Abstract
To investigate the clinical effect of multiple course of repetitive transcranial magnetic stimulation (rTMS)
combined with intensive occupational therapy (IOT) in the post-stroke patients with upper limb hemiparesis.
NovEl Intervention Using Repetitive Transcrarnial magnetic stimulation and Intensive Occupational Therapy:
NEURO-15, which performs rTMS followed by IOT during the 15-day hospitalization period, was applied
multiple times to 18 patients with upper limb hemiparesis after stroke, and the clinical utility of such procedure
were examined. Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT) and Simple Test for
Evaluating Hand Function (STEF) as the upper limb function evaluation items, and Jikei Assessment Scale for
Motor Impairment in Daily Living (JASMID) and Visual Analog Scale (VAS) as evaluation criteria for the
paralyzed upper limb were used, respectively. In 12 out of 18 cases, an improvement in the frequency of use of
the upper limb function of JASMID was observed in the second course compared to the first course of NEURO-
15. In addition, significant improvements in the frequency of use of the upper limb function of JASMID, VAS,
STEF and ARAT were also observed at the second and subsequent NEURO-15, but FMA did not. Furthermore,
in 18 cases who received multiple courses of NEURO-15, there was no correlation between an improvement in
the frequency of use of the upper limb function of JASMID ARAT, but in 12 cases excluding 6 cases with
ARAT≧50, positive correlation between both criteria was observed. Clinical utility of multiple course of NEURO-
15 for the post-stroke patients with upper limb hemiparesis were confirmed. Also, patients with higher
improvement in the frequency of use of the upper limb function of JASMID at the second course of NEURO-15
tend to have higher ARAT scores. Therefore, it was suggested that such criteria would be useful in determining
whether multiple courses of NEURO-15 is clinically relevant.
