Patients with focal hand dystonia demonstrate abnormally increased corticospinal excitability, which has been reported to be ameliorated, at least for a short term, with low frequency repetitive transcranial magnetic stimulation (rTMS). Transcranial direct current stimulation (tDCS), which is less costly and easier to apply than rTMS, is also known to modulate cortical excitability. Especially with cathodal tDCS, cortical excitability can be reduced. On the other hand, upper extremity splinting is also known to reduce dystonic symptoms by inhibiting abnormal movement. We therefore combined cathodal tDCS with finger splinting to treat focal hand dystonia in a 34-year-old man with traumatic brain injury who showed involuntary movement of his right fingers during writing and chopsticks use. After 5 days of cathodal tDCS sessions (1mA, 10min), he was encouraged to use interphalangeal joint splints for his thumb and index finger during these activities. We assessed computer-rated handwriting, reciprocal inhibition and intracortical inhibition before, 24 hours and 3 months after the 5-day tDCS sessions. Before the treatment, his flexor pollicis longus (FPL) and first dorsal interosseous (FDI) muscles showed 4Hz rhythmic hyperactivity during writing, and reciprocal inhibition at interstimulus intervals (ISI) of 20 and 100 ms were lost. Paired pulse TMS also revealed disinhibited short interval intracortical inhibition (SICI) at an ISI of 2 and 3 ms. The 5-day tDCS sessions reduced FPL and FDI EMG activities, and SICI and RI at 20 and 100 ms were also restored. Wearing the finger splints, these improvements were maintained at the 3-month follow-up. This case report is the first to demonstrate the possible long-term effects of tDCS combined with splinting for focal hand dystonia. It is supposed that splinting after tDCS plays an important role in making the tDCS aftereffects last longer.

The aim of this study was to clarify the experience of recurrent/advanced cancer patients receiving outpatient cancer rehabilitation and evaluate true endpoints of cancer rehabilitation. The study was conducted by semi-structured interviews of 13 recurrent/advanced patients undergoing cancer rehabilitation during cancer chemotherapy. Six categories were extracted: [Finding the physical condition suitable for me] [Being unable to find movements that I can effectively utilize myself] [Being able to continue normal everyday life] [Showing people around me that I can still move] [Having fun actively moving my body] [Gives meaning to my present “living”]. Cancer rehabilitation is considered to give patients with recurrent/advanced cancer a chance to adapt to their present predicament by helping them re-establish the meaning, value, and objective of living. These results suggest that acquiring mastery can be a new endpoint of cancer rehabilitation.