Beetsterzwaag

Every year, about 40,000 people in the Netherlands experience a stroke, and many survivors face challenges with upper limb function, which is important for daily activities. This trial evaluates the effectiveness and cost-effectiveness of continuous theta burst stimulation (cTBS) treatment to improve upper limb recovery in stroke patients admitted to rehabilitation centers. This phase III, multi-center, double-blind, randomized, and sham-controlled clinical trial aims to build on promising phase II results showing significant improvement in arm function and reduced rehabilitation stay. Participants will receive either 10 daily sessions of active cTBS or sham cTBS delivered to the contralesional primary motor cortex within 3 weeks after stroke onset. These sessions are administered over 2 weeks and are given immediately before the patients' regular physical therapy for the affected upper limb. Two groups will be compared: one receiving active cTBS and the other receiving sham cTBS. During the study, researchers will assess upper limb recovery using the Fugl-Meyer Assessment at 90 days post-stroke as the primary outcome. Additional outcomes include arm function tests, stroke impact measures, quality of life, and disability scales at 90 days and one year after stroke. Participants will be closely monitored throughout the study to track their progress and safety, with total participation lasting up to one year after stroke.

Children with cerebral palsy (CP) often face difficulties with walking due to motor impairments caused by early developmental brain damage. These challenges can limit their ability to participate in physical and social activities alongside their peers, which may hinder their overall development. Functional power training (FPT) has recently emerged as a promising exercise method that may better improve walking ability and endurance than traditional strength training, thereby supporting increased participation in ambulant children with CP. However, strong scientific evidence confirming the benefits of FPT is still needed, along with understanding which children benefit most and how long the effects last. This study compares twelve weeks of FPT using MegaPower training to usual care in ambulant children with CP aged 4 to 12 years. One group will receive the FPT program designed to improve power through high-velocity and resistance exercises that mimic everyday activities like running and sprinting. The control group will receive their usual care during the same period. After the initial 24-week follow-up, the control group will also have the opportunity to receive the MegaPower training. Participants will be involved for a total of 36 weeks with assessments at the start and at 12, 24, and 36 weeks. Researchers will evaluate how well children achieve personalized participation and activity goals using Goal Attainment Scaling. Additional measurements include walking ability, aerobic endurance, and anaerobic capacity. The study will also monitor how well the training was implemented at different centers and whether benefits are maintained after training ends. Safety and progress will be carefully tracked throughout the study.