RESUMO
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. We have already reported that the function of the paralyzed upper limb in the post-stroke hemiplegic patients was improved after a 15-day hospitalization protocol, named NEURO-15. In this present study, we investigated whether two courses (2X) of NEURO-15 were superior to a single one in therapeutic efficacy. Methods: During NEURO-15, each patient was scheduled to receive 21 treatment sessions of 20-min low-frequency rTMS followed by 120-min intensive OT daily. Low-frequency pulses of 1 Hz were applied to the motor cortex of the nonlesional hemisphere. Fugl-Meyer Assessment (FMA), log performance time of the Wolf Motor Function Test (WMFT) and modified Ashworth Scale (MAS) were evaluated on the days of admission and discharge. The first NEURO-15 was given to 16 apoplectic hemiplegic patients whose Brunnstrom Recovery Stage in their fingers ranged from IV to V. After an average of 13.6 months, the second NEURO-15 was administered to all 16 patients. Results : The 2X protocol was completed by all patients without any adverse effects. After the first course of NEURO-15, all patients showed improvement in their paralyzed upper limb function ; improvements which remained until the second NEURO-15 course. The second NEURO-15 course yielded even further improvement in the paralyzed upper limb function. Conclusions : Our proposed combination treatment is a safe, feasible, and clinically useful neurorehabilitative intervention for post-stroke patients with upper limb hemiparesis when administered as both a single application or as a 2X protocol. The effectiveness of the 2X protocol or even more frequent application of NEURO-15 courses needs to be further explored.
RESUMO
The purpose of this study was to evaluate the pathologic physiology of the brain during selective cerebral perfusion (SCP) during surgery for aortic dissection and aortic arch aneurysm. To evaluate the differences in cerebral blood flow and cerebral oxygen metabolism during SCP and normal cardiopulmonary bypass (CPB), we compared 10 patients undergoing selective cerebral purfusion (SCP group) with 20 patients undergoing normal cardiopulmonary bypass surgery (CPB group). In this study, the middle cerebral arterial blood flow velocity (MCAV) was continuously measured in both groups with a Labodop DP-100 trans cranial doppler velocimeter (TCD) during operation to measure the changes in cerebral blood flow. The tympanitic membrane temperature, the bladder temperature, the temporal arterial pressure, the internal jugular venous pressure and the arterial blood hemoglobin concentration were measured every 20min to evaluate the cerebral blood flow conditions. Further more the oxygen partial pressure (PaO<sub>2</sub>), the carbon dioxide partial pressure (PaCO<sub>2</sub>) and the oxygen saturation were also measured in arterial and internal jugular venous blood to evaluate the cerebral oxygen metabolism. The cerebral oxygen extraction rate (COER), and the cerebral metabolic rate for oxygen (CMRO<sub>2</sub>) were calculated. The cerebral perfusion pressure and the brain temperature in the SCP group were lower than those of the CPB group, while PaCO<sub>2</sub> in the SCP group was higher than that of the CPB group during SCP. In spite of the low cerebral perfusion pressure and the decrease in cerebral metabolism in the SCP group, mean MCAV remained at levels similar to those of the CPB group during SCP. This suggests that the high PaCO<sub>2</sub> level may be a significant factor in the increased cerebral blood flow during SCP. In conclusion, MCAV in the SCP group was maintained by the high PaCO<sub>2</sub> levels during SCP, causing COER and CMRO<sub>2</sub> levels to be much the same as in the CPB group.