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Continuous theta burst stimulation combined with skilled motor practice after stroke : effects on implicit learning and electroneurophysiology Linsdell, Meghan Ashley
Abstract
After stroke, cortical excitability is decreased in the ipsilesional primary motor cortex and increased in the contralesional primary motor cortex. This abnormal pattern of excitability detrimentally affects performance with the hemiparetic arm. Short lasting improvements in motor performance occur following repetitive transcranial magnetic stimulation (rTMS) over the contralesional hemisphere after stroke; however, no work has considered the impact of pairing rTMS with skilled motor practice over multiple days on motor learning, hemiparetic arm function, or electroneurophysiology in the brain. The aim of this thesis was to determine the impact of 3 days of continuous theta burst stimulation (cTBS) over contralesional primary motor cortex paired with skilled motor practice on 1) learning of a novel motor task and hemiparetic arm motor function and 2) levels of intracortical inhibition, intracortical facilitation, and transcallosal inhibition following stroke. In a cross-over design, participants with chronic stroke were randomized to first receive either active or sham cTBS over the contralesional primary motor cortex. Functional measures, motor task performance, and electroneurophysiology were assessed at baseline. 3 days of cTBS paired with skilled motor practice were completed; functional measures, motor learning, and electroneurophysiology were re-evaluated at posttesting. After a 2-week washout period participants underwent the second half of the study with the other form of cTBS. Participants showed larger motor learning related change following active cTBS than sham cTBS. The magnitude of this improvement correlated with enhanced performance on standardized measures of arm function after stroke. Active cTBS also decreased levels of facilitation in the contralesional hemisphere and decreased the amount of inhibition being sent from the contralesional hemisphere to the ipsilesional hemisphere. No adverse effects were reported. Results of this thesis suggest that cTBS over the contralesional motor cortex iii paired with skilled motor practice facilitates both improved hemiparetic arm function and motor learning beyond that seen with skilled motor practice alone. The results of this thesis contribute to research relevant to rehabilitation of individuals with stroke and may facilitate the development of new rehabilitation strategies to improve functional recovery after stroke.
Item Metadata
Title |
Continuous theta burst stimulation combined with skilled motor practice after stroke : effects on implicit learning and electroneurophysiology
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Creator | |
Publisher |
University of British Columbia
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Date Issued |
2010
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Description |
After stroke, cortical excitability is decreased in the ipsilesional primary motor cortex and
increased in the contralesional primary motor cortex. This abnormal pattern of excitability
detrimentally affects performance with the hemiparetic arm. Short lasting improvements in
motor performance occur following repetitive transcranial magnetic stimulation (rTMS) over the
contralesional hemisphere after stroke; however, no work has considered the impact of pairing
rTMS with skilled motor practice over multiple days on motor learning, hemiparetic arm
function, or electroneurophysiology in the brain. The aim of this thesis was to determine the
impact of 3 days of continuous theta burst stimulation (cTBS) over contralesional primary motor
cortex paired with skilled motor practice on 1) learning of a novel motor task and hemiparetic
arm motor function and 2) levels of intracortical inhibition, intracortical facilitation, and
transcallosal inhibition following stroke. In a cross-over design, participants with chronic stroke
were randomized to first receive either active or sham cTBS over the contralesional primary
motor cortex. Functional measures, motor task performance, and electroneurophysiology were
assessed at baseline. 3 days of cTBS paired with skilled motor practice were completed;
functional measures, motor learning, and electroneurophysiology were re-evaluated at posttesting.
After a 2-week washout period participants underwent the second half of the study with
the other form of cTBS. Participants showed larger motor learning related change following
active cTBS than sham cTBS. The magnitude of this improvement correlated with enhanced
performance on standardized measures of arm function after stroke. Active cTBS also decreased
levels of facilitation in the contralesional hemisphere and decreased the amount of inhibition
being sent from the contralesional hemisphere to the ipsilesional hemisphere. No adverse effects
were reported. Results of this thesis suggest that cTBS over the contralesional motor cortex
iii
paired with skilled motor practice facilitates both improved hemiparetic arm function and motor
learning beyond that seen with skilled motor practice alone. The results of this thesis contribute
to research relevant to rehabilitation of individuals with stroke and may facilitate the
development of new rehabilitation strategies to improve functional recovery after stroke.
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Genre | |
Type | |
Language |
eng
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Date Available |
2010-12-21
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Provider |
Vancouver : University of British Columbia Library
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Rights |
Attribution-NonCommercial-NoDerivatives 4.0 International
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DOI |
10.14288/1.0071520
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URI | |
Degree | |
Program | |
Affiliation | |
Degree Grantor |
University of British Columbia
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Graduation Date |
2011-05
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Campus | |
Scholarly Level |
Graduate
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Rights URI | |
Aggregated Source Repository |
DSpace
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Rights
Attribution-NonCommercial-NoDerivatives 4.0 International