{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T16:22:00Z","timestamp":1788193320031,"version":"build-2803163510"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,11,23]],"date-time":"2021-11-23T00:00:00Z","timestamp":1637625600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Rehabilit. Sci."],"abstract":"<jats:p><jats:bold>Introduction:<\/jats:bold> Patients with Parkinson's disease (PD) often exhibit difficulties with dexterity during the performance of activities of daily living (ADL) due to dysfunctional supplementary motor area (SMA). The aim of this clinical trial protocol work is to describe how the effectiveness of a combined repetitive transcranial magnetic stimulation (rTMS) over SMA and video-game-based skill training (VBT) in PD will be evaluated. The short and long-term benefits are assessed.<\/jats:p><jats:p><jats:bold>Methods and analysis:<\/jats:bold> A single-blind (patients) stratified (based on Hoehn &amp;amp; Yahr) parallel randomized sham-controlled rTMS-VBT study with a baseline and two follow-up measurements (3 and 12 weeks) is being conducted. These measurements include the dexterity questionnaire 24 (DextQ-24) as a primary outcome, and nine hole peg test and coin rotation task as main secondary dexterity outcomes. Further secondary outcomes will be the subscale II of the movement disorders society unified PD rating scale (MDS-UPDRS) to assess improvements on overall ADL and the Parkinson's Disease Questionnaire-39 to assess quality of life. Thirty-six outpatients (from one neurorehabilitation center) with PD (diagnosis based on brain bank criteria) will be recruited who report difficulties with dexterity in performing ADL. All PD patients will receive a 45-min VBT three times a week for 3 weeks. The PD patients randomized in the experimental group will receive VBT preceded by real rTMS, being intermittent theta burst (iTBS) stimulation sessions. The PD patients randomized to the control group receive a VBT with sham rTMS.<\/jats:p><jats:p><jats:bold>Discussion:<\/jats:bold> The study will provide evidence to determine whether a combined iTBS and VBT skill intervention is more effective than a VBT intervention alone to improve dexterity in PD.<\/jats:p><jats:p><jats:bold>Ethics and dissemination:<\/jats:bold> The study was approved by the Ethics Committee for Northwest and Central Switzerland (EKNZ), Switzerland 2019\u201300433. The study will be conducted in accordance with the Helsinki Declaration and the Guidelines of Good Clinical Practice. Informed consent will be signed prior to subject enrolment. Dissemination will include submission to international peer-reviewed professional journals and presentation at international congresses.<\/jats:p><jats:p>The study protocol has been registered in the clinicaltrials.gov registry with the identification code: NCT04699149.<\/jats:p>","DOI":"10.3389\/fresc.2021.777981","type":"journal-article","created":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T12:08:45Z","timestamp":1638274125000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Combining Repetitive Transcranial Magnetic Stimulation and Video Game-Based Training to Improve Dexterity in Parkinson's Disease: Study Protocol of a Randomized Controlled Trial"],"prefix":"10.3389","volume":"2","author":[{"given":"Manuela","family":"Pastore-Wapp","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Lehnick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Nef","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Bohlhalter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Vanbellingen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,11,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/ene.13021","article-title":"Limb-kinetic apraxia affects activities of daily living in Parkinson's disease: a multi-center study","volume":"23","author":"Foki","year":"2016","journal-title":"Eur J Neurol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1002\/mdc3.12572","article-title":"Limb kinetic apraxia is an independent predictor for quality of life in Parkinson's disease","volume":"5","author":"Vanbellingen","year":"2018","journal-title":"Mov Disord Clin Pract."},{"key":"B3","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/j.bandc.06.003","article-title":"Impaired finger dexterity in Parkinson's disease is associated with praxis function","volume":"77","author":"Vanbellingen","year":"2011","journal-title":"Brain Cogn."},{"key":"B4","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/j.parkreldis.09.015","article-title":"Reliability and validity of a new dexterity questionnaire (DextQ-24) in Parkinson's disease","volume":"33","author":"Vanbellingen","year":"2016","journal-title":"Parkinsonism Relat Disord"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1701","DOI":"10.1002\/mds.22199","article-title":"Poor dopaminergic response of impaired dexterity in Parkinson's disease: Bradykinesia or limb kinetic apraxia?","volume":"23","author":"Gebhardt","year":"2008","journal-title":"Mov Disord."},{"key":"B6","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1016\/j.pmrj.06.004","article-title":"Effects of a single hand-exercise session on manual dexterity and strength in persons with Parkinson disease: a randomized controlled trial","volume":"8","author":"Mateos-Toset","year":"2016","journal-title":"PM R"},{"key":"B7","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1016\/j.parkreldis.05.021","article-title":"Home based training for dexterity in Parkinson's disease: a randomized controlled trial","volume":"41","author":"Vanbellingen","year":"","journal-title":"Parkinsonism Relat Disord"},{"key":"B8","doi-asserted-by":"publisher","first-page":"S53","DOI":"10.1016\/S1353-8020(09)70781-3","article-title":"Motor learning in Parkinson's disease: limitations and potential for rehabilitation","volume":"15","author":"Nieuwboer","year":"2009","journal-title":"Parkinsonism Relat Disord."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12984-019-0492-1","article-title":"Recent advances in rehabilitation for parkinson's disease with exergames: a systematic review","volume":"16","author":"Garcia-Agundez","year":"2019","journal-title":"J Neuroeng Rehabil"},{"key":"B10","doi-asserted-by":"publisher","first-page":"167","DOI":"10.3389\/fnagi.2015.00167","article-title":"Exergaming as a viable therapeutic tool to improve static and dynamic balance among older adults and people with idiopathic Parkinson's disease: a systematic review and meta-analysis","volume":"7","author":"Harris","year":"2015","journal-title":"Front Aging Neurosci."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12984-019-0593-x","article-title":"Leap motion controlled video game-based therapy for upper limb rehabilitation in patients with Parkinson's disease: a feasibility study","volume":"16","author":"Fern\u00e1ndez-Gonz\u00e1lez","year":"2019","journal-title":"J Neuroeng Rehabil."},{"key":"B12","doi-asserted-by":"publisher","first-page":"7148427","DOI":"10.1155.\/2018\/7148427","article-title":"Effectiveness of serious games for leap motion on the functionality of the upper limb in parkinson's disease: a feasibility study","volume":"2018","author":"O\u00f1a","year":"2018","journal-title":"Comput Intell Neurosci"},{"key":"B13","doi-asserted-by":"publisher","first-page":"2168","DOI":"10.3390\/s20082168","article-title":"The impact of a novel immersive virtual reality technology associated with serious games in Parkinson's disease patients on upper limb rehabilitation: a mixed methods intervention study","volume":"20","author":"S\u00e1nchez-Herrera-Baeza","year":"2020","journal-title":"Sensors"},{"key":"B14","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1097\/NPT.0000000000000278","article-title":"Exergaming-Based Dexterity training in persons with Parkinson disease: a pilot feasibility study","volume":"43","author":"van Beek","year":"2019","journal-title":"J Neurol Phys Ther"},{"key":"B15","doi-asserted-by":"publisher","first-page":"e238","DOI":"10.1016\/j.clinph.07.197","article-title":"S187 Influence of repetitive transcranial magnetic stimulation on cognitive and motor performance in Parkinson's disease patients","volume":"128","author":"El Tamawy","year":"2017","journal-title":"Clin Neurophysiol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1016\/j.neucli.05.002","article-title":"Transcranial magnetic stimulation and gait disturbances in Parkinson's disease: a systematic review","volume":"50","author":"Nardone","year":"2020","journal-title":"Clin Neurophysiol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"e01132","DOI":"10.1002\/brb3.1132","article-title":"Repetitive transcranial magnetic stimulation therapy for motor recovery in Parkinson's disease: a meta-analysis","volume":"8","author":"Yang","year":"2018","journal-title":"Brain Behav."},{"key":"B18","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1177\/1545968312451915","article-title":"Combination of rTMS and treadmill training modulates corticomotor inhibition and improves walking in parkinson disease: a randomized trial","volume":"27","author":"Yang","year":"2013","journal-title":"Neurorehabil Neural Repair."},{"key":"B19","doi-asserted-by":"publisher","first-page":"719","DOI":"10.2522\/ptj.20060274","article-title":"Putting the brain on the map: use of transcranial magnetic stimulation to assess and induce cortical plasticity of upper-extremity movement","volume":"87","author":"Butler","year":"2007","journal-title":"Phys Ther."},{"key":"B20","doi-asserted-by":"publisher","first-page":"S141","DOI":"10.1002\/mds.22782","article-title":"Enhancing neuroplasticity in the basal ganglia: the role of exercise in Parkinson's disease","volume":"25","author":"Petzinger","year":"2010","journal-title":"Mov Disord."},{"key":"B21","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1177\/1545968309345270","article-title":"Contribution of transcranial magnetic stimulation to the understanding of functional recovery mechanisms after stroke","volume":"24","author":"Dimyan","year":"2010","journal-title":"Neurorehabil Neural Repair."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12883-019-1302-x","article-title":"Intermittent theta burst stimulation enhances upper limb motor function in patients with chronic stroke: a pilot randomized controlled trial","volume":"19","author":"Chen","year":"2019","journal-title":"BMC Neurol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.neubiorev.01.008","article-title":"Use of theta-burst stimulation in changing excitability of motor cortex: a systematic review and meta-analysis","volume":"63","author":"Chung","year":"2016","journal-title":"Neurosci Biobehav Rev"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1670","DOI":"10.1002\/hbm.25319","article-title":"Structural correlates underlying accelerated magnetic stimulation in Parkinson's disease","volume":"42","author":"Ji","year":"2021","journal-title":"Hum Brain Mapp."},{"key":"B25","doi-asserted-by":"publisher","first-page":"3871","DOI":"10.1113\/jphysiol.2008.152736","article-title":"The physiological basis of the effects of intermittent theta burst stimulation of the human motor cortex","volume":"586","author":"Di Lazzaro","year":"2008","journal-title":"J Physiol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1111\/j.1460-9568.2011.07924.x","article-title":"The application of spaced theta burst protocols induces long-lasting neuroplastic changes in the human motor cortex","volume":"35","author":"Goldsworthy","year":"2012","journal-title":"Eur J Neurosci."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1011","DOI":"10.1016\/j.clinph.08.016","article-title":"The theoretical model of theta burst form of repetitive transcranial magnetic stimulation","volume":"122","author":"Huang","year":"2011","journal-title":"Clin Neurophysiol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"2669","DOI":"10.1111\/j.1460-9568.2012.08158.x","article-title":"Effect of intermittent theta-burst stimulation on akinesia and sensorimotor integration in patients with Parkinson's disease","volume":"36","author":"Degardin","year":"2012","journal-title":"Eur J Neurosci."},{"key":"B29","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1212\/WNL.0b013e31820ce6bb","article-title":"Intermittent theta-burst transcranial magnetic stimulation for treatment of Parkinson disease","volume":"76","author":"Benninger","year":"2011","journal-title":"Neurology."},{"key":"B30","doi-asserted-by":"publisher","first-page":"1400","DOI":"10.1212\/WNL.0b013e31828c2f66","article-title":"Supplementary motor area stimulation for Parkinson disease: a randomized controlled study","volume":"80","author":"Shirota","year":"2013","journal-title":"Neurology."},{"key":"B31","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1016.\/B978-0-443-10321-6.00013-8","article-title":"Parkinson's disease","author":"Johns","year":"2014","journal-title":"Clinical Neuroscience"},{"key":"B32","doi-asserted-by":"publisher","first-page":"856","DOI":"10.1038\/nrn2478","article-title":"Functional role of the supplementary and pre-supplementary motor areas","volume":"9","author":"Nachev","year":"2008","journal-title":"Nat Rev Neurosci."},{"key":"B33","doi-asserted-by":"publisher","first-page":"749","DOI":"10.1002\/ana.410320608","article-title":"Impaired activation of the supplementary motor area in Parkinson's disease is reversed when akinesia is treated with apomorphine","volume":"32","author":"Jenkins","year":"1992","journal-title":"Ann Neurol."},{"key":"B34","doi-asserted-by":"publisher","first-page":"3691","DOI":"10.1002\/hbm.24204","article-title":"Deficient supplementary motor area at rest: Neural basis of limb kinetic deficits in Parkinson's disease","volume":"39","author":"K\u00fcbel","year":"2018","journal-title":"Hum Brain Mapp."},{"key":"B35","doi-asserted-by":"publisher","first-page":"751925","DOI":"10.1155.\/2013\/751925","article-title":"Repetitive transcranial magnetic stimulation improves handwriting in parkinson's disease","volume":"2013","author":"Randhawa","year":"2013","journal-title":"Parkinson's Dis"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1020","DOI":"10.1002\/mds.20213","article-title":"Movement disorder society task force report on the hoehn and yahr staging scale: status and recommendations","volume":"19","author":"Goetz","year":"2004","journal-title":"Mov Disord."},{"key":"B37","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1136\/jnnp.55.3.181","article-title":"Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases","volume":"55","author":"Hughes","year":"1992","journal-title":"J Neurol Neurosurg Psychiatry."},{"key":"B38","doi-asserted-by":"publisher","first-page":"1043","DOI":"10.1002\/mds.22017","article-title":"The Montreal cognitive assessment as a screening tool for cognitive impairment in Parkinson's disease","volume":"23","author":"Gill","year":"2008","journal-title":"Movement Disorders."},{"key":"B39","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1016\/0028-3932(71)90067-4","article-title":"The assessment and analysis of handedness: The Edinburgh inventory","volume":"9","author":"Oldfield","year":"1971","journal-title":"Neuropsychologia."},{"key":"B40","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1111\/j.1532-5415.2005.53221.x","article-title":"The montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment","volume":"53","author":"Nasreddine","year":"2005","journal-title":"J Am Geriatr Soc."},{"key":"B41","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1002\/mds.22340","article-title":"Movement disorder society-sponsored revision of the unified parkinson's disease rating scale (MDS-UPDRS): scale presentation and clinimetric testing results","volume":"23","author":"Goetz","year":"2008","journal-title":"Mov Disord."},{"key":"B42","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1097\/NPT.0b013e318235da08","article-title":"The 9-hole peg test of upper extremity function: average values, test-retest reliability, and factors contributing to performance in people with parkinson disease","volume":"35","author":"Earhart","year":"2011","journal-title":"J Neurol Phys Ther."},{"key":"B43","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080.\/09638288.2020.1754474","article-title":"Hand dexterity assessment in Parkinson's disease: construct validity of the 9-hole peg test for the more affected hand","author":"Proud","year":"2020","journal-title":"Disabil Rehabil."},{"key":"B44","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1093\/arclin\/acp030","article-title":"Coin rotation task (CRT): a new test of motor dexterity","volume":"24","author":"Mendoza","year":"2009","journal-title":"Arch Clin Neuropsychol."},{"key":"B45","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1055\/s-0042-102406","article-title":"Screening f\u00fcr die fingergeschicklichkeit \u2013 coin rotation test","volume":"14","author":"Ineichen-Furrer","year":"2016","journal-title":"Physiopraxis."},{"key":"B46","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1093\/ageing\/30.4.299","article-title":"Determining minimally important differences for the PDQ-39 Parkinson's disease questionnaire","volume":"30","author":"Peto","year":"2001","journal-title":"Age Ageing."},{"key":"B47","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1113\/jphysiol.2004.070755","article-title":"Increased corticospinal excitability after 5 Hz rTMS over the human supplementary motor area","volume":"562","author":"Matsunaga","year":"2005","journal-title":"J Physiol."},{"key":"B48","doi-asserted-by":"publisher","first-page":"792","DOI":"10.1109.\/ICORR.2015.7281299","article-title":"Comparison of flexible and rigid hand-grip control during a feed-forward visual tracking task","author":"Mace","year":"2015","journal-title":"IEEE International Conference on Rehabilitation Robotics"},{"key":"B49","doi-asserted-by":"publisher","first-page":"550","DOI":"10.1007\/BF00237997","article-title":"Roles of glabrous skin receptors and sensorimotor memory in automatic control of precision grip when lifting rougher or more slippery objects","volume":"56","author":"Johansson","year":"1984","journal-title":"Exp Brain Res."},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.5772.\/intechopen.93462","article-title":"GRIP: dexterous manipulation of objects in weightlessness","author":"Thonnard","year":"2020","journal-title":"Preparation of Space Experiments"},{"key":"B51","doi-asserted-by":"publisher","first-page":"1742","DOI":"10.1016\/j.jbiomech.04.006","article-title":"Validation of the leap motion controller using markered motion capture technology","volume":"49","author":"Smeragliuolo","year":"2016","journal-title":"J Biomech"},{"key":"B52","doi-asserted-by":"publisher","first-page":"6380","DOI":"10.3390\/s130506380","article-title":"Analysis of the accuracy and robustness of the leap motion controller","volume":"13","author":"Weichert","year":"2013","journal-title":"Sensors."},{"key":"B53","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1007\/s00415-011-6128-4","article-title":"Effects of low versus high frequencies of repetitive transcranial magnetic stimulation on cognitive function and cortical excitability in Alzheimer's dementia","volume":"259","author":"Ahmed","year":"2012","journal-title":"J Neurol."},{"key":"B54","doi-asserted-by":"publisher","first-page":"758","DOI":"10.2340\/16501977-0590","article-title":"Long-term effects of RTMS on motor recovery in patients after subacute stroke","volume":"42","author":"Chang","year":"2010","journal-title":"J Rehabil Med."}],"container-title":["Frontiers in Rehabilitation Sciences"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fresc.2021.777981\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T12:08:47Z","timestamp":1638274127000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fresc.2021.777981\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,23]]},"references-count":54,"alternative-id":["10.3389\/fresc.2021.777981"],"URL":"https:\/\/doi.org\/10.3389\/fresc.2021.777981","relation":{},"ISSN":["2673-6861"],"issn-type":[{"value":"2673-6861","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,23]]},"article-number":"777981"}}