We analyzed the results of the Frostig Developmental Test of Visual Perception (F test) and the Wechsler intelligence scale series (W test) in children with low-birth-weight, no total developmental delay, good motor function of the upper extremities, and good visual acuity. All children were examined using both tests, followed by the W test afterward. The subjects were divided into two groups depending on their test age : 4 to 7 yrs (younger group : 19 cases) and 7 to 11 yrs (older group : 23 cases). We examined the correlation between the results of the two tests in each group. Furthermore, we examined if the initial F test results in younger group can predict the W test results at a later age. In the younger group, there was a significant positive correlation between standard scores (ss) on Frostig subtests, except Position in space (IV), and performance IQ, whereas there was a significant negative correlation between ss on subtest IV and their test age in months. In the older group, ss on all subtests, including IV, were significantly correlated with performance IQ ; and ss on Frostig subtests, except Eye-motor coordination, were significantly correlated with verbal IQ. Children in the younger group with low scores on the F test had low scores on Block Design in their later W test. Therefore, our analysis revealed that children in the younger group had impairments in visual processing, including working memory and volitional saccades, and that impairments of visuospatial perception found in the majority of them persisted afterward.

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The purpose of the present study is to examine the facilitatory effects of motor imagery on motor evoked potentials (MEPs) with transcranial magnetic stimulation (TMS) in five persons with hemiparetic stroke and five healthy persons. The participants were instructed to imagine clenching their fist when a red LED was turned on for two seconds, and to stop imagining when the LED was turned off. MEPs were recorded from the right (healthy persons) or affected (hemiparetic patients) first dorsal interosseous muscle (FDI). TMS over primary motor cortex (M 1) was delivered and MEPs were recorded from the FDI at 0, 1, 2, or 3 seconds after the LED cue. In patients with hemiparetic stroke, as well as in the healthy persons, the MEPs increased significantly at 1 second after the cue and returned to baseline after 3 seconds. The EMG remained silent in the FDI and did not show any significant temporal changes during the test. This study suggested that motor imagery could have a facilitatory effect on corticospinal excitability similar to that seen during actual motor performance, and might have potential therapeutic implications for stroke rehabilitation.

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Recent authors reported a cerebellar contribution to cognitive functions such as executive function, personality, spatial cognition, language and memory. Middleton and Strick showed the neuroanatomical projection from the dentate nucleus to dorsolateral prefrontal cortex. Patients with cerebellar diseases were reported to have cognitive impairment in their neuropsychological assessments. The present patient with cerebellar hemorrhage showed disorder of executive function and memory disorder in his neuropsy-chological assessments. In his daily living, we found him to exhibit a distractible affection and disinhibition, which often disrupted the rehabilitation processes. A brain MRI showed no lesions in the bilateral frontal areas but SPECT showed a lower blood flow there. To approach these cases, we should recognize the existence of impaired higher brain function, and not only be mindful of motor deficits.

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Postoperative C 5 palsy is defined as paresis of the deltoid and/or biceps brachii muscle after cervical spine decompressive surgery without any worsening of myelopathic symptoms. Various sites of involvement, including radiculopathy and otherwise subclinical myelopathy, have been proposed for postoperative C 5 palsy, but controversy persists. Postoperative C 5 palsy generally carries a good prognosis for functional recovery, but some patients have a limited recovery with severe residual paresis. Here we report a patient with postoperative C 5 palsy occurring during rehabilitation with poor motor recovery and compromised activities of daily living (ADL). A 76-year-old man who underwent cervical laminoplasty for myelopathy developed bilateral C 5 palsy during postoperative rehabilitation. While an electrodiagnostic examination suggested radiculopathy as the major cause of palsy, the severity and poor recovery suggested double-crash syndrome with the anterior column as well as axonal injury. Postoperative C 5 palsy may be difficult to recognize during rehabilitation, given limited experience, and the vast majority of postoperative C 5 palsies occur within 1 week following surgery, generally followed by good functional recovery. However, some cases of palsy do indeed present during rehabilitation and these tend to have a poor prognosis. The present case underscores the importance of recognizing postoperative C 5 palsy during rehabilitation, precise assessment, and specific treatment of the palsy to maximally improve ADL.

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Several instruments that are used in pediatric rehabilitation and pediatric physical therapy to assess the functional motor abilities of children with cerebral palsy (CP) were developed within the last decade. It is concluded that the Gross Motor Function Measure (GMFM), the Pediatric Evaluation of Disability Inventory (PEDI) and the Functional Independence Measure for Children (Wee FIM) fulfill the criteria of reliability and validity. The purpose of this paper was to review the literature concerning GMFM using PubMed to find relative articles from the Medline database. GMFM was used as a keyword. The results of our query yielded 61 references for the ten years from 1995 to 2004. We selected and reviewed about 39 of these which described such topics as motor development curves for children with CP and other child disorders, the effect of several treatments for reducing spasticity, an equine-movement therapy program, muscle-tendon surgery, etc. In addition, in clinical research, the relative evidence level is set up according to the kind of research design. Statistically, as bias is minimized, the strength of evidence becomes stronger. In this article, the evidence level was evaluated for each reference. Our conclusion is that GMFM is one of the most useful objective methods for the evaluation of gross motor development in children. Furthermore, this method can be used for judging the effects of pediatric rehabilitation and for comparison with other methods.

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[in Japanese]

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