[article] 
inAnnals of physical and rehabilitation medicine > Vol. 61, n°4 (Juillet 2018) . - p. 224-234

Titre :	Changes in transcranial magnetic stimulation outcome measures in response to upper-limb physical training in stroke: A systematic review of randomized controlled trials
Type de document :	texte imprimé
Auteurs :	Louis-David Beaulieu ; Marie-Hélène Milot
Année de publication :	2018
Article en page(s) :	p. 224-234
Note générale :	Doi : 10.1016/j.rehab.2017.04.003
Langues :	Anglais (eng)
Mots-clés :	Transcranial magnetic stimulation  Stroke  Upper-limb physical training  Systematic review  Brain plasticity  Clinical outcome
Résumé :	Background Physical training is known to be an effective intervention to improve sensorimotor impairments after stroke. However, the link between brain plastic changes, assessed by transcranial magnetic stimulation (TMS), and sensorimotor recovery in response to physical training is still misunderstood. We systematically reviewed reports of randomized controlled trials (RCTs) involving the use of TMS over the primary motor cortex (M1) to probe brain plasticity after upper-limb physical training interventions in people with stroke. Methods We searched 5 databases for articles published up to October 2016, with additional studies identified by hand-searching. RCTs had to investigate pre/post-intervention changes in at least one TMS outcome measure. Two independent raters assessed the eligibility of potential studies and reviewed the selected articles’ quality by using 2 critical appraisal scales. Results In total, 14 reports of RCTs (pooled participants=358; mean 26±12 per study) met the selection criteria. Overall, 11 studies detected plastic changes with TMS in the presence of clinical improvements after training, and these changes were more often detected in the affected hemisphere by using map area and motor evoked potential (MEP) latency outcome measures. Plastic changes mostly pointed to increased M1/corticospinal excitability and potential interhemispheric rebalancing of M1 excitability, despite sometimes controversial results among studies. Also, the strength of the review observations was affected by heterogeneous TMS methods and upper-limb interventions across studies as well as several sources of bias within the selected studies. Conclusions The current evidence encourages the use of TMS outcome measures, especially MEP latency and map area to investigate plastic changes in the brain after upper-limb physical training post-stroke. However, more studies involving rigorous and standardized TMS procedures are needed to validate these observations.
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[article] Changes in transcranial magnetic stimulation outcome measures in response to upper-limb physical training in stroke: A systematic review of randomized controlled trials [texte imprimé] / Louis-David Beaulieu ; Marie-Hélène Milot . - 2018 . - p. 224-234.
Doi : 10.1016/j.rehab.2017.04.003
Langues : Anglais (eng)
in Annals of physical and rehabilitation medicine > Vol. 61, n°4 (Juillet 2018) . - p. 224-234

Mots-clés :	Transcranial magnetic stimulation  Stroke  Upper-limb physical training  Systematic review  Brain plasticity  Clinical outcome
Résumé :	Background Physical training is known to be an effective intervention to improve sensorimotor impairments after stroke. However, the link between brain plastic changes, assessed by transcranial magnetic stimulation (TMS), and sensorimotor recovery in response to physical training is still misunderstood. We systematically reviewed reports of randomized controlled trials (RCTs) involving the use of TMS over the primary motor cortex (M1) to probe brain plasticity after upper-limb physical training interventions in people with stroke. Methods We searched 5 databases for articles published up to October 2016, with additional studies identified by hand-searching. RCTs had to investigate pre/post-intervention changes in at least one TMS outcome measure. Two independent raters assessed the eligibility of potential studies and reviewed the selected articles’ quality by using 2 critical appraisal scales. Results In total, 14 reports of RCTs (pooled participants=358; mean 26±12 per study) met the selection criteria. Overall, 11 studies detected plastic changes with TMS in the presence of clinical improvements after training, and these changes were more often detected in the affected hemisphere by using map area and motor evoked potential (MEP) latency outcome measures. Plastic changes mostly pointed to increased M1/corticospinal excitability and potential interhemispheric rebalancing of M1 excitability, despite sometimes controversial results among studies. Also, the strength of the review observations was affected by heterogeneous TMS methods and upper-limb interventions across studies as well as several sources of bias within the selected studies. Conclusions The current evidence encourages the use of TMS outcome measures, especially MEP latency and map area to investigate plastic changes in the brain after upper-limb physical training post-stroke. However, more studies involving rigorous and standardized TMS procedures are needed to validate these observations.
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