Upper Limb Function Recovery by Combined Repetitive Transcranial Magnetic Stimulation and Occupational Therapy in Patients with Chronic Stroke According to Paralysis Severity

Abstract

Repetitive transcranial magnetic stimulation (rTMS) with intensive occupational therapy improves upper limb motor paralysis and activities of daily living after stroke; however, the degree of improvement according to paralysis severity remains unverified. Target activities of daily living using upper limb functions can be established by predicting the amount of change after treatment for each paralysis severity level to further aid practice planning. We estimated post-treatment score changes for each severity level of motor paralysis (no, poor, limited, notable, and full), stratified according to Action Research Arm Test (ARAT) scores before combined rTMS and intensive occupational therapy. Motor paralysis severity was the fixed factor for the analysis of covariance; the delta (post-pre) of the scores was the dependent variable. Ordinal logistic regression analysis was used to compare changes in ARAT subscores according to paralysis severity before treatment. We implemented a longitudinal, prospective, interventional, uncontrolled, and multicenter cohort design and analyzed a dataset of 907 patients with stroke hemiplegia. The largest treatment-related changes were observed in the Limited recovery group for upper limb motor paralysis and the Full recovery group for quality-of-life activities using the paralyzed upper limb. These results will help predict treatment effects and determine exercises and goal movements for occupational therapy after rTMS.

Repetitive peripheral magnetic stimulation combined with transcranial magnetic stimulation in rehabilitation of upper extremity hemiparesis following stroke: a pilot study

“…during recovery after stroke (11,12). Consistent with the interhemispheric inhibition model, high-frequency rTMS can both partially restore the excitability of the ipsilesional M1 and suppress contralesional M1 excitability (13,14).…”

“…Numerous preliminary studies have identified the benefits of repetitive transcranial magnetic stimulation (rTMS) in motor recovery related to modulated cortical reorganization and induced neural plasticity ( 7 – 10 ). The lesioned hemisphere’s primary motor cortex (M1) is intensely involved in cortical reorganization of the motor functional network during recovery after stroke ( 11 , 12 ). Consistent with the interhemispheric inhibition model, high-frequency rTMS can both partially restore the excitability of the ipsilesional M1 and suppress contralesional M1 excitability ( 13 , 14 ).…”

Upper-Limb Functional Recovery in Chronic Stroke Patients after COVID-19-Interrupted Rehabilitation: An Observational Study

“…In this study, recovery of upper-limb function was suggested by improvements in part D scores of the FMA-UE, as well as grip and gross movement scores of the ARAT. Patients with more severe motor paralysis showed greater recovery in the ARAT grip and gross movement scores, whereas those with less severe motor paralysis were more likely to improve the quality of life activities using the paralyzed upper extremity when assessed during a 2-week treatment combining transcranial magnetic stimulation and occupational therapy [45]. Reports examining the degree of difficulty in the sub-items of the FMA-UE have shown that the items in part D are more difficult [46,47].…”

Impact of Shaking Exercise on Functional Recovery in Patients with Chronic Post-Stroke Upper Limb Paralysis: A Multicenter, Open-Label, Quasi-Randomized Controlled Trial

“…Recent advancements in noninvasive cerebral stimulation therapies such as repetitive transcranial magnetic stimulation (rTMS) combined with intensive upper limb training have shown promise in improving functions previously considered irreversible [4,[17][18][19][20][21]. Despite these advancements, the accessibility of innovative treatments in home settings remains limited, which poses a significant barrier to sustaining patient engagement and recovery.…”