Abstract
Background and Purpose: Recently, low-frequency repetitive transcranial magnetic stimulation (RTMS) applied to the non-lesional hemisphere has been reported to improve motor function of the paretic upper limb after stroke. Some clinical studies have confirmed the beneficial effect of intensive occupational therapy (OT) for upper limb hemiparesis after stroke. The purpose of this study was to clarify the safety, feasibility and efficacy of combined protocol of these two interventions which we developed for this patient population.
Methods: The study subjects were 1,008 post-stroke patients with upper limb hemiparesis (mean age: 61.1±12.4 years) from eight institutions in Japan. During 15-day hospitalization, each patient was scheduled to receive 22 treatment sessions of 20-min low-frequency RTMS followed by 120-min intensive OT daily. Low-frequency pulses of 1 Hz were applied to motor cortex of the non-lesional hemisphere. Fugl-Meyer Assessment (FMA), log performance time of Wolf Motor Function Test (WMFT) and Functional Ability Scale (FAS) of WMFT were evaluated serially.
Results: The protocol was completed by all patients without any adverse effects. With the 15-day protocol, the FMA score increased and log performance time of WMFT decreased significantly (all p<0.001). A significant increase in FAS of WMFT was also found (p<0.001). Linear regression analysis indicated that the response to the treatment was significantly influenced by the severity and side of hemiparesis.
Conclusions: Our proposed combination treatment is safe and feasible. The treatment seems to improve motor function of the paretic upper limb after stroke, although the efficacy of the treatment needs to be confirmed in a further study.
