Theta burst stimulation in the rehabilitation of the upper limb: A semirandomized, placebo-controlled trial in chronic stroke patients

Penelop E. Talelli, Amanda Wallace, Michelle Dileone, Damon Hoad, Binith Cheeran, Rupert Oliver, Mehdi Vandenbos, Ulrike Hammerbeck, Karen Barratt, Cecilia Gillini, Gabriella Musumeci, Marie Hélène Boudrias, Geoffrey C. Cloud, Joanna Ball, Jonathan F. Marsden, Nicholas S. Ward, Vincenzo Di Lazzaro, Richard G. Greenwood, John C. Rothwell

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103 Citations (Scopus)


Background. Noninvasive cortical stimulation could represent an add-on treatment to enhance motor recovery after stroke. However, its clinical value, including anticipated size and duration of the treatment effects, remains largely unknown. Objective. The authors designed a small semi-randomized clinical trial to explore whether long-lasting clinically important gains can be achieved by adding theta burst stimulation (TBS), a form of repetitive transcranial magnetic stimulation (TMS), to a rehabilitation program for the hand. Methods. A total of 41 chronic stroke patients received excitatory TBS to the ipsilesional hemisphere or inhibitory TBS to the contralesional hemisphere in 2 centers; each active group was compared with a group receiving sham TBS. TBS was followed by physical therapy for 10 working days. Patients and therapists were blinded to the type of TBS. Primary outcome measures (9-hole Peg Test [9HPT], Jebsen Taylor Test [JTT], and grip and pinch-grip dynamometry) were assessed 4, 30, and 90 days post treatment. The clinically important difference was defined as 10% of the maximum score. Results. There were no differences between the active treatment and sham groups in any of the outcome measures. All patients achieved small sustainable improvements-9HPT, 5% of maximum (confidence interval [CI] = 3%-7%); JTT, 5.7% (CI = 3%-8%); and grip strength, 6% (CI = 2%-10%)-all below the defined clinically important level. Conclusions. Cortical stimulation did not augment the gains from a late rehabilitation program. The effect size anticipated by the authors was overestimated. These results can improve the design of future work on therapeutic uses of TMS.

Original languageEnglish
Pages (from-to)976-987
Number of pages12
JournalNeurorehabilitation and Neural Repair
Issue number8
Publication statusPublished - Oct 2012
Externally publishedYes


  • motor control
  • stroke rehabilitation
  • theta burst stimulation
  • transcranial magnetic stimulation
  • upper extremity

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