Effects Of Mirror Therapy Combined With Theta Burst Stimulation On Motor Recovery Of Upper Limbs After Stroke

Part Ⅰ: Effects of mirror therapy combined with Theta burst stimulation on motor recovery of upper limbs in patients with acute strokeObjective: To investigate the effects of intermittent Theta burst stimulation(i TBS)and mirror therapy(MT)combined with i TBS on upper limb(UL)motor function,activities of daily living(ADL),cortical excitability in patients with acute stroke.Methods: Twenty-four patients were randomly assigned into 4 groups: control group(n=6),i TBS group(n=6),MT group(n=6),MT combined with i TBS group(n=6).All the four groups were given routine rehabilitation.The three treatment groups were treated with i TBS,MT,MT combined with i TBS respectively.All the patients received the therapy 5days per week for two weeks(10 working days).Patients were evaluated before treatment,then immediately,1 month and 3 months after treatment.The assessments included:National Institutes of Health Stroke Scale(NIHSS),upper limb Fugl-Meyer assessment(UL-FMA),Brunnstrom scale(BS),modified Barthel index(MBI),Stroke-specific quality of life scale(SS-QOL),resting motor threshold(RMT)and motor evoked potential(MEP).Results: On comparison with baseline data,the NIHSS,UL-FMA,MBI,and SS-QOL scores of the four groups were improved at each time point after treatment(p<0.05).For upper limb BS,the control group and the MT group at 1 month after treatment,while the i TBS group and combined treatment group at immediately after treatment showed significant increase(P<0.05).For hand BS,the control group,i TBS group,and MT group at 1 month after treatment,while the combined treatment group at immediately after treatment showed statistical difference(P<0.05).For the intergroup comparing,the combined treatment group significantly increased the UL-FMA and MBI scores at 1 month and 3 months after treatment compared with the control group(p<0.05).There were no significant differences in the NIHSS,BS,and SS-QOL scores between the four groups(p>0.05).On the contralesional hemisphere,the RMT increased,the MEP latency increased,and the MEP amplitude decreased statistically in i TBS group;the RMT decreased,the MEP latency decreased,and the MEP amplitude increased statistically in MT group(P<0.05).Conclusions: Addition of the i TBS and combination therapy to conventional rehabilitation could improve UL motor function and the ADL in patients with acute stroke.The combined treatment group did not show statistical significance compared to the i TBS group and MT group.The i TBS group showed inhibition,while the MT group showed facilitation of hemisphere excitability in the contralateral side.The inhibition and facilitation of the contralateral hemisphere in the combined treatment group were not obvious.Part Ⅱ: Effects of mirror therapy combined with Theta burst stimulation on motor recovery of upper limbs in patients with subacute strokeObjective: To investigate the effects of intermittent Theta burst stimulation(i TBS)and mirror therapy(MT)combined with i TBS on upper limb(UL)motor function,activities of daily living(ADL),cortical excitability in patients with subacute stroke.Methods: Forty-six patients were randomly assigned into 4 groups: control group(n=11),i TBS group(n=12),MT group(n=11),MT combined with i TBS group(n=12).All the four groups were given routine rehabilitation.The three treatment groups were treated with i TBS,MT,MT combined with i TBS respectively.All the patients received the therapy5 days per week for two weeks(10 working days).Patients were evaluated before treatment,then immediately,1 month and 3 months after treatment.The assessments included:National Institutes of Health Stroke Scale(NIHSS),upper limb Fugl-Meyer assessment(UL-FMA),Brunnstrom scale(BS),modified Barthel index(MBI),Stroke-specific quality of life scale(SS-QOL),resting motor threshold(RMT)and motor evoked potential(MEP).Results: On comparison with baseline data,the NIHSS,UL-FMA proximal,upper limb BS,MBI and SS-QOL of four groups were improved at all time point after treatment(p<0.05).For the FMA distal,the control group and the MT group at 1 month after treatment,while the i TBS group and the combined treatment group at immediately after treatment showed significant increase(P<0.05).For hand BS,the control group,i TBS group and MT group at 1 month after treatment,while the combined treatment group at immediately after treatment have a significant change(P<0.05).For the intergroup comparing,the combined treatment group significantly improved the upper limb BS(3months after treatment),UL-FMA proximal(1 month and 3 months after treatment),MBI(1 month after treatment),and SS-QOL(1 month after treatment)compared with the control group(p<0.05).At 3 months after treatment,the i TBS group significantly improved the upper limb BS compared with the control group,the combined treatment group also significantly improved the upper limb BS compared with the MT group.There was no significant difference between the NIHSS,the UL-FMA distal,and the hand BS between four groups(P>0.05).On the contralesional hemisphere,the decrease of RMT,the increase of MEP amplitude of the MT group,and the increase of the MEP latency of the i TBS group were statistically significant(P<0.05).The MEP was measured in 5 cases in the control group,5 cases in the i TBS group,5 cases in the MT group,and 6 cases in the combined treatment group for the affected side.The three treatment groups decreased in RMT,decreased in MEP latency,and increased in MEP amplitude significantly compared with pretreatment(P<0.05).There was a positive correlation between the change of MEP amplitude(both contralesional and affected hemisphere)and the change of upper limb FMA.The correlation coefficient of “r” was 0.719 and 0.679 respectively.There was a negative correlation between the change of the RMT,the change of MEP latency of the affected side,and the change of the FMA of the upper limb.The correlation coefficient “r”was-0.816 and-0.865 respectively.Conclusions: Addition of the i TBS and combination therapy to conventional rehabilitation could improve UL motor function and the ADL in patients with subacute stroke.The combined treatment group was more effective than MT group and showed no statistical significance compared with the i TBS group.The i TBS group showed the facilitation of hemisphere excitability in the affected side and the inhibition of hemisphere excitability in the contralateral side.The MT group showed a facilitative effect on bilateral cortical excitability.The combined treatment group showed significant facilitation of the affected hemisphere,while the inhibition and facilitation of the contralateral hemisphere were not obvious.There was a good correlation between excitability of the affected hemisphere,some index of contralateral hemisphere and the recovery of UL motor function.