Abstract: Background Balance dysfunction is one of the most common sequelae in patients with supratentorial stroke. The cerebellum, which plays a crucial role in balance, has been targeted with intermittent theta burst stimulation (iTBS) to improve balance function in these patients. However, the improvement of different types of balance abilities by this approach remains unclear. Objective To explore the influence of cerebellum intermittent theta burst stimulation (iTBS) intervention on the three types of balance abilities of static balance, dynamic balance and dual-task balance in supratentorial stroke patients. Methods Forty supratentorial stroke patients who were admitted to the Rehabilitation Medicine Center of Changzhou Dean Hospital from July 2023 to December 2024 were selected and divided into an experimental group (n=20) and a control group (n=20) by using a random number table. Both groups of subjects received conventional rehabilitation intervention. The experimental group received cerebellar iTBS intervention on this basis, while the control group received sham cerebellar iTBS intervention. The Berg Balance Scale (BBS) and Trunk Injury Scale (TIS) were used for assessment before the intervention and 2 weeks after the intervention. They were classified and statistically analyzed according to the static balance items and dynamic balance items. In addition, a balancing instrument was used to measure the overall stability index (OSI), anterior-posterior stability index (APSI) and medial lateral stability index (MLSI) of the patients in the stable platform, unstable platform and dual-task stable platform.Results One participant in each of the experimental and control groups dropped out during the treatment period; thus, 19 patients in each group were ultimately included in the analysis. After 2 weeks of intervention, the static balance subscore of the BBS increased significantly compared with baseline within both groups (P<0.05). After 2 weeks of intervention, the OSI, APSI, and MLSI under the stable surface condition were all significantly reduced compared with pre-intervention values within both groups (P<0.05). After 2 weeks of intervention, the dynamic balance subscores of the BBS and TIS were significantly increased compared with baseline within both groups (P<0.05). After 2 weeks of intervention, patients in the experimental group showed significant reductions in the OSI and APSI under the unstable surface condition compared with pre-intervention values (P<0.05). After 2 weeks of intervention, both groups exhibited significant reductions in the OSI and MLSI under the dual-task stable surface condition compared with baseline (P<0.05).Between-group comparisons demonstrated that improvements in the experimental group were significantly greater than those in the control group in terms of the total scores of the static and dynamic balance items of the BBS, the total scores of the dynamic balance items of the TIS, the OSI and APSI under the unstable surface condition, and the OSI under the dual-task stable surface condition (P<0.05). Conclusion Cerebellar iTBS can effectively improve the balance function of patients with supratentorial stroke, and has a positive impact on static balance, dynamic balance and dual-task balance.

Key words: Stroke, Cerebellum, Intermittent theta burst stimulation, Balance, Randomized controlled trials

摘要： 背景 平衡功能障碍是幕上卒中患者常见的后遗症之一，而小脑凭借在平衡中发挥的重要作用，已被作为间歇性θ短阵脉冲刺激（iTBS）的新靶点以改善患者的平衡功能，然而其对于不同类型的平衡能力的改善情况尚不明确。目的 探索小脑iTBS干预对幕上卒中患者静态平衡、动态平衡和双任务平衡三种类型平衡能力的影响。方法 选取2023年7月—2024年12月期间在常州市德安医院康复医学中心收治的40例幕上卒中患者，依据随机数字表法将患者分成试验组20例和对照组20例。两组受试者均接受常规康复干预，试验组在此基础上接受小脑iTBS干预，对照组接受伪小脑iTBS干预。分别于干预前和干预2周后采用Berg平衡量表、躯干损伤量表进行评估，且按照静态平衡条目和动态平衡条目进行分类统计，此外还使用平衡仪测量患者在稳定平面、不稳定平面以及双任务稳定平面下的总稳定性指数、前后稳定性指数和左右稳定性指数。结果 试验组、对照组治疗过程中各脱落1例，最终纳入试验组和对照组各19例。干预2周后两组患者Berg平衡量表的静态平衡部分得分较组内干预前均升高（P<0.05）。干预2周后两组患者稳定平面下的总稳定性指数、前后稳定性指数和左右稳定性指数均较组内治疗前降低（P<0.05）。干预2周后两组患者Berg平衡量表、躯干损伤量表的动态平衡部分得分较组内干预前均升高（P<0.05）。干预2周后试验组患者不稳定平面下的总稳定性指数、前后稳定性指数均较组内干预前降低（P<0.05）。干预2周后两组患者双任务稳定平面下的总稳定性指数、左右稳定性指数均较组内干预前降低（P<0.05）。组间比较显示，试验组在Berg平衡量表静态平衡条目及动态平衡条目总分、躯干损伤量表动态平衡条目总分、不稳定平面下的总稳定性指数及前后稳定性指数、双任务稳定平面下的总稳定性指数显著上的改善优于对照组（P<0.05）。结论 小脑iTBS能够有效改善幕上卒中患者的平衡功能，并且在静态平衡、动态平衡及双任务平衡方面均产生积极影响。

关键词: 脑卒中, 小脑, 间歇性 θ 短阵脉冲刺激, 平衡, 随机对照试验