The Effectiveness of Paired Associative Stimulation on Motor Recovery after Stroke: A Scoping Review

Author:

Baroni Andrea12ORCID,Antonioni Annibale123ORCID,Fregna Giulia13,Lamberti Nicola1ORCID,Manfredini Fabio12ORCID,Koch Giacomo145,D’Ausilio Alessandro14,Straudi Sofia12ORCID

Affiliation:

1. Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy

2. Department of Neuroscience, Ferrara University Hospital, 44124 Ferrara, Italy

3. Doctoral Program in Translational Neurosciences and Neurotechnologies, University of Ferrara, 44121 Ferrara, Italy

4. Center for Translational Neurophysiology of Speech and Communication (CTNSC), Italian Institute of Technology (IIT), 44121 Ferrara, Italy

5. Non Invasive Brain Stimulation Unit, Istituto di Ricovero e Cura a Carattere Scientifico Santa Lucia, 00179 Rome, Italy

Abstract

Paired associative stimulation (PAS) is a non-invasive brain stimulation technique combining transcranial magnetic stimulation and peripheral nerve stimulation. PAS allows connections between cortical areas and peripheral nerves (C/P PAS) or between cortical regions (C/C PAS) to be strengthened or weakened by spike-timing-dependent neural plasticity mechanisms. Since PAS modulates both neurophysiological features and motor performance, there is growing interest in its application in neurorehabilitation. We aimed to synthesize evidence on the motor rehabilitation role of PAS in stroke patients. We performed a literature search following the PRISMA Extension for Scoping Reviews Framework. Eight studies were included: one investigated C/C PAS between the cerebellum and the affected primary motor area (M1), seven applied C/P PAS over the lesional, contralesional, or both M1. Seven studies evaluated the outcome on upper limb and one on lower limb motor recovery. Although several studies omit crucial methodological details, PAS highlighted effects mainly on corticospinal excitability, and, more rarely, an improvement in motor performance. However, most studies failed to prove a correlation between neurophysiological changes and motor improvement. Although current studies seem to suggest a role of PAS in post-stroke rehabilitation, their heterogeneity and limited number do not yet allow definitive conclusions to be drawn.

Funder

Ministry of University and Research (MUR), National Recovery and Resilience Plan

Ricerca Finalizzata 2018—Giovani Ricercatori

EU project PRIMI

Publisher

MDPI AG

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