Impairments in gait and balance are not uncommon after stroke, and are associated with poorer functional recovery. The contralesional cerebellum is strongly implicated in the functional reorganization of the motor network when recovery takes place. In fact, magnetic resonance imaging (MRI) studies have shown that activity in the contralesional cerebellum is positively associated with gait recovery in patients with stroke. Cerebellar mediated motor learning can be potentiated using non-invasive brain stimulation methods, including cerebellar intermittent θ-burst stimulation (CRB-iTBS). In this randomized controlled trial, 34 patients were randomized to receive a 3-week treatment of CRB-iTBS coupled with physiotherapy or sham iTBS, to determine whether CRB-iTBS can improve balance and gait functions in patients with hemiparesis due to stroke. The primary outcome was the between-group difference in change from baseline in the Berg Balance Scale. Secondary exploratory measures included the between-group difference in change from baseline in Fugl-Meyer Assessment scale, Barthel Index, and locomotion assessment with gait analysis and cortical activity measured by transcranial magnetic stimulation in combination with electroencephalogram. Researchers found that patients treated with CRB-iTBS, but not with sham iTBS, showed an improvement in gait and balance functions, as revealed by a pronounced increase in the mean Berg Balance Scale score (p<0.001). No overall treatment-associated differences were noted in the Fugl-Meyer Assessment. In addition, patients treated with CRB-iTBS, but not sham iTBS, showed a reduction in step width from a baseline mean of 16.8 cm to 14.3 cm after 3 weeks of treatment (p<0.05). Increased neural activity over the posterior parietal cortex was also noted in the intervention group. This study therefore shows that cerebellar intermittent θ-burst stimulation may promote gait and balance recovery in patients affected by stroke.
Click to read the study in JAMA Neurology
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