The upper extremity functions of 56 cervical myelopathy patients were evaluated using the Simple Test for Evaluating Hand Function (STEF), pre- and post-operatively. The patients were 39 males and 17 females, the average age of them was 56.8 years old, ranging from 35 to 77 years old. The STEF was designed to evaluate upper extremity functions, especially the smoothness of motions objectively and easily in a short time. It consists of 10 subtests, and 10 grades (1-10 points) of each subtest are established in accordance with the time to complete each subtest. Ten subtests are performed with right and left upper extremities respectively. The sum of 10 subtests is 100 points. Post-operative STEF scores were significantly higher than pre-operative scores. The STEF is useful when the effects of operation and rehabilitation are evaluated. Among 10 subtests, the subtest 8, 9, and 10 showed high improvement post-operatively when compared with pre-operatively. Patients who showed low scores could not perform these subtests quickly and sometimes failed to pick up the test objects. These subtests require patients to pinch with the thumb and index finger and the clumsiness of fingers can be quantitatively evaluated by these subtests. The Spearman's rank correlation coefficient between the STEF and the motor dysfunction of the upper extremity of the Japanese Orthopaedic Association (JOA) score was 0.70 (p<0.01) pre-operatively and was 0.55 (p<0.01) post-operatively. The JOA score, the 10 seconds test, and the Finger Escape Sign are commonly used when the upper extremity functions of cervical myelopathy patients are evaluated. The JOA score is easily used, but bilateral upper extremities cannot be evaluated respectively, and different scores are often observed by other examiners. The JOA score is often influenced by the examiner's subjectivity. The 10 seconds test and the Finger Escape Sign are also easily used, but they are not suitable for evaluating functions of the thumb and index finger that are essential for hand functions. When the upper extremity functions of cervical myelopathy patients are evaluated, the STEF's three main merits are objectivity, bilateral upper extremity functions can be evaluated respectively, and the clumsiness of fingers can be quantitatively evaluated by the subtest 8, 9, and 10 that require patients to pinch with the thumb and index finger.

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Few studies have demonstrated the relationship between parameters of motor evoked potentials (MEPs) by transcranial magnetic stimulation (TMS) and the degree of hemiparesis in stroke patients on several steps of voluntary contraction at a tested muscle. The purpose of this study was to determine MEPs parameters useful for the evaluation of hemiparesis. The TMS elicited MEPs from the extensor carpi radialis and flexor carpi radialis in 28 stoke patients (mean age, 58.3 years) with hemiparesis. The TMS over the motor arm area contralateral to the tested muscle was applied at rest, at motor intention without voluntary contraction and at a rectified index (RI) of 10%, 20%, 30%, or 40% of maximal voluntary contraction. A concentric active electrode was adjoined to the tested muscle to record MEPs. The averages of the amplitude, area, latency and silent period were calculated as parameters from MEPs elicited by four stimuli under each facilitated condition. The ratio of the affected side toward the unaffected side was calculated for each of amplitude and area and respectively designed the amp-ratio and area-ratio. The hemiparesis was evaluated by SIAS (stroke impairment assessment set). The change of each parameter between the affected and unaffected side was analyzed for the three levels of SIAS 3, SIAS 4, SIAS 5 and for the six conditions from rest to the 40% RI of maximal contraction. In both the affected and unaffected side, the amplitude and area significantly increased and the latency significantly decreased from rest to the 40% RI of maximal contraction. The amplitude and the area in the affected side significantly decreased than those in the unaffected side in all of six conditions. There was a significant difference in both the amp-ratio and the area-ratio between the two groups at each of the three levels of SIAS at 10% and 40% RI of maximal dorsiflexion. A significant difference was also found in the latency measured at 10% RI between SIAS 5 and other two levels. As the hemiparesis became serious from SIAS 5 to SIAS 3, the amp-ratio and the area-ratio tended to decrease and the latency to increase. It was therefore concluded that the amp-ratio, the area-ratio and the latency was useful MEP parameters for the evaluation of hemiparesis.

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We observed the change of levodopa effects on neurological symptoms related to kinds of common enteral feeding products in a Parkinson patient with a percutaneous endoscopic gastrostomy tube. The first feeding product did not change the resting tremor of extremities and rabbit syndrome. The second one increased these symptoms. Therefore, we replaced the second diet to the first diet and observed that these symptoms were returned to his previous condition. It was speculated that some contents of the enteral nutrient formula modified levodopa effects, thus we studied the changes of neurological symptom during three other feeding products in the patient. One of them worsened the symptoms in the patient and finally we found two feeding products which deteriorated the symptom in the patient. One of the two diets had high concentration of neutral amino acids and the other had rich dietary fibers. Large neutral amino acids and dietary fibers were reported to decrease the absorption of levodopa in the duodenum and the proximal jejunum. We should consider the concentration of large neutral amino acids and dietary fibers of enteral feeding products in a levodopa treated patient with Parkinson's disease.

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