Role of Intermittent Theta-Burst Stimulation in Stroke Recovery

Intermittent theta-burst stimulation (iTBS) has emerged as a promising therapeutic approach for enhancing stroke recovery, particularly in improving motor and cognitive functions through its influence on neural plasticity. The application of iTBS, a form of transcranial magnetic stimulation (TMS), targets the cerebellum, which plays a critical role in motor control and cognitive processes. Research has demonstrated that iTBS can significantly enhance cortical activation in stroke patients, particularly affecting regions such as the dorsolateral prefrontal cortex (DLPFC) and primary motor cortex (PMC) (Xu et al., 2025).

A recent study employing functional near-infrared spectroscopy (fNIRS) found that iTBS applied to the cerebellum resulted in immediate neuroplastic changes in the cortex of stroke patients, indicating enhanced activation levels and improved neural connectivity. Specifically, patients demonstrated increased blood oxygenation levels in the left DLPFC and PMC during iTBS compared to sham stimulation (Xu et al., 2025). These findings highlight the potential of iTBS to facilitate functional recovery by promoting neural reorganization and enhancing cortical connectivity across motor and cognitive areas.

Furthermore, the effects of iTBS extend beyond immediate cortical activation. Enhanced resting-state functional connectivity (FC) between the temporal cortex and somatosensory cortex (SSC), as well as between the frontal eye field (FEF) and PMC, were observed after iTBS application. These improvements in connectivity suggest that iTBS not only activates cortical areas but also promotes integrated brain function, which is crucial for motor learning and recovery post-stroke (Xu et al., 2025).

Benefits of Vibrotactile Stimulation for Cochlear Implant Users

Vibrotactile music stimulation has been shown to enhance the auditory experiences of cochlear implant (CI) users, providing a multisensory approach to music perception that improves both enjoyment and comprehension of auditory signals. The integration of vibrotactile feedback—delivered through devices such as haptic vests—enriches the music listening experience by engaging the sense of touch, thereby compensating for some of the limitations of auditory processing in CI users (Turchet, 2025).

In a study comparing audio-only conditions to audio-vibrotactile conditions, CI users exhibited significantly improved performance on tonal and speech audiometric tests when exposed to vibrotactile music. This enhancement was particularly notable in the ability to decode tonal and speech signals, demonstrating that the addition of tactile stimulation can lead to a more immersive and engaging listening experience (Turchet, 2025). Participants reported heightened levels of emotional engagement and arousal during vibrotactile conditions, indicating that the combination of audio and tactile feedback can evoke stronger emotional responses compared to audio alone (Turchet, 2025).

The findings also suggest that vibrotactile stimulation can facilitate a greater sense of connection to music, which is often perceived as a critical element in the rehabilitation process for individuals with auditory impairments. This multisensory engagement can not only help in improving auditory skills but also enhance the overall quality of life for CI users by fostering a deeper appreciation of music (Turchet, 2025).

Immediate Neuroplastic Changes in the Cerebral Cortex

The application of iTBS to the cerebellum has been associated with immediate neuroplastic changes in the cerebral cortex, as evidenced by studies utilizing fNIRS to assess cortical activation and connectivity. The enhancements observed in cortical activation following iTBS indicate that this intervention may promote neuroplasticity, which is essential for recovery after a stroke.

In the aforementioned study, the increased activation in the left DLPFC and PMC during iTBS was accompanied by significant improvements in FC between brain regions involved in motor and cognitive functions. Notably, these changes were observed shortly after stimulation, highlighting the potential for iTBS to induce rapid neuroplastic changes that can facilitate functional recovery in stroke patients (Xu et al., 2025).

Additionally, the amplitude of low-frequency fluctuations (ALFF) in the medial superior frontal gyrus (SFGmed) increased significantly after iTBS, further supporting the notion that iTBS can enhance spontaneous neuronal activity during resting states. This increase in ALFF is indicative of heightened neural engagement in the SFGmed, a region involved in cognitive processing and decision-making (Xu et al., 2025).

These immediate neuroplastic changes underscore the importance of iTBS as a therapeutic tool in stroke rehabilitation, as they reveal the potential for leveraging brain stimulation techniques to accelerate recovery processes and improve functional outcomes.

Influence of Emotional Music on Cognitive Performance

The impact of emotional music on cognitive performance has garnered significant attention in recent years, particularly regarding its ability to enhance various cognitive functions such as attention, memory, and problem-solving. Studies have demonstrated that engaging with music that resonates emotionally can lead to improvements in cognitive performance, with specific effects observed based on the emotional content of the music (Turchet, 2025).

In the context of CI users, the addition of vibrotactile stimulation during music listening has been shown to amplify the cognitive benefits associated with musical exposure. The multisensory nature of vibrotactile stimulation not only enhances the auditory experience but also contributes to increased emotional arousal, which is linked to improved cognitive engagement and performance on auditory tasks (Turchet, 2025).

Participants in studies involving emotional music and vibrotactile feedback have reported greater immersion and connection to the music, which in turn fosters enhanced cognitive processing. This suggests that the emotional qualities of music, when combined with tactile stimulation, can serve as a potent tool for improving cognitive performance in populations with hearing impairments, thereby highlighting the therapeutic potential of music in rehabilitation settings (Turchet, 2025).

Key Mechanisms Behind Enhanced Audiometric Outcomes

The mechanisms underlying the enhanced audiometric outcomes observed in CI users exposed to vibrotactile music are multifaceted, involving both physiological and psychological components. The integration of tactile feedback with auditory stimulation has been shown to facilitate better auditory processing by engaging additional sensory pathways, thereby enhancing the perception of sound features that may be less accessible via auditory input alone (Turchet, 2025).

One key mechanism involves the recruitment of neural resources dedicated to processing tactile stimuli, which can enhance the overall engagement and responsiveness of the auditory system. This multisensory approach allows CI users to experience music more fully, leading to improvements in tonal and speech recognition tasks (Turchet, 2025).

Moreover, the emotional arousal elicited by vibrotactile music may play a crucial role in enhancing cognitive performance. As previous studies have indicated, emotional engagement is closely tied to improved learning and memory outcomes, suggesting that the use of vibrotactile stimulation can create a more enriching auditory environment for CI users (Turchet, 2025).

In summary, the combination of auditory and vibrotactile stimulation serves to enhance audiometric performance and emotional engagement in CI users, providing a novel approach to improving music perception and overall quality of life.

References

Xu, S., Chen, S., Zhang, Z., Liang, C., Huang, H., Zou, H., & Jiang, H. (2025). Immediate Neuroplastic Changes in the Cortex After iTBS on the Cerebellum of Stroke Patients: A Preliminary fNIRS Study. Neural Plasticity
Turchet, L. (2025). Exposure to vibrotactile music improves audiometric performances in individuals with cochlear implants. Scientific Reports. https://doi.org/10.1038/s41598-025-02946-4

FAQ

What is iTBS and how does it aid stroke recovery?
Intermittent theta-burst stimulation (iTBS) is a form of transcranial magnetic stimulation aimed at enhancing neural plasticity and improving recovery outcomes in stroke patients by targeting the cerebellum.

How does vibrotactile stimulation benefit cochlear implant users?
Vibrotactile stimulation enhances the auditory experience for cochlear implant users by providing tactile feedback that improves sound feature recognition and emotional engagement with music.

What neuroplastic changes occur in the brain following iTBS?
iTBS induces immediate neuroplastic changes in the cerebral cortex, including increased activation in motor and cognitive areas and enhanced functional connectivity between these regions.

What role does emotional music play in cognitive performance?
Emotional music can enhance cognitive performance by engaging listeners’ attention and memory, with benefits further amplified when combined with vibrotactile stimulation for cochlear implant users.

What are the implications of these findings for stroke rehabilitation?
The findings suggest that integrating iTBS and vibrotactile music can serve as effective therapeutic strategies to improve functional recovery in stroke patients and enhance the listening experience for cochlear implant users.