Hoensbroek

Every year, many people in the Netherlands experience a stroke, with a significant number requiring rehabilitation due to lasting disabilities. This trial focuses on adults who have had a first-ever ischemic stroke or intracerebral hemorrhage resulting in weakness on one side of their upper limb. Researchers aim to evaluate the effectiveness and cost-effectiveness of continuous theta burst stimulation cTBS to improve arm function after stroke, building on earlier findings that showed promising recovery benefits. Participants will receive 10 daily sessions of cTBS treatment over two weeks, targeting the brain area controlling the unaffected arm side. This treatment is given immediately before regular physical therapy for the affected arm. The study compares active cTBS with a sham placebo version, using special coils to deliver the stimulation. The trial is double-blind and randomized, meaning neither patients nor researchers know which treatment is given until the study ends. During the study, participants arm function will be assessed using various tests at 90 days and one year after their stroke. These include the Fugl-Meyer Assessment, Action Research Arm Test, and others measuring hand use, daily activities, and quality of life. Researchers will also monitor medical care use and productivity costs. The study lasts up to one year, with evaluations designed to track recovery progress and treatment impact over time.

This research investigates recovery of arm and hand function in people with cervical spinal cord injury SCI, focusing on neurological changes that might improve independence and quality of life. It explores how early and intensive motor training can affect both central and peripheral nervous systems. The study aims to understand brain and nerve changes after this therapy, and how these relate to motor recovery, using advanced clinical and neurophysiological measures in a randomized controlled trial with 44 participants. Participants are assigned to one of two groups an intervention group receiving an additional 6 hours of targeted upper limb motor training weekly for 8 weeks alongside usual rehabilitation, and a control group receiving only standard care. The training is personalized and goal-directed, focusing on muscles below the injury level and functional activities. This early and intensive program starts within 13 weeks of injury, with measurements taken before, during, and after the 8-week training period, plus a 6-month follow-up. During the study, participants undergo assessments including brain stimulation tests, nerve function evaluations, and clinical motor function tests before starting, at 4 weeks, at the end of 8 weeks, and again 6 months later. Outcomes measured include changes in motor thresholds, nerve responses, muscle strength, and functional independence. The study monitors safety and tracks participant progress to understand the relationship between therapy dose and recovery in arm and hand function after cervical SCI.