Cerebello-Motor Paired Associative Stimulation and Motor Recovery in Stroke: a Randomized, Sham-Controlled, Double-Blind Pilot Trial

Targeting Cerebellum with Non-Invasive Transcranial Magnetic or Current Stimulation after Cerebral Hemispheric Stroke—Insights for Corticocerebellar Network Reorganization: A Comprehensive Review

“…Moreover, cerebellar activity, assessed through structural and functional connectivity, is associated both with motor recovery and the residual motor output following supratentorial stroke [ 51 ]. Neurophysiological measurements from the studies included in this review did not show a significant increase in MEP amplitudes in the affected hemisphere following non-invasive cerebellar stimulation, regardless of the clinical improvement observed [ 39 , 41 , 42 , 43 , 44 ].…”

“…Rosso et al (2022) studied a different protocol using paired-associative stimulation (PAS) between the contralesional cerebellum and the ipsilesional motor cortex in 27 chronic stroke patients with upper limb motor dysfunction. PAS is based on a classical conditioning-test TMS paradigm and is able to induce spike-time-dependent plasticity changes between two nodes [ 43 ]. A score-specific clinical improvement was recorded 30 days following the intervention in the active stimulation group in the Jebsen Taylor Test (JTT) score evaluating hand coordination and dexterity, and an equivalent increase in M1 activation was observed.…”

“…A score-specific clinical improvement was recorded 30 days following the intervention in the active stimulation group in the Jebsen Taylor Test (JTT) score evaluating hand coordination and dexterity, and an equivalent increase in M1 activation was observed. It is thus concluded by the authors that the cerebellar-motor PAS exerts a plasticity-mediated positive effect in upper limb recovery in stroke patients, which may specifically favor cerebellar participation in motor functions [ 43 ]. Chen et al (2021) studied an iTBS protocol to investigate the effects on upper limb poststroke spasticity in 32 subacute stroke survivors.…”

“…For example, in studies investigating dysphagia recovery, the coil was positioned 4.3 cm lateral and 2.4 cm below the inion, an area corresponding to the pharyngeal cortical representation area [ 38 ], while in studies investigating gait/balance recovery, the coil was positioned 3 cm lateral and 1 cm below the inion, a site which targets the posterior and superior cerebellar lobules [ 42 ]. The stimulus intensity was set to 80–110% of resting motor threshold (RMT) or 80% of active motor threshold (AMT), with concerns arising about efficacy based on the fact that the RMT in the affected hemisphere is generally higher and demands higher stimulation intensity, which can cause patient discomfort [ 43 ]. There were no serious safety issues met in the included studies.…”

Inter-brain plasticity as a biological mechanism of change in psychotherapy: A review and integrative model

“…For example, a study of infants aged 5-8 months (King et al, 2021) has shown that exposure to language was associated with higher connectivity between regions in the auditory cortex, the left inferior frontal gyrus (IFG), and the bilateral superior temporal gyrus (STG). Recent studies have managed to purposefully activate such plasticity by using transcranial magnetic stimulation (TMS) to stimulate two brain regions in rapid succession (Suppa et al, 2022); for example, in one study researchers were able to improve participants' hand dexterity after stroke by stimulating the cerebellum and the motor cortex (Rosso et al, 2022).…”