Effects of robot-assisted upper limb training combined with intermittent theta burst stimulation (iTBS) on cortical activation in stroke patients: A functional near-infrared spectroscopy study

Article type: Research Article

Authors: Dai, Lei^{a; 1} | Zhang, Wanying^{a; 1} | Zhang, Huihuang^{b; 1} | Fang, Linjie^{c; 1} | Chen, Jianer^{a; b; c; *} | Li, Xiang^d | Yu, Hong^c | Song, Jianfei^c | Chen, Shishi^a | Zheng, Beisi^a | Zhang, Yujia^a | Li, Zhongyi^e

Affiliations: [a] The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China | [b] The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China | [c] Zhejiang Rehabilitation Medical Center, Hangzhou, China | [d] Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China | [e] Hangzhou Innovation Institute, Beihang University, Hangzhou, China

Correspondence: [*] Address for correspondence: Jianer Chen, Zhejiang Rehabilitation Medical Center, No. 2828 Binsheng Road, Binjiang District, Hangzhou City, Zhejiang Province, China. E-mail: chenje@zcmu.edu.com.

Note: [1] These authors contributed equally to the manuscript.

Abstract: BACKGROUND: The therapeutic effect and mechanism of robot-assisted upper limb training (RT) combined with intermittent theta burst stimulation (iTBS) for stroke patients are unclear. OBJECTIVE: The purpose of this study was to evaluate changes in brain activation after combination therapy and RT alone using functional near-infrared spectroscopy (fNIRS). METHODS: Patients were randomly assigned to two groups (iTBS + RT Group, n = 18, and RT Group, n = 18). Training was conducted five times a week for four weeks. fNIRS was used to measure changes in oxyhemoglobin in both the primary motor cortex (M1) and pre-motor and supplementary motor area (pSMA) during affected limb movement. Fugl-Meyer Assessment-Upper Extremity (FMA-UE) was employed for evaluating the function of upper limbs. RESULTS: Thirty-two patients with subacute stroke completed the study. The cortex of both hemispheres was extensively activated prior to treatment in the RT group. After training, overactivation decreased. The brain activation of the combined treatment group transferred to the affected side after the treatment. There was a notable enhancement in the FMA-UE scores for both groups, with the combined group’s progress significantly surpassing that of the RT group. CONCLUSION: RT combined with iTBS can improve the motor function of stroke patients and promote the balance between cerebral hemispheres.

Keywords: Stroke, rehabilitation, upper extremity, transcranial magnetic stimulation, robotics, near-infrared spectroscopy

DOI: 10.3233/NRE-230355

Journal: NeuroRehabilitation, vol. 54, no. 3, pp. 421-434, 2024