脳卒中片麻痺患者における反復経頭蓋磁気刺激と作業療法の併用効果—手指運動麻痺の軽度群と重度群の2群間における治療効果の差

The effects of combining repetitive transcranial magnetic stimulation with occupational therapy among post-hemiplegic stroke survivors: Comparing the therapeutic effects between mild and severe finger motor dysfunction

要旨：脳卒中片麻痺患者の運動麻痺に対する低頻度の反復経頭蓋磁気刺激と作業療法の併用療法効果について，手指運動麻痺の軽度群と重度群の2群に分類し，治療効果の違いをFugl-Meyer Assessment，10秒間テスト，他動的関節可動域（Passive-Range of Motion；以下，P-ROM），Modified Ashworth Scale（以下，MAS），Motor Activity Log（以下，MAL），運動誘発電位を用いて検討した．手指の運動麻痺が軽度な患者群は治療後に全ての項目で有意な改善を認めた．一方，重度な患者群は，MASやP-ROMの改善に伴い，MALが改善した．併用療法は，重症度により，治療効果に差を認めることが示唆された．

　The purpose of this study was to investigate the effect of low frequency repetitive transcranial magnetic stimulation (rTMS) combined with occupational therapy (OT) on the evaluation of motor function; Fugl-Meyer Assessment, 10-second tests, Passive-Range of Motion (P-ROM), Modified Ashworth Scale (MAS) and Motor Activity Log (MAL), evoked potential improvement in patients of stroke hemiplegia. The analysis included a severe hemiplegia group and a mild hemiplegia group. This therapy showed improvement of statistical significance in all measures in patients with mild motor dysfunction. It showed improvement of statistical significance on MAS, P-ROM and MAL in patients of severe motor dysfunction. We found that MAL was improved because of improvement of MAS and P-ROM. These results indicate that rTMS combined with OT has therapeutic effect in patients with severe symptoms.