title: Effects of repetitive transcranial magnetic stimulation and intensive occupational therapy on motor neuron excitability in poststroke hemiparetic patients: a neurophysiological investigation using F-wave parameters.
abstract: BACKGROUND
  The combination protocol of repetitive transcranial magnetic stimulation (RTMS) and intensive occupational therapy (OT) improves motor function of the paretic upper limb in poststroke patients. However, the effect of RTMS/OT on motor neuron excitability remains to be investigated. The purpose of this study was to determine the effect of 15-day application of RTMS/OT on motor neuron excitability in such patients using neurophysiological studies including F-wave parameter measurements.
  
  
  METHODS
  Ten poststroke patients with spastic upper limb hemiparesis were studied (mean age: 57.4 ± 8.1 years, ± SD). Patients were hospitalized for 15 days to receive RTMS/OT. One session of 40-min low-frequency RTMS and two sessions of 120-min intensive OT were provided daily. Neurophysiological studies including F-wave parameters measurements were performed on the days of admission/discharge. Motor function and spasticity of the affected upper limb were evaluated on the same time points.
  
  
  RESULTS
  RTMS/OT significantly improved motor function of the affected upper limb. RTMS/OT decreased the modified Ashworth scale (MAS) in the affected upper limb (p < 0.05), but did not change F-wave frequency in either upper limb. However, both F-mean/M ratio and F-max/M ratio significantly decreased in the affected upper limb (all p < 0.05).
  
  
  CONCLUSIONS
  The 15-day protocol of LF-RTMS/OT produced significant reduction of motor neuron excitability. RTMS/OT can potentially produce significant reduction in upper limb spasticity in the affected upper limb, although this finding should be confirmed in a larger number of patients.
authors.affiliation: 1Shimizu Hospital, Kurayoshi , Tottori , Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kondo
authors.forename: Wataru
authors.initials: W
authors.lastname: Kakuda
authors.forename: Naoki
authors.initials: N
authors.lastname: Yamada
authors.forename: Masato
authors.initials: M
authors.lastname: Shimizu
authors.forename: Masahiro
authors.initials: M
authors.lastname: Abo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058256:Brain Waves / Q000502:physiology*; D004569:Electroencephalography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009046:Motor Neurons / Q000502:physiology*; D009788:Occupational Therapy; D010291:Paresis / Q000209:etiology / Q000473:pathology* / Q000628:therapy*; D018709:Statistics, Nonparametric; D020521:Stroke / Q000150:complications; D065908:Transcranial Direct Current Stimulation; D034941:Upper Extremity / Q000503:physiopathology; D055815:Young Adult
keywords: Occupational therapy; f-wave; spasticity; stroke; transcranial magnetic stimulation; upper limb hemiparesis