Effectiveness of central plus peripheral stimulation (CPPS) on post stroke upper limb motor rehabilitation

Purpose: This study was to assess the motor-cortex integrity and reaction time of the upper limb in patients early after stroke after CPPS approach with Theta Burst Stimulation (TBS) an repetitive Trans-cranial Magnetic Stimulation (TMS) paradigm and Neuromuscular Electrical Stimulation (NMES).Methods: Ten patients and ten age matched controls underwent three experimental sessions in three consecutive weeks. First-week W1 (TBS) with TBS alone, second-week W2 (NMES) with NMES alone and third-week W3 (TBS+NMES) with both TBS and NMES given sequentially. Cortical excitability was assessed with single pulse TMS stimulator before and immediately after the three interventions for Resting Motor Threshold (RMT) from the ipsilesional and contralesional hemisphere in the corresponding first dorsal interossei muscle of the ipsilateral and contralateral hand. Post intervention functional assessment was done with 9 Hole Peg Test (9PHT) for change in reaction time (RT) for both ipsilataral and contralateral hand.Results: All the three interventions showed significant improvement from the baseline, however W3 (TBS+NMES) showed significantly greater improvement when compared to other interventions in RMT and 9 HPT.Conclusion: CPPS with TBS and NMES showed synergistic effect in both electrophysiological and clinical assessment. A combined approach (CPPS) may be more effective for post-stroke motor rehabilitation.