Aimee Arely Flores Sandoval | rTMS for enhancing BCI-induced plasticity in stroke: a crossover design

Stroke is the third leading cause of motor disability worldwide. The global increase in life expectancy and the improvement in the acute management of stroke are expected to produce an increment in the prevalence of stroke survivors, urging the development of better strategies for functional rehabilitation. Traditional rehabilitation strategies, such as physiotherapy and occupational therapy produce limited effects on individuals with moderate to severe hemiparesis, especially if they have reached the chronic stage of stroke recovery. In these cases, diminished sensorimotor neural activity and brain plasticity mechanisms hamper motor rehabilitation.

Brain-computer interface (BCI) mediated training could be a valuable strategy to engage sensorimotor loops, as it can deliver sensory stimulation based on brain activity (e.g., imagery-induced EEG activity) (Peng et al., 2022). In addition, animal and human studies suggest that repetitive transcranial magnetic stimulation (rTMS) protocols such as intermittent theta burst stimulation (iTBS) could enhance neuroplasticity mechanisms (Suppa et al. 2016). In line with this rationale, we propose applying iTBS over ipsilesional premotor cortex, a key area for motor execution and imagery, immediately before BCI-mediated training to enhance its effects and potentially benefit even individuals with chronic stroke and moderate to severe hemiparesis.

The present pilot study aims to explore preliminary evidence of the effects of iTBS on the neuroplastic mechanisms elicited by BCI-mediated training to assess whether this intervention would merit further research in an adequately powered randomized clinical trial.

References:

Suppa, A., Huang, Y. Z., Funke, K., Ridding, M. C., Cheeran, B., Di Lazzaro, V., … Rothwell, J. C. (2016). Ten Years of Theta Burst Stimulation in Humans: Established Knowledge, Unknowns and Prospects. Brain Stimulation, 9(3), 323–335. https://doi.org/10.1016/j.brs.2016.01.006

Peng, Y., Wang, J., Liu, Z., Zhong, L., Wen, X., Wang, P., … Liu, H. (2022). The Application of Brain-Computer Interface in Upper Limb Dysfunction After Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Frontiers in Human Neuroscience, 16(March), 1–10. https://doi.org/10.3389/fnhum.2022.798883