A multi-center study on low-frequency rTMS combined with intensive occupational therapy for upper limb hemiparesis in post-stroke patients

Kakuda, Wataru; Abo, Masahiro; Shimizu, Masato; Sasanuma, Jinichi; Okamoto, Takatsugu; Yokoi, Aki; Taguchi, Kensuke; Mitani, Sugao; Harashima, Hiroaki; Urushidani, Naoki; Urashima, Mitsuyoshi

doi:10.1186/1743-0003-9-4

Cited by 96 publications

(89 citation statements)

References 26 publications

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“…For example, many recent studies have combined high and low frequency craniocerebral magnetic stimulation and conventional localized induction therapy, [5] as well as the use of visual-motor feedback technology such as Wii, XBOX-Kinect, [32] or the recent rise of mirror therapy. [33] The effectiveness of these emerging therapies have been clinically acclaimed and a growing number of investigators have attempted to apply these findings extensively to patients with stroke at different ages and stages, with many traditional therapeutic limitations reaching a breakthrough development.…”

Section: Discussionmentioning

confidence: 99%

“…[4] This period refers to "rapid restoration of function", commonly known as "Key rehabilitation period". Nevertheless, Kakuda et al [5] attempted to rehabilitate 204 patients with chronic stroke with a mean incidence of 5 years, using repetitive transcranial magnetic stimulation (rTMS) combined with high-frequency functional therapy. After 15 days of treatment found that upper limb movement quality and speed of execution activities are patient appears very significant improvement.…”

Section: Introductionmentioning

confidence: 99%

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Predicting rehabilitation treatment helpfulness to stroke patients: A supervised learning approach

Tseng

2017

AIR

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Stroke (Cerebral vascular accident, CVA) is a common and serious disease. Most of the survivals would be disabled after their illness recovery, causes serious burden on caregivers. It is said that rehabilitation could help functional recovery of stroke patients, regain independence after stroke. Due to the long course of stroke, how to prevent survivals from recurrence is an important issue. This study attempts to examine the relationship between stroke recurrence and strength of rehabilitation, and build a stroke recurrence prediction model utilizing a number of supervised learning techniques to assist physicians with making clinical decisions.In the past, most of the related work used the samples from a single hospital as a sample, but it cannot fully catch all the clinic information of the patients. Therefore, this study used the Longitudinal Health Insurance Database 2010 of the NHIRD as the data source, to examine the effectiveness of rehabilitation.In terms of accuracy rate of all classifiers, we get the best effectiveness (78%) while adopting the inpatient admission dataset and C4.5 to predict recurrence. We also find physical therapy, occupational therapy and speech therapy treatments during inpatient admission are the key factors to decrease the chance to recrudesce in the rehabilitation periods. The higher strength and frequency rehabilitation treatment is also the key influence variables in our high accuracy prediction model which means that is useful to lower the recurrence rate of stroke patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predicting rehabilitation treatment helpfulness to stroke patients: A supervised learning approach

Tseng

2017

AIR

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“…Plot showing the partial correlation between the MEP ratio and motor function tests controlling for the period after stroke onset (A-C): black circles (T1) and squares (T2), affected hand; white circles (T1) and squares (T2), unaffected hand. and chronic stroke 24,25 ) . However, the neurophysiological mechanisms underlying such functional recovery are not well understood.…”

Section: Discussionmentioning

confidence: 99%

Correlation between changes of contralesional cortical activity and motor function recovery in patients with hemiparetic stroke

Matsuura¹,

Karita²,

Nakada³

et al. 2017

Phys Ther Res

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ABSTRACT. Objective: To investigate the correlation between changes of contralesional cortical excitability evaluated by transcranial magnetic stimulation (TMS) and functional recovery in patients with hemiparetic stroke. Methods: Eight inpatients (mean age: 75.9 13.8 years) with mild to moderate hemiparesis were enrolled. TMS was delivered to the optimal scalp position over the contralesional (ipsilateral to the paresis) primary motor cortex (M1) to activate the unaffected flexor carpi radialis muscle (FCR) while the patient picked up a wooden block with the affected hand. The amplitude of the motor-evoked potential (MEP) was measured and then was divided by the resting MEP amplitude (MEP ratio). For evaluation of motor function, we tested grip strength (GS), performed the upper extremity motor section of the Fugl-Meyer Assessment (FMA-UE), and performed the Purdue Pegboard Test (PPT) when the patients were admitted to our hospital (T1) and 2 months after admission (T2). Results: The MEP ratio was significantly decreased at the second examination. The partial correlations between the MEP ratio and FMA-UE at T1, and PPT of an affected hand at T2 were observed while controlling for the period after stroke onset as the confounding variable. Conclusion: The reduction of contralesional cortical hyperactivity is related to the functional recovery in part, but not related with the period after stroke onset. This suggests that enhanced reduction of contralesional M1 hyperactivity contributes to functional recovery after stroke.

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“…In general, a greater effectiveness of NIBS in subcortical stroke patients in comparison with patients with non specified lesion site has been confirmed in a recent meta-analysis [58]. Also baseline severity of the affected upper limb significantly influenced the treatment outcome, greatest results have been observed for less impaired patients [49]. The neurochemical predictors of behavioural response to tDCS after stroke have been searched using magnetic resonance spectroscopy [70].…”

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confidence: 96%

“…This effect, in line with effects on cortical motor excitability in human [6,[44][45][46] and animal models [47], is however transitory and outlasts the stimulation period from minutes to 1 -2 hours. Multiple stimulation sessions and/ or the association of a motor training are needed to induce longer lasting effects on cortical excitability and motor function (2-4 weeks) [42,[48][49][50]. In particular, Avenanti et al (2012) evaluated the effect of 10 daily sessions of 1 Hz rTMS administered either immediately before or after physiotherapy (PT), in 30 subjects affected by chronic subcortical stroke.…”

mentioning

confidence: 99%

Non Invasive Neuromodulation in Motor Recovery after Stroke: State of the Art, Open Questions and Future Perspectives

Chieffo

Comi²,

Leocani³

2013

J Neurol Neurophysiol

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IntroductionStroke is a leading cause of adult disability in the western world [1]. Sensorimotor and cognitive impairments often have a great impact on quality of life in post stroke survivors. It is well known that the human brain continues to adjust throughout life. After ischemic brain injury, neuroplasticity is particularly active in the first months [2]. However, it has been demonstrated that, even years after stroke, the human brain still retains the capacity to reorganize in response to interventions influencing motor recovery [3]. Several efforts have focused on the development of new restorative therapies. In particular, non invasive brain stimulation (NIBS) techniques, such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), constitute an extensive chapter on this topic. The rationale for the application of NIBS for rehabilitation of neurological deficits is its capacity of modulate cortical excitability and induce plasticity in humans. Repetitive TMS (rTMS) refers to regularly repeated single TMS pulses delivered in trains at specific frequencies. In general, low-frequency rTMS (≤ 1 Hz) usually results in cortical excitability reduction [4] in healthy subjects, whereas with higher frequencies (5 Hz or more) cortical excitability is usually increased [5]. Modulation by rTMS does not only depend on pulses frequency. Intensity of stimulation, trains duration and inter-train wait time can be all manipulated to influence neuroplasticity [6]. Theta-burst stimulation (TBS) is a relative more recent technique, consisting in brief bursts of theta frequency low intensity stimuli. TBS delivered in a continuous pattern (cTBS) produces a decrease in motor cortex excitability, while an intermitted paradigm (iTBS) produces an opposite effect [7]. The so called tDCS consists in the application of weak electrical currents through the scalp. This technique utilizes two surface electrodes (anode and cathode), which placement is fundamental for outcome, by determining the direction of the current flow. The montage with anode on the brain region of interest (anodal tDCS) has an excitatory effect (and cathodal tDCS the opposite), possibly through mechanisms involving neuronal membrane depolarization or hyperpolarization respectively [8,9].In general, a single session of NIBS induces reversible effects that last from a few minutes up to about 1 h. To induce long lasting effects several stimulation sessions are often needed. The mechanisms underlying long-term effects of rTMS are not completely understood.It is likely that a number of interacting mechanisms are involved. There are several evidences that the effects of these NBS techniques are mainly due to long term potentiation (LTP)-like and long term depression (LTD)-like mechanisms [10][11][12][13]. Moreover, experiments performed in healthy rat brain shown that NIBS has the ability to mediate neural plasticity by enhancing the expressions of neurotransmitters and neurotrophins, such as glutamate, N-methyl-D-aspartate (NMDA), an...

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A multi-center study on low-frequency rTMS combined with intensive occupational therapy for upper limb hemiparesis in post-stroke patients

Cited by 96 publications

References 26 publications

Predicting rehabilitation treatment helpfulness to stroke patients: A supervised learning approach

Predicting rehabilitation treatment helpfulness to stroke patients: A supervised learning approach

Correlation between changes of contralesional cortical activity and motor function recovery in patients with hemiparetic stroke

Non Invasive Neuromodulation in Motor Recovery after Stroke: State of the Art, Open Questions and Future Perspectives

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