學院	醫學院
系所	職能治療學系
題名	Augmented efficacy of intermittent theta burst stimulation on the virtual reality-based cycling training for upper limb function in patients with stroke: a double-blinded, randomized controlled trial
作者	Chen, Y-H., Chen, C-L*., Huang, Y-Z., Chen, H-C., Chen, C-Y., Wu, C-Y., & Lin, K-C
期刊名稱	Journal of NeuroEngineering and Rehabilitation (SCIE 期刊)
發表日期	2021
著作性質	原著
語文	英文
關鍵字	Theta burst stimulation, Virtual reality, Stroke, Upper limb, Motor function, Rehabilitation
摘要	Background: Virtual reality and arm cycling have been reported as efective treatments for improving upper limb motor recovery in patients with stroke. Intermittent theta burst stimulation (iTBS) can increase ipsilesional cortical excitability, and has been increasingly used in patients with stroke. However, few studies examined the augmented efect of iTBS on neurorehabilitation program. In this study, we investigated the augmented efect of iTBS on virtual reality-based cycling training (VCT) for upper limb function in patients with stroke. Methods: In this randomized controlled trial, 23 patients with stroke were recruited. Each patient received either 15 sessions of iTBS or sham stimulation in addition to VCT on the same day. Outcome measures were assessed before and after the intervention. Primary outcome measures for the improvement of upper limb motor function and spasticity were Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and Modifed Ashworth Scale Upper-Extremity (MAS-UE). Secondary outcome measures for activity and participation were Action Research Arm Test (ARAT), Nine Hole Peg Test (NHPT), Box and Block Test (BBT) and Motor Activity Log (MAL), and Stroke Impact Scale (SIS). Wilcoxon signed-rank tests were performed to evaluate the efectiveness after the intervention and Mann–Whitney U tests were conducted to compare the therapeutic efects between two groups. Results: At post-treatment, both groups showed signifcant improvement in FMA-UE and ARAT, while only the iTBS+VCT group demonstrated signifcant improvement in MAS-UE, BBT, NHPT, MAL and SIS. The Mann–Whitney U tests revealed that the iTBS+VCT group has presented greater improvement than the sham group signifcantly in MAS-UE, MAL-AOU and SIS. However, there were no signifcant diferences in the changes of the FMA-UE, ARAT, BBT, NHPT and MAL-QOM between groups. Conclusions: Intermittent TBS showed augmented efcacy on VCT for reducing spasticity, increasing actual use of the afected upper limb, and improving participation in daily life in stroke patients. This study provided an integrated innovative intervention, which may be a promising therapy to improve upper limb function recovery in stroke reha‑ bilitation. However, this study has a small sample size, and thus a further larger-scale study is warranted to confrm the treatment efcacy.