Hebbian-Type Primary Motor Cortex Stimulation: A Potential Treatment of Impaired Hand Function in Chronic Stroke Patients.
Kate Pirog Revill, Marc W Haut, Samir R Belagaje and 3 others
PMID 31976804WHAT IT FOUND
No significant difference between Hebbian-type and sham stimulation on the primary hand function measure.
Both groups improved after training, and only the Hebbian-type group remained significantly better than baseline at four weeks.
Key findings
01On the primary Jebsen Taylor hand function test, the real stimulation and sham groups did not differ significantly.
02Both groups improved immediately after training, but only the Hebbian group remained significantly better than baseline at four-week follow-up on the primary test.
03The secondary Motor Activity Log daily hand use measure showed a significant interaction between intervention and time, with further improvement in the Hebbian group between posttest and follow-up.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Only 22 participants were randomized and 20 were analysed, so the trial is small. fMRI data were missing for two of the analysed participants. The main intervention comparison on the primary hand function test was not significant. The four-week group difference came from separate post-hoc tests. Follow-up was only four weeks, so longer-term maintenance is unknown. The sample was too small to examine differences between cortical and subcortical strokes. Participants needed a measurable motor evoked potential and no aphasia-related communication impairment, so results may not apply to people with more severe paralysis or communication difficulties. The study cannot show that stimulation caused the brain activity changes or hand function gains. Other rTMS protocols were not tested, so the design does not rule out similar effects from different settings.
Declared interests
The authors declared no conflicts of interest. The publication types list NIH extramural and non-U.S. government research support.
The easy way to misread this
Do not conclude that Hebbian-type stimulation improves hand function compared with sham. The primary hand function comparison was not significant, and the four-week maintenance difference came from separate post-hoc tests in a small trial.