{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T15:06:26Z","timestamp":1775142386097,"version":"3.50.1"},"reference-count":66,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2021,7,21]],"date-time":"2021-07-21T00:00:00Z","timestamp":1626825600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: The motor sequelae after a stroke are frequently persistent and cause a high degree of disability. Cortical ischemic or hemorrhagic strokes affecting the cortico-spinal pathways are known to cause a reduction of cortical excitability in the lesioned area not only for the local connectivity impairment but also due to a contralateral hemisphere inhibitory action. Non-invasive brain stimulation using high frequency repetitive magnetic transcranial stimulation (rTMS) over the lesioned hemisphere and contralateral cortical inhibition using low-frequency rTMS have been shown to increase the excitability of the lesioned hemisphere. Mental representation techniques, neurofeedback, and virtual reality have also been shown to increase cortical excitability and complement conventional rehabilitation. Materials and Methods: We aim to carry out a single-blind, randomized, controlled trial aiming to study the efficacy of immersive multimodal Brain\u2013Computer Interfacing-Virtual Reality (BCI-VR) training after bilateral neuromodulation with rTMS on upper limb motor recovery after subacute stroke (&gt;3 months) compared to neuromodulation combined with conventional motor imagery tasks. This study will include 42 subjects in a randomized controlled trial design. The main expected outcomes are changes in the Motricity Index of the Arm (MI), dynamometry of the upper limb, score according to Fugl-Meyer for upper limb (FMA-UE), and changes in the Stroke Impact Scale (SIS). The evaluation will be carried out before the intervention, after each intervention and 15 days after the last session. Conclusions: This trial will show the additive value of VR immersive motor imagery as an adjuvant therapy combined with a known effective neuromodulation approach opening new perspectives for clinical rehabilitation protocols.<\/jats:p>","DOI":"10.3390\/medicina57080736","type":"journal-article","created":{"date-parts":[[2021,7,23]],"date-time":"2021-07-23T00:07:40Z","timestamp":1626998860000},"page":"736","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Clinical Effects of Immersive Multimodal BCI-VR Training after Bilateral Neuromodulation with rTMS on Upper Limb Motor Recovery after Stroke. A Study Protocol for a Randomized Controlled Trial"],"prefix":"10.3390","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6202-7071","authenticated-orcid":false,"given":"Francisco Jos\u00e9","family":"S\u00e1nchez-Cuesta","sequence":"first","affiliation":[{"name":"Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, 28223 Pozuelo de Alarc\u00f3n, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8704-242X","authenticated-orcid":false,"given":"Aida","family":"Arroyo-Ferrer","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, 28223 Pozuelo de Alarc\u00f3n, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3819-3090","authenticated-orcid":false,"given":"Yeray","family":"Gonz\u00e1lez-Zamorano","sequence":"additional","affiliation":[{"name":"Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28933 Alcorc\u00f3n, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9676-8599","authenticated-orcid":false,"given":"Athanasios","family":"Vourvopoulos","sequence":"additional","affiliation":[{"name":"Institute for Systems and Robotics-Lisboa, Department of Bioengineering, Instituto Superior T\u00e9cnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4452-0414","authenticated-orcid":false,"given":"Sergi Berm\u00fadez i","family":"Badia","sequence":"additional","affiliation":[{"name":"Faculdade de Ci\u00eancias Exatas e da Engenharia, Madeira Interactive Technologies Institute, NOVA LINCS, Universidade da Madeira, 9020-105 Funchal, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0743-0869","authenticated-orcid":false,"given":"Patricia","family":"Figuereido","sequence":"additional","affiliation":[{"name":"Institute for Systems and Robotics-Lisboa, Department of Bioengineering, Instituto Superior T\u00e9cnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9333-1305","authenticated-orcid":false,"given":"Jos\u00e9 Ignacio","family":"Serrano","sequence":"additional","affiliation":[{"name":"Neural and Cognitive Engineering Group (gNeC), Centre for Automation and Robotics (CAR), Spanish National Research Council (CSIC-UPM), 28500 Arganda del Rey, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3190-1296","authenticated-orcid":false,"given":"Juan Pablo","family":"Romero","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, 28223 Pozuelo de Alarc\u00f3n, Spain"},{"name":"Brain Damage Unit, Beata Mar\u00eda Ana Hospital, 28007 Madrid, Spain"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e139","DOI":"10.1161\/CIR.0000000000000757","article-title":"Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association","volume":"141","author":"Virani","year":"2020","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1310\/3TKX-7XEC-2DTG-XQKH","article-title":"Ottawa Panel Evidence-Based Clinical Practice Guidelines for Post-Stroke Rehabilitation","volume":"13","author":"Panel","year":"2006","journal-title":"Top. 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