The present prospective, randomized, controlled, double-blinded trial investigates the effects of intermittent theta-burst stimulation (iTBS) during the early rehabilitation after stroke. Patients with hemipresis will receive either sham or real iTBS over their affected hemispheres before occupational therapy for 8 days. Motor recovery is assessed one day after the intervention phase and three months after enrollment.
To date, rehabilitation of stroke with hemiparesis mainly includes physiotherapy and occupational therapy. Yet, the majority of patients retain movement impairment relevant for activities of daily living. One explanation for this deficit is the insufficient recovery of connectivity between brain regions after stroke. It is possible to modulate this process by repetitive transcranial magnetic stimulation (rTMS) using the protocol of intermittent theta-burst stimulation (iTBS). Previous data indicate that modulation of the motor cortex with iTBS enhances the effects of subsequent motor training. The present study aims at investigating whether daily repetitive transcranial magnetic stimulation over 8 days combined with subsequent physiotherapy leads to better motor recovery, compared with physiotherapy after sham stimulation. In the first weeks and after three months, motor function, degree of disability and quality of life are examined in order to evaluate the effects of iTBS in the rehabilitation of stroke patients. Amendment (approved by the Ethics-Committee of the Medical Faculty of the University of Cologne, 20/12/2016): Specification of exclusion criteria. Amendment (approved by the Ethics-Committee of the Medical Faculty of the University of Cologne, 15/11/2018): Change of inclusion and exclusion criteria.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
150
iTBS applied over ipsilesional M1
iTBS applied with tilted coil over parieto-occipital vertex
Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln
Cologne, North Rhine-Westphalia, Germany
Relative grip force
grip force as measured with vigorimeter
Time frame: 3 months after enrollment
Relative grip force
grip force as measured with vigorimeter
Time frame: after 8 days of intervention, and 3 months after enrollment
Motor function
Action Research Arm Test, ARAT
Time frame: after 8 days of intervention, and 3 months after enrollment
Motor function
Fugl-Meyer Motor Scale of the upper extremity, FM
Time frame: after 8 days of intervention, and 3 months after enrollment
Stroke severity
National Instituts of Health Stroke Scale, NIHSS
Time frame: after 8 days of intervention, and 3 months after enrollment
Degree of disability
modified Rankin Scale, mRS
Time frame: after 8 days of intervention, and 3 months after enrollment
Motorcortex excitability
Motor evoked potential induced by stimulation of the affected motor cortex, MEP
Time frame: after 8 days of intervention, and 3 months after enrollment
Motorcortex excitability
Resting motor threshold as measured by stimulation of the affected motor cortex, RMT
Time frame: after 8 days of intervention, and 3 months after enrollment
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Quality of life
EuroQol 5D questionnaire, EQ-5D
Time frame: after 8 days of intervention, and 3 months after enrollment
Activities of daily living at admission and discharge in external rehabilitation facility
Barthel-Index (BI) scores as documented by external rehabilitation facility
Time frame: 3 months after enrollment
Days of rehabilitation after intervention phase
Days of rehabilitation after intervention phase as documented by external rehabilitation facility
Time frame: 3 months after enrollment