- 著者
- KATO Kenji NISHIMURA Yukio
- 出版者
- Japanese Society for Brain Function and Rehabilitation
- 雑誌
- Journal of Rehabilitation Neurosciences (ISSN:24342629)
- 巻号頁・発行日
- pp.200731, (Released:2020-08-23)
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.
- 著者
- YADA Takuya KAWASAKI Tsubasa
- 出版者
- 脳機能とリハビリテーション研究会
- 雑誌
- Journal of Rehabilitation Neurosciences (ISSN:24342629)
- 巻号頁・発行日
- pp.190520, (Released:2020-05-14)
両側延髄内側梗塞例は希有な症例であり,予後を含む詳細な臨床所見を記載した報告例は乏しい.われわれは,同部位梗塞後に予後良好であった症例を経験した.本症例における臨床所見,特に運動機能障害に着眼した評価結果について報告する.症例は40歳代の男性であり,左上下肢の動かしづらさを自覚した翌日に当院を受診し,入院した.第2病日の拡散強調画像において両側延髄内側(錐体,下オリーブ核,内側毛帯を含む)に高信号域がみられた.第2-3病日において,Brunnstrom recovery stage(BRS)はVI-VI-VI / V-V-V(上肢-手指-下肢, 右 / 左),Scale for the assessment and rating of ataxia(SARA)は合計9点(歩行3,立位2,坐位2,指追い試験0/1, 鼻-指試験0/1, 踵-すね試験0/2, 右/左),Functional independence measure(FIM)は121点(減点項目: 移動項目5点, 階段4点)であった.第15病日において,SARAは合計6.5点(歩行2, 立位1, 坐位2, 指追い試験0/1, 鼻-指試験0/1, 踵-すね試験0/1),FIMは124点(減点項目: 階段)に改善したが,BRSに変化は認められなかった.本症例は,体幹や左側上下肢の軽度運動機能障害が残存したが,第15病日にはFIMにて階段以外の日常生活活動が完全に自立した.
- 著者
- Isato FUKUSHI Yasumasa OKADA
- 出版者
- Japanese Society for Brain Function and Rehabilitation
- 雑誌
- Journal of Rehabilitation Neurosciences (ISSN:24342629)
- 巻号頁・発行日
- vol.19, no.1, pp.22-32, 2019 (Released:2019-10-25)
Dyspnea is defined as “a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity”. In patients especially with pulmonary diseases, dyspnea reduces daily activity, which worsens the physical condition, and thereby further increases dyspnea, forming a vicious cycle. In clinical practice, reduction of dyspnea in patients with diseases is crucial. One of the goals in pulmonary rehabilitation is reduction of dyspnea to break the above-mentioned vicious cycle. However, the mechanism of dyspnea perception has not been fully elucidated because it is complex and is not explained by a single factor such as changes in blood gas. Not all patients with chronic respiratory failure with hypercapnia are dyspneic, or not all patients with COPD with severe hypoxemia perceive dyspnea. To date, sufficiently effective methods to relieve dyspnea have not been established. We integrated the theories which explain the mechanisms of dyspnea perception with our considerations from the viewpoint of respiratory neurophysiology, and propose a model of dyspnea perception mechanism. In our model, dyspnea results from disassociation or mismatch between the neural respiratory motor output from the respiratory neural network in the lower brainstem and the actually accomplished ventilation. The projection modality of neural information on dyspnea to the higher sensory center of the brain, and the brain regions for comparison of the intended respiratory neural output from the brainstem respiratory center and the monitored actual ventilatory output remain unknown. Further clarification of these issues will enlighten understanding of the pathophysiology of dyspnea and contribute to more effective practice of pulmonary rehabilitation.
- 著者
- Toru YAMADA
- 出版者
- Japanese Society for Brain Function and Rehabilitation
- 雑誌
- Journal of Rehabilitation Neurosciences (ISSN:24342629)
- 巻号頁・発行日
- vol.19, no.1, pp.10-21, 2019 (Released:2019-10-25)
Continuous wave functional near-infrared spectroscopy (CW-fNIRS) has potential advantages in the detection of cerebral functional activation, such as safety, portability, resistance to electromagnetic noise, time resolution higher than that of functional magnetic resonance imaging (fMRI), spatial resolution higher than that of electroencephalography (EEG), and the lack of need for subject restraint. However, for practical application of the fNIRS technique, a careful study design is required for experiments, practical measurements, and data analysis. Each step should be based on accurate knowledge of both the advantages and drawbacks of the fNIRS technique. This review will describe various signal components in the fNIRS measurement and their appropriate management through critical discussions on the measurement principle and the physiological origin of the signal.
- 著者
- Shinichiro MAESHIMA Aiko OSAWA
- 出版者
- Japanese Society for Brain Function and Rehabilitation
- 雑誌
- Journal of Rehabilitation Neurosciences (ISSN:24342629)
- 巻号頁・発行日
- vol.19, no.1, pp.3-9, 2019 (Released:2019-10-25)
A variety of cognitive dysfunctions occur after subcortical damage. Aphasia and unilateral spatial neglect often result from lesions of the putamen and thalamus. They are particularly frequent during the acute stage of cerebral hemorrhage, with approximately 80 % of patients presenting such symptoms. To understand the mechanism by which they appear, we must not only consider causes related to damage to the subcortical white matter fibers, but also secondary functional decline caused by direct damage to the cortex as well as by diaschisis. Infratentorial lesions are known to cause language deficits, visuospatial inattention, executive function disorders, personal change, and other symptoms. Many of these reports pertain to cerebellar lesions; however, there are not a few cases where cognitive dysfunction develops because of brainstem lesions. Impairment of the cortical pontocerebellar tract’s fiber connections and damage to the brainstem reticular regulatory system may be considered as the mechanism by which cognitive dysfunction appears. Because of this, detailed cognitive function assessments must also be performed for patients with infratentorial lesions.
- 著者
- Takayuki WATABE Hisayoshi SUZUKI Shuichi SASAKI Rikitaro SAKO Yoshihumi OZASA Jun NAGASHIMA Nobuyuki KAWATE Hiroo ICHIKAWA
- 出版者
- Japanese Society for Brain Function and Rehabilitation
- 雑誌
- Journal of Rehabilitation Neurosciences (ISSN:24342629)
- 巻号頁・発行日
- pp.200115, (Released:2020-03-05)
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.