title: Effects of repetitive facilitative exercise with neuromuscular electrical stimulation, vibratory stimulation and repetitive transcranial magnetic stimulation of the hemiplegic hand in chronic stroke patients.
abstract: OBJECTIVE
  Repetitive facilitative exercise (RFE) is a developed approach to the rehabilitation of hemiplegia. RFE can be integrated with neuromuscular electrical stimulation (NMES), direct application of vibratory stimulation (DAVS) and repetitive transcranial magnetic stimulation (rTMS). The aims of the present study were to retrospectively compare the effects of RFE and NMES, DAVS with those of RFE and rTMS, and to determine the maximal effect of the combination of RFE with NMES, DAVS, rTMS and pharmacological treatments in stroke patients.
  
  
  METHODS
  Thirty-three stroke patients were enrolled and divided into three groups: 15 who received RFE with rTMS (4 min) (TMS4 alone), 9 who received RFE with NMES, DAVS (NMES, DAVS alone) and 9 who received RFE with NMES, DAVS and rTMS (10 min) (rTMS10 + NMES, DAVS). The subjects performed the Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT) before and after the 2-week session. The 18 patients in the NMES, DAVS alone and rTMS10 + NMES, DAVS group underwent the intervention for 4 weeks.
  
  
  RESULTS
  There were no significant differences in the increases in the FMA, ARAT scores in the three groups. The FMA or ARAT scores in the NMES, DAVS alone and the rTMS10 + NMES, DAVS group were increased significantly. The FMA and ARAT scores were significantly improved after 4 weeks in the NMES, DAVS alone group.
  
  
  CONCLUSIONS
  RFE with NMES, DAVS may be more effective than RFE with rTMS for the recovery of upper-limb function. Patients who received RFE with NMES, DAVS and pharmacological treatments showed significant functional recovery.
authors.affiliation: a 1 Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Etoh
authors.affiliation: b 2 Department of Rehabilitation, Kirishima Rehabilitation Center of Kagoshima University Hospital , Kagoshima , Japan.
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Noma
authors.affiliation: c 3 Nanbu Tokushukai Hospital , Okinawa , Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Takiyoshi
authors.affiliation: a 1 Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan.
authors.forename: Michiko
authors.initials: M
authors.lastname: Arima
authors.affiliation: a 1 Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan.
authors.forename: Rintaro
authors.initials: R
authors.lastname: Ohama
authors.affiliation: a 1 Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan.
authors.forename: Katsuya
authors.initials: K
authors.lastname: Yokoyama
authors.affiliation: a 1 Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Hokazono
authors.affiliation: a 1 Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan.
authors.forename: Yumeko
authors.initials: Y
authors.lastname: Amano
authors.affiliation: a 1 Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan.
authors.forename: Megumi
authors.initials: M
authors.lastname: Shimodozono
authors.affiliation: a 1 Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan.
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kawahira
mesh_terms: D000368:Aged; D002908:Chronic Disease; D003131:Combined Modality Therapy; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006429:Hemiplegia / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation / Q000379:methods*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*; D014732:Vibration / Q000627:therapeutic use*
keywords: direct application of vibratory stimulation; neuromuscular electrical stimulation; repetitive facilitative exercise; repetitive transcranial magnetic stimulation; stroke