Efficacy of Repetitive Transcranial Magnetic Stimulation and Virtual Cycling Training on Upper Limb Function in Patients with Stroke

Stroke is the major cause of motor impairment and physical disabilities in the adult population. Recently, current interventions, such as virtual reality (VR) and repetitive transcranial magnetic stimulation (rTMS), were used for the treatment of upper extremity (UE) dysfunction in patients with stroke. This project proposes different novel treatment strategies in the treatment of UE dysfunction in patients with stroke: combined facilitatory (intermittent theta burst stimulation)/inhibitory (continuous theta burst stimulation) rTMS, VR-based cycling training (VCT), and integrated intervention (rTMS and VCT). This study aims 1. to establish the protocol and clinimetric properties of clinical and motor control measures for patients with stroke; 2. to identify the most optimal treatment protocols of rTMS; 3. to establish the integrated novel treatment protocol; 4. determine it's the neuro-motor control mechanism of novel treatment protocol underlying clinical improvement for patients with stroke; 5. to identify clinical predictors and related biomarkers influencing the outcome for different treatment protocols. This 3-year project will enroll 96-120 participants and conduct a well-designed randomized controlled trial (RCT) for different novel protocols in the treatment of UE dysfunction in patients with stroke. In the 1st phase (1-2 year), 48-60 patients will be randomized into 4 groups: facilitatory, inhibitory, combined facilitatory/inhibitory rTMS and control (sham rTMS) groups to identify optimal treatment protocol of rTMS. In the 2nd phase (2-3 year), 48-60 patients will be randomized into 4 groups: optimal rTMS group, VCT group, integrated intervention (rTMS with VCT) and control groups to identify optimal integrated novel treatment protocol. The outcome measurements include motor control (motor evoked potential, muscle tone, kinetic, and kinematics) and clinical assessments (body function, activity, and participation and health status (HRQOL)), administered at pretest, posttest, and 3-month follow-up. This goal of this study will establish the novel assessment and treatment protocols in patients with stroke. We will establish the procedure of motor control assessment and determine the optimal and effective treatment protocol of rTMS. This study will apply the translational and evidence-based medicine into the neuro-rehabilitaion field of stroke research with significant contribution for further developing the new therapeutic protocol for these patients.

Project ID:PC10601-0847
External Project ID:MOST105-2314-B182-020-MY3