Abstract
Objectives
The combination of repetitive transcranial magnetic stimulation (rTMS) and motor practice
is based on the theory of neuromodulation and use-dependent plasticity. Predictive
planning of occupational therapy (OT) is important for patients with rTMS conditioning.
Recovery characteristics based on the severity of pretreatment upper extremity paralysis
can guide the patient’s practice plan for using the paretic hand. Therefore, we evaluated
the recovery of patients with upper limb paralysis due to stroke who underwent a novel
intervention of rTMS combined with OT (NEURO) according to the severity of upper limb
paralysis based on the scores of the Fugl–Meyer assessment for upper extremity (FMA-UE)
with recovery in proximal upper extremity, wrist, hand, and coordination.
Materials and Methods
In this multicenter retrospective cohort study, the recovery of 1397 patients with
upper limb paralysis was analyzed by severity at six hospitals that were accredited
by the Japanese Stimulation Therapy Society for treatment. The delta values of the
FMA-UE scores before and after NEURO were compared among the groups with severe, moderate,
and mild paralysis using the generalized linear model.
Results
NEURO significantly improved the FMA-UE total score according to the severity of paralysis
(severe = 5.3, moderate = 6.0, and mild = 2.9). However, when the FMA-UE subscores
were analyzed separately, the results indicated specific improvements in shoulder/elbow,
wrist, fingers, and coordination movements, depending on the severity.
Conclusions
This study had enough patients who were divided according to severity and stratified
by lesion location and handedness parameters. Our results suggest that independently
of these factors, the extent of recovery of upper limb motor parts after NEURO varies
according to the severity of paralysis.
Keywords
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Comment
Article info
Publication history
Published online: March 16, 2023
Accepted:
February 6,
2023
Received in revised form:
February 5,
2023
Received:
June 11,
2022
Publication stage
In Press Corrected ProofFootnotes
Source(s) of financial support: This work was supported by JSPS KAKENHI (Grant number: 18K10691).
Conflict of Interest: The authors reported no conflict of interest.
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© 2023 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.
