Therapeutic effects of transcutaneous electrical stimulation (TES), such as reduction of spasticity and improvements in motor control, have often been observed. The purpose of this study is to evaluate the efficacy of TES on paretic lower extremities of hemiplegic patients from the viewpoint of gait speed, voluntary movement in paretic lower extremity, flexor reflex, and reciprocal Ia inhibition. The tibialis anterior muscle on the paretic side was stimulated by surface electrodes. The frequency of impulses was 30Hz and the pulse width 0.2msec. The intensity of stimulation was adjusted to a level over the threshold for a visible muscle contraction. TES was applied for 20 minutes, with cycles of five seconds of stimulation and five seconds of rest. After TES, the pace of walking among patients quickened and the speed of the voluntary knee extension increased when conducting paretic knee bends. At the same time, the surface EMG showed a reduction in co-contraction and change to reciprocated movements of quadriceps and hamstrings. These findings suggest improvements in voluntary movements of knee joints, though TES was applied on paretic lower leg. Electrophysiologically, the latency of the second component of flexor reflex was prolonged after TES and this change did not occur after only resting without applying TES. Reciprocal Ia inhibition, which was tested by recording H-reflex responses in the calf muscles, was not observed in paretic lower extremity of hemiplegic patients. But the mean amplitude of H-reflex responses of calf muscles was lowered after TES. These findings suggest that TES could lead to improved voluntary movements effecting directly not only at the spinal segmental level but also indirectly at the supra spinal level. TES may also inhibit alpha motoneurones by controlling premotoneuronal interneurone pool.

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The incidence of spinal vascular diseases (SVD) is much lower than that of traumatic spinal cord injury (SCI). We performed a 6-year retrospective study of etiology, epidemiology, level and completeness, and functional outcome of twenty-nine SCI patients with SVD (spinal cord infarction with aortic aneurysm or aortic dissection, 7 cases; spinal cord infarction after cardiopulmonary arrest, 2 cases; spinal cord infarction with unknown etiology including anterior spinal artery syndrome (ASAS), 11 cases; spinal arteriovenous malformations, 6 cases; spinal cord hemorrhage with unknown etiology, 3 cases) to compare with one hundred and five individuals with traumatic SCI. No significant difference of age at admission was noted between the group with traumatic SCI and that with SVD. The SVD group had significantly more persons with paraplegia than those with tetraplegia, which seemed to have something to do with Great Artery of Adamkiewicz. Paraplegic-incomplete SCI sujects with SVD had higher admission motor FIM scores than those with traumatic SCI. On the other hand, both SVD and traumatic SCI could achieve similar functional outcomes in this study. The results of this study provided more insight into spinal vascular diseases. More research is needed to evaluate the rehabilitation programs and long-term prognosis for these patients.

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The effects of rehabilitation and the functional outcome were studied in 58 amputees who had been admitted to our hospital for rehabilitation during the past 9 years. The patients were divided into two groups according to age (>60 years or ≤60 years) and amputation level (trans-femoral or trans-tibial). On discharge, unilateral trans-femoral amputees exhibited almost the same scores on the activities of daily living (ADL) scale (motor FIM scores) as the unilateral trans-tibial amputees, and the percentage of those who were able to walk was almost the same. The percentage of elderly patients who were able to walk was low. The outcome study was carried out using questionnaires sent by mail or by telephone interview after discharge. Forty-five patients were evaluated for their functional outcome. There were no significant differences in the percentage of the patients wearing prosthesis, walking ability, or dependence rate in ADL between two amputation level groups. The percentage of the patients wearing prosthesis and able to walk was low and the dependence rate in ADL was high among elderly patients. Neither amputation level nor the presence or absence of concurrent medical problems had a significant impact on their functional status. Appropriate rehabilitation and the use of prosthesis are expected to enable even trans-femoral amputees to manage themselves adequately in ADL. Age was an important factor influencing the functional outcome of lower limb amputees, and older patients tended to be less able to perform their activities of daily living.

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The author showed in the first place how to evaluate facial paralysis and synkinesis electrophysiologically. The blink reflex is a useful means to make a diagnosis and an assessment of peripheral facial paralysis. In the process of exacerbation, all components become small and eventually disappear, reflecting clinical facial involvement in a couple of days after onset. Then, the reflex responses return with small amplitudes with clinical recovery. Amplitudes become bigger and latencies shorter in the passage of time. Recovery rate can be measured by R₁ amplitude ratio between involved and intact sides. Prognosis is dependent upon the time when the reflex responses recover. The less facial axons degenerate, the earlier the reflex responses return. The more axonal involvement is severe, the more aberrant regeneration develops in the involved facial muscles. For assessment of facial synkinesis resulting from aberrant regeneration circuits, one of sequelae of the facial paralysis, facial reflex is employed with additional recording electrodes being placed over the orbicularis oris muscles and platysma, besides orbicularis oculi muscles. Without aberrant regeneration after facial paralysis, no synkinetic responses can be elicited over the orbicularis oris and platysma. Aberrant regeneration can be measured on the amplitude of synkinetic responses over the orbicularis oris muscle. Amplitude ratio between R₁ in the orbicularis oculi and S₁ in the orbicularis oris reflects severity of aberrant regeneration. Furthermore, surface EMG is a useful armament to evaluate misdirection not only from orbicularis oculi to orbicularis oris at eye closing but also from orbicularis oris to orbicularis oculi at whistling. The aim of rehabilitation is to make facial synkinesis inconspicuous as much as possible. Maximal effort movements easily tend to induce associated movements in the paralyzed facial muscles with cortical recruitment. Using electrical stimulation also reinforces abnormal movement patterns and asymmetry. Patients are instructed in slow, small volitional movements while selectively inhibiting synkinesis with antagonists. Sensory feedback including mirror and EMG biofeedback are fundamental in the rehabilitation.

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