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A 10-Hz cerebellar repetitive transcranial magnetic stimulation (rTMS) could increase corticobulbar tract excitability in healthy individuals. However, its clinical efficacy for poststroke dysphagia (PSD) remains unclear. To investigate the effectiveness of 10-Hz cerebellar rTMS in PSD patients with infratentorial stroke (IS). In this single-blinded, randomized controlled trial, 42 PSD patients with subacute IS were allocated to three groups: bilateral cerebellar rTMS (biCRB-rTMS), unilateral cerebellar rTMS (uniCRB-rTMS), or sham-rTMS. The stimulation parameters were 5 trains of 50 stimuli at 10 Hz with an interval of 10 s at 90% of the thenar resting motor threshold (RMT). The Functional Oral Intake Scale (FOIS) was assessed at T0 (baseline), T1 (day 0 after intervention), and T2 (day 14 after intervention), whereas the Dysphagia Outcome and Severity Scale (DOSS), Penetration Aspiration Scale (PAS), and neurophysiological parameters were evaluated at T0 and T1. Significant time and intervention interaction effects were observed for the FOIS score (F = 3.045, p = 0.022). The changes in the FOIS scores at T1 and T2 were both significantly higher in the biCRB-rTMS group than in the sham-rTMS group (p < 0.05). The uniCRB-rTMS and biCRB-rTMS groups demonstrated greater changes in the DOSS and PAS at T1, compared with the sham-rTMS group (p < 0.05). Bilateral corticobulbar tract excitability partly increased in the biCRB-rTMS and uniCRB-rTMS groups at T1, compared with T0. The percent changes in corticobulbar tract excitability parameters at T1 showed no difference among three groups. A 10-Hz bilateral cerebellar rTMS is a promising, noninvasive treatment for subacute infratentorial PSD. • 10Hz bilateral cerebellar rTMS is curative for post stroke dysphagia. • Cerebellar rTMS with double-cone coil is safe and well-tolerated in patients. • Corticobulbar tract excitability increased after combined therapy. [ABSTRACT FROM AUTHOR]

AiWalker is a newly developed robot-assisted gait training system, which features over-ground walking paradigm and somatosensory stimulation during training compared to commonly-used robot-assisted gait training devices (e.g. Lokomat). However, no study has examined its true therapeutic effect and possible mechanism or mediating factor(s). To investigate 1) the therapeutic effect of AiWalker on the balance and walking ability in patients with stroke, and 2) whether the improvement in somatosensory function represents one of the possible mediating factors for such effect. Three patients with impaired balance and walking ability due to stroke were recruited. Two patients received AiWalker training plus conventional training; while the other one only experienced conventional training. Standing balance and walking ability were assessed before and after all the training, which were represented by 6 variables. Lower limb somatosensory function was examined using Fugl-Meyer Assessment Scale. Five out of the 6 variables showed greater changes in patients who received AiWalker training compared to the one who only experienced conventional training. Greater improvement in lower limb somatosensory function was observed in one patient who received AiWalker training compared to the one who only experienced conventional training. The novel robot-assisted gait training system may elicit greater improvement of balance and walking ability in patients with stroke compared to conventional interventions. Lower limb somatosensory function may be improved by AiWalker, and its improvement might represent one of the possible mediating factors for the therapeutic effect of AiWalker on balance and walking ability. [ABSTRACT FROM AUTHOR]

Background Continuous theta burst stimulation (cTBS) and intermittent TBS (iTBS) are powerful patterns of repetitive transcranial magnetic stimulation (rTMS), with substantial potential for motor function rehabilitation post-stroke. However, TBS of suprahyoid motor cortex excitability has not been investigated. This study investigated TBS effects on suprahyoid motor cortex excitability and its potential mechanisms in healthy subjects. Methods Thirty-five healthy subjects (23 females; mean age = 21.66 ± 1.66 years) completed three TBS protocols on separate days, separated by at least one week. A stereotaxic neuronavigation system facilitated accurate TMS positioning. Left and right suprahyoid motor evoked potentials (SMEP) were recorded using single-pulse TMS from the contralateral suprahyoid motor cortex before stimulation (baseline) and 0, 15, and 30 min after stimulation. The SMEP latency and amplitude were analyzed via repeated measures analysis of variance. Results cTBS suppressed ipsilateral suprahyoid motor cortex excitability and activated the contralateral suprahyoid motor cortex. iTBS facilitated ipsilateral suprahyoid motor cortex excitability; however, it did not affect the contralateral excitability. iTBS eliminated the inhibitory effect caused by cTBS applied to the contralateral suprahyoid motor cortex. TBS had no significant effect on the latencies of bilateral SMEP. TBS effects on suprahyoid motor cortex excitability lasted a minimum of 30 min. Conclusions TBS effectively regulates suprahyoid motor cortex excitability. Suppression of excitability in one hemisphere leads to further activation of the corresponding contralateral motor cortex. iTBS reverses the inhibitory effect induced by cTBS of the contralateral suprahyoid motor cortex. [ABSTRACT FROM AUTHOR]

Purpose: Impaired postural control is a key characteristic of mobility problems in stroke patients and has great impact on the incidence of falls and on the level of independence in activities of daily living. The role played by the thigh muscles in balance impairment in stroke patients has not been sufficiently investigated. This study investigated the activities of the thigh muscles in stroke patients during standing balance manipulations. Method: Ten stroke patients and 15 healthy subjects performed 5 upright standing tasks on a force platform: normal standing with eyes open, normal standing with eyes closed, feet together, semi-tandem standing, and a dynamic measurement along a predefined route. The posturography parameters, normalized muscle activity by maximal voluntary isometric contraction of the thigh muscles, were measured. The Berg Balance Scale was administered to evaluate functional balance. Results: The stroke patients showed excessive postural sway compared with healthy control subjects in all conditions of the static balance tests (P < .05). Muscle activity measured by surface electromyography (sEMG) showed higher normalized average EMG (aEMG) in the vastus medialis, rectus femoris, and biceps femoris on the affected side than that in control subjects during all static balance tests (P < .05). The rectus femoris on the unaffected side showed higher aEMG than that in control subjects in the 4 static standing tasks (P < .05). In dynamic tests, the performance time and excursion of the center of pressure were longer in the stroke patients than in the control subjects (P < .05). The activity of the biceps femoris muscle on the affected side was significantly different from that of the control subjects (P < .01). Conclusions: The vastus medialis, rectus femoris, and biceps femoris muscles on the affected side and the rectus femoris muscle on the unaffected side of stroke patients are involved in the static balance deficits, while the biceps femoris on the affected side influences dynamic balance control. [ABSTRACT FROM AUTHOR]