脳卒中後遺症の改善

―経頭蓋磁気刺激によるわれわれの知見から考えられること―

抄録

　Rehabilitation for vestibular dysfunction patients has been performed through group exercise or home exercise with the aid of a pamphlet. We believe, however, that an individual rehabilitation program should be performed under the supervision of a clinician, because in the United States vestibular dysfunction patients are treated by clinicians in cooperation with a physical therapist. Thus, we must establish rehabilitation of vestibular dysfunction through pre-graduate, post-graduate, and lifelong education.
　Several years ago, we proposed a combination protocol of repetitive transcranial magnetic stimulation (rTMS) and intensive occupational therapy for upper limb hemiparesis after a stroke. Furthermore, our proposed combination protocol could be a potentially safe and useful therapeutic intervention for post-stroke upper limb hemiparesis. This combination protocol demonstrated that neural activation in the lesional hemisphere plays an important role in such recovery in poststroke hemiparetic patients together with functional MRI, and upper limb motor function improvement in post-stroke patients reflects evolution of brain perfusion in single-photon emission computed tomography. In addition, this method produced significant reduction of motor neuron excitability using neurophysiological studies including F-wave parameter measurements. It is our hope that this method can play a role in the treatment of the vestibular dysfunction patient in the clinical setting.