Koji Shomoto

Effects of dual task balance training on dual task performance in elderly people: a randomized controlled trial:

Objective: To investigate the effects of dual task balance training in the elderly on standing postural control while performing a cognitive task. Design: A randomized two-group parallel controlled trial. Participants: Forty-three subjects (all >65 years old) were enrolled in the study and were assigned randomly to either an experimental group (n = 21) or a control group (n = 22). Interventions: Subjects in the experimental group were given strength and balance training while performing cognitive tasks simultaneously. Subjects in the control group were given strength and balance training only. The training was administered twice a week for three months. Measurements: The Chair Stand Test, Functional Reach Test, Timed Up and Go Test and Trail Making Test were measured. The sway length of the centre of gravity was measured during standing while performing the Stroop task. The rate of Stroop task was also measured. All measurements were collected at baseline and after the training period. Results: There were no significant differences in Functional Reach Test, Timed Up and Go Test and sway length at baseline and after training between the two groups. However, the rate of Stroop task (P < 0.05) was significantly higher after training in the experimental group than in the control group. Conclusions: These results suggest that dual task balance training in elderly people improves their dual task performance during standing postural control.

Enhancement of precise hand movement by transcranial direct current stimulation.

The effect of transcranial direct current stimulation (tDCS) on the precise nondominant hand movement was investigated by applying anodal stimulation over the right primary motor cortex. We recruited 14 healthy participants for this single-blind, sham-controlled crossover trial. A circle-drawing task was performed before, immediately after, and at 30 min after 20 min of 1 mA anodal or sham tDCS. Anodal tDCS, compared with sham stimulation, significantly improved the circle-drawing task compared with sham stimulation. The deviation area and path length of the task were significantly decreased after anodal tDCS application and were further enhanced at 30 min after stimulation. These results suggest that anodal tDCS over the primary motor cortex enhances the precise movement of the nondominant hand for 30 min in healthy participants.

Effects of peripheral sensory nerve stimulation plus task-oriented training on upper extremity function in patients with subacute stroke: a pilot randomized crossover trial

Objective: To investigate the feasibility of peripheral sensory nerve stimulation combined with task-oriented training in patients with stroke during inpatient rehabilitation. Design: A pilot randomized crossover trial. Setting: Two rehabilitation hospitals. Subjects: Twenty-two patients with subacute stroke. Interventions: Participants were randomly assigned to two groups and underwent two weeks of training in addition to conventional inpatient rehabilitation. The immediate group underwent peripheral sensory nerve stimulation combined with task-oriented training in the first week, followed by another week with task-oriented training alone. The delayed group underwent the same training in reverse order. Main measures: Outcome measures were the level of fatigue and Wolf Motor Function Test. Patients were assessed at baseline, one and two weeks. Results: All participants completed the study with no adverse events. There was no significant difference in level of fatigue between each treatment. From baseline to one week, the immediate group showed larger improvements than the delayed groups in the Wolf Motor Function Test (decrease in mean time (± SD) from 41.9 ± 16.2 seconds to 30.6 ± 11.4 seconds versus from 46.8 ± 19.4 seconds to 42.9 ± 14.7 seconds, respectively) but the difference did not reach significance after Bonferroni correction (P = 0.041). Within-group comparison showed significant improvements in the Wolf Motor Function Test mean time after the peripheral sensory nerve stimulation combined with task-oriented training periods in each group (P < 0.01). Conclusion: Peripheral sensory nerve stimulation is feasible in clinical settings and may enhance the effects of task-oriented training in patients with subacute stroke.

Does assessing error in perceiving postural limits by testing functional reach predict likelihood of falls in hospitalized stroke patients

Objective: To investigate the relationship between errors in perceiving postural limits and falls in hospitalized hemiplegic patients and to determine whether this relationship is useful for identifying patients at high risk of falls. Design: Observational study. Subjects: Seventy-six hemiplegic patients who were admitted to a rehabilitation hospital. Methods: Error in perceiving postural limits was defined as the difference between the estimated maximum reach and actual reach distances, and its relationship to falls during hospitalization was investigated. Other measurements included Functional Ambulation Category, Brunnstroms recovery stage, sensory disturbance, fear of falling and the Japanese version of the Montgomery-Åsberg Depression Rating Scale (MADRS-J). Results: For the multiple fall group, the error in estimated distance (EED) was significantly greater than that for the zero/single fall group (P<0.01). Stepwise logistic regression analysis showed that EED (odds ratio 1.2, 95% confidence interval (CI) 1.1—1.4, P<0.01) and MADRS-J scores (odds ratio 1.1, 95% CI 1.0—1.3, P<0.05) were correlated with multiple falls. According to the receiver operating characteristic curve for EED, the cut-off value for discriminating multiple fallers was 6.3cm (sensitivity 81.0%, specificity 78.2%, area under the curve 0.8). Conclusions: The results suggest that assessing error in perceiving postural limits by measuring the maximum reach of the non-affected side of hemiplegic patients is one way to identify those who are at high risk for falling.

Effects of Ultrasound Therapy on Calcificated Tendinitis of the Shoulder

In general, surgery is recommended for calcificated tendinitis of the shoulder if the patients have symptoms after conservative treatments, including needle aspiration and physical therapy. Many researchers agree about the need for adequate physical therapy consisting of range of motion exercise, muscle strengthening exercises and electrophysical agents. Some researchers report that ultrasound (u/s) promotes angiogenesis and calcium uptake to fibroblasts, but there are few studies about u/s effects on calcificated tendinitis of the shoulder. The purpose of this study was to evaluate the u/s therapy effect on calcification, pain during active movement, and to identify factors related to improvement in a randomized controlled fashion. We used the stratified random allocation method to assign 40 consecutive patients to experimental and control groups, so each group consisted of 20 patients. The experimental group was treated by u/s therapy and therapeutic exercises, and the control group was treated with therapeutic exercises only. All patients in both groups came to our department 3 times per week and u/s therapy was performed 3 times per week until the end of the study. First, we classified the calcifications as type I (clearly circumscribed and with dense appearance on radiography), type II (dense or clearly circumscribed appearance) and type III (translucent or cloudy appearance without clear circumscription) according to the classification of Gartner and Heyer. Radiography was performed every one month, and the main outcome measure was the change from the base-line of the calcification on radiography at the end of the treatment. The three point scale of Gartner and Heyer was used, in which a score of 1 indicates no change or a worsening of the condition, a score of 2 a decrease of at least 50 percent in the area and density of the calcification, and a score of 3 a complete resolution of the calcification. We also examined the affected shoulders for presence or absence of pain in active movement at the start and at the end of the study. The calcifications improved significantly and fewer patients had pain during active movement in the experimental group. There was a statistical significant disease duration difference from the first clinical presentation between scores 2 and 3 in the experimental group. The results of this study suggest that u/s therapy helps to resolve calcifications of shorter disease duration. Calcifications of longer disease duration tended to persist in spite of u/s therapy, but we thought treatment of 27-38 times (95% CI), until score 2 was attained, was a desirable strategy.

Can Postural Instability Respond to Galvanic Vestibular Stimulation in Patients with Parkinson’s Disease?

Objective Galvanic vestibular stimulation (GVS) activates the vestibular afferents, and these changes in vestibular input exert a strong influence on the subject’s posture or standing balance. In patients with Parkinson’s disease (PD), vestibular dysfunction might contribute to postural instability and gait disorders. Methods Current intensity was increased to 0.7 mA, and the current was applied to the patients for 20 minutes. To perform a sham stimulation, the current intensity was increased as described and then decreased to 0 mA over the course of 10 seconds. The patient’s status was recorded continuously for 20 minutes with the patient in the supine position. Results Three out of 5 patients diagnosed with PD with postural instability and/or abnormal axial posture showed a reduction in postural instability after GVS. The score for item 12 of the revised Unified Parkinson’s Disease Rating Scale part 3 was decreased in these patients. Conclusions The mechanism of postural instability is complex and not completely understood. In 2 out of the 5 patients, postural instability was not changed in response to GVS. Nonetheless, the GVS-induced change in postural instability for 3 patients in our study suggests that GVS might be a therapeutic option for postural instability.

Effect of modulated-frequency and modulated-intensity transcutaneous electrical nerve stimulation after abdominal surgery: a randomized controlled trial.

Purpose:This study aimed to evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) for treatment of postoperative pain and pulmonary functions (vital capacity [VC]; cough peak flow, [CPF]) in patients who underwent abdominal surgery. Materials and Methods:Forty-eight patients were randomly allocated to receive TENS, placebo TENS, or no TENS (control) 1 hour a day for 3 days postoperatively. A 0-100 visual analog scale was used to assess pain at preintervention, mid-intervention, and postintervention on the third postoperative day. Pulmonary functions (VC, CPF) were evaluated by spirometer at preoperation (baseline) and at preintervention, mid-intervention, and postintervention on the third postoperative day. One-way analysis of variance was used to assess differences between groups at baseline. Mann-Whitney test was used to compare the control group with the placebo-TENS and TENS group, at each assessment timepoint. Two-way analysis of variance and Bonferroni post hoc test assessed the difference between the 2 (placebo-TENS×TENS) groups. A value of P<0.01 was considered statistically significant. Results:The baselines were not significantly different between any groups. The TENS group had significant reductions in postoperative pain compared with the placebo group (P<0.01) and control group (P<0.01). There was also improvement in pulmonary functions (VC, CPF) at mid-TENS and post-TENS, but not in the placebo-TENS (P<0.01) or control groups (P<0.01). Conclusions:TENS is a valuable treatment to alleviate postoperative pain and improve pulmonary functions (ie, VC, CPF) in patients following abdominal surgery.

Effects of galvanic vestibular stimulation combined with physical therapy on pusher behavior in stroke patients: A case series

BACKGROUND A recent study investigated the effects of galvanic vestibular stimulation (GVS) on pusher behavior (PB) in post-stroke patients. However, there have been no reports about the effects of multisession GVS on PB. OBJECTIVE The purpose of this study was to investigate the feasibility and effects of multisession GVS combined with physical therapy for PB in stroke patients. METHODS Two stroke patients who showed PB were enrolled. The ABAB single-case design was used. Each phase lasted 1 wk. In phases A1 and A2, the patients underwent a 60-min-long physical therapy session 5 days a week. In phases B1 and B2, they underwent GVS for 20 min before each physical therapy session, and then the same physical therapy program as in phases A1 and A2 were performed. PB was evaluated using the Scale for Contraversive Pushing (SCP) and the Burke Lateropulsion Scale (BLS). Outcomes were tested at the baseline and after each phase. RESULTS In both patients, the SCP scores were reduced only during phase B2. Although the BLS scores improved at the A1 phase, a larger improvement was seen at the two B phases. CONCLUSIONS Multisession GVS combined with physical therapy may have positive effects on PB in clinical setting.

Galvanic Vestibular Stimulation for Camptocormia in Parkinson's Disease: A Case Report

Background: We explored the use of galvanic vestibular stimulation (GVS) as a tool of intervention for camptocormia in a patient with Parkinson’s disease. Methods: A 73-year–old man with a 13-year history of Parkinson’s disease presented with camptocormia. Binaural monopolar GVS was applied at 1.5 mA with the patient in the supine position for 20min. His trunk flexion angle during the standing position with eyes open and with eyes closed for 60 sec each was assessed before the GVS, after the GVS, and 1.5months after the GVS. Results: The patient’s trunk flexion angle while standing after the GVS was reduced, especially with eyes closed (by 25.2°; 55.8%) compared to that before the GVS. The patient reported that standing and sitting in his daily life were improved after the GVS, and the improvement continued up to approximately 1month after the GVS. His average trunk flexion angle while standing at the follow-up test conducted 1.5 months after the GVS was increased compared to that after the GVS, but was still smaller than that before the GVS. Conclusion: The results of this case report demonstrated significant improvement of the trunk forward flexion angle in a patient with Parkinson’s disease with camptocormia. Limitations and future research suggestions were identified.

Feasibility study of a combined treatment of electromyography-triggered neuromuscular stimulation and mirror therapy in stroke patients: A randomized crossover trial

BACKGROUND Mirror therapy (MT) and electromyography-triggered neuromuscular stimulation (ETMS) are both effective treatments for impaired upper limbs following stroke. A combination of these two treatments (ETMS-MT) may result in greater gain than either treatment alone. OBJECTIVES The feasibility and possible effects of ETMS-MT upon upper extremity function were investigated in stroke patients. METHODS Thirteen post-acute stroke patients were randomly assigned to an immediate ETMS-MT group or a delayed ETMS-MT group and then underwent an 8-week training program. The immediate ETMS-MT group received ETMS-MT in addition to physical and occupational therapy (PT+OT) for 4 weeks. They then received only PT+OT for the next 4 weeks. In the delayed ETMS-MT group, interventions were provided in the reverse order. The main outcome measure was the Fugl-Meyer Assessment (FMA). RESULTS The immediate ETMS-MT group showed significantly greater gain in FMA in the first 4 weeks. The delayed ETMS-MT group showed significantly greater gain in active range of motion during the latter 4 weeks. No adverse effects were reported following ETMS-MT. CONCLUSION ETMS-MT might be as effective as independent MT or ETMS without causing any side effects. Future research should focus upon the direct comparisons between independent and combined interventions.