Priming sensorimotor cortex to enhance task-specific training after subcortical stroke

Useless. 'May' is not good enough.  Obviously no stroke protocol was written up and distributed worldwide.  So wasted research.

Priming sensorimotor cortex to enhance task-specific training after subcortical stroke

 Suzanne J. Ackerley a,c, 

Cathy M. Stinear b,c, 

P. Alan Barber c,d, 

Winston D. Byblow a,c,
⇑
a Movement Neuroscience Laboratory, Department of Sport and Exercise Science, The University of Auckland, Auckland, New Zealand
b Clinical Neuroscience Laboratory, Department of Medicine, The University of Auckland, Auckland, New Zealand
c Centre for Brain Research, The University of Auckland, Auckland, New Zealand
d Neurology Department, Auckland City Hospital, Auckland, New Zealand
a r t i c l e i n f o
 Article history:
Accepted 23 November 2013Available online xxxx
Keywords:
Sensorimotor integration Short latency afferent inhibition Stroke rehabilitation Theta burst stimulation Transcranial magnetic stimulation
highlights

 The effects of Theta Burst Stimulation (TBS)-primed dexterity training on sensorimotor integration,corticomotor excitability, sensation and grip-lift kinetics were examined in chronic subcortical stroke patients.

 Intermittent TBS(iTBS) of ipsilesional primary motor cortex(M1) modulated corticomotor excitability and increased M1 receptiveness to sensory input.

 Priming ipsilesional M1withiTBS prior to upper limb therapy may facilitate sensorimotor integration and serve as a useful adjunct to improve the quality of sensorimotor training during rehabilitation after subcortical stroke.

Abstract

Objective:
 This double-blind sham-controlled crossover study investigated the interactions between primary sensory and motor cortex after stroke and their response to Theta Burst Stimulation (TBS).
Methods:
 Thirteen chronic subcortical stroke patients with upper limb impairment performed standardised dexterity training primed with ipsilesional M1 intermittent TBS (iTBS
iM1),  contralesional M1 continuous TBS (cTBS
cM1
) or sham TBS. The effects on sensorimotor integration, corticomotor excitability,sensation and grip-lift kinetics were examined.
Results:
 AfteriTBSiM1, improvements in paretic grip-lift performance were accompanied by an immediate facilitation of ipsilesional M1 excitability and a subsequent increase in ipsilesional short latency afferent inhibition (SAI) during training. Precision grip-lift performance improved after cTBS
cM1
 and training,alongside increased ipsilesional M1 excitability with no effect on ipsilesional SAI. There were no effectson sensory performance.
Conclusion:
 Primary motor cortex iTBS not only modulates M1 corticospinal excitability but also increases M1 receptiveness to sensory input.
Significance:
 Priming with iTBSiM1
may enhance ipsilesional sensorimotor integration and facilitate better quality sensorimotor training after subcortical stroke.

 2013 Published by Elsevier Ireland Ltd. on behalf of International Federation of ClinicalNeurophysiology.