title: Baseline severity of upper limb hemiparesis influences the outcome of low-frequency rTMS combined with intensive occupational therapy in patients who have had a stroke.
abstract: OBJECTIVE
  To clarify whether the efficacy of combined low-frequency repetitive transcranial magnetic stimulation (rTMS) and intensive occupational therapy (OT) depends on baseline severity of upper limb hemiparesis after stroke.
  
  
  METHODS
  Retrospective comparative study.
  
  
  METHODS
  Department of Rehabilitation Medicine at a university hospital.
  
  
  METHODS
  Fifty-two patients who had sustained a stroke and had upper limb hemiparesis (age: 57 ± 13 years; time after onset: 50 ± 33 months). Based on the Brunnstrom stage for hand-fingers at admission, patients were divided into a Stage 3 group (n = 13), a Stage 4 group (n = 20), and a Stage 5 group (n = 19).
  
  
  METHODS
  During a 15-day hospitalization, each patient underwent 22 sessions of 20-minute low-frequency rTMS that was applied to the non-lesional hemisphere and 120 minutes of intensive OT (one-on-one training and self-training).
  
  
  METHODS
  Motor function of the affected upper limb was evaluated with the Fugl-Meyer Assessment and the Wolf Motor Function Test (WMFT) on the days of admission and discharge. WMFT performance time data were log-transformed.
  
  
  RESULTS
  The Fugl-Meyer Assessment score increased significantly in all patients (from 40.2 ± 12.2 to 43.4 ± 11.8 points, P < .001), but the score increase was significantly larger in the Stage 4 group than in the other two groups (2.1 ± 2.3 points in the Stage 3 group, 5.1 ± 2.9 points in the Stage 4 group, and 2.3 ± 1.8 points in the Stage 5 group, all P < .05). Similarly, the WMFT performance time decreased significantly in all patients (from 3.27 ± 0.90 to 2.96 ± 1.10, P < .001), but the difference in the extent of the decrease was significant between Stage 3 and Stage 4 groups and between Stage 3 and Stage 5 groups (0.04 ± 0.07 in the Stage 3 group, 0.41 ± 0.29 in the Stage 4 group, and 0.35 ± 0.31 in the Stage 5 group, all P < .01).
  
  
  CONCLUSIONS
  Our 15-day protocol of low-frequency rTMS and intensive OT is potentially promising in improving motor function of the affected upper limb. The extent of motor improvement by the intervention seemed to be influenced by the severity of upper limb hemiparesis at study entry.
authors.affiliation: Department of Rehabilitation Medicine, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Kakuda
authors.forename: Masahiro
authors.initials: M
authors.lastname: Abo
authors.forename: Kazushige
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Toshimitsu
authors.initials: T
authors.lastname: Takagishi
authors.forename: Ryo
authors.initials: R
authors.lastname: Momosaki
authors.forename: Aki
authors.initials: A
authors.lastname: Yokoi
authors.forename: Akiko
authors.initials: A
authors.lastname: Fukuda
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ito
authors.forename: Ayumi
authors.initials: A
authors.lastname: Tominaga
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009788:Occupational Therapy / Q000379:methods*; D010291:Paresis / Q000503:physiopathology / Q000534:rehabilitation*; D012189:Retrospective Studies; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome