Combining theta burst and low frequency transcranial magnetic stimulation with physical training improves arm recovery in patients with stroke

This study investigated the effect of theta-burst stimulation (TBS) and low-frequency magnetic stimulation (LFMS) in patients with stroke and arm impairment. Researchers suggested that TBS and LFMS combined with physical therapy improved arm function in these patients.

Stroke is one of the main causes of chronic disability and is present in more than 795,000 people in the US. It happens when the blood flow to the brain stops due to a blood clot or a burst blood vessel. Brain cells stop receiving oxygen and begin to die causing symptoms such as arm paralysis.

The standard treatment is physical therapy. However, this can be of limited effectiveness in patients with chronic stroke (stoke happened more than 6 months before). LFMS is a brain stimulation method that delivers magnetic pulses to specific brain areas. Prior studies suggested that LFMS improved arm function when applied at a low frequency to unaffected brain areas. LFMS is known to also improve spasticity (muscle rigidity).     

TBS is a newer form of LFMS consisting of short bursts of stimulation at high frequencies. It allows more pulses to be delivered in less time when compared to conventional LFMS. During treatment, patients must keep their position stable. Therefore, TBS might a better option in terms of patient comfort. The effectiveness of LFMS compared to TBS on spasticity and arm recovery in chronic stroke is still not clear.

This study included information about 20 patients with chronic stroke. Participants were assigned to receive 10 sessions of either LFMS (7), TBS (7), or placebo treatment (6). All three groups also received standard physical therapy. Patients were followed up before treatment, after treatment, and at 4 weeks.

LFMS and TBS combined with physical therapy improved arm function after treatment and at 4 weeks. In the placebo group, no significant improvement was observed.

LFMS improved spasticity in the elbow, forearm, wrist, and fingers. TBS improved spasticity in the elbow and wrist. No significant improvement in spasticity was observed in the placebo group. 

This study concluded that LFMS and TBS combined with physical therapy improve arm function in patients with chronic stroke.

This study included a very small number of participants and a short follow-up period. Further studies with larger populations and extended follow-up periods are needed.