- Intelligent Sensing and Proactive Health Research Center, School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Hailiang Wang
- School of Design, the Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Lisha Yu
- School of Design, the Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Kwok-Leung Tsui
- Grado Department of Industrial and Systems Engineering, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Yang Zhao
- Intelligent Sensing and Proactive Health Research Center, School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China.
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Landers MR, Haller AM, Aldaco A, La B, Babarinde AA, Rider JV, Longhurst JK. The psychometric properties of the modified fear of falling avoidance behavior questionnaire in Parkinson's disease and older adults. Arch Physiother 2024; 14:11-19. [PMID: 38707914 PMCID: PMC11067869 DOI: 10.33393/aop.2024.2702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 04/04/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction The Fear of Falling Avoidance Behavior Questionnaire (FFABQ) has good psychometric properties. However, we have recently modified the FFABQ (mFFABQ) to improve the clarity of the questions and Likert responses. This study aimed to examine the reliability and validity of this modified version in older adults and people with Parkinson's disease (PD). Methods A total of 88 participants, 39 with PD (age = 72.2 ± 9.5; 29 males, 10 females) and 49 older adults (age = 72.8 ± 5.0; 13 males, 36 females), answered the mFFABQ twice, separated by 1 week, for test-retest reliability. Construct validity was evaluated through correlational analyses with fall history, Activities-Specific Balance Confidence Scale (ABC), Berg Balance Scale (BBS), Timed Up and Go, 30-Second Sit to Stand, Sensory Organization Test, Zung Anxiety Scale, Beck Depression Inventory, Consequences of Falling Questionnaire (CoFQ), and average daily activity levels using an activity monitor. Results The mFFABQ had good overall test-retest reliability (intraclass correlational coefficient [ICC] = 0.822; older adult ICC = 0.781, PD ICC = 0.806). The mFFABQ correlated with fall history (r = -0.430) and exhibited high correlation with the ABC (rho = -0.804) and moderate correlations with CoFQ (rho = 0.582) and BBS (rho = -0.595). The mFFABQ also correlated with time stepping (rho = -0.298) and number of steps (rho = -0.358). Conclusion These results provide supportive evidence for the reliability and validity of the mFFABQ in older adults and people with PD, which supports its suitability as a clinical and research tool for the assessment of fear of falling avoidance behavior.
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Affiliation(s)
- Merrill R. Landers
- Department of Physical Therapy, School of Integrated Health Sciences, University of Nevada, Las Vegas, Nevada - USA
| | - Ash M. Haller
- Sequoia Hospital, Dignity Health, Redwood City, California - USA
| | - Arturo Aldaco
- Sunrise Hospital and Medical Center, Las Vegas, Nevada - USA
| | - Billy La
- FYZICAL Balance and Therapy Centers – Buffalo, Las Vegas, Nevada - USA
| | - Adetayo A. Babarinde
- School of Integrated Health Sciences, University of Nevada, Las Vegas, Nevada - USA
| | - John V. Rider
- School of Occupational Therapy, Touro University Nevada, Henderson, Nevada - USA
| | - Jason K. Longhurst
- Department of Physical Therapy and Athletic Training, Doisy College of Health Sciences, Saint Louis University, St. Louis, Missouri - USA
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Milne SC, Roberts M, Ross HL, Robinson A, Grove K, Modderman G, Williams S, Chua J, Grootendorst AC, Massey L, Szmulewicz DJ, Delatycki MB, Corben LA. Interrater Reliability of the Scale for the Assessment and Rating of Ataxia, Berg Balance Scale, and Functional Independence Measure Motor Domain in Individuals With Hereditary Cerebellar Ataxia. Arch Phys Med Rehabil 2023; 104:1646-1651. [PMID: 37268274 DOI: 10.1016/j.apmr.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/02/2023] [Accepted: 05/06/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To determine the interrater reliability of the Scale for the Assessment and Rating of Ataxia (SARA), Berg Balance Scale (BBS), and motor domain of the FIM (m-FIM) administered by physiotherapists in individuals with a hereditary cerebellar ataxia (HCA). DESIGN Participants were assessed by 1 of 4 physiotherapists. Assessments were video-recorded and the remaining 3 physiotherapists scored the scales for each participant. Raters were blinded to each other's scores. SETTING Assessments were administered at 3 clinical locations in separate states in Australia. PARTICIPANTS Twenty-one individuals (mean age=47.63 years; SD=18.42; 13 male and 8 female) living in the community with an HCA were recruited (N=21). MAIN OUTCOME MEASURES Total and single-item scores of the SARA, BBS, and m-FIM were examined. The m-FIM was conducted by interview. RESULTS Intraclass coefficients (2,1) for the total scores of the m-FIM (0.92; 95% confidence interval [CI], 0.85-0.96), SARA (0.92; 95% CI, 0.86-0.96), and BBS (0.99; 95% CI, 0.98-0.99) indicated excellent interrater reliability. However, there was inconsistent agreement with the individual items, with SARA item 5 (right side) and item 7 (both sides) demonstrating poor interrater reliability and items 1 and 2 demonstrating excellent reliability. CONCLUSIONS The m-FIM (by interview), SARA, and BBS have excellent interrater reliability for use when assessing individuals with an HCA. Physiotherapists could be considered for administration of the SARA in clinical trials. However, further work is required to improve the agreement of the single-item scores and to examine the other psychometric properties of these scales.
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Affiliation(s)
- Sarah C Milne
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, Australia; Physiotherapy Department, Monash Health, Cheltenham, Australia; School of Primary and Allied Health Care, Monash University, Frankston, Australia; Department of Pediatrics, The University of Melbourne, Parkville, Australia.
| | - Melissa Roberts
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, Australia; Physiotherapy Department, Monash Health, Cheltenham, Australia
| | - Hannah L Ross
- Physiotherapy Department, Monash Health, Cheltenham, Australia
| | | | - Kristen Grove
- Physiotherapy Department, Sir Charles Gairdner Hospital, Nedlands, Australia; Physiotherapy Department, Royal Perth Hospital, Perth, Australia
| | - Gabrielle Modderman
- Rehabilitation Services, Royal Darwin and Palmerston Regional Hospital, Darwin, Australia
| | - Shannon Williams
- Physiotherapy Department, Sir Charles Gairdner Hospital, Nedlands, Australia; Physiotherapy Department, Royal Perth Hospital, Perth, Australia
| | | | | | - Libby Massey
- MJD Foundation, Darwin, Australia; College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - David J Szmulewicz
- Balance Disorders & Ataxia Service, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Monash Medical Centre, Monash Health, Clayton, Australia; The Florey Institute of Neuroscience and Mental Health, Parkville, Australia
| | - Martin B Delatycki
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, Australia; Department of Pediatrics, The University of Melbourne, Parkville, Australia; Victorian Clinical Genetics Services, Melbourne, Australia
| | - Louise A Corben
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, Australia; Department of Pediatrics, The University of Melbourne, Parkville, Australia; Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
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Yin L, Wang X, Chen L, Liu D, Li H, Liu Z, Huang Y, Chen J. Repetitive transcranial magnetic stimulation for cerebellar ataxia: a systematic review and meta-analysis. Front Neurol 2023; 14:1177746. [PMID: 37483443 PMCID: PMC10360185 DOI: 10.3389/fneur.2023.1177746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
Background Repetitive transcranial magnetic stimulation, a non-invasive brain stimulation technique, can manage cerebellar ataxia (CA) by suppressing cerebral cortical excitability. Hence, this study aimed to summarize the efficacy and safety of rTMS for CA patients by meta-analysis. Methods The PubMed, Embase, Web of Science, and Cochrane Library databases were searched for eligible studies published till 20 May 2023. Weighted mean difference (MD) and 95% confidence intervals (CIs) were used to assess the effect of rTMS treatment. Additionally, the quality of the included studies and the risk of bias were evaluated using the Physiotherapy Evidence Database (PEDro) scale. Results Overall, eight studies involving 278 CA patients were included in this meta-analysis. rTMS could significantly improve the Scale for the Assessment and Rating of Ataxia (SARA) (MD: -2.00; 95% CI: -3.97 to -0.02, p = 0.05), International Cooperative Ataxia Rating Scale (ICARS) (MD: -3.96; 95% CI: -5.51 to -2.40, p < 0.00001), Timed Up-and-Go test (TUG) (MD: -1.54; 95% CI: -2.24 to -0.84, p < 0.0001), 10-m walk test (10 MWT) (MD10-m steps: -2.44; 95% CI: -4.14 to -0.73, p = 0.005), and Berg Balance Scale (BBS) (MD: 2.59; 95% CI: 1.15-4.03, p = 0.0004) as compared to sham stimulation. Active rTMS was not significantly different from sham rTMS in changing the duration (MD10-m time: -1.29; 95% CI: -7.98 to 5.41, p = 0.71). No severe adverse events were observed in both sham stimulation and active rTMS groups. Conclusion This meta-analysis provides limited evidence that rTMS may be beneficial in treating CA patients. However, these findings should be treated with caution due to the limitations of the smaller sample size and the inconsistent approach and target of rTMS treatment. Therefore, more large-scale RCTs are required to further validate our analytical findings. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=295726, identifier: CRD42022295726.
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Affiliation(s)
- Lianjun Yin
- Rehabilitation Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Xiaoyu Wang
- Department of Tuina, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Lianghua Chen
- Rehabilitation Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Dandan Liu
- Rehabilitation Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Haihong Li
- Rehabilitation Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Zhaoxing Liu
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Yong Huang
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Junqi Chen
- Rehabilitation Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
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Chen Y, Su W, Gui CF, Guo QF, Tan HX, He L, Jiang HH, Wei QC, Gao Q. Effectiveness of cerebellar vermis intermittent theta-burst stimulation in improving trunk control and balance function for patients with subacute stroke: a randomised controlled trial protocol. BMJ Open 2023; 13:e066356. [PMID: 36631236 PMCID: PMC9835952 DOI: 10.1136/bmjopen-2022-066356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Balance impairments frequently occur after stroke. Achieving effective core trunk stability is the key to improving balance ability. However, there is still a lack of advanced well-defined rehabilitation protocols for balance improvement in patients with stroke. Intermittent theta-burst stimulation (iTBS) is a non-invasive brain activity modulation strategy that can produce long-term potentiation. The cerebellar vermis is a fundamental structure involved in balance and motor control. However, no study has demonstrated the therapeutic effect and potential mechanism of cerebellar vermis iTBS on balance after stroke. METHODS AND ANALYSIS This study will be a prospective single-centre double-blind randomised controlled clinical trial with a 3-week intervention and 3-week follow-up. Eligible participants will be randomly allocated to the experimental group or the control group in a 1:1 ratio. After routine conventional physical therapy, patients in the experimental group will receive cerebellar vermis iTBS, whereas patients in the control group will receive sham stimulation. The overall intervention period will be 5 days a week for 3 consecutive weeks. The outcomes will be measured at baseline (T0), 3 weeks postintervention (T1) and at the 3-week follow-up (T2). The primary outcomes are Berg Balance Scale and Trunk Impairment Scale scores. The secondary outcomes are balance test scores via the Balance Master system, muscle activation of the trunk and lower limbs via the surface electromyography recordings, cerebral cortex oxygen concentrations measured via the resting-state functional near-infrared spectroscopy, Fugl-Meyer Assessment of Lower Extremity and Barthel index scores. ETHICS AND DISSEMINATION This study was approved by the West China Hospital Clinical Trials and Biomedical Ethics Committee of Sichuan University. All participants will sign the informed consent form voluntarily. The results of this study will be published in peer-reviewed journals and disseminated at academic conferences. TRIAL REGISTRATION NUMBER ChiCTR2200065369.
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Affiliation(s)
- Yi Chen
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, People's Republic of China
| | - Wei Su
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, People's Republic of China
| | - Chen-Fan Gui
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, People's Republic of China
| | - Qi-Fan Guo
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, People's Republic of China
| | - Hui-Xin Tan
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, People's Republic of China
| | - Lin He
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, People's Republic of China
| | - Han-Hong Jiang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, People's Republic of China
| | - Qing-Chuan Wei
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, People's Republic of China
| | - Qiang Gao
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, People's Republic of China
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9
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Onder H, Comoglu S. Letter to the Editor Regarding “Impact of Subjective Evaluations in Predicting Response to Ventriculoperitoneal Shunt for Idiopathic Normal-Pressure Hydrocephalus”. World Neurosurg 2022; 168:314-315. [DOI: 10.1016/j.wneu.2022.08.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 08/16/2022] [Indexed: 12/15/2022]
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10
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Dejvajara D, Aungkasuraphan R, Palee P, Piankusol C, Sirikul W, Siviroj P. Effects of Home-Based Nine-Square Step Exercises for Fall Prevention in Thai Community-Dwelling Older Adults during a COVID-19 Lockdown: A Pilot Randomized Controlled Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10514. [PMID: 36078234 PMCID: PMC9517798 DOI: 10.3390/ijerph191710514] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 06/15/2023]
Abstract
The deterioration of muscle strength in aging has been associated with fall risks. During the COVID-19 pandemic, older adults were restricted from doing outdoor activities. This study aimed to investigate the effect of Nine-Square Step Exercises (NSSE) on improving physical performance and balance in older adults at risk of falling. We conducted an open-labelled, assessor-blinded, randomized controlled trial in 46 (aged 65-84 years) community-dwelling older adults. They were randomly assigned to an NSSE group (n = 24) instructed to perform the program for at least 45 days over 8 weeks or a control group (n = 22). The outcomes were measured by the Timed Up and Go Test (TUG), the Berg Balance Scale (BBS), the Five-Times-Sit-to-Stand test (FTSS), and hand grip strength during the baseline, 4th and 8th weeks in both groups. A mixed-effect linear regression model analysis was performed to estimate the independent effect of NSSE by the intention-to-treat over the 8-week period. The NSSE group showed significant weekly changes in BBS (β 0.57, 95% CI: 0.30, 0.84), TUG (β -0.44, 95% CI: -0.74, -0.14), and FTSS (β -0.52, 95% CI: -0.78, -0.25), demonstrating beneficial improvements in lower extremity and balance, whereas the control group did not demonstrate significant changes over time in any parameter.
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Affiliation(s)
| | | | - Piyathida Palee
- Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Chanodom Piankusol
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Wachiranun Sirikul
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Center of Data Analytics and Knowledge Synthesis for Health Care, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Penprapa Siviroj
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
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11
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Wang L, Huang G, Zhang L, Yang J, Ren C, Liang C, Shen Y, Su B. Effects of the Intermittent Theta Burst Stimulation of the Cerebellar Vermis on Balance Recovery After Stroke: A Study Protocol for a Randomized Controlled Trial. Front Aging Neurosci 2022; 14:881311. [PMID: 35572148 PMCID: PMC9099377 DOI: 10.3389/fnagi.2022.881311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/28/2022] [Indexed: 12/04/2022] Open
Abstract
Background The recovery of balance function is a critical segment in the rehabilitation treatment of stroke. The cerebellum is considered as the key structure involved in balance and motor control. The cerebellar vermis plays an important role in integrating vision, proprioception, and sensory skin input and may be a candidate stimulation target for regulating the motor network related with balance. However, evidence that the intermittent theta burst stimulation (iTBS) of cerebellar vermis can promote the recovery of balance function after stroke remains insufficient. Therefore, this study aims to explore the efficacy of the cerebellar vermis iTBS for the treatment of balance function in patients with stroke. Methods and Analysis Forty patients with stroke will be recruited in this prospective, randomized, sham-controlled trial. Participants will be randomized in a 1:1 ratio to receive either 15 sessions of cerebellar vermis iTBS (600 pulses) or sham stimulation. Additionally, a routine rehabilitation therapy follows the intervention. The primary outcome is the Berg Balance Scale, and the secondary outcomes are the Fugl–Meyer assessment of the lower extremity and modified Barthel index. The above outcomes will be assessed before intervention and at the end of each week. Pre- and post-iTBS resting-state functional magnetic resonance imaging (rs-fMRI) will be acquired, and the regional homogeneity, fractional amplitude of low-frequency fluctuation and functional connectivity will be calculated and analyzed. Discussion This protocol holds promise as a potential method to improve balance function in patients with stroke. If the outcomes of patients improve after the intervention, the study will provide new insights into improving balance function. Ethics and Dissemination This study has been approved by the Medical Research Ethics Committee of Wuxi Mental Health Center (Wuxi Tongren Rehabilitation Hospital). Results will be disseminated through (open-access) peer-reviewed publications, networks of scientists, professionals, and the public and presented at conferences. Clinical Trial Registration Number www.chictr.org.cn, identifier ChiCTR2100052590.
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Affiliation(s)
- Lin Wang
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Guilan Huang
- Department of Rehabilitation, Wuxi Tongren Rehabilitation Hospital, Wuxi, China
| | - Li Zhang
- Department of Rehabilitation, Wuxi Tongren Rehabilitation Hospital, Wuxi, China
| | - Jinyu Yang
- Department of Rehabilitation, Wuxi Tongren Rehabilitation Hospital, Wuxi, China
| | - Caili Ren
- Department of Neurorehabilitation, Wuxi Tongren Rehabilitation Hospital, Wuxi, China
| | - Chengpan Liang
- Department of Rehabilitation, Wuxi Tongren Rehabilitation Hospital, Wuxi, China
| | - Ying Shen
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Ying Shen,
| | - Bin Su
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
- Department of Rehabilitation, Wuxi Tongren Rehabilitation Hospital, Wuxi, China
- Bin Su,
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12
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Krupp S, Freiberger E, Renner C, Hofmann W. [Assessment of mobility/motor skills in old age : Based on the S1 guideline "Geriatric assessment level 2, living guideline"]. Z Gerontol Geriatr 2022; 55:239-248. [PMID: 35441870 DOI: 10.1007/s00391-022-02060-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 01/27/2022] [Indexed: 10/18/2022]
Abstract
In addition to locomotion, mobility also includes any motor performance that serves other purposes and movements that are unplanned. This article presents the instruments mentioned in the S1 guideline "Geriatric assessment level 2, living guideline", as well as additional ones that are less known. The classification is into three categories: instruments that focus on the upper extremities, instruments without performance, which mainly focus on the functions and capabilities of the lower extremities, and those that do this using performance tests.
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Affiliation(s)
- S Krupp
- Forschungsgruppe Geriatrie Lübeck, Krankenhaus Rotes Kreuz Lübeck - Geriatriezentrum, Marlistr. 10, 23566, Lübeck, Deutschland.
| | - E Freiberger
- Institut für Biomedizin des Alterns, FAU Erlangen-Nürnberg, Kobergerstr. 60, 90408, Nürnberg, Deutschland
| | - C Renner
- MediClin Waldkrankenhaus Bad Düben, Gustav-Adolf-Str. 15a, 04849, Bad Düben, Deutschland
| | - W Hofmann
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
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13
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Ning M, Chen F, Wu H, Zheng H, Zheng C, Li S. Effect of Early Rehabilitation and Nursing Intervention on the Rehabilitation Prognosis of Elderly Stroke Hemiplegia Patients in the Department of Neurology. Appl Bionics Biomech 2022; 2022:4958044. [PMID: 35342455 PMCID: PMC8941575 DOI: 10.1155/2022/4958044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 02/20/2022] [Accepted: 03/04/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To explore the influence of rehabilitation outcomes in older patients with stroke hemiplegia from the neurology department by early rehabilitation nursing. Methods 70 cases of old patients with stroke hemiplegia from 2020/01 to 2021/01 were randomly divided into observation group (35 cases) and control group (35 cases). The control group was nursed by usual care. The observation group was nursed by early rehabilitation nursing. Nursing efficacy was observed. Results The scores of active demand, resistance, and rehabilitation nursing cooperation degree after the nursing for the observation group were higher than the control group (P < 005). The score of NIHSS after the nursing for the observation group was lower than that for the control group (P < 005). The scores of BI, BBS, and Fugl-Meyer after the nursing for the observation group were higher than those for the control group (P < 005). The total rate of nursing satisfaction for the observation group was higher than the control group (P < 005). Conclusion Early rehabilitation nursing can improve rehabilitation initiatives, rehabilitation outcomes, and nursing satisfaction in older patients with stroke hemiplegia from the neurology department.
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Affiliation(s)
- Min Ning
- Hainan Cadre Nursing Home (Hainan Geriatric Hospital) Rehabilitation Department, China
| | - Fang Chen
- Hainan Cadre Nursing Home (Hainan Geriatric Hospital) Rehabilitation Department, China
| | - Hui Wu
- Hainan Cadre Nursing Home (Hainan Geriatric Hospital) Nursing Department, Haikou, Hainan 571100, China
| | - Haihua Zheng
- Hainan Cadre Nursing Home (Hainan Geriatric Hospital) Nursing Department, Haikou, Hainan 571100, China
| | - Chunmei Zheng
- Hainan Cadre Nursing Home (Hainan Geriatric Hospital) Nursing Department, Haikou, Hainan 571100, China
| | - Shufen Li
- Hainan Cadre Nursing Home (Hainan Geriatric Hospital) Nursing Department, Haikou, Hainan 571100, China
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14
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Liao LY, Xie YJ, Chen Y, Gao Q. Cerebellar Theta-Burst Stimulation Combined With Physiotherapy in Subacute and Chronic Stroke Patients: A Pilot Randomized Controlled Trial. Neurorehabil Neural Repair 2020; 35:23-32. [PMID: 33166213 DOI: 10.1177/1545968320971735] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Intermittent theta-burst stimulation (iTBS) has been suggested to improve poststroke rehabilitation. The cerebellum is considered crucial for motor control. However, the effects of cerebellar iTBS with routine physical therapy on balance and motor recovery in subacute and chronic stroke patients have not been explored. OBJECTIVE To measure the short-term effects of cerebellar iTBS with physiotherapy on the balance and functional outcomes in subacute and chronic stroke patients with hemiparesis. METHODS Thirty hemiparetic patients were recruited for this randomized, double-blinded, sham-controlled trial, and randomized into either the treatment or sham group. Both groups participated in physiotherapy 5 times per week for 2 weeks, and cerebellar iTBS or sham iTBS was performed daily, immediately before physiotherapy. The primary outcome was the Berg balance scale (BBS) score. Secondary outcomes included the trunk impairment scale (TIS) score, Fugl-Meyer assessment scale score for lower extremities (FMA-LE), Barthel index (BI), and corticospinal excitability, as measured by transcranial magnetic stimulation. The outcomes were measured before and 1 week and 2 weeks after the intervention. RESULTS Compared with those at baseline, significant increases were identified in all clinical scores (BBS, TIS, FMA-LE, and BI) in both groups after the 2-week intervention. The BBS and TIS scores improved more in the iTBS group than in the sham group. CONCLUSIONS Cerebellar iTBS with physiotherapy promotes balance and motor recovery in poststroke patients. Therefore, this method can be used in low-cost, fast, and efficient protocols for stroke rehabilitation (Chinese Clinical Trial Registry: ChiCTR1900026450).
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Affiliation(s)
- Ling-Yi Liao
- West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Daping Hospital, Third Military Medical University, Chongqing, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, China
| | - Yun-Juan Xie
- West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, China
| | - Yi Chen
- West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, China
| | - Qiang Gao
- West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, China
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