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.
Repeated gait training with a flexible knee brace and an oil damper hinged ankle-foot orthosis (GSD, Gaitsolution Design, Kawamura Gishi, Osaka, Japan) improved the gait abnormalities and speed in a stroke patient with ataxic hemiparesis. Here, we report on a female in her 50s with a cerebral infarction in the posterolateral thalamus. She had ataxic hemiparesis in her lower left leg. While walking, her knee was bending at initial contact and loading response due to the ataxic hemiparesis, and her gait speed remained at 52.2 m/min. To reconstruct the inverted pendulum model, we provided gait training with a flexible knee brace and GSD. As a result, her gait abnormalities were resolved and her gait speed improved up to 72.6 m/min. We speculated that the one of the reasons for the improvement in gait speed was the adjustment of the task difficulty to address the gait abnormality due to the ataxic hemiplegia, and repeating gait training with an inverted pendulum model. We concluded that providing repeated gait training with a flexible knee brace and GSD to construct the inverted pendulum model may improve the gait abnormalities and speed in patients with ataxic hemiparesis.
Right-sided unilateral spatial neglect (USN) of patients with left hemisphere stroke disappears within a few months from the onset. Also, it has been reported that right-sided USN of bilateral hemisphere lesions patients persists even after 6 months from the onset. Herein, we present the case of a left middle cerebral artery stroke patient with persistent right-sided USN. The patient was right-handed female in her eighties. She was diagnosed with myelodysplastic syndrome 12 years before and then had severe anemia. She suffered from stroke and was hospitalized. She complained of severe right-sided hemiparesis, sensory disturbance, USN, and aphasia. During hospitalization, the laboratory tests revealed a hemoglobin level of 6.0 – 10.2 g/dL and hematocrit level of 18.3–31.8 %. She underwent rehabilitation for fatigue from the anemia. However, her right-sided hemiparesis and USN persisted, and on day 174 post onset she needed support for activities of daily living. Studies have reported that the persistence of the right-sided USN with left hemisphere lesions have a strong relationship with hypoperfusion in the left hemisphere and right parietal regions, even if the right hemisphere has no lesion at all. The decrease in the bilateral hemisphere function is known to hinder the improvement of right-sided USN. Severe anemia (hematocrit level 21.0 %) has also been reported to decrease the oxygen metabolism of whole brain cortex. From these studies severe anemia was thought to hinder the improvement of right-sided USN.
We report a case of left thalamic hemorrhage with motor paralysis in the right upper and lower extremities, somatosensory dysfunction, right homonymous hemianopsia, decreased spontaneity, and amnestic aphasia five months after onset of hemorrhage. The brain image findings revealed that it was a case of thalamic hemorrhage originating from the thalamic geniculate artery, and the major lesional area was the posterior thalamic region, including the posterolateral ventral nucleus, the median nucleus, part of the dorsal medial nucleus, the lateral ventral nucleus, and the pulvinar. In addition, Parkinson’s-like symptoms were occasionally observed five months after thalamic hemorrhage onset, and these might be associated with a previous right putaminal hemorrhage. Here, we report the clinical course and neuro-imaging findings from the onset of thalamic hemorrhage to five months post-event and discuss the causative factors of each clinical finding.
Rehabilitation is a co-creative medical service that strongly requires patient involvement. Encouraging patients to continue rehabilitation is an important role of medical services, and evaluation technology is also important from that perspective. The evaluation technology for rehabilitation was developed from the physical structure evaluation using medical images to the physical function evaluation using motion capture, ground reaction force and digital human models. Also, the idea that what should be restored is not only physical function but also daily-living function has been advocated, and standard description and evaluation of daily-living functioning have been promoted since the latter half of the 1990s. Furthermore, since 2000, research to evaluate functional recovery of the cranial nervous system, which controls motor function recovery, has made rapid progress in the field of neuro-rehabilitation. The rehabilitation evaluation has been integrated by the evaluation of the physical function, daily-living functioning, and the functional recovery of the cranial nervous system. In the future, these three functional evaluation technologies will be implemented in cooperation with advanced medical equipment that can be used in hospitals and wearable equipment and nursing robots that can be used in daily life. We believe that each person will be able to continue their daily rehabilitation with motivation while confirming to what extent the effects of rehabilitation are exerted on their cranial nerves, motor functions, and daily-living functions.
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.
Abstract: Bilateral infarction of the medial medulla is rare, and few reports have described its prognosis and detailed clinical findings. This case report describes a 40-year-old male patient with bilateral infarction of the medial medulla who underwent rehabilitation and subsequently showed satisfactory improvement in motor function. The patient reported his difficulty in moving his left upper and lower limbs and was then admitted to an acute care hospital the next day. On the second day of hospitalization, high intensity in the bilateral medial medulla was observed in the brain magnetic response (MR) diffusion-weighted images. Rehabilitation was started on this day. Physical therapy assessment was as follows: Brunnstrom recovery stage (BRS), VI-VI-VI/V-V-V (upper-finger-lower, right/left); scale for the assessment and rating of ataxia (SARA), 9 (walking, 3; stance, 2; sitting, 2; finger chase, 0/1; nose-finger test, 0/1; heel-shin test, 0/2 [right/left]); and Functional Independence Measure (FIM), 121. After 15 days, some motor deficits were improved (i.e., SARA, 6.5 [walking, 2; stance, 1; sitting, 2; finger chase, 0/1; nose-finger test, 0/1; heel-shin test, 0/1]; FIM, 124）, but not BRS. This showed that this patient still had a mild motor deficit of the trunk and left limbs, despite his independence in activities of daily living except for going up and down the stairs.
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.
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.