http://onlinelibrary.wiley.com/doi/10.1111/ijs.12100/abstract;jsessionid=4BDD708102D049BF4F8A1B596D4D96FB.d04t03?deniedAccessCustomisedMessage=&userIsAuthenticated=false
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Keywords:
- constraint-induced movement therapy;
- occupational therapy;
- randomized controlled trial;
- repetitive transcranial magnetic stimulation;
- stroke;
- upper limb hemiparesis
Background
Many
poststroke patients suffer functional motor limitation of the affected
upper limb, which is associated with diminished health-related quality
of life.
Aims
The
aim of this study is to conduct a randomized, multicenter, comparative
study of low-frequency repetitive transcranial magnetic stimulation
combined with intensive occupational therapy, NEURO (NovEl intervention
Using Repetitive TMS and intensive Occupational therapy) versus
constraint-induced movement therapy in poststroke patients with upper
limb hemiparesis.
Methods
In
this randomized controlled study of NEURO and constraint-induced
movement therapy, 66 poststroke patients with upper limb hemiparesis
were randomly assigned at 2:1 ratio to low-frequency repetitive
transcranial magnetic stimulation plus occupational therapy (NEURO
group) or constraint-induced movement therapy (constraint-induced
movement therapy group) for 15 days. Fugl–Meyer Assessment and Wolf
Motor Function Test and Functional Ability Score of Wolf Motor Function
Test were used for assessment.
Results
No
differences in patients' characteristics were found between the two
groups at baseline. The Fugl–Meyer Assessment score was significantly
higher in both groups after the 15-day treatment compared with the
baseline. Changes in Fugl–Meyer Assessment scores and Functional Ability
Score of Wolf Motor Function Test were significantly higher in the
NEURO group than in the constraint-induced movement therapy group,
whereas the decrease in the Wolf Motor Function Test log performance
time was comparable between the two groups (changes in Fugl–Meyer
Assessment score, NEURO: 5·39 ± 4·28, constraint-induced movement
therapy: 3·09 ± 4·50 points; mean ± standard error of the mean; P
< 0·05) (changes in Functional Ability Score of Wolf Motor Function
Test, NEURO: 3·98 ± 2·99, constraint-induced movement therapy:
2·09 ± 2·96 points; P < 0·05).
Conclusions
The
results of the 15-day rehabilitative protocol showed the superiority of
NEURO relative to constraint-induced movement therapy; NEURO improved
the motion of the whole upper limb and resulted in functional
improvement in activities of daily living.
The Fugl-Meyer tests reflexes and limb synergies which is what a "neuro" approach usually focuses on so of course the Fugl-Meyer score showed a significant difference between the two groups. The two groups showed the same progress on the Wolf test which focuses solely on hand use. This study shows that the results you get are as dependent on the evaluation tool used as the treatment given.
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