Neurogenic bladder (NB) is a lower urinary tract dysfunction (LUTD) caused by underlying neural diseases that affect the central nervous system and peripheral nerves. LUTD includes urine storage dysfunction and voiding dysfunction. LUTD causes various lower urinary tract symptoms (LUTS) and has a negative impact on patients' quality of life. In addition, urinary tract infection and upper urinary problems can be associated with LUTD, especially with NB. Thus, the diagnosis and management of NB in patients with underlying neural diseases are very important in patient care. LUTD can be screened by a careful history taking of LUTS and simple, non-invasive measures such as postvoid residual urine measurement and uroflowmetry. A urodynamic study is required for precise evaluation of urine storage function and voiding function. Urine storage dysfunction is predominantly caused by detrusor overactivity (involuntary detrusor contractions during bladder filling) and occasionally caused by sphincter deficiency, while voiding dysfunction is caused by detrusor-sphincter dyssynergia (DSD) and/or impaired detrusor contraction. Urodynamic evaluation is mandatory for proper management of NB. Management of detrusor overactivity includes pharmacotherapy using anticholinergics and selective β3-receptor agonist, and neuromodulation. For refractory cases, surgery such as bladder augmentation can be a treatment option. Pharmacotherapy for voiding dysfunction includes α-blockers for DSD and cholinergic agents for impaired detrusor contraction. However, their efficacy has been limited, and not a few patients with NB need urinary management by clean intermittent catheterization (CIC). The goals of urinary management in patients with NB are to render patients free from significant urinary problems, maintain continence, and provide better quality of life. For this purpose, close collaboration between physicians involved in rehabilitation medicine and urology is very important and should be promoted.

View full abstract

Functional Near-Infrared Spectroscopy (fNIRS) is a characteristically functional neuroimaging technique which enables us to measure the daily tasks related to cortical activation including gait and postural task. Using fNIRS, it was found that the medial sensorimotor and supplementary motor area play an important role in gait and postural control in healthy subjects. In addition, it was also revealed that the individual balance ability was correlated with the cortical activation in the supplementary motor area during the postural task. These findings supported the notion that the supplementary motor area is one of the key structures for balance recovery in stroke patients. Not only can fNIRS effectively monitor the functional reorganization of the central nervous system, but fNIRS has also been used as a therapeutic tool. With recent advances in technique enabling real-time decoding of brain activity, functional neuroimaging can now be used as a neurofeedback tool, in which the voluntary modulation of cortical activation is available. After we developed a working fNIRS mediated neurofeedback system and confirmed its neuromodulation effect in healthy subjects, we investigated its clinical efficacy as a therapeutic tool for augmenting the functional recovery after stroke. Our pilot randomized control study revealed the promising result that neurofeedback intervention could improve finger function in chronic stroke patients including patients with moderate to severe paresis. These findings provide a new therapeutic possibility for those patients who gain only limited functional recovery from conventional rehabilitative interventions in the chronic stage.

View full abstract

Evaluations of brain function pre- and intra- operatively has been essential to maintain the quality of life in patients undergoing neurosurgery. These evaluations, which have been developed through studies in epilepsy, are now essential in neurosurgery for brain tumors and vascular diseases. The goal of functional brain mapping followed by function monitoring, is to perform surgery more safely and effectively thereby allowing for better outcomes. When choosing among multiple modern modalities for brain functional evaluation, we should consider the physiological aspects of each of these methods from a view point of functional recovery or compensation. Clinical usefulness and differences between intraoperative electrical stimulation of the cortex and subcortical fibers and clininical symptoms under an awake state to preserve affected or unaffected function during neurosurgery are also discussed. Further consideration of the actual network connecting each eloquent area may ultimately lead to a new concept in neurosurgery as well as in neuroscience itself.

View full abstract

Objectives : In Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV), full scale intelligence quotient (FSIQ) and the index scores are thought to be solely important and supplemental subtests are not taken into account in the score.However, in assessment by intelligent tests it is required that we analyze the result from many directions. Accordingly, the factor of “Cancellation” was taken up and the importance of adding a focus on the qualitative side of the test results was examined. Methods : Some 412 children who received WISC-IV in our developmental evaluation center were divided into three groups according to their intellectual level, and of these, 30 persons were assigned to each group [total of 90] selected at random to comprise the sample. By comparing the index scores and the scaled scores for each group,we have classified the procedures of deletion into six types. Results : The more the intellectual level increases, the lower the “Cancellation” scaled score becomes compared to the other subtests. Further, the scaled score was lower in the type of deletion procedure such as systematic linear strategy. Conclusion : In the high intellect level group, the scaled “Cancellation” score was lower than the other subtests, it was thought to be because there were many “order type” subjects using a systematic linear strategy. It was also considered that attention to the qualitative aspects as well as quantitative is important in “Cancellation”. Therefore, when assessing high intellect children with developmental disabilities in the future, a clinical examination that incorporates “Cancellation” to detect executive function disabilities such as persistence or poor planning ability is desirable.

View full abstract

Objective : The objective of the present study was to clarify the differences in statistical imaging analysis of functional and morphologic imaging between neuropsychological impairments (NPI) and nonorganic mental disorder (MD) after traumatic head injury. Methods : Six depressive patients after head injury without abnormal findings on conventional MRI (MD group), six nondepressive patients with NPI after diffuse axonal injury (NPI group), and six healthy subjects with a history of head injury (control group) were enrolled in this study. For all subjects, ^99mTc-ethylcysteinate dimmer (Tc-ECD) SPECT and MRI 3D volumetry were performed. Imaging data were analyzed using statistical parametric mapping, and then, the analyzed data were compared among the three groups (2 sample t test, uncorrected p<0.01). Results : Compared to the Control group, significant low Tc-ECD uptake and regional grey matter volume reduction were noticed bilaterally in the anterior medial brain aspects such as the anterior cingulate cortex in both the MD group and the NPI group. These findings were significantly greater in the NPI group than in the MD group. Moreover, these functional and morphologic abnormalities were also spread to more medial and deep aspects such as the posterior limbic and the brain stem in the NPI group. Conversely, in the MD group without morphologic abnormalities, only functional abnormalities spread above the common lesions to the dorsolateral brain aspects such as the superior frontal lobe. Conclusion : Our results revealed some characteristics of statistical imaging analysis in functional and morphologic imaging of MD and NPI patients after head injury. These findings seem to be novel and can serve as useful information for future investigation of neural correlates with both NPI and MD after head injury.

View full abstract

Objective : The Mini-Balance Evaluation Systems Test (Mini-BESTest) is an assessment tool for dynamic balance dysfunction developed by simplifying the Balance Evaluation Systems Test (BESTest). The purpose of our study was to examine the validity of the Japanese version of the Mini-BESTest (J-Mini-BESTest) we translated. Methods : The J-Mini-BESTest was produced using a translation and back translation method referring to a guideline proposed by Guillemin et al. We tested 20 patients with balance dysfunction due to various diseases and 7 healthy persons with the J-Mini-BESTest, the Berg Balance Scale (BBS), the Falls Efficacy Scale-International (FES-I) and the Activities-specific Balance Confidence Scale (ABC Scale). We assessed the concurrent validity of the J-Mini-BESTest by comparing it with the other measures using the Spearman's correlation method. Results : The average assessment time when using the J-Mini-BESTest was 20.0 minutes. The J-Mini-BESTest was correlated with the BBS (r=0.82, p<0.01), FES-I (r=-0.72, p<0.01) and ABC Scale (r=0.80, p<0.01). The distribution of the BBS scores was more skewed compared to the J-Mini-BESTest (BBS skewness=-1.30 vs. J-Mini-BESTest skewness=-0.47) and the BBS also had a ceiling effect (9 participants had a perfect score in the BBS versus none in the J-Mini-BESTest). Conclusion : The J-Mini-BESTest was suggested as a clinically useful tool for detecting subtle dynamic balance deficits with good concurrent validity.

View full abstract