Low-frequency repetitive transcranial magnetic stimulation and intensive occupational therapy for poststroke patients with upper limb hemiparesis: preliminary study of a 15-day protocol

The purpose of the study was to determine the safety and feasibility of a 15-day protocol of low-frequency repetitive transcranial magnetic stimulation (rTMS) combined with intensive occupational therapy (OT) on motor function and spasticity in hemiparetic upper limbs in poststroke patients. Fifteen poststroke patients (age at study entry 55 +/- 17 years, time after stroke 57 +/- 55 months) with upper limb hemiparesis categorized as Brunnstrom stages 3-5 for hand-fingers were recruited. They were considered to have reached a plateau state at study entry, based on the lack of any increase in Fugl-Meyer Assessment (FMA) Score in the last 3 months. During the 15-day hospitalization, each patient received 22 sessions of rTMS with 1 Hz applied to the contralesional cerebral hemisphere, followed by intensive OT (one-to-one training including shaping techniques and self training). Upper limb motor function was evaluated by FMA and Wolf Motor Function Test at admission and discharge. The spasticity of finger flexors, wrist flexors and elbow flexors in the affected upper limb was also evaluated with Modified Ashworth Scale. The 15-day protocol was well tolerated by all patients. At discharge, the FMA Score was increased in all 15 patients (17-57 to 18-61 points). Shortening of performance time on Wolf Motor Function Test was noted in 12 patients (44-1584 to 39-1485 s). The Modified Ashworth Scale Score for some flexor muscles decreased in 12 patients. In conclusion, our 15-day protocol of low-frequency rTMS combined with intensive OT seems feasible not only for improving motor function, but also for reducing spasticity in the affected upper limb in poststroke hemiparetic patients.