{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T05:55:05Z","timestamp":1781848505062,"version":"3.54.5"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100005622","name":"Health Research","doi-asserted-by":"publisher","award":["2022YFC3602802"],"award-info":[{"award-number":["2022YFC3602802"]}],"id":[{"id":"10.13039\/100005622","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      \u201cBCI illiteracy,\u201d characterized by insufficient\n                      <jats:italic>\u03bc<\/jats:italic>\n                      -rhythm Event-Related Desynchronization (ERD) in approximately 40% of stroke patients, limits the efficacy of Brain\u2013Computer Interface (BCI) training. Intermittent Theta Burst Stimulation (iTBS) can modulate cortical excitability. We hypothesized that sequential application of iTBS over the affected primary motor cortex (M1) before BCI training may enhance cortical activation, improve BCI decoding efficiency, and thereby promote upper limb motor recovery after stroke.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This exploratory single-center randomized controlled trial (RCT) enrolled 18 subacute stroke patients, randomized to: BCI group (conventional rehab + BCI training) or iTBS + BCI group (conventional rehab\u202f+\u202fiTBS applied to the affected M1 cortex followed sequentially by BCI training). Interventions occurred 10 times over 2\u202fweeks. Primary outcome: Fugl-Meyer Assessment - Upper Extremity (FMA-UE) score. Secondary outcomes: Modified Barthel Index (MBI), BCI task accuracy (BCI-TA). Mechanistic measures: sensorimotor cortex ERD and Laterality Index (LI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In this exploratory study, FMA-UE improvement was greater in the iTBS\u202f+\u202fBCI group, with significant differences at week 4 (\n                      <jats:italic>Z<\/jats:italic>\n                      \u202f=\u202f2.569,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.008). iTBS\u202f+\u202fBCI group showed a greater BCI-TA increase (87.22\u202f\u00b1\u202f10.83% vs. 68.24\u202f\u00b1\u202f5.75%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.041), which correlated negatively with attention improvement (Schulte test time reduction;\n                      <jats:italic>r<\/jats:italic>\n                      \u202f=\u202f\u22120.796,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Only the iTBS+BCI group demonstrated deeper ERD over the affected sensorimotor cortex (C4;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.001) and a shift in LI towards the affected side (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.017) during affected hand motor imagery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This exploratory study suggests that sequential iTBS combined with BCI may have potential benefits in enhancing upper limb function in stroke patients. It boosts affected cortical excitability, improves BCI decoding efficiency, and remodels motor network activation, offering a new strategy to overcome \u201cBCI illiteracy.\u201d<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.chictr.org.cn\/showproj.html?proj=173657<\/jats:ext-link>\n                      , Identifier: ChiCTR2300069203.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1839697","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T05:48:41Z","timestamp":1781848121000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Intermittent theta burst stimulation enhances the efficacy of brain\u2013computer interface in upper limb rehabilitation post-stroke"],"prefix":"10.3389","volume":"17","author":[{"given":"Xiaoqian","family":"Xia","sequence":"first","affiliation":[{"name":"School of Rehabilitation Medicine, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyu","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Beijing Bo\u2019ai Hospital, China Rehabilitation Research Center","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingyun","family":"Jia","sequence":"additional","affiliation":[{"name":"School of Rehabilitation Medicine, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qianhui","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Rehabilitation Medicine, The Second Affiliated Hospital of Wenzhou Medical University","place":["Wenzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linyao","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Rehabilitation Medicine, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruoqing","family":"Zhang","sequence":"additional","affiliation":[{"name":"Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yizheng","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Rehabilitation Medicine, Capital Medical University","place":["Beijing, China"]},{"name":"Neurorehabilitation Department, Beijing Bo\u2019ai Hospital, China Rehabilitation Research Center","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoli","family":"Wu","sequence":"additional","affiliation":[{"name":"School of Rehabilitation Medicine, Capital Medical University","place":["Beijing, China"]},{"name":"Neurorehabilitation Department, Beijing Bo\u2019ai Hospital, China Rehabilitation Research Center","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaogang","family":"Chen","sequence":"additional","affiliation":[{"name":"Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lixu","family":"Liu","sequence":"additional","affiliation":[{"name":"School of Rehabilitation Medicine, Capital Medical University","place":["Beijing, China"]},{"name":"Neurorehabilitation Department, Beijing Bo\u2019ai Hospital, China Rehabilitation Research Center","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1016\/s1474-4422(24)00369-7","article-title":"Global, regional, and national burden of stroke and its risk factors, 1990-2021: a systematic analysis for the global burden of disease study 2021","volume":"23","year":"2024","journal-title":"Lancet Neurol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1002\/ana.25679","article-title":"Predicting upper limb motor impairment recovery after stroke: a mixture model","volume":"87","author":"van der Vliet","year":"2020","journal-title":"Ann Neurol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"3717","DOI":"10.1161\/strokeaha.122.040687","article-title":"Network Meta-analysis of non-conventional therapies for improving upper limb motor impairment 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