Motor impairment following stroke is one of the most important issues to be addressed in clinical care. In this review, we summarize a study in which lost volitional motor control of the hand was regained in a monkey model of stroke using an “artificial cortico-muscular connection” (ACMC) via a neural interface that bypassed the damaged neural pathway after stroke. The ACMC was produced by a computer interface that can detect the high-gamma cortical oscillations and converted in real-time to activity-contingent electrical stimuli delivered to the paralyzed muscles. As a result, within 20 min, the monkeys learned rapidly to use the ACMC and reacquired volitional motor control of the affected hand. Learning to use the ACMC was achieved regardless of whether the input signal was extracted from the primary motor area or the primary somatosensory area, and the activation areas of the input high-gamma signals were changed to concentrate around the arbitrarily-assigned input electrode as learning progressed. This study may have the potential to lead to the development of a clinically effective neural prosthesis to regain lost motor function by bypassing the lesion site and activating paralyzed muscles via an artificial neural connection, even after a limb is paralyzed due to stroke.
The objectives of this study were to develop an oculomotor rehabilitation program by means of expert discussion, based on the results of a systematic review, that may be easily administered in clinical settings; it also aimed to evaluate the efficacy of the newly developed program in a single case. Four experts with extensive knowledge and experience of brain trauma rehabilitation (mean length of clinical experience 30.5 0.6 years) developed an oculomotor rehabilitation program on the basis of the types, duration, frequency, and timing of exercises previously found to be effective in available literature. In this program, a clinician indicated a target to the patient, who performed exercises to encourage fixation, saccade, pursuit, and vergence in sessions lasting 20 minutes a day, 6 days a week, for a total of 8 weeks. An immediate effect was evident after the first session, with an increase in oculomotor range of motion compared to before the session. The supraduction range of motion of the right eye increased from 1.44 mm before the start of the 8-week program to 4.36 mm after its completion; the patient’s ability to perform activities of daily living also improved. The use of this program improved contraction and weakness of the extraocular muscle, and increased the oculomotor range of motion.
There are few case reports of patients with hemiparetic stroke who had previously been diagnosed with poliomyelitis (polio). Herein, we present the case of an 84-year-old male stroke patient with right-sided hemiparesis and polio. He was infected with polio at age 6 and had severe right-leg palsy. He was able to walk independently, performed knee hyperextension, and walked using a cane prior to the stroke at age 84. He was transferred to our hospital 31 days post-stroke. At that time, manual muscle test (MMT) was Poor-to-Good for the right ankle muscles and Trace for the right hip and knee muscles. He required assistance from a therapist to walk even with grasping parallel bars because he could not hyperextend the right knee and the knee had collapsed. For physical therapy, he performed stretching, muscle strengthening, standing, and walking exercises. Consequently, he was able to walk with a walking frame independently at discharge (day 131 after the onset). He regained knee hyperextension and resolved the knee collapse. MMT for the right hip muscles became Poor. This hemiparetic stroke patient with polio had severe right leg palsy and consequently had trouble walking due to knee collapse. It is postulated that regaining the knee hyperextension enabled him to walk safely.
Coronavirus disease 2019 (COVID-19) has a profound impact on our society, and health care professionals are challenged by the present outbreak. A recent study showed that a significant proportion of second-line workers and frontline workers experienced psychological distress. Although these findings suggest the possibility that rehabilitation therapists, especially those who work at the hospital, experience psychological distress, their mental health state has been largely dismissed and the number of an evidence-based practice is limited. Here, we discuss the importance of focusing on the mental health of therapists by introducing studies that focus on the mental health of health care workers during the COVID-19, SARS, and H1N1 influenza pandemics. We then noted the need to track the dynamic relationship between the mental health of therapists and the COVID-19 pandemic by employing longitudinal data collection with psychological measures that reliably and validly capture the mental health of therapists. This approach would be effective for preparation for future pandemics, as we have learned much from previous pandemics. We hope that our Tutorial Note will help readers who are interested in the mental health of rehabilitation therapists and encourage future studies.