Wataru Kakuda

Association Between 7 Days Per Week Rehabilitation and Functional Recovery of Patients With Acute Stroke: A Retrospective Cohort Study Based on the Japan Rehabilitation Database

OBJECTIVE To test the hypothesis that functional outcome of patients with stroke who receive 7d/wk of rehabilitation is generally better than that of similar patients who undergo 5 or 6d/wk of rehabilitation. DESIGN Retrospective cohort study. SETTING Acute hospitals. PARTICIPANTS From the Japan Rehabilitation Database, which includes data on 8033 patients with acute stroke collected between January 2005 and December 2013, we included 3072 patients with stroke who were admitted to the acute hospitals and received 7d/wk of rehabilitation. INTERVENTION Seven days per week of rehabilitation was defined as rehabilitation therapy administrated by a physical or occupational therapist on every weekday, Saturday, and Sunday. MAIN OUTCOME MEASURE Favorable functional independence in daily living, defined as a modified Rankin Scale score of 0 to 2 at the time of discharge. RESULTS A total of 1075 (35.0%) patients received 7d/wk of rehabilitation. Univariate analysis demonstrated a significant difference in favorable functional recovery between the 7d/wk rehabilitation group and non-7d/wk rehabilitation group (43.3% vs 37.6%, respectively; P=.002). Multivariate logistic regression analysis using the generalized estimating equations method showed that 7d/wk of rehabilitation was independently associated with favorable functional recovery. CONCLUSIONS Our cohort analysis demonstrated that 7d/wk of rehabilitation in early rehabilitation for patients with acute stroke can lead to functional recovery.

Functional MRI-Based Strategy of Therapeutic rTMS Application: A Novel Approach forPost-Stroke Aphasic Patients

In this chapter, we first discuss the concept of therapeutic application of repetitive transcranial magnetic stimulation (rTMS) in post-stroke aphasic patients. Second, we describe our protocol of functional MRI-based therapeutic rTMS for this patient population and report the clinical results of the treatment. Finally, we comment on future directions of therapeutic application of rTMS in research and clinical practice.