研究者詳細 - 辻　哲也

論文 - 辻　哲也

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The effect of active pedaling combined with electrical stimulation on spinal reciprocal inhibition

Yamaguchi Tomofumi, Fujiwara Toshiyuki, Saito Kei, Tanabe Shigeo, Muraoka Yoshihiro, Otaka Yohei, Osu Rieko, Tsuji Tetsuya, Hase Kimitaka, Liu Meigen

Journal of Electromyography and Kinesiology 23 （ 1 ） 190 - 194 2013年02月

ISSN 1050-6411

Objective: Pedaling is widely used for rehabilitation of locomotion because it induces muscle activity very similar to locomotion. Afferent stimulation is important for the modulation of spinal reflexes. Furthermore, supraspinal modulation plays an important role in spinal plasticity induced by electrical stimulation. We, therefore, expected that active pedaling combined with electrical stimulation could induce strong after-effects on spinal reflexes. Design: Twelve healthy adults participated in this study. They were instructed to perform 7. min of pedaling. We applied electrical stimulation to the common peroneal nerve during the extension phase of the pedaling cycle. We assessed reciprocal inhibition using a soleus H-reflex conditioning-test paradigm. The magnitude of reciprocal inhibition was measured before, immediately after, 15 and 30. min after active pedaling alone, electrical stimulation alone and active pedaling combined with electrical stimulation (pedaling. +. ES). Results: The amount of reciprocal inhibition was significantly increased after pedaling. +. ES. The after-effect of pedaling. +. ES on reciprocal inhibition was more prominent and longer lasting compared with pedaling or electrical stimulation alone. Conclusions: Pedaling. +. ES could induce stronger after-effects on spinal reciprocal inhibitory neurons compared with either intervention alone. Pedaling. +. ES might be used as a tool to improve locomotion and functional abnormalities in the patient with central nervous lesion. © 2012 Elsevier Ltd.

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State of intracortical inhibitory interneuron activity in patients with chronic stroke

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

Clinical Neurophysiology 124 （ 2 ） 364 - 370 2013年02月

ISSN 1388-2457

Objectives: Few studies have assessed short intracortical inhibition (SICI) in the affected hemisphere (AH) in a large number of patients with chronic stroke. In this study, SICI was assessed in chronic stroke patients with severe hemiparesis, and its relationship to clinical parameters was examined. Methods: The participants were 72 patients with chronic hemiparetic stroke. SICI of both the AH and the unaffected hemisphere (UH) was assessed. The relationships between SICI and the location of lesion, time from onset, and finger function were studied. Motor function of the paretic finger was assessed with the Stroke Impairment Assessment Set (SIAS) and the Fugl-Meyer test upper extremity motor score. To compare the results with those of healthy subjects, SICI was assessed in seven age-matched control subjects. Results: MEPs of the UH were evoked in all 72 subjects, and MEPs of the AH were evoked in 24 subjects. SICI of the AH was inversely correlated with paretic finger motor function and time from stroke onset. SICI of the UH was not correlated with either one. SICI of the UH was higher in the cortical lesion group than in the control group. Conclusions: The state of intracortical inhibitory neuron activity depends on the state of motor function and lesion site even in chronic stroke patients with severe hemiparesis. Significance: The inhibitory system of the AH is involved in functional recovery of the paretic hand even in the chronic stage of stroke. © 2012 International Federation of Clinical Neurophysiology.

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Natural history of lymph pumping pressure after pelvic lymphadenectomy

Okitsu T., Tsuji Tetsuya, Fujii T., Mihara M., Hara H., Kisu I., Aoki D., Miyata C., Otaka Y., Liu M.

Lymphology 45 （ 4 ） 165 - 176 2012年12月

ISSN 0024-7766

Lower limb lymphedema is difficult to prevent and diagnose early because its natural history is unclear. Therefore, the aim of this study was to clarify its pathogenesis and to identify risk factors that may lead to early diagnosis. In 29 patients, aged 25 to 74 years with cervical, uterine, or ovarian cancer who underwent pelvic lymphadenectomy, indocyanine green fluorescence lymphangiography was performed with an infrared camera system, and lymph pumping pressure was measured indirectly preoperatively, and one, two, three, and six months postoperatively. Of these 29 patients, 22 (75.9%) completed the examinations. In the non-lymphedema group, the average lymph pumping pressure did not change significantly at postoperative follow-up compared with preoperative values. On the other hand, lymph pumping pressure increased at various time points in five patients who developed early lymphatic changes with dermal diffusion at the level of the proximal femur. An increase in lymph flow path resistance due to pelvic lymphadenectomy resulted in an initial increase in lymph pumping pressure, followed by a subsequent decrease, in the early lymphatic changes group. This trend in the pressure change signifies that the lymph vessels became dysfunctional as they were overwhelmed by the overload condition and this feature may be a clinically useful signal for the early diagnosis of developing lymphedema.

Newer challenges to restore hemiparetic upper extremity after stroke: HANDS therapy and BMI neurorehabilitation

Liu Meigen, Fujiwara Toshiyuki, Shindo Keiichiro, Kasashima Yuko, Otaka Yohei, Tsuji Tetsuya, Ushiba Junichi

Hong Kong Physiotherapy Journal 30 （ 2 ） 83 - 92 2012年12月

Because recovery of upper extremity (UE) functions to a practical level has been considered difficult in many patients with stroke, compensatory approaches have been emphasised. Recently, based on basic and clinical research indicating a greater potential for plastic changes in the brain, approaches directed toward functional restoration are becoming increasingly popular. Meta-analysis has indicated the effectiveness of constraint-induced movement therapy, electromyography biofeedback, electrostimulation, mental practice, and robot exercise to improve UE functions, but not hand functions. Therefore, we devised two new interventions to improve the paretic hand. One is hybrid assistive neuromuscular dynamic stimulation therapy, designed to facilitate daily use of the hemiparetic UE by combining electromyography (EMG)-triggered electrical stimulation with a wrist splint. We demonstrated improvement of motor function, spasticity, functional scores, and neurophysiologic parameters in chronic hemiparetic stroke. With a randomised controlled trial, we also demonstrated its effectiveness in subacute stroke. The other is brain-machine interface neurofeedback training, which provides real-time feedback based on analysis of volitionally decreased amplitudes of sensory motor rhythm during motor imagery involving extension of the affected fingers. This elicited new voluntary EMG activities, and improved finger functions and neurophysiological parameters. These interventions may offer powerful neurorehabilitative tools for improving hemiparetic UE function after stroke. © 2012 Hong Kong Physiotherapy Association Ltd.

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Comparison of the after-effects of transcranial direct current stimulation over the motor cortex in patients with stroke and healthy volunteers

Suzuki K., Fujiwara T., Tanaka N., Tsuji T., Masakado Y., Hase K., Kimura A., Liu M.

International Journal of Neuroscience 122 （ 11 ） 675 - 681 2012年11月

ISSN 0020-7454

It is known that weak transcranial direct current stimulation (tDCS) induces persistent excitability changes in the cerebral cortex. There are, however, few studies that compare the after-effects of anodal versus cathodal tDCS in patients with stroke. This study assessed the after-effects of tDCS over the motor cortex in patients with hemiparetic stroke and healthy volunteers. Seven stroke patients and nine healthy volunteers were recruited. Ten minutes of anodal and cathodal tDCS (1 mA) and sham stimulation were applied to the affected primary motor cortex (M1) on different days. In healthy subjects, tDCS was applied to the right M1. Before and after tDCS, motor-evoked potentials (MEPs) in the first dorsal interosseous (FDI) muscle and silent period were measured. Anodal tDCS increased the MEPs of the affected FDI in patients with stroke as well as in healthy subjects. Cathodal tDCS increased the MEPs of the affected FDI in patients with stroke. In healthy subjects, however, cathodal tDCS decreased the MEPs. We found no significant change in the duration of the silent period after anodal or cathodal tDCS. We found that both anodal and cathodal tDCS increased the affected M1 excitability in patients with stroke. It is thought that the after-effects of tDCS are different in patients with stroke compared with healthy subjects. © 2012 Informa Healthcare USA, Inc.

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Modulation of event-related desynchronization during motor imagery with transcranial direct current stimulation (tDCS) in patients with chronic hemiparetic stroke

Kasashima Yuko, Fujiwara Toshiyuki, Matsushika Yayoi, Tsuji Tetsuya, Hase Kimitaka, Ushiyama Junichi, Ushiba Junichi, Liu Meigen

Experimental Brain Research 221 （ 3 ） 263 - 268 2012年09月

ISSN 0014-4819

Electroencephalogram-based brain-computer interface (BCI) has been developed as a new neurorehabilitative tool for patients with severe hemiparesis. However, its application has been limited because of difficulty detecting stable brain signals from the affected hemisphere. It has been reported that transcranial direct current stimulation (tDCS) can modulate event-related desynchronization (ERD) in healthy persons. The objective of this study was to test the hypothesis that anodal tDCS could modulate ERD in patients with severe hemiparetic stroke. The participants were six patients with chronic hemiparetic stroke (mean age, 56.8 ± 9.5 years; mean time from the onset, 70.0 ± 19.6 months; Fugl-Meyer Assessment upper extremity motor score, 30.8 ± 16.5). We applied anodal tDCS (10 min, 1 mA) and sham stimulation over the affected primary motor cortex in a random order. ERD of the mu rhythm (mu ERD) with motor imagery of extension of the affected finger was assessed before and after anodal tDCS and sham stimulation. Mu ERD of the affected hemisphere increased significantly after anodal tDCS, whereas it did not change after sham stimulation. Our results show that anodal tDCS can increase mu ERD in patients with hemiparetic stroke, indicating that anodal tDCS could be used as a conditioning tool for BCI in stroke patients. © Springer-Verlag 2012.

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Immediate effects of electrical stimulation combined with passive locomotion-like movement on gait velocity and spasticity in persons with hemiparetic stroke

Yamaguchi Tomofumi, Tanabe Shigeo, Muraoka Yoshihiro, Masakado Yoshihisa, Kimura Akio, Tsuji Tetsuya, Liu Meigen

Clinical Rehabilitation 26 （ 7 ） 619 - 628 2012年07月

ISSN 0269-2155

Objective: Research to examine the immediate effects of electrical stimulation combined with passive locomotion-like movement on gait velocity and spasticity.Design: A single-masked, randomized controlled trial design.Subjects: Twenty-seven stroke inpatients in subacute phase (ischemic n=16, hemorrhagic n=11).Interventions: A novel approach using electrical stimulation combined with passive locomotion-like movement.Main measures: We assessed the maximum gait speed and modified Ashworth scale before and 20 minutes after the interventions.Results: The gait velocity of the electrical stimulation combined with passive locomotion-like movement group showed the increase form 0.68±0.28 (mean±SD, unit: m) to 0.76±0.32 after the intervention. Both the electrical stimulation group and passive locomotion-like movement group also showed increases after the interventions (from 0.76±0.37 to 0.79±0.40, from 0.74±0.35 to 0.77±0.36, respectively). The gait velocity of the electrical stimulation combined with passive locomotion-like movement group differed significantly from those of the other groups (electrical stimulation combined with passive locomotion-like movement versus electrical stimulation: P=0.049, electrical stimulation combined with passive locomotion-like movement versus passive locomotion-like movement: P=0.025). Although there was no statistically significant difference in the modified Ashworth scale among the three groups, six of the nine subjects (66.6%) in the electrical stimulation combined with passive locomotion-like movement group showed improvement in the modified Ashworth scale score, while only three of the nine subjects (33.3%) in the electrical stimulation group and two of the nine subjects (22.2%) improved in the passive locomotion-like movement group.Conclusion: These findings suggest electrical stimulation combined with passive locomotion-like movement could improve gait velocity in stroke patients. © The Author(s) 2011.

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Contraction level-related modulation of corticomuscular coherence differs between the tibialis anterior and soleus muscles in humans

Ushiyama J., Masakado Y., Fujiwara T., Tsuji T., Hase K., Kimura A., Liu M., Ushiba J.

Journal of Applied Physiology 112 （ 8 ） 1258 - 1267 2012年04月

ISSN 8750-7587

The sensorimotor cortex activity measured by scalp EEG shows coherence with electromyogram (EMG) activity within the 15- to 35-Hz frequency band (β-band) during weak to moderate intensity of isometric voluntary contraction. This coupling is known to change its frequency band to the 35- to 60-Hz band (γ-band) during strong contraction. This study aimed to examine whether such contraction level-related modulation of corticomuscular coupling differs between muscles with different muscle compositions and functions. In 11 healthy young adults, we quantified the coherence between EEG over the sensorimotor cortex and rectified EMG during tonic isometric voluntary contraction at 10-70% of maximal voluntary contraction of the tibialis anterior (TA) and soleus (SOL) muscles, respectively. In the TA, the EEG-EMG coherence shifted from the β-band to the γ-band with increasing contraction level. Indeed, the magnitude of β-band EEG-EMG coherence was significantly decreased, whereas that of γ-band coherence was significantly increased, when the contraction level was above 60% of maximal voluntary contraction. In contrast to the TA, the SOL showed no such frequency changes of EEG-EMG coherence with alterations in the contraction levels. In other words, the maximal peak of EEG-EMG coherence in the SOL existed within the β-band, irrespective of the contraction levels. These findings suggest that the central nervous system regulates the frequency of corticomuscular coupling to exert the desired levels of muscle force and, notably, that the applicable rhythmicity of the coupling for performing strong contractions differs between muscles, depending on the physiological muscle compositions and functions of the contracting muscle. Copyright © 2012 the American Physiological Society.

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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: A randomized controlled pilot trial

Shindo K., Fujiwara T., Hara J., Oba H., Hotta F., Tsuji T., Hase K., Liu M.

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.

Considerations for establishing community liaison for stroke: From a rehabilitation perspective

Tsuji T.

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

ISSN 13468650

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 T., Tanabe A., Uchikawa K., Tsuji T., Tanuma A., Hase K., Liu M.

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 FIMSM 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 K., Fujiwara T., Tsuji T., Liu M.

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 K., Liu M., Higuchi Y., Fujiwara T., Tsuji T., Hase K., Ishihara T.

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 T., Tanuma A., Onitsuka T., Ebihara M., Iida Y., Kimura A., Liu M.

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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辻 哲也

論文 - 辻 哲也

辻　哲也

論文 - 辻　哲也