研究者詳細 - 辻　哲也

論文 - 辻　哲也

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Modulation of event-related desynchronization during motor imagery with transcranial direct current stimulation in a patient with severe hemiparetic stroke

Tohyama Takamichi, Fujiwara Toshiyuki, Matsumoto Jun, Honaga Kaoru, Ushiba Junichi, Tsuji Tetsuya, Hase Kimitaka, Liu Meigen

Keio Journal of Medicine 60 （ 4 ） 114 - 118 2011年12月

ISSN 0022-9717

Recently, surface electroencephalogram (EEG)-based brain-machine interfaces (BMI) have been used for people with disabilities. As a BMI signal source, event-related desynchronization of alpha-band EEG (8-13 Hz) during motor imagery (mu ERD), which is interpreted as desynchronized activities of the activated neurons, is commonly used. However, it is often difficult for patients with severe hemiparesis to produce mu ERD of sufficient strength to activate BMI. Therefore, whether it is possible to modulate mu ERD during motor imagery with anodal transcranial direct-current stimulation (tDCS) was assessed in a severe left hemiparetic stroke patient. EEG was recorded over the primary motor cortex (M1), and mu ERD during finger flexion imagery was measured before and after a 5-day course of tDCS applied to M1. The ERD recorded over the affected M1 increased significantly after tDCS intervention. Anodal tDCS may increase motor cortex excitability and potentiate ERD during motor imagery in patients with severe hemiparetic stroke. © 2011 by The Keio Journal of Medicine.

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Effectiveness of hybrid assistive neuromuscular dynamic stimulation therapy in patients with subacute stroke

Shindo Keiichiro, Fujiwara Toshiyuki, Hara Joji, Oba Hideki, Hotta Fujiko, Tsuji Tetsuya, Hase Kimitaka, Liu Meigen

Neurorehabilitation and Neural Repair 25 （ 9 ） 830 - 837 2011年11月

ISSN 1545-9683

Background and objective. Hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy was devised to facilitate the use of the hemiparetic upper extremity in daily life by combining assistive neuromuscular electrical stimulation, referred to as the integrated volitional electrical stimulator (IVES), with a splint. The aim of this study is to assess the effectiveness of HANDS therapy for patients with subacute stroke. Methods. The participants were 24 inpatients receiving rehabilitation for hemiparetic stroke within 60 days of onset. Entry criteria included inability to individuate finger extension. Patients were randomly assigned to 2 groups. The HANDS group (n = 12) used the IVES combined with a wrist splint for 8 hours a day for 3 weeks, and the control group (n = 12) wore a wrist splint alone. All patients received the same daily dose and length of standard poststroke multidisciplinary rehabilitation. Outcome measures were the upper extremity portion of the Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Motor Activity Log-14 (MAL). Results. In all, 10 patients in each group completed the interventions. Compared with the control group, the HANDS group showed significantly greater gains in distal (wrist/hand) portion of the FMA (P <.01) and improvement of the ARAT (P <.05). The gains in the MAL did not differ. No adverse effects occurred and the HANDS therapy was well accepted. Conclusion. HANDS therapy in addition to conventional therapy may improve hand function in patients with moderate to severe hand impairment during early rehabilitation. © 2011 American Society of Neurorehabilitation.

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Prism adaptation therapy enhances rehabilitation of stroke patients with unilateral spatial neglect: a randomized, controlled trial

Mizuno Katsuhiro, Tsuji Tetsuya, Takebayashi Toru, Fujiwara Toshiyuki, Hase Kimitaka, Liu Meigen

Neurorehabilitation and Neural Repair 25 （ 8 ） 711 - 720 2011年10月

ISSN 1545-9683

Background and objective. Unilateral spatial neglect (USN) can interfere with rehabilitation processes and lead to poor functional outcome. The purpose of this study was to determine whether prism adaptation (PA) therapy improves USN and functional outcomes in stroke patients in the subacute stage. Methods. A multicenter, double-masked, randomized, controlled trial was conducted to evaluate the effects of a 2-week PA therapy on USN assessed with the Behavioral Inattention Test (BIT), the Catherine Bergego Scale (CBS), and activities of daily living (ADL) as evaluated with the Functional Independence Measure (FIM). A total of 38 USN patients with right-brain damage were divided into prism (n = 20) and control (n = 18) groups. Patients were divided into mild and severe USN groups according to BIT behavioral test (mild 55 and severe<55). The prism group performed repetitive pointing with prism glasses that induce rightward optical shift twice daily, 5 days per week, for 2 weeks, whereas the control group performed similar pointing training with neutral glasses. Results. The FIM improved significantly more in the prism group. In mild USN patients, there was significantly greater improvement of BIT and FIM in the prism group. Conclusions. PA therapy can significantly improve ADL in patients with subacute stroke. © 2011 American Society of Neurorehabilitation.

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Transcranial direct current stimulation modulates the spinal plasticity induced with patterned electrical stimulation

Fujiwara Toshiyuki, Tsuji Tetsuya, Honaga Kaoru, Hase Kimitaka, Ushiba Junichi, Liu Meigen

Clinical Neurophysiology 122 （ 9 ） 1834 - 1837 2011年09月

ISSN 1388-2457

Objective: Patterned sensory electrical stimulation (PES) has been shown to induce plasticity in spinal reciprocal Ia inhibition of the calf muscles. To study the cortical modulation of spinal plasticity, we examined the effects of giving transcranial direct current stimulation (tDCS) to the motor cortex before PES. Methods: Seven healthy volunteers participated in this study. PES involved stimulating the left common peroneal nerve at the fibular head with a train of 10 pulses at 100. Hz every 1.5. s for 20. min using an intensity equal to the motor threshold of the tibialis anterior. tDCS was applied for 10. min before PES. For anodal stimulation, the electrode was placed over the motor cortex, and the cathodal electrode over the contralateral supraorbital area. For cathodal stimulation, the electrodes were reversed. Reciprocal inhibition was assessed using a soleus H reflex conditioning-test paradigm. Results: PES increased disynaptic reciprocal inhibition from the peroneal nerve to the soleus H reflex. When cathodal tDCS was applied before PES, PES no longer increased reciprocal inhibition. Conclusions: Applying tDCS before PES modulated the effects of PES on spinal reciprocal inhibition in a polarity specific manner. Significance: We suggest that the motor cortex may play a role in spinal plasticity. © 2011 International Federation of Clinical Neurophysiology.

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Considerartions for establishing community liaison for stroke: from a rehabilitation perspective

Tsuji Tetsuya

Japan Medical Association Journal 53 （ 5 ） 311 - 318 2010年09月

ISSN 1346-8650

Each stage of stoke requires different approach in treatment. In the acute phase, treatment is centered on the "disease" itself according to the critical path specific to the disease. In the convalescent phase, treatment is centered on the "impairments" through rehabilitation programs to treat functional impairments such as motor paralysis and aphasia as well as disability in walking and activities of daily living (ADL). In the chronic phase, the focus is on the "life quality," and patients receive disease management mainly from primary care physicians to prevent the recurrence of stroke and to control comorbidities, while taking advantages of social welfare services and undergoing rehabilitation management that aims at preventing the deterioration of walking ability and ADL. Since the approach to stroke patients shifts from "disease" to "impairment" and then to "life quality" according to the disease stage, therefore, it is necessary to formulate a system that facilitate appropriate treatment and care across disease stages with mutual understanding and consent among involved parties. Such system will entail close collaborative relationships among the various care facilities to share awareness, information, assessment procedures, etc., and should provide rational explanations to patients and their families who transfer from one facility to another. In this regard, a community liaison path can serve as a tool to smoothly connect various facilities designed for particular stages of disease. This paper describes the concept of a community liaison path for stroke from a perspective of rehabilitation medicine.

Activities of daily living (ADL) structure of patients with Duchenne muscular dystrophy, including adults

Fujiwara Toshiyuki, Tanabe Aya, Uchikawa Ken, Tsuji Tetsusya, Tanuma Akira, Hase Kimitaka, Liu Meigen

Keio Journal of Medicine 58 （ 4 ） 223 - 226 2009年12月

ISSN 0022-9717

Objective: To study the activities of daily living (ADL) structure of patients with Duchenne muscular dystrophy (DMD). Design: Cross-sectional survey. Subjects: Seventy-two patients with DMD (mean [SD] age, 17.2 [8.1] years), recruited in 160-bed regional center for neuromuscular disease. Methods: We assessed 72 participants with the Functional Independence Measure (FIM ^SM), and determined the difficulty order of the FIM^SM items with the percentage of patients who were independent (6 or 7) for each FIM item (% independence). Results: The ADL of patients with DMD had an order in terms of difficulty. For the motor subscale, the most difficult item was stairs, and the easiest item was locomotion. On the cognitive subscale, problem solving was the most difficult item. When we compared item difficulty between patients <15 years of age and those ≥ 15 years, the % independence was lower in the older age group for all motor items. The decrease in the % independence of the eating item with age was significant; however bladder management was well maintained. Conclusions: ADL of patients with DMD has a specific difficulty order. The order of difficulty is based on the relative level of independence/dependence. The difficulty order was maintained, although the structure of ADL changed with age.

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Motor improvement and corticospinal modulation induced by hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy in patients with chronic stroke

Fujiwara Toshiyuki, Kasashima Yuko, Honaga Kaoru, Muraoka Yoshihiro, Tsuji Tetsuya, Osu Rieko, Hase Kimitaka, Masakado Yoshihisa, Liu Meigen

Neurorehabilitation and Neural Repair 23 （ 2 ） 125 - 132 2009年02月

ISSN 1545-9683

Background and objective. We devised a therapeutic approach to facilitate the use of the hemiparetic upper extremity (UE) in daily life by combining integrated volitional control electrical stimulation with a wrist splint, called hybrid assistive neuromuscular dynamic stimulation (HANDS). Methods. Twenty patients with chronic hemiparetic stroke (median 17.5 months) had moderate to severe UE weakness. Before and immediately after completing 3 weeks of training in 40-minute sessions, 5 days per week over 3 weeks and wearing the system for 8 hours each day, clinical measures of motor impairment, spasticity, and UE functional scores, as well as neurophysiological measures including electromyography activity, reciprocal inhibition, and intracortical inhibition were assessed. A follow-up clinical assessment was performed 3 months later. Results. UE motor function, spasticity, and functional scores improved after the intervention. Neurophysiologically, the intervention induced restoration of presynaptic and long loop inhibitory connections as well as disynaptic reciprocal inhibition. Paired pulse transcranial magnetic stimulation study indicated disinhibition of the short intracortical inhibition in the affected hemisphere. The follow-up assessment showed that improved UE functions were maintained at 3 months. Conclusion. The combination of hand splint and volitional and electrically induced muscle contraction can induce corticospinal plasticity and may offer a promising option for the management of the paretic UE in patients with stroke. A larger sample size with randomized controls is needed to demonstrate effectiveness. © 2009 The American Society of Neurorehabilitation.

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Identification of quasi-in-need-of-care state (QUINOCS) among community dwelling elderly people using a seven-item subset of the Functional Independence Measure (FIM™)

Yamada Shin, Liu Meigen, Fujimoto Mikio, Hase Kimitaka, Tsuji Tetsuya, Fujiwara Toshiyuki, Okajima Yasutomo

Disability and Rehabilitation 31 （ 5 ） 381 - 386 2009年

ISSN 0963-8288

Purpose. To develop a screening test to identify community dwelling elderly people who are in need of assistive care but whose activities of daily living (ADLs) can be improved by appropriate rehabilitation intervention, so-called 'quasi-in-need-of-care state (QUINOCS)'. Method. A total of 32 persons (mean age 77.3 years) from the metropolitan area and 51 persons (mean age 82.7 years) from a rural area were enrolled. Two physiatrists examined them and judged whether they could benefit from rehabilitation intervention while visiting nurses evaluated their ADLs using the Functional Independence Measure (FIM™). A screening test to identify the QUINOCS was created using a seven-item subset score of the FIM™ (feeding, bathing, dressing lower-body, bladder management, bed/chair/wheel chair transfer, walking/wheel chair, stairs). Results. Fourteen in the metropolitan and 19 in the rural inhabitants were judged as the QUINOCS by the physiatrists. Persons whose subset scores included or ran across the intermediate range of independent levels (scores 3 and 4 of the FIM™) showed tendency to be judged suitable for rehabilitation intervention. This finding was applied for screening algorism to identify the QUINOCS. Sensitivity and specificity of this test were 0.71 and 0.78 for the metropolitan, and 0.74 and 0.78 for the rural groups, respectively. Conclusion. The screening method using the 7-item subset of the FIM™ can be used for identification of the QUINOCS among elderly people efficiently.

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Effects of prosthetic gait training for stroke patients to induce use of the paretic leg: a report of three cases

Hase Kimitaka, Fujiwara Toshiyuki, Tsuji Tetsuya, Liu Meigen

Keio Journal of Medicine 57 （ 3 ） 162 - 167 2008年09月

ISSN 0022-9717

During recovery from a stroke, body weight-bearing on a paretic leg is spontaneously avoided. In physiotherapy for hemiparetic gait, as long as the patients can use their non-paretic leg, adaptive and compensatory strategies are always used to support and move the body. We examined the effects of gait training using prosthetics to induce the use of a paretic leg during walking. The prosthesis was applied to the non-paretic leg of three right hemiparetic patients. Prosthetic gait training was performed until finishing 5 successive motor learning sessions involving walking over 200 m and the changes of asymmetric gait performances were analyzed. The ground reaction forces during the initial stance phase of the paretic leg were increased in all patients after prosthetic gait training. Simultaneously, the propulsive force produced by the paretic leg was increased in 2 patients. By contrast, another patient developed more use of his non-paretic leg for propulsion corresponding to acquiring stability on the paretic leg, resulting in an improvement in single-support-time asymmetry. Task-specific effects provided by prosthetic gait training may be able to reorganize the motor strategy for hemiparetic gait by inducing the use of the paretic leg to support and propell the body.

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Dysphagia in patients with duchenne muscular dystrophy evaluated with a questionnaire and videofluorography

Hanayama Kozo, Liu Meigen, Higuchi Yoshiko, Fujiwara Toshiyuki, Tsuji Testuya, Hase Kimitaka, Ishihara Tadayuki

Disability and Rehabilitation 30 （ 7 ） 517 - 522 2008年

ISSN 0963-8288

Purpose. To investigate swallowing problems in patients with Duchenne muscular dystrophy (DMD) using a questionnaire and videofluorography (VF). Method. A questionnaire survey was performed of swallowing-related symptoms and VF in 31 male patients with DMD (mean age 19.9 years, range 9-26 years). The relationships among age, frequency of symptoms and VF abnormalities were analysed using Spearman's rank correlation. The differences in VF abnormalities among different food textures were analysed with the Kruskal-Wallis test. Results. Symptoms related to pharyngeal phase dysfunction were more frequent than those related to oral and oesophageal phases. Coughing while eating was seen in 71% of the patients, choking while eating in 32% and the need to clear the throat in 26%. VF abnormalities were observed in 30 patients (96.8%). Common VF abnormalities included pooling in the valleculae (90.3%) and in the pyriform sinus (90.3%). Pharyngo-oral regurgitation was seen in 35.5% of the patients. Pooling in the pyriform sinus after repeated swallowing seen in VF correlated significantly with symptoms related to the pharyngeal phase (Spearman's rho 0.356-0.544). Conclusion. Because oropharyngeal dysphagia in DMD was evident in teenage patients as well as those without clinical symptoms, VF is recommended in patients with DMD.

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Electromyographic findings after different selective neck dissections

Tsuji Tetsuya, Tanuma Akira, Onitsuka Tetsuro, Ebihara Mitsuru, Iida Yoshiyuki, Kimura Akio, Liu Meigen

Laryngoscope 117 （ 2 ） 319 - 322 2007年02月

ISSN 0023-852X

OBJECTIVES: The objective was to compare electrophysiologic investigations of the upper trapezius muscle (UT) after different selective neck dissections (SND) and analyze the differences between types of SND and the preservation and excision of the cervical nerves (the C2-4 rami of the cervical plexus). STUDY DESIGN: Retrospective study of 54 patients (average age, 65.1 ± 9.6 yr, 45 males) with 70 SND. METHODS: Patients underwent needle electromyography (EMG) of the UT by 4 months after surgery. The findings were rated according to the 5 point EMG scale system from 1 (total denervation: positive sharp wave or fibrillation potential at rest and electrical silence at voluntary contraction) to 5 (normal pattern). RESULTS: The average EMG scale was 1.7 ± 1.1, 58.6% for score 1 and only 5.7% for score 5. There was not a significant difference in the EMG scale between the types of SND, whereas the group in which the cervical nerves were excised was significantly lower than in that in which it was preserved. The average EMG scales in the former and latter were 1.5 ± 0.8 and 2.0 ± 1.3, 68.8%. CONCLUSIONS: The study data confirm that complete or incomplete denervation of the UT was caused by axonal injury of the spinal accessory nerve, even though it was spared, because of traction of the nerve during neck dissection. Second, the excision of the C2 to 4 rami of the cervical plexus caused worse damage of the UT. It is suggested that it is important to preserve the cervical nerves to avoid denervation of the UT. © The American Laryngological, Rhinological & Otological Society, Inc.

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The effect of zaltoprofen on physiotherapy for limited shoulder movement in breast cancer patients: a single-blinded before-after trial

Hase Kimitaka, Kamisako Michiyo, Fujiwara Toshiyuki, Tsuji Tetsuya, Liu Meigen

Archives of Physical Medicine and Rehabilitation 87 （ 12 ） 1618 - 1622 2006年12月

ISSN 0003-9993

Hase K, Kamisako M, Fujiwara T, Tsuji T, Liu M. The effect of zaltoprofen on physiotherapy for limited should movement in breast cancer patients: a single-blinded before-after trial. Objective: To determine the efficacy of oral administration of zaltoprofen on shoulder range of motion (ROM) exercises for breast cancer patients after surgery. Design: Single-blind, before-after trial. Setting: Rehabilitation facility in a Japanese university hospital. Participants: Forty breast cancer patients (age range, 37-72y) with limited shoulder movement after surgery. Intervention: Single session of physiotherapy (PT) with or without oral administration of zaltoprofen. Main Outcome Measures: Active shoulder ROM in flexion, abduction, and external rotation, as well as subjective pain score during shoulder movements. Results: Active shoulder movements after ingesting a zaltoprofen tablet significantly improved in flexion, abduction (P<.001), and external rotation (P<.005). PT treatment improved flexion and abduction ROM in both the zaltoprofen and control groups and led to significantly larger flexion and abduction movements in the zaltoprofen group than in the control group (P<.01). There were no differences in pain scores between groups, but 2 patients who did not receive zaltoprofen complained of increased pain just after ROM exercises. Conclusion: Zaltoprofen taken orally before ROM exercises for painful shoulder after breast cancer surgery may enhance the effects of PT. © 2006 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.

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Stroke rehabilitation--functional evaluation and rehabilitation approach

Tsuji Tetsuya

Nippon rinsho. Japanese journal of clinical medicine 64 Suppl 7 753 - 763 2006年10月

ISSN 0047-1852

Development of a short version of the motor fim™ for use in long-term care settings

Yamada Shin, Liu Meigen, Hase Kimitaka, Tanaka Naofumi, Fujiwara Toshiyuki, Tsuji Tetsuya, Ushiba Jun Ichi

Journal of Rehabilitation Medicine 38 （ 1 ） 50 - 56 2006年01月

ISSN 0036-5505

Objective: To develop a short version of the motor Functional Independence Measure (FIM™) for use in long-term care settings. Participants: For model construction, the participants were 398 community-dwelling persons with disability (mean age 79.3 years (SD 10.3)) who were receiving visiting nurse services. For cross-validation, 169 patients with stroke (mean age 78.0 years (SD 11.2)) in the chronic phase and 187 patients with stroke (mean age 63.4 years (SD 12.7)) in the recovery phase. Design: Model construction and cross-validation study. Main outcome measures: The second power of correlation coefficient (R 2) was used for agreement analysis between the short and the full version. Cross-validation of the models was estimated with the intraclass correlation coefficient (ICC). Results: Five to 7 motor FIM™ items were selected for the models based on Rasch calibration and consideration of internal consistency. Total motor FIM™ was estimated with the 6-item and 7-item models with regression analysis, which yielded high correlations with the original 13-item motor FIM™ score (R²>0.95). Regression formulas derived from the models could estimate total motor FIM™ scores accurately in the 2 cross-validation samples (ICC>0.98). Conclusion: The short version of the motor FIM™ developed is a useful measure of functional status, not only in long-term care but in the recovery phase rehabilitation settings. © 2006 Taylor & Francis.

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Clinical electromyography and electrodiagnosis course at Keio University Hospital - A 7-year experience

Liu Meigen, Hase Kimitaka, Tsuji Tetsuya, Fujiwara Toshiyuki, Yamada Shin, Masakado Yoshihisa, Kimura Akio

Keio Journal of Medicine 54 （ 4 ） 193 - 196 2005年12月

ISSN 0022-9717

Although electromyography and electrodiagnosis (EMG-EDX) is one of the most fundamental skills in rehabilitation medicine, the number of residency programs that can provide comprehensive postgraduate EMG-EDX training is still limited in Japan. Under these circumstances, we started a 2-day primer course in EMG-EDX at Keio University Hospital in 1998. To review our 7-year experience with the course, we analyzed the number and specialty of the participants, their appraisal of the lectures and practical sessions, and the score distribution of the final examination. The number of participants totaled 288 during the past 7 years, and the mean number for each year was 41. The distribution by specialty for the whole period was 64.0% for rehabilitation medicine, 25.4% for orthopedic surgery, 5.1% for neurology, 1.0% for pediatrics, 0.5% for gerontology and 4.1% for physical therapists and occupational therapists. The difficulty levels of the lectures were judged as appropriate by 81 to 95.5% of the participants, and the presentation was judged as good by 34 to 67% of them. For the practice sessions, the difficulty levels were judged as appropriate by 88% of the participants, and the quality of the supervisors was judged as good by 64% of them. The mean score for the final examination was 56.0 (SD 15.2, median 60). In conclusion, our course has played an important role to promote EMG-EDX in our country by providing compact introductory exposure to EMG-EDX for beginners. A follow-up system for the course graduates is planned to support their EMG-EDX practice.

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Palatoplasty and total laryngectomy for untreated cleft palate with laryngeal cancer

Nakagawa Masahiro, Inoue Keita, Ugumori Toru, Ebihara Mitsuru, Onitsuka Tetsuro, Tsuji Tetsuya, Ando Makiko

Japanese Journal of Plastic and Reconstructive Surgery 48 （ 9 ） 1039 - 1044 2005年09月

ISSN 0021-5228

Aging cleft palate and total laryngectomy patients suffer degradation of their deglutition function. We experienced an elderly patient with laryngeal cancer and untreated cleft palate. The operation, which consisted of a total laryngectomy and cleft palate plasty via the push back method, was simultaneously performed. The patient did not have dysphagia because of complete velopharyngeal closure after the operation. Also, he was able to rapidly resume eating a general diet. In the course of their treatment, we also need to consider the dietary QOL of cancer patients with head and neck lesions.

Identification of a simple screening tool for dysphagia in patients with stroke using factor analysis of multiple dysphagia variables

Nishiwaki Kaori, Tsuji Tetsuya, Liu Meigen, Hase Kimitaka, Tanaka Naofumi, Fujiwara Toshiyuki

Journal of Rehabilitation Medicine 37 （ 4 ） 247 - 251 2005年07月

ISSN 1650-1977

Objective: To identify a most useful and simple clinical screening tool to predict videofluoroscopic aspiration in patients with stroke. Design: Factor analysis of multiple dysphagia variables and sensitivity and specificity testing with chi-square test. Patients: Sixty-one consecutive stroke patients with symptoms suggestive of dysphagia admitted to a university hospital and its 4 affiliated hospitals in Japan. Methods: Factors were extracted from 6 oromotor examinations (lip closure, tongue movement, palatal elevation, gag reflex, voice quality and motor speech function), 2 swallow screen tests (saliva swallowing test and our modified water swallowing test using 30 ml of water) and 4 parameters evaluated with a videofluoroscopic swallow study. Sensitivity and specificity of each dysphagia-related variable was determined against aspiration in a videofluoroscopic swallow study. Results: Factor analysis revealed that cough/voice change in the water swallowing test and aspiration on videofluoroscopic swallow study belonged to the same factor. Chi-square analysis showed that cough/voice change in the water swallowing test was the only variable that was significantly associated with aspiration on videofluoroscopic swallow study, with a sensitivity of 72% (95% CI: 61-83%) and a specificity of 67% (CI: 55-79%) as a predictor of aspiration (p < 0.05). Conclusion: We recommend our modified 30 ml water-swallowing test as a useful single task-screening tool to detect aspiration. © 2005 Taylor & Francis.

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Long-lasting effects of paired associative stimulation in hemiparetic stroke patients

Tsuji Tsuji, Suzuki Kanjiro, Masakado Yoshihisa, Ota Tetsuo, Kimura Akio, Liu Meigen, Chino Naoichi

International Congress Series 1278 280 - 283 2005年03月

ISSN 0531-5131

Purpose: To establish whether motor point stimulation paired with repetitive transcranial magnetic stimulation (rTMS) produces a lasting modulation of the primary motor cortex in persons with hemiparetic stroke. Methods: Subjects were nine hemiparetic patients after stroke, all right-handed. The mean days from onset were 80 days. Repeated measurements of the motor evoked potential (MEP) in the affected first dorsal inter osseous (FDI) muscle in all subjects were performed. For determination of baseline, a single measurement of the MEPs was given before intervention stimulation. Subjects received 30 min of just suprathreshold motor point stimulation of the affected abductor pollicis brevis (APB) muscle paired every 10 s with TMS over the motor cortex. After intervention stimulation, measures of MEPs were taken immediately (0 min) and at 10, 20 and 30 min. Results: The MEPs significantly increased in amplitude immediately after pairing stimulation and recovered to baseline after 30 min in amplitude. Conclusions: In stroke hemiparetic patients, as well as healthy subjects, paired stimulation increases the corticomotor excitability for short periods after stimulation. This finding might have potential therapeutic implications for stroke rehabilitation. © 2005.

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Visual evoked fields in patients of unilateral spatial neglect

Mizuno Katsuhiro, Tsuji Tetsuya, Masakado Yoshihisa, Ota Tetsuo, Honaga Kaoru, Liu Meigen, Kimura Akio, Ohde Hisao

International Congress Series 1278 215 - 218 2005年03月

ISSN 0531-5131

Purpose: To establish whether the visual evoked fields (VEFs) in patients of unilateral spatial neglect (USN) caused by cerebrovascular accident (CVA) are different from ones in subjects without USN. Method: In three patients of CVA with left USN and three controls (a healthy subject, a patient of CVA without USN and a patient of hemianopsia), the VEFs following pattern reversal stimulation on the left hemifield were measured. Magnetic recordings were conducted using a 160-channel helmet-type axial superconducting quantum interference device (SQUID) gradiometer system. The behavioural inattention test (BIT) was also scored in patients of USN. Results: Magnetic source imaging revealed two components (P100m and N145m) on the VEFs in the healthy subject and patient of CVA without USN, and no component in the patient of hemianopsia. The pattern of two components in patients with USN was various. Only P100m for patient 1, N145m for patient 2 and both components for patient 3 were detected. Concerning the BIT scores, line bisection and cancellation task for patient 1, coping, drawing and cancellation task for patient 2, and only cancellation task for patient 3 were impaired. Conclusion: Our results demonstrate that pattern of two components (P100m and N145m) on the VEFs does not reflect only hemianopsia, but also USN caused by deficits of the cortical process of attention. © 2005.

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Pedaling exercise for neuromuscular re-education

Fujiwara Toshiyuki, Liu Meigen, Tanuma Akira, Hase Kimitaka, Tsuji Testuya

Critical Reviews in Physical and Rehabilitation Medicine 17 （ 3 ） 163 - 177 2005年

ISSN 0896-2960

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