Akiyoshi Matsugi

Revision of the Predictive Method Improves Precision in the Prediction of Stroke Outcomes for Patients Admitted to Rehabilitation Hospitals

[Purpose] The purpose of this study was to confirm the accuracy of a revised method for predicting the Functional Independence Measure (FIM) at discharge when stroke patients are first admitted to a rehabilitation hospital. [Subjects and Methods] The predictive equation with logarithmic trend line was calculated based on the total score of the FIM at admission and discharge in 93 patients with cerebral infarction (CI) and 60 patients with intracerebral hemorrhage (ICH). In other patients with CI or ICH (validation group), the differences between the actual FIM and the predicted FIM at discharge calculated by the CI or ICH equation and the combined (CI + ICH) equation, as well as by the CI or ICH equation and combined equation used in a previous study, were calculated. [Results] The multiple correlation coefficients of the CI equation, ICH equation, and combined equation were 0.87, 0.71, and 0.8. The residual of the actual FIM and predicted FIM at discharge calculated by the CI equation was the smallest in the CI validation group. In the ICH validation group, the residual calculated for ICH patients alone was smaller than that calculated by the previous ICH equation. [Conclusion] This easy-to-use method using a new equation for prediction was more precise than the previous equation. Therefore, we should revise the equation for predicting stroke patient outcome strata according to data from within the governing medical administration system.

Task dependency of the long-latency facilitatory effect on the soleus H-reflex by cerebellar transcranial magnetic stimulation.

We investigated whether cerebellar transcranial magnetic stimulation (C-TMS) facilitates the excitability of the ipsilateral soleus motoneuron pool in resting humans, and whether the facilitation is modulated by a task that promotes cerebellar activity. A test tibial nerve stimulus evoking the H-reflex from the right soleus muscle was delivered before or after conditioning C-TMS in prone individuals. The amplitude of the H-reflex was significantly increased at conditioning-test interstimulus intervals of 110, 120, and 130 ms. Furthermore, we revealed that this facilitation effect was inhibited while the individuals tapped their right index finger. These findings indicate that C-TMS facilitates spinal motoneuronal excitability with an ∼100 ms latency in resting humans, and that this cerebellar spinal facilitation is modulated by a task that might increase cerebellar activity. Cerebellar spinal facilitation could thus be useful for assessing the excitability of the cerebellum, or the cerebellar output to spinal motoneurons.

Effect of gaze-stabilization exercises on vestibular function during postural control

Gaze-stabilization exercise (GSE) is often conducted in vestibular rehabilitation, but its effect on vestibular function in postural control is not clear. We investigated whether GSE affects vestibular function during static upright standing and vestibulospinal reflex (VSR) in healthy young adults. First, the center of pressure of the total trajectory length (CoP-L) was measured before each GSE task or control (only standing) task (pre), immediately after (post), and 10 min after (post10) in the static standing position on foam rubber with the eyes open or closed (EC). Second, the H-reflex on the soleus muscle was measured after the onset of ipsilateral anodal galvanic vestibular stimulation before and after a GSE or a control task to estimate the amount of VSR induced by electrical vestibular input. CoP-L for the pre, post, and post10 control tasks and the GSE in EC did not differ significantly; the CoP-L for the post and post10 tasks in EC were significantly lower than that for the pretask. The H-reflex was inhibited by galvanic vestibular stimulation in the pre-GSE tasks. The inhibition increased after GSE, but not during control tasks. These findings suggest that GSE immediately improves the postural stability required for vestibular function and can be mediated by VSR improvements.

Effect of cerebellar transcranial magnetic stimulation on soleus Ia presynaptic and reciprocal inhibition.

Previously, we reported that cerebellar transcranial magnetic stimulation (C-TMS) facilitates spinal motoneuronal excitability in resting humans. In this study, we aimed to characterize the descending pathway that is responsible for the C-TMS-associated cerebellar spinal facilitation. We evaluated the effect of C-TMS on ipsilateral soleus Ia presynaptic inhibition (PSI) and reciprocal inhibition (RI) because the vestibulospinal and reticulospinal tracts project from the cerebellum to mediate spinal motoneurons via interneurons associated with PSI. PSI and RI were measured with a soleus H-reflex test following operant conditioning using electrical stimulation of the common peroneal nerve. C-TMS was delivered before test tibial nerve stimulation with conditioning-test interstimulus intervals of 110 ms. C-TMS did not generate motor-evoked potentials, and it did not increase electromyography activity in the ipsilateral soleus muscle, indicating that C-TMS does not directly activate the corticospinal tract and motoneurons. However, C-TMS facilitated the ipsilateral soleus H-reflex and reduced the amount of soleus Ia PSI, but not RI. These findings indicate that C-TMS may facilitate the excitability of the spinal motoneuron pool via the vestibulospinal or reticulospinal tracts associated with PSI. Cerebellar spinal facilitation may be useful for assessing the functional connectivity of the cerebellum and vestibular nuclei or reticular formation.

Prediction of Advisability of Returning Home Using the Home Care Score

Purpose. The aim of this study was to assess whether the home care score (HCS), which was developed by the Ministry of Health and Welfare in Japan in 1992, is useful for the prediction of advisability of home care. Methods. Subjects living at home and in assisted-living facilities were analyzed. Binominal logistic regression analyses, using age, sex, the functional independence measure score, and the HCS, along with receiver operating characteristic curve analyses, were conducted. Findings/Conclusions. Only HCS was selected for the regression equation. Receiver operating characteristic curve analysis revealed that the area under the curve (0.9), sensitivity (0.82), specificity (0.83), and positive predictive value (0.84) for HCS were higher than those for the functional independence measure, indicating that the HCS is a powerful predictor for advisability of home care. Clinical Relevance. Comprehensive measurements of the condition of provided care and the activities of daily living of the subjects, which are included in the HCS, are required for the prediction of advisability of home care.

Effect of Posture during Trumpet and Marching Euphonium Performance on the Trunk and Lower Limb Musculoskeletal System.

[Purpose] The purpose of the present study was to investigate the effect of trumpet and marching euphonium performance posture on the trunk and lower limb musculoskeletal system. [Subjects] The subjects were 10 female university students. [Methods] Subjects maintained a resting position, a trumpet performance posture, and a marching euphonium performance posture. The angles and muscle activities of the trunk and lower limbs were then measured. [Results] The anterior tilt angle of the trunk decreased significantly in the trumpet and marching euphonium performance postures compared with the resting standing position, as well as in the marching euphonium performance posture compared with the trumpet performance posture. The muscle activity of the cervical paraspinal muscles, upper fibers of the trapezius, and lumbar paraspinal muscles increased significantly in the marching euphonium performance posture compared with the resting standing position, as well as in the marching euphonium performance posture compared with the trumpet performance posture. [Conclusion] The results suggest that the performance position for trumpet and the marching euphonium performance increases the load on the cervical and thoracic musculoskeletal system, which increases with greater instrument weight. However, the same instrument performance postures had no affect on the musculoskeletal system of the lower limbs.

Prediction of destination at discharge from a comprehensive rehabilitation hospital using the home care score

[Purpose] This study investigated whether it is possible to predict return to home at discharge from a rehabilitation hospital in Japan using the home care score of patients with cerebrovascular or osteoarticular disease and low activities of daily living at admission. [Subjects and Methods] The home care score and functional independent measurement were determined for 226 patients at admission and at discharge from five hospitals, and receiver operating characteristic analyses were conducted. [Results] The home care score cutoff point for the prediction of return to home at admission and at discharge was 11, and the area under the curve was more than 0.8. The area under the curve of the home care score was 0.77 for patients with low activities of daily living and within this group, the probability of return to home was approximately 50%, as predicted by the functional independent measurement. The home care score increased after receiving intervention at a rehabilitation hospital. [Conclusion] The home care score is useful for the prediction of return to home from a rehabilitation hospital, although prediction using the functional independent measurement is difficult for patients with low activities of daily living. Moreover, comprehensive interventions provided by the rehabilitation hospitals improve the ability to provide home care of the patient’s family, which is assessed by the home care score.

Abnormal bias in subjective vertical perception in a post-stroke astasia patient

[Purpose] Post-stroke astasia is an inability to stand without external support despite having sufficient muscle strength. However, the dysfunction underlying astasia is unclear. We tested the hypothesis that astasia is the result of an abnormal bias in vertical perception, especially subjective postural vertical (SPV), mediated by somatosensory inputs. [Subjects and Methods] A patient with a right posterolateral thalamus hemorrhage had a tendency to fall toward the contralesional side during standing after 8 weeks of treatment. SPV, standing duration, and physical function were evaluated before and after a 1 week standard rehabilitation baseline period, and after a 1 week intervention period, where standing training requiring the patient to control his body orientation in reference to somatosensory inputs from his ipsilateral upper limb was added. [Results] SPV was biased toward the contralesional side before and after the 1 week baseline period. However, SPV improved into the normal range and he could stand for a longer duration after the intervention period. [Conclusion] This case suggests that abnormal SPV is one of the functional mechanisms underlying astasia, and it indicates the effectiveness of standing training with somatosensory information to improve abnormal SPV and postural disorders.

The effects of imaginary voluntary muscle contraction and relaxation on cerebellar brain inhibition

The purpose of this study was to investigate cerebellar brain inhibition (CBI) of the contralateral primary motor cortex (M1) during imaginary muscle contraction (Contract-I) and relaxation (Relax-I) using transcranial magnetic stimulation (TMS). Twenty-nine healthy adults completed two experiments. Motor evoked potentials (MEPs) in the right first dorsal interosseous (FDI) muscle were induced by TMS over the left M1 and measured with or without TMS over the right cerebellum during Contract-I (first experiment) and Relax-I (second experiment) of the right FDI, and these were compared to the findings in a no-imagery (No-I) condition. MEPs during Contract-I were significantly higher than those during No-I, and MEPs during Relax-I were significantly lower than those during No-I. In contrast, CBI was significantly higher during Contract-I than during No-I, while there was no significant difference in CBI between Relax-I and No-I. These findings indicate that the cerebellum exerts facilitatory control over M1 excitability during imaginary muscle contraction but not during imaginary muscle relaxation.

The effect of advance information about the sequence of a to-be-signaled motor response on corticospinal excitability during the foreperiod.

We investigated the effect of advance information about the sequence of a to-be-signaled motor response on corticospinal excitability during the foreperiod in healthy humans. Advance information about the sequence of a to-be-signaled motor response was provided by a precue signal 600 ms before a response signal during a warned choice reaction task. The precue signal indicated the sequence of one of three to-be-signaled motor responses: simple, repetitive, or sequential motor responses. The amplitude of the motor-evoked potential (MEP) decreased significantly 100 ms before the response signal in both the first dorsal interosseous (FDI) and abductor pollicis brevis (APB) muscles, but a significant decrease was present only in the APB muscle 300 ms before the response signal. The decrease in the MEP amplitude 100 ms before the response signal induced by the precue signal indicating the repetitive motor response was significantly smaller than that induced by the precue signal indicating the simple or sequential motor response in the FDI muscle, and was significantly smaller than that induced by the precue signal indicating the sequential motor response in the APB muscle. The decrease in corticospinal excitability in the middle foreperiod is larger when the advance information about a to-be-signaled motor response is unrelated to the muscle tested, and the decrease in the late foreperiod is affected by advance information about the sequence of a to-be-signaled motor response.