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
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
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DOI：
10.1016/j.pmrj.2011.02.015
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发表时间：
2011-06-01
期刊：
影响因子：
2.1
通讯作者：
Tominaga, Ayumi
中科院分区：
文献类型：
--
作者：
Kakuda, Wataru;Abo, Masahiro;Tominaga, Ayumi
目的：探讨低频重复经颅磁刺激(RTMS)联合强化作业疗法(OT)的疗效是否取决于卒中后上肢偏瘫的基线严重程度。设计：回顾性对比研究。地点：某大学医院康复医学部。研究对象：52例脑卒中后上肢偏瘫患者(年龄：57±13岁；发病时间：50+/-33个月)。根据入院时手指的Brunnstrom分期，患者被分为3期组(n=13)、4期组(n=20)和5期组(n=19)。干预：在15天的住院期间，每个患者接受22次20分钟的低频rTMS，对非皮损大脑半球进行120分钟的强化训练(一对一训练和自我训练)。主要观察指标：入院和出院时采用Fugl-Meyer评估和Wolf运动功能测试评估患侧上肢的运动功能。结果：所有患者的Fugl-Meyer评分均有显著提高(从40.2+/-12.2分增加到43.4+/-11.8分，P均<0.05)，但4期组的增加幅度明显大于其他两组(3期组为2.1+/-2.3分，4期组为5.1+/-2.9分，5期组为2.3+/-1.8分，P均<0.05)。同样，所有患者的WMFT操作时间显著减少(从3.27+/-0.90降至2.96+/-1.10，P<；.001)，但在3期与4期组之间以及3期与5期组之间的减少程度有显著差异(3期组0.04+/-0.07，4期组0.41+/-0.29，5期组0.35+/-0.31，均P<；结论：我们的为期15天的低频rTMS和强化OT方案在改善患侧上肢的运动功能方面具有潜在的前景。干预后运动改善的程度似乎受研究开始时上肢偏瘫的严重程度的影响。PM R 2011；3：516-522
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. PM R 2011;3:516-522