Improvement in Paralyzed Upper Limb Function following Two Courses of Low-frequency Repetitive Transcranial Magnetic Stimalation (rTMS) Combined with Intensive Occupational Therapy / The Japanese Journal of Rehabilitation Medicine

ABSTRACT

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.