A multi-center study on low-frequency rTMS combined with intensive occupational therapy for upper limb hemiparesis in post-stroke patients

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• 作者：Wataru Kakuda (1)
  Masahiro Abo (1)
  Masato Shimizu (2)
  Jinichi Sasanuma (3)
  Takatsugu Okamoto (4)
  Aki Yokoi (1)
  Kensuke Taguchi (1)
  Sugao Mitani (2)
  Hiroaki Harashima (5)
  Naoki Urushidani (4)
  Mitsuyoshi Urashima (6)
  
• 关键词：Repetitive transcranial magnetic stimulation ; Occupational therapy ; Stroke ; Upper limb hemiparesis ; Rehabilitation
• 刊名：Journal of NeuroEngineering and Rehabilitation
• 出版年：2012
• 出版时间：December 2012
• 年：2012
• 卷：9
• 期：1
• 全文大小：251KB
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• 作者单位：Wataru Kakuda (1)
  Masahiro Abo (1)
  Masato Shimizu (2)
  Jinichi Sasanuma (3)
  Takatsugu Okamoto (4)
  Aki Yokoi (1)
  Kensuke Taguchi (1)
  Sugao Mitani (2)
  Hiroaki Harashima (5)
  Naoki Urushidani (4)
  Mitsuyoshi Urashima (6)
  
  1. Department of Rehabilitation Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
  2. Shimizu Hospital, 129, Miyagawa-Cho, Kurayoshi, Tottori, 682-0881, Japan
  3. Department of Neurosurgery, Tokyo General Hospital, 3-15-2, Egota, Nakano-Ku, Tokyo, 165-8906, Japan
  4. Nishi-Hiroshima Rehabilitation Hospital, 6-265, Miyake, Saeki-Ku, Hiroshima, Hiroshima 731-5143, Japan
  5. Department of Rehabilitation Medicine, Tokyo General Hospital, 3-15-2, Egota, Nakano-Ku, Tokyo, 165-8906, Japan
  6. Division of Molecular Epidemiology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
  

文摘

Background Both low-frequency repetitive transcranial magnetic stimulation (rTMS) and intensive occupational therapy (OT) have been recently reported to be clinically beneficial for post-stroke patients with upper limb hemiparesis. Based on these reports, we developed an inpatient combination protocol of these two modalities for the treatment of such patients. The aims of this pilot study were to confirm the safety and feasibility of the protocol in a large number of patients from different institutions, and identify predictors of the clinical response to the treatment. Methods The study subjects were 204 post-stroke patients with upper limb hemiparesis (mean age at admission 58.5 ± 13.4 years, mean time after stroke 5.0 ± 4.5 years, ± SD) from five institutions in Japan. During 15-day hospitalization, each patient received 22 treatment sessions of 20-min low-frequency rTMS and 120-min intensive OT daily. Low-frequency rTMS of 1 Hz was applied to the contralesional hemisphere over the primary motor area. The intensive OT, consisting of 60-min one-to-one training and 60-min self-exercise, was provided after the application of low-frequency rTMS. Fugl-Meyer Assessment (FMA) and Wolf Motor Function Test (WMFT) were performed serially. The physiatrists and occupational therapists involved in this study received training prior to the study to standardize the therapeutic protocol. Results All patients completed the protocol without any adverse effects. The FMA score increased and WMFT log performance time decreased significantly at discharge, relative to the respective values at admission (change in FMA score: median at admission, 47 points; median at discharge, 51 points; p < 0.001. change in WMFT log performance time: median at admission, 3.23; median at discharge, 2.51; p < 0.001). These changes were persistently seen up to 4 weeks after discharge in 79 patients. Linear regression analysis found no significant relationship between baseline parameters and indexes of improvement in motor function. Conclusions The 15-day inpatient rTMS plus OT protocol is a safe, feasible, and clinically useful neurorehabilitative intervention for post-stroke patients with upper limb hemiparesis. The response to the treatment was not influenced by age or time after stroke onset. The efficacy of the intervention should be confirmed in a randomized controlled study including a control group.