Priming the brain after stroke for a better response to arm training

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Advances in acute medical care have increased survivorship after stroke, but frequently patients are left with disability, commonly including deficits of the motor system. Despite neurorehabilitation, most patients have ongoing impairment six months after stroke, which limits activity and restricts participation in life roles. Upper-limb weakness, in particular, is a major limiting factor in recovery of function. It is important to explore new ways to help improve upper limb recovery following stroke. Theta burst stimulation (TBS) of the primary motor cortex can be used to increase or decrease the excitability of the brain (where excitability refers to the responsiveness of neurons in the brain). We have previously shown that priming the brain with TBS, before practising a grip lift task with the affected hand, can improve grip function. We hypothese that TBS allows the primary motor cortex in the stroke affected hemisphere to be more receptive to inputs from the sensory cortex and this in turn allows strengthening and formation of new neural connections during subsequent precision grip training. We expect that this mechanism explains the observed improvements in performance of the affected hand. This project therefore aims to extend our previous findings by investigating these hypotheses. This will provide important knowledge regarding the mechanisms that give rise to behavioural improvements following primed motor training.

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