Article

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. DESIGN:
Retrospective comparative study. SETTING: Department of Rehabilitation Medicine
at a university hospital. SUBJECTS: 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). INTERVENTIONS: 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). MAIN OUTCOME MEASURES: 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.
CI - Copyright (c) 2011 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS