Use-dependent Plasticity and Its Modulation of Transcranial Magnetic Stimulation <Review Ariticle>…Satoko KOGANEMARU, Tatsuya MIMA, Hidenal FUKUYAMA, Kazuhisa DOMEN 264

Intensive Neurorehabilitation Featuring Repetitive Transcranial Magnetic Stimulation for Upper Limb Hemiparesis after Stroke <Review Article>…Wataru KAKUDA, Masahiro ABO 271

New Therapeutic Methods for Paretic Upper Extremities in Stroke Patients : HANDS Therapy, tDCS and BMI…Toshiyuki FUJIWARA 277

Robotic Arm Training with Transcranial Direct Current Stimulation…Satoru SAEKI, Taiji ODA, Yasuyuki MATSUSHIMA, Mitsuhiro OCHI, Akiko HACHISUKA, Hideaki ITOH, Junichiro SHIRAISHI, Kosei YOSHIKAWA, Kenji HACHISUKA 281

Rehabilitation in an Experimental Stroke Model : The Effect of an Enriched Environment for Neuronal Recovery…Yuji SHONO 285

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There are many stroke patients who have eating and swallowing problems after stroke, especially in the acute phase. However, little is known about the relationship between lesion, hematoma volume and pattern of dysphagia in hemorrhagic stroke. Accordingly, we evaluated the clinical features of swallowing function in acute cerebral hemorrhage. Four hundred and forty-seven newly diagnosed acute cerebral hemorrhage patients including 183 putamen, 119 thalamus, 30 cerebellum, 25 brainstem, and 90 subcortical hemorrhages were studied. Patients were referred for bedside swallowing assessment (BSA) using the Repetitive Saliva Swallowing Test and the Modified Water Swallowing Test at initial evaluation. Additionally, videofluoroscopy was performed in 129 patients to determine their oral intake status. The type of diet and outcomes were assessed on discharge. As results, most patients with normal BSA were consuming a regular diet on discharge. However, the number of patients who consumed a regular meal amongst the 289 patients with abnormal BSA was very few. Two hundred ten patients were nutritionally managed using enteral feeding. Lesion site and hematoma volume were related to the BSA result and oral intake outcome at discharge. Eating and swallowing dysfunction is not rare in patients with acute cerebral hemorrhage. We therefore recommend that all patients with cerebral hemorrhage should undergo a swallowing assessment and management in the acute stage.

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Injecting botulinum toxin type A (BTX-A) into spastic muscles is a recent alternative for treating conditions such as stroke, spinal cord injury, and cerebral palsy. BTX-A injection blocks acetylcholine release at the neuromuscular junction (NMJ) in the muscles. Therefore, BTX-A must be injected near the NMJ. In this paper, the anatomical, histochemical, and electrophysiological studies to determine the location of NMJs in the extremities are reviewed. Further, methylene blue vital staining as a method to identify the intramuscular nerve fibers and NMJs in the muscle and propose a so-called “mid portion of muscle fibers” along with the NMJ map of the upper and lower limbs are discussed.

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