Recent advances in robotic technology have been widely applied in rehabilitation medicine. In particular, a robot-aided self-training regimen in combination with virtual reality (VR) feedback is a vital alternative to conventional therapeutic maneuvers (e.g. passive and active range of motion training). Such a self-administered regimen using robotic-aid could lead to longer training hours, in turn leading to intensive rehabilitation potential for both hospital and home settings. To this end, we developed an upper limb rehabilitation robot that allows three-dimensional training in combination with visual feedback and force feedback by the use of VR technology, and we evaluated its effectiveness for patients with hemiplegia after stroke. We recruited 6 chronic patients of stroke-induced hemiplegia. The subjects received 40 minutes of robotic therapy 3 times a week for 6 weeks. The Fugl-Meyer Assessment (FMA) and Motricity Index where measured before beginning and after completion of the 6-week training course. The nonparametric Wilcoxon signed rank test was used to assess any improvement in the test scores between the before and after experimental periods. For the FMA assessment, the paired t-test detected statistically significant improvement (p <0.05). The FMA consisted of four subcomponents for shoulder/elbow/forearm movements, wrist movements, finger movements and speed and coordination. To further investigate the statistically significant improvements in the FMA, additional analyses were performed using these subclass scores. The nonparametric Wilcoxon signed rank test detected statistically significant improvement in the shoulder/elbow/forearm movements (p <0.05), but not in the wrist or finger movements.

View full abstract

We report a patient with chronic hemiparesis whose upper extremity functions improved remarkably with the application of an Integrated Volitional control Electrical Stimulator (IVES) coupled with a wrist-hand splint. The patient was a 32-year-old male with right hemiparesis secondary to a brain tumor that was removed a year ago. He demonstrated increased tone in his upper extremities and could not move his fingers individually. He did not meet the conventional criteria for constraint-induced movement therapy (CIMT), but he could slightly extend his fingers voluntarily, and he was free of contractures or sensory disturbance in the hand. For therapeutic electrical stimulation (TES), we used newly developed equipment that could stimulate the target muscle (extensor digitorum communis) in proportion to its voluntary activity, and this was coupled with the application of a simple wrist-hand splint. After using the system for 8 hours a day for 8 days, a marked improvement was noted in the patient's finger motor function, muscle tone, wrist and shoulder range of motion, and quality and amount of use of the affected arm. It is suggested that IVES coupled with a wrist-hand splint could be an effective alternative for improving paretic arm fun tion in patients not meeting CIMT criteria.

View full abstract

We report a case of a 39-yr-old man with a bilateral occipito-parietal contusion. After conservative treatment at an emergency hospital, he was transferred to our hospital for rehabilitative intervention. On admission, he presented with mild cortical blindness and visual agnosia. As his visual acuity gradually improved, Bálint's syndrome became apparent. This syndrome is characterized by difficulties with visual scanning, dysmetria secondary to visual perceptual deficits, and an inability to perceive more than one object at a time. After rehabilitative intervention, consisting of both visuo-perceptual retraining and a functional adaptation program, he was able to bathe and toilet independently. However, neuropsychological findings over 3 years remain consistent with Bálint's syndrome.

View full abstract

There have been a number of recent reports in the English literature regarding false recognition of unknown faces, although it has attracted little attention in Japan. The false recognition of unknown faces may have severe negative consequences in daily life, and this condition should be investigated in more detail. Here, we report a patient who showed false recognition and misidentification of unknown faces. The patient, a 37-year-old right-handed woman, had suffered right cerebral infarction due to Takayasu arteritis at the age of 16. The patient showed mild unilateral spatial neglect and mild impairment of recognition of familiar faces, but showed no signs of anosognosia or anosodiaphoria for false recognition. Neuropsychological investigations suggested that her symptoms may be due to a delayed information processing speed regarding faces. The patient's impairment has been ameliorated by continuous instruction urging her to think carefully before coming to a conclusion regarding the identities of faces. We also present a review of the literature regarding false recognition of unknown faces.

View full abstract

The exercise capacity of the patients with renal dysfunction declines and this phenomenon is distinctly related to the extent of renal function deterioration. It is suggested that appropriate exercise training may improve the physical strength and the quality of life in patients with chronic renal failure(CRF)besides the improvement of glucose and lipid metabolism. However, it is required to consider the influence of exercise on renal function thoroughly, because acute exercise causes proteinuria and decreases renal blood flow and glomerular filtration rate. At present, there are few reports concerning the optimal intensity and duration of exercise training for patients with CRF. Moreover, there has been no definite conclusion as to whether or not chronic exercise training(EX)has any renal protective effect in animal models of CRF. Recently, the renal and peripheral effects of long-term moderate to intense exercise training in various rat models of CRF has been extensively reported. The effects of a combination of EX and rennin-angiotensin system inhibitors(ARI)on renal function were also assessed. The results indicated that moderate to intense EX and ARI can yield a renal protective effect in some models. They also suggested that the simultaneous treatment of moderate EX and ARI provided a greater renoprotective effect than treatment by ARI alone. Further investigations will be needed to examine the mechanism of the renal protective effect of EX. A better understanding of the mechanism may lead to improved exercise strategies and the establishment of a renal rehabilitation regime for CRF patients.

View full abstract

[in Japanese]

View full abstract