Therapeutic administration of atomoxetine combined with rTMS and occupational therapy for upper limb hemiparesis after stroke: a case series study of three patients.

Atomoxetine, a selective noradrenaline reuptake inhibitor, has been reported to enhance brain plasticity, but has not yet been used in stroke patients. We reported the feasibility and clinical benefits on motor functional recovery of the combination of repetitive transcranial magnetic stimulation (rTMS) and intensive occupational therapy (OT) in stroke patients. This pilot study was designed to evaluate the additive effects of oral atomoxetine to rTMS/OT in post-stroke hemiparetic patients. The study included three post-stroke patients with upper limb hemiparesis. Treatment with 40 mg/day atomoxetine commenced 2 weeks before admission. After confirming tolerance, the dose was increased to 120 mg/day. Low-frequency rTMS/OT was provided daily for 15 days during continued atomoxetine therapy. Motor function of the affected upper limb was evaluated with the Fugl-Meyer Assessment and Wolf Motor Function test. All patients completed the protocol and showed motor improvement up to 4 weeks after the treatment. No atomoxetine-related side effects were noted. Our protocol of triple therapy of atomoxetine, low-frequency rTMS, and OT is safe and feasible intervention for upper limb hemiparesis after stroke.

Effects of respiratory-muscle exercise on spinal curvature.

DESIGN: Randomized controlled study. SETTING: Laboratory. PARTICIPANTS: 26 healthy swimmers randomly assigned to an exercise (n = 13; Ex) or control group (n = 13; Cont). INTERVENTION: The Ex group performed respiratory-muscle exercises for 10 min thrice a week for 4 wk. CONTEXT: Respiratory-muscle exercises are used not only in the rehabilitation of patients with respiratory disease but also in endurance training for athletes. Respiration involves the back and abdominal muscles. These muscles are 1 of the elements responsible for posture control, which is integral to injury prevention and physical performance. However, the effects of respiratory-muscle exercise on posture remain unclear. OBJECTIVE: To examine the potential of respiratory-muscle exercise for improving posture. MAIN OUTCOME MEASURES: Spinal curvature, pulmonary function, and trunk-muscle strength were measured for both the groups at baseline and after 4 wk. The data were compared between the Ex and Cont groups with Mann-Whitney U test and preintervention and postintervention within groups with a Wilcoxon signed rank-sum test. RESULTS AND CONCLUSION: The spinal curvature was significantly different in the Ex group, indicating a decrease in the thoracic (-13.1%, P < .01) and lumbar (-17.7%, P < .05) angles. The Ex group presented with lower thoracic (-8.6%) and lumbar (-20.9%) angles at postexercise than the Cont group (P < .05). With respect to trunk-muscle strength, only trunk-flexion strength significantly increased from pretest to posttest in the Ex group (P < .05). For pulmonary function, forced vital capacity and forced expiratory volume in 1.0 s were significantly increased after 4 wk in the Ex group (P < .05). The results suggest that respiratory-muscle exercise straightened the spine, leading to good posture control, possibly because of contraction of abdominal muscles.