Primed Physical Therapy Enhances Recovery of Upper Limb Function in Chronic Stroke Patients

Suzanne J Ackerley, Winston D Byblow, P Alan Barber, Hayley MacDonald, Andrew McIntyre-Robinson, Cathy M Stinear

Research output: Contribution to journalArticlepeer-review

28 Citations (Scopus)
185 Downloads (Pure)


BACKGROUND: Recovery of upper limb function is important for regaining independence after stroke.

OBJECTIVE: To test the effects of priming upper limb physical therapy with intermittent theta burst stimulation (iTBS), a form of noninvasive brain stimulation.

METHODS: Eighteen adults with first-ever chronic monohemispheric subcortical stroke participated in this randomized, controlled, triple-blinded trial. Intervention consisted of priming with real or sham iTBS to the ipsilesional primary motor cortex immediately before 45 minutes of upper limb physical therapy, daily for 10 days. Changes in upper limb function (Action Research Arm Test [ARAT]), upper limb impairment (Fugl-Meyer Scale), and corticomotor excitability, were assessed before, during, and immediately, 1 month and 3 months after the intervention. Functional magnetic resonance images were acquired before and at one month after the intervention.

RESULTS: Improvements in ARAT were observed after the intervention period when therapy was primed with real iTBS, but not sham, and were maintained at 1 month. These improvements were not apparent halfway through the intervention, indicating a dose effect. Improvements in ARAT at 1 month were related to balancing of corticomotor excitability and an increase in ipsilesional premotor cortex activation during paretic hand grip.

CONCLUSIONS: Two weeks of iTBS-primed therapy improves upper limb function at the chronic stage of stroke, for at least 1 month postintervention, whereas therapy alone may not be sufficient to alter function. This indicates a potential role for iTBS as an adjuvant to therapy delivered at the chronic stage.

Original languageEnglish
Pages (from-to)339-348
Number of pages10
JournalNeurorehabilitation and Neural Repair
Issue number4
Early online date15 Jul 2015
Publication statusPublished - May 2016


  • Adult
  • Aged
  • Aged, 80 and over
  • Chronic Disease
  • Double-Blind Method
  • Exercise Therapy/methods
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Motor Cortex/physiopathology
  • Outcome Assessment (Health Care)
  • Recovery of Function/physiology
  • Stroke/physiopathology
  • Stroke Rehabilitation/methods
  • Transcranial Magnetic Stimulation/methods
  • Upper Extremity/physiopathology
  • Young Adult


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