Navigated Repetitive Transcranial Magnetic Stimulation or Brunnstrom Hand Manipulation: Which Treatment is More Effective in Stroke Cases?

摘要

Objective: We investigated the effects of navigated repetitive transcranial magnetic stimulation (rTMS) and Brunnstrom hand manipulation (BHM) on hand function in stroke cases.Methods: This trial used a randomised, double-blinded sham-controlled design with a 3month follow-up. In total, 21 subjects who had suffered a stroke at least 1 month earlier were recruited. The cases in the treatment group received real rTMS(1 Hz rTMS at 90% resting motor threshold, 25 min) over the hand area of the motor cortex in the unaffected hemisphere, determined with navigation. The treatment group(10 cases) received real rTMS, and the control group(11 cases) received sham rTMS, for 10 days. Cases in both groups underwent BHM and upper extremity exercises. Upper extremity motor function was measured with the upper extremity Fugl-Meyer Assessment(UE-FMA) and hand skills were evaluated with the Jebsen-Taylor Hand Function Test(JTT). All outcomes were measured before treatment and 10 days, 1 month, and 3 months after treatment.Results: No significant difference was found between the two groups in terms of their UE-FMA total, upper arm, or wrist scores at any of the four measurement times(p ≥ 0.05). There were significant differences among the cases in the treatment group in terms of their mean UE-FMA(total, upper arm, wrist, hand)scores(p ≤ 0.05).Intragroup comparisons conducted at the same times revealed significant differences among the cases in each group in terms of JTT scores for the affected hand(p ≤ 0.05).Conclusions: These findings indicated that BHM after navigated rTMS resulted in improvements in hand function in stroke cases.