title: Combination Protocol of Low-Frequency rTMS and Intensive Occupational Therapy for Post-stroke Upper Limb Hemiparesis: a 6-year Experience of More Than 1700 Japanese Patients.
abstract: Several years ago, we proposed a combination protocol of repetitive transcranial magnetic stimulation (rTMS) and intensive occupational therapy (OT) for upper limb hemiparesis after stroke. Subsequently, the number of patients treated with the protocol has increased in Japan. We aimed to present the latest data on our proposed combination protocol for post-stroke upper limb hemiparesis as a result of a multi-institutional study. After confirming that a patient met the inclusion criteria for the protocol, they were scheduled to receive the 15-day inpatient protocol. In the protocol, two sessions of 20-min rTMS and 120-min occupational therapy were provided daily, except for Sundays and the days of admission/discharge. Motor function of the affected upper limb was evaluated by the Fugl-Meyer assessment (FMA) and Wolf motor function test (WMFT) at admission/discharge and at 4 weeks after discharge if possible. A total of 1725 post-stroke patients were studied (mean age at admission 61.4 ± 13.0 years). The scheduled 15-day protocol was completed by all patients. At discharge, the increase in FMA score, shortening in performance time of WMFT, and increase in functional ability scale (FAS) score of WMFT were significant (FMA score 46.8 ± 12.2 to 50.9 ± 11.4 points, p < 0.001; performance time of WMFT 2.57 ± 1.32 to 2.21 ± 1.33, p < 0.001; FAS score of WMFT 47.4 ± 14. to 51.4 ± 14.3 points, p < 0.001). Our proposed combination protocol can be a potentially safe and useful therapeutic intervention for upper limb hemiparesis after stroke, although its efficacy should be confirmed in a randomized controlled study.
authors.affiliation: Department of Rehabilitation Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan. wkakuda@jikei.ac.jp.
authors.forename: Wataru
authors.initials: W
authors.lastname: Kakuda
authors.affiliation: Department of Rehabilitation Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Abo
authors.affiliation: Shin-Yurigaoka General Hospital, 255, Furusawa-Tsuko, Asao-Ku, Kawasaki, Kanagawa, 215-0026, Japan.
authors.forename: Jinichi
authors.initials: J
authors.lastname: Sasanuma
authors.affiliation: Shimizu Hospital, 129, Miyagawa-Cho, Kurayoshi, Tottori, 682-0881, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Shimizu
authors.affiliation: Nishi-Hiroshima Rehabilitation Hospital, 6-265, Miyake, Saeki-Ku, Hiroshima, Hiroshima, 731-5143, Japan.
authors.forename: Takatsugu
authors.initials: T
authors.lastname: Okamoto
authors.affiliation: Kimura Hospital, 4-4-9, Asahi-Machi, Sabae, Fukui, 916-0025, Japan.
authors.forename: Chikou
authors.initials: C
authors.lastname: Kimura
authors.affiliation: Kyoto Ohara Memorial Hospital, 164, Ohara-Idecho, Sakyo-Ku, Kyoto, Kyoto, 601-1246, Japan.
authors.forename: Kiyohito
authors.initials: K
authors.lastname: Kakita
authors.affiliation: Kikyougahara Hospital, 1295, Souga, Shiojiri, Nagano, 399-6461, Japan.
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Hara
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007564:Japan; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009788:Occupational Therapy / Q000379:methods*; D010291:Paresis / Q000209:etiology* / Q000628:therapy*; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology*
keywords: Neural plasticity; Occupational therapy; Rehabilitation; Repetitive transcranial magnetic stimulation; Stroke; Upper limb hemiparesis