Article

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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Langue : ANGLAIS