Development of repetitive transcranial magnetic stimulation therapy for post-stroke upper limb hemiparesis based on the fNIRS measurement

2019 Fiscal Year Final Research Report

• Project/Area Number: 16K16443
• Research Category: Grant-in-Aid for Young Scientists (B)
• Allocation Type: Multi-year Fund
• Research Field: Rehabilitation science/Welfare engineering
• Research Institution: Jikei University School of Medicine
• Principal Investigator: Kinoshita Shoji 東京慈恵会医科大学, 医学部, 助教 (60748383)
• Project Period (FY): 2016-04-01 – 2020-03-31
• Keywords: 脳卒中 / 脳機能画像 / 機能的近赤外分光分析法

Outline of Final Research Achievements

The brain activity of the subacute stroke patients was serially measured using fNIRS. We found the positive correlation between the improvement of upper limb function and the activation of the unaffected cerebral hemisphere. A multidisciplinary rehabilitation of sub-acute stroke patients might enhance the compensatory movements and pre-existing motor network from the non-lesional motor cortex.
The case report described the progression of interhemispheric asymmetry in a patient with subacute stroke using fNIRS measurements. The low frequency repetitive transcranial magnetic stimulation and intensive occupational therapy (LF-rTMS/OT) improved upper limb motor function and facilitated a shift in brain activation to the lesional hemisphere.
The patients with shift in brain activation to the non-injured side showed better motor recovery in response to rTMS/OT therapy. Evaluation of brain asymmetry with fNIRS may allow the prediction of response to LF-rTMS/OT treatment.

Free Research Field

リハビリテーション医学

Academic Significance and Societal Importance of the Research Achievements

上肢麻痺に対する有効なリハビリテーション治療を提供するためには、上肢麻痺改善の神経学的機序を理解することが必要である。大脳の半球間不均衡の形成過程とリハビリテーションに影響を与える要因を機能的近赤外分光分析法（fNIRS）を用いて検討した。
回復期リハビリテーションを受ける期脳卒中患者においては半球間不均衡の進展と上肢機能改善に関連を認めた。このような症例に反復性経頭蓋磁気刺激と集中リハビリテーションを実施することで上肢麻痺と半球間不均衡の改善を認めた。
また、慢性期脳卒中患者においては半球間不均衡を認める方が反復性経頭蓋磁気刺激の治療効果が高いことが示された。