Background and Purpose: Intermittent theta‐burst stimulation (iTBS) targeting the cerebellum represents a promising therapeutic approach, demonstrating efficacy in the rehabilitation of motor and cognitive impairments after stroke. This study aims to evaluate the real‐time and immediate effects of cerebellar iTBS on the cerebral cortex of stroke patients. Methods: This study was conducted in a crossover design, initiating with sham‐iTBS followed by iTBS after a 24‐h washout period. The functional near‐infrared spectroscopy (fNIRS) was applied to observe cortical activation from cerebellar iTBS in stroke patients and changes in resting‐state functional connectivity (FC) and amplitude of low‐frequency fluctuations (ALFF) poststimulation. Results: Compared to sham stimulation, significant enhancement of cortical activation was observed in the left dorsolateral prefrontal cortex (DLPFC; Channel 26, t = 2.47, p = 0.036, Cohen’s d = 0.783) and left primary motor cortex (PMC; Channel 61, t = 2.88, p = 0.018, Cohen’s d = 0.907; Channel 62, t = 2.62, p = 0.028, Cohen’s d = 0.826). Compared to the resting period after sham‐iTBS, the resting period following iTBS demonstrated significantly enhanced FC between the temporal cortex (TC) and the somatosensory cortex (SSC) ( p = 0.029), as well as between the frontal eye field (FEF) and the PMC ( p = 0.031). Additionally, the ALFF value of the medial superior frontal gyrus (SFGmed) also increased significantly during the resting period after iTBS (Channel 20, t = 5.79, p = 0.027, Cohen’s d = 0.63). Conclusion: The application of iTBS to the cerebellum significantly enhances the activation of cognitive and motor areas in the cerebral cortex. Additionally, improved FC between brain regions and increased spontaneous neuronal activity were observed following stimulation. These findings reveal the potential mechanisms by which cerebellar iTBS may facilitate functional recovery in stroke patients.

Background: Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive and painless technique used to modulate central nervous system activity. It has shown promise in improving motor, swallowing, speech, and cognitive functions in patients after stroke. However, limited research has focused on its effect on post-stroke balance, and stimulation parameters remain inconsistent. Objective: To systematically evaluate the efficacy of rTMS on balance function in stroke patients by analyzing stimulation parameters, target sites, and clinical outcomes from recent RCTs, and to identify optimal evidence-based protocols for post-stroke balance rehabilitation. Methods: The PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched for RCTs. Eighteen RCTs were included. All included studies demonstrated high methodological quality (PEDro scores ≥ 6). Results: The primary motor cortex (M1) and cerebellum were the most frequently targeted stimulation sites. Most studies employed low-frequency rTMS (LF-rTMS) or iTBS. Across the included studies, rTMS demonstrated improvements in balance(BBS), lower-limb motor function(FMA-LE) and gait parameters compared with control groups (P < 0.05). Effect sizes varied depending on stimulation site and parameters. Clinical improvements were sustained across multiple assessment domains. Some studies reported a greater reduction in pdBSI in the rTMS group (mean difference: −0.12, 95% CI:-0.22 to −0.02, P = 0.026) and a smaller increase in MEP amplitude (mean difference: 8.5 μV, 95% CI:0.9 to 16.1 μV, P = 0.028). Conclusion: Current evidence suggests that rTMS targeting M1 or cerebellum may effectively improve balance in stroke patients. Preliminary evidence supports either (1) LF-rTMS to the unaffected M1 or (2) cerebellar iTBS as potentially effective protocols. However, further high-quality trials are needed to establish standardized treatment parameters.

Background and Purpose: Intermittent theta-burst stimulation (iTBS) targeting the cerebellum represents a promising therapeutic approach, demonstrating efficacy in the rehabilitation of motor and cognitive impairments after stroke. This study aims to evaluate the real-time and immediate effects of cerebellar iTBS on the cerebral cortex of stroke patients.

Post-stroke aphasia concurrent with upper limb (UL) motor dysfunction is very common and difficult to rehabilitate. Although mirror therapy (MT) has demonstrated efficacy in treating aphasia and UL motor dysfunction separately, it has not been utilized to address both conditions simultaneously. Our study introduces a novel Synchronous Mirror Therapy (SMT) system that integrates speech-language therapy with UL motor training to evaluate its clinical feasibility, preliminary efficacy, and potential cortical mechanisms. Fifteen patients and five therapists participated in this study. The patients had aphasia and UL motor dysfunction and underwent the SMT intervention ten times. They were evaluated through functional assessment scales (Aphasia Quotient of Western Aphasia Battery (WAB-AQ); Assessment of Fugl-Meyer Upper Limb scale (FMA-UL); Action Research Arm Test (ARAT)) and three questionnaires, and functional near-infrared (fNIRS) test. We analyzed the questionnaire results, functional changes before and after SMT, and differences between the SMT intervention and rest periods. Nine patients underwent all SMT treatment sessions. Patients and therapists gave high ratings for SMT. Compared with before SMT interventions, significant improvements were observed in language function (WAB-AQ: p = 0.008) and UL motor function (FMA-UL: p = 0.007; ARAT: p = 0.016) after all SMT interventions, along with significant changes in three fNIRS channels (channel 9, p < 0.001; channel 20, p = 0.005; channel 30, p = 0.046) during the SMT intervention. The SMT intervention demonstrated feasibility and received positive feedback from both patients and therapists. The results indicate potential benefits of SMT in improving language and UL motor function for post-stroke patients. fNIRS findings suggest possible enhanced cortical activation during SMT, which may be associated with neural recovery processes. While encouraging, this still necessitates validation through larger sample sizes and rigorous randomized controlled designs.

Objective: The aim of this study was to confirm whether transcranial direct current stimulation over the vagus nerve can improve swallowing function in patients with poststroke dysphagia. Design: This is a parallel-group, randomized, double-blind, sham-controlled clinical trial. Methods: Sixty-four patients with poststroke dysphagia were randomly allocated to receive real or sham transcranial direct current stimulation over the vagus nerve combined with routine swallowing rehabilitation therapy. Swallowing function was assessed by Fiberoptic Endoscopic Dysphagia Severity Scale, Modified Mann Assessment of Swallowing Ability Scale, Functional Communication Measure, and Rosenbek Penetration-Aspiration Scale before and after treatment. Results: After 4 weeks of treatment, swallowing function improved in both the transcranial direct current stimulation over the vagus nerve group and control group. Intragroup changes in the Fiberoptic Endoscopic Dysphagia Severity Scale, Modified Mann Assessment of Swallowing Ability Scale, Functional Communication Measure, and Rosenbek Penetration-Aspiration Scale scores were more significant in the transcranial direct current stimulation over the vagus nerve group than in the control group. Conclusions: This preliminary study suggested that the performance of transcranial direct current stimulation over the vagus nerve improved the swallowing function in patients with poststroke dysphagia and extended the clinical application of transcranial direct current stimulation in poststroke dysphagia.