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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

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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.

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Acknowledgments

On behalf of the NEURO investigators, the authors gratefully acknowledge the support and the participation of the patients in this study. The NEURO investigators are as follows: Department of Rehabilitation Medicine, Jikei University School of Medicine (Tokyo): Masahiro Abo, MD, PhD; Wataru Kakuda, MD, PhD; Kentaro Kobayashi, MD; Kazushige Kobayashi, MD, PhD; Ryo Momosaki, MD, PhD; Naoki Yamada, MD; Takatoshi Hara, MD; Tomoko Tanaka, OTR; Atsushi Ishikawa, OTR; Kensuke Taguchi, OTR; Takuma Umemori, OTR; Hiroyuki Ozawa, OTR; Yosuke Sase, OTR; Ryo Okuma, OTR. Tokyo General Hospital (Tokyo): Miki Kojima, OTR; Yusuke Haga, OTR; Toshihiro Sato, OTR; Yuki Obara, OTR; Hiroaki Harashima, RPT; Shigeto Watanabe, RPT; Yutaka Yoshida, RPT; Akiko Yoritsune, RPT; Masaya Imai, RPT. Shin-Yurigaoka General Hospital (Kanagawa): Jinichi Sasanuma, MD, PhD. Shimizu Hospital (Tottori): Masato Shimizu, MD; Gentaro Hashimoto, MD; Sugao Mitani, RPT, PhD; Hidenobu Saeki, RPT; Junichi Nishimura, OTR; Takahiro Kondo, OTR; Chika Kodani, OTR. Nishi-Hiroshima Rehabilitation Hospital (Hiroshima): Takatsugu Okamoto, MD, PhD; Eiji Inoue, OTR, MS; Sachiko Shiraoka, OTR; Naoki Urushidani, OTR; Hiroaki Tamashiro, OTR; Takashi Kurushima, OTR; Takashi Matsuda, OTR. Kyoto Ohara Memorial Hospital (Kyoto): Kiyohito Kakita, MD, PhD; Hiroshi Urabe, MD, PhD; Risa Fukuzumi, OTR; Ryunosuke Yamazaki, OTR; Takeshi Masuda, OTR. Kimura Hospital (Fukui): Chikou Kimura, MD, PhD; Masachika Niimi, MD; Tamiko Kajikawa, OTR; Kaori Mori, OTR; Terukazu Kawabata, OTR; Yuuki Matsuura, OTR. Hakodate Shintoshi Hospital (Hokkaido): Satoshi Takagi, MD; Mitsunori Suzuki, OTR; Junko Hasuda, OTR; Shunsuke Kadowaki, OTR; Kazumi Fukusi, OTR; Yosinari Izumi, OTR. Kousei Hospital (Hyogo): Kazuyosi Korosue, MD, PhD; Shohei Ishikawa, OTR; Yuji Nitta, OTR; Yuko Sakata, OTR. Kikyougahara Hospital (Nagano): Hiroyoshi Hara, MD, PhD. Aizawa Hospital (Nagano): Koji Namiki, OTR. Suwanomori Hospital (Oita): Mitsuo Takei, MD, PhD.

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Authors and Affiliations

  1. Department of Rehabilitation Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan

    Wataru Kakuda & Masahiro Abo

  2. Shin-Yurigaoka General Hospital, 255, Furusawa-Tsuko, Asao-Ku, Kawasaki, Kanagawa, 215-0026, Japan

    Jinichi Sasanuma

  3. Shimizu Hospital, 129, Miyagawa-Cho, Kurayoshi, Tottori, 682-0881, Japan

    Masato Shimizu

  4. Nishi-Hiroshima Rehabilitation Hospital, 6-265, Miyake, Saeki-Ku, Hiroshima, Hiroshima, 731-5143, Japan

    Takatsugu Okamoto

  5. Kimura Hospital, 4-4-9, Asahi-Machi, Sabae, Fukui, 916-0025, Japan

    Chikou Kimura

  6. Kyoto Ohara Memorial Hospital, 164, Ohara-Idecho, Sakyo-Ku, Kyoto, Kyoto, 601-1246, Japan

    Kiyohito Kakita

  7. Kikyougahara Hospital, 1295, Souga, Shiojiri, Nagano, 399-6461, Japan

    Hiroyoshi Hara

Authors
  1. Wataru Kakuda
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  2. Masahiro Abo
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  3. Jinichi Sasanuma
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  4. Masato Shimizu
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  5. Takatsugu Okamoto
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  6. Chikou Kimura
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  7. Kiyohito Kakita
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  8. Hiroyoshi Hara
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Corresponding author

Correspondence to Wataru Kakuda.

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Funding

Funding for this study was provided by a Grant-in-Aids for Scientific Research from the Japan Society for the Promotion of Science.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments. This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Kakuda, W., Abo, M., Sasanuma, J. et al. 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. Transl. Stroke Res. 7, 172–179 (2016). https://doi.org/10.1007/s12975-016-0456-8

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  • DOI: https://doi.org/10.1007/s12975-016-0456-8

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