A Review of 6-Sessions (In-patient) and 10-Sessions (Day-Patient) Repetitive Transcranial Magnetic Stimulation with Occupational-Therapy (OT) Comprehensive Upper-Limb-Stroke Program.

Abstract Description

Authors (including presenting author) :

Fong CH(1),Yeung MP(1),Yu KK(1),Chung YK(1),Chan YL(2),Tsang KY(2),Cheung P(2),Li KT(2),Cheng YS(1),Cheng YY(1),Lam YF(1),Tai ML(1),Li A(1),Lee YY(1)

Affiliation :

(1) Department of Rehabilitation, Kowloon Hospital (2) Department of Occupational Therapy, Kowloon Hospital

Introduction :

Transcranial-magnetic-stimulation (TMS) is a non-invasive brain stimulation and the therapeutic action of repetitive TMS (rTMS) may enhance neuroplasticity through modulating/reversing abnormal activity in cortical and subcortical networks.

Objectives :

To evaluate the clinical outcomes after 6-sessions-in-patient/ 10-sessions-out-patient rTMS and upper-limb-rehabilitation by occupational-therapist (OT) on upper-limb-motor-recovery in stroke patients.

Methodology :

A retrospective study of patients who received rTMS and stroke-upper-limb-motor-rehabilitation by OT in Kowloon-Hospital from January-2022 to December-2024

Result & Outcome :

A total of 22 patients received low-frequency(1Hz)-rTMS. 11 patients received in-patient-6-session (TMS-6) whereas 11 patients received out-patient-10-session (TMS-10).

For the baseline characteristics, 36%(TMS-6)/55%(TMS-10) were female with mean-age 60.5(32 to 85) in TMS-6 and 47.8(18 to 79) in TMS-10. The onset-time from stroke to first rTMS session was 26 days (TMS-6) and 167 days (TMS-10). The pre-rTMS mean-score in Hong-Kong-version-of-Montreal-Cognitive-Assessment (HK-MoCA) was 20(TMS-6) and 26(TMS-10); Functional-Independence-Measure (FIM) was 61(TMS-6) and 95(TMS-10). 17 patients had completed the pre-and post-rTMS assessment for analysis.

Outcome assessments were arranged at baseline, immediate, 1-and 3-month post-rTMS which included total-FIM, active-and passive-range-of-motion(AROM and PROM)of upper limb joints, V3-Tardieu-test(scale/ROM), Functional-Test-for-The-Hemiplegic-Upper-Extremity (FTHUE), Fugl-Meyer-Score (FMS) (upper-limb and hand-score).

Total 17(n=8 in TMS-6 and n=9 in TMS-10) patients were analyzed and no adverse event was reported.

In 3-month post-rTMS assessment for TMS-6, the improvement in total-FIM (Z= -2.524, p=0.012), FIM-motor-score(Z= -2.521, p=0.012), FTHUE(Z= -2.232, p=0.026) and FMS upper-limb(Z= -2.366, p=0.018) were statistically significant. For TMS-10, the improvement in total-FIM (Z= -2.106, p=0.035), FIM-motor-score(Z= -2.100, p=0.036), FMS upper-limb(Z= -2.680, p=0.007) and hand-score(Z= -2.371, p=0.018), shoulder-flexion-AROM (Z= -2.032, p=0.042) were statistically significant.

In 3-month post-rTMS assessment of these 17 patients, the improvement in total-FIM (Z= -3.311, p=0.001), FIM-motor-score(Z= -3.310, p=0.001), FTHUE (Z= -2.859, p=0.004), FMS upper-limb(Z= -3.524, p<0.001) and hand-score(Z=-2.983, p=0.003) were statistically significant. For upper limb joints outcomes, the improvement in shoulder-flexion-AROM (Z= -2.088, p=0.037) and elbow-extension-AROM (Z= -2.023, p=0.043) were statistically significant.

In conclusion, rTMS with upper-limb-motor-rehabilitation by occupational-therapist is suggested to promote upper-limb-motor-recovery and functional independence in both TMS-6 and TMS-10 group. Considering the mean gain in total-FIM for TMS-6 was 11.4 while the mean gain for stroke patients (total 825) after conventional in-patient rehabilitation in our hospital from April-2023 to March-2024 was 7.7, early in-patient rTMS rehabilitation program is suggested to be beneficial on functional improvement in stroke patients.