Nobuyuki Dohi

An analysis of sit-to-stand movements

We analyzed the movements involved in rising from a knee-high chair in 12 healthy men weighing within +/- 10% of standard body weight. A regular series of transition points was observed in the angles of the hip, knee, and ankle joints throughout the sit-to-stand movement, which was classified into six stages. As the duration of sit-to-stand movements increased, the duration of Stage 2 decreased, whereas Stage 3 grew longer. The durations of stages 4 and 5 remained constant. We also calculated the minimum unilateral hip and knee extension torque per weight in kilograms required for natural sit-to-stand movements, or N-Stand (1.7-2.3 seconds), and found that minimum hip extension torque was 0.7Nm and minimum knee extension torque was 0.9Nm. The minimum hip and knee extension torque required for N-Stand corresponds to a mean 27% and 30%, respectively, of the actual maximum hip and knee extension torque.

Rehabilitation of patients with anosognosia for hemiplegia due to intracerebral haemorrhage

We have studied the differences in the lesions, concomitant symptoms and ADL levels in patients in acute-stage cerebral-haemorrhage and manifesting anosognosia. Twelve of 50 patients (24.0%) presented with anosognosia. The (+) group had longer intervals between onset and the first evaluation than did the (-) group, demonstrating severe sensory disturbance. The volume of haemorrhage was significantly larger in the (+) group. Anosognosia disappeared within 3 months in all cases. In the (+) group the time until discharge was long, with the ADL level at the time of discharge being low. Therefore, it was considered that anosognosia was important as an inhibitory factor hampering rehabilitation.

A study of right unilateral spatial neglect in left hemispheric lesions: the difference between right-handed and non-right-handed post-stroke patients.

We report 20 cases of right unilateral spatial neglect caused by lesions in the left cerebral hemisphere. Differences in neuropsychological symptoms and lesion sites are discussed in connection with handedness. Of the right‐handed patients, 6 had severe aphasia, 4 had Gerstmanns syndrome, and 1 had pure agraphia, but unilateral spatial neglect in these cases disappeared after a number of months. Six of the non‐right‐handed patients had moderate‐to‐severe aphasia, while the other 3 cases had no aphasia at all. Eight of the 9 cases in this group continued to have right unilateral spatial neglect for more than 6 months. Lesion site as determined by CT differed as to hemisphere, but all fell into the common area previously mentioned in connection with such disorders: i.e., the temporal, parietal and occipital lobes.

Factor analysis of the components of 12 standard test batteries, for unilateral spatial neglect, reveals that they contain a number of discrete and important clinical variables

The aim of this study was to investigate a conventional battery of tests capable of assessing the presence of the component and extent of the lesions in patients with unilateral spatial neglect. Ninety-four patients who had unilateral spatial neglect with a stroke in right hemisphere were assessed on 12 traditional neglect batteries 4 weeks after the onset. Computerized tomography was also performed to investigate the possible anatomical relationships with each neglect battery. Factor analysis showed that the tests loaded significantly on five factors. There are not only visual scanning factors but also factors of imaging, visual judgement, visual cognition and effectiveness from left hemisphere in the unilateral spatial neglect. There are high correlations between each neuropsychological test and neglect batteries. Furthermore, lesions in the paraventricular white matter were associated with clock and person drawing tasks. Lesions in the occipital lobe were associated with reading, explaining and visual counting tasks. Lesions in the temporal lobe and the posterior limb of the internal capsule were associated with line bisection tasks. It is suggested that it is possible that there are some different components in unilateral spatial neglect. Failure in some tasks may predict different lesions in terms which include localization.

Functional outcome following thalamic haemorrhage: Relationship between motor and cognitive functions and ADL

Twenty-two patients with thalamic haemorrhage were examined to investigate the relationship between motor and cognitive function, and activities of daily living (ADL). Patients with unilateral spatial neglect had lower ADL scores on admission than patients without unilateral spatial neglect (Mean: 17.0 and 24.6, respectively; F = 4.38, df = 1, p < 0.05). Unilateral spatial neglect related to feeding, bowel control and transfer in Barthel index on admission. Patients with aphasia on admission had lower ADL at discharge than patients without aphasia on admission (Mean: 57.0 and 84.7, respectively; F = 7.70, df = 1, p < 0.05). Aphasia related to the bathing, toilet, stair climbing, dressing, and ambulation in Barthel index on discharge. There was a significant difference between the severity of paresis in upper and lower limb on admission and ADL at discharge. The two-way repeated measures ANOVA showed a significant difference between severity of paresis in lower limb and ADL improvement. It can be suggested that the most important predictor of outcome was paresis in lower limb, and not aphasia or unilateral spatial neglect.

Buccofacial apraxia and left cerebral haemorrhage

We examined 33 patients with left intracerebral haemorrhage to investigate the relations to buccofacial apraxia (BFA). BFA was present in 18 cases at 1 month and disappeared in 3 cases and persisted in 15 cases at 6 month from the onset. The existence of BFA seems to be partially dependent the haematoma volume which may cause the organic damage in lenticulate nucleus, insula, posterior limb or internal capsule and anterior portion of paraventricle white matter. All patients with BFA had aphasia (Broca 6, Wernicke 1, Total 10, Amnestic 1). Aphasia of the patients with transient BFA improved as well as the patients without BFA after BFA disappeared. We suspected that improvement or aphasia might be affected by BFA.

Unilateral spatial neglect in patients with cerebral hemorrhage: the relationship between hematoma volume and prognosis

We examined patients with cerebral hemorrhage to determine the correlations between unilateral spatial neglect (USN) and neurological deficits, the site of lesions, and performance on activities of daily living (ADL) tests at discharge. Thirty-two right-handed patients with right hypertensive intracerebral hemorrhage (putamen 16, thalamus 16) were examined for neurological and neuropsychological deficits in addition to USN, and they received CT scans. USN was revealed in 26 of the patients (81.3%), of which 13 cases were putaminal hemorrhage and the other 13 were thalamic hemorrhage. The 32 patients were subdivided into three groups: those without USN, those with transient USN, and those with persistent USN. Among the patients with putaminal hemorrhage, the presence and persistence of USN seemed to be largely dependent on the size of the hematoma. Of the 7 cases with hematoma volume greater than 40ml, 4 revealed persistent USN; the other 3 cases, each of whom was under 50 years of age, showed transient USN. No cases with hematoma smaller than 20ml revealed USN. Among the thalamic hemorrhages, the size of the hematoma had no relation to the presence of USN. All 13 cases of USN caused by thalamic hemorrhage were transient. Among all the patients, those with USN showed lower ADL scores on admission than patients without USN. At discharge, ADL among patients with transient USN had improved more than the ADL of patients without USN. Therefore, we suspected that improvement in ADL might be affected by USN.

Apraxia and cerebral haemorrhage: the relationship between haematoma volume and prognosis.

In this study, we examined twenty-five patients with left putaminal haemorrhage to investigate the relations between ideational apraxia (IA) and intracerebral haemorrhage. Apraxias were determined at 1 and 6 months after the stroke onset. Extension and volume of haematoma were examined with CT scan within 2 days of stroke onset. IA was present in 10 cases at 1 month and disappeared in 6 cases (transient IA) and persisted in 4 cases(persisted IA) at 6 months from the onset. Although the haematoma volume related to the existence of IA, there was no significant difference between transient and persistent IA. All three patients with the haematoma volume larger than 40 ml in the transient IA group were younger than 50 years old. All cases with persistent IA were older than 50 years old. Consequently, the existence of IA seems to be partially dependent on the haematoma volume which may cause the organic damage of subcortical white matter. However, patients age is also important to determine the prognosis of IA. This maybe related to the nature of the haemorrhage and the mode of the onset. These factors remain to be determined.

Exploratory-motor task to evaluate right frontal lobe damage

An exploratory-motor (E-M) task was performed by 20 patients with right hemispheric damage and unilateral spatial neglect and by 15 adult controls. None of the subjects in the control group demonstrated E-M neglect, other types of unilateral spatial neglect, or motor impersistence. In the unilateral spatial neglect group, 14 of 20 patients revealed E-M neglect. The presence or absence of E-M neglect related to word fluency, digit span recall (backward), and motor impersistence. In addition, E-M neglect frequency was observed in patients with lesions in the frontal lobe. The frontal lobe may play an important role in the performance of an E-M task. Therefore, we think that E-M task performance is a useful method for evaluating the site of right frontal lobe damage.

Palilalia and unilateral spatial neglect caused by a right frontal lesion: Case study

Abstract A 55-year-old, right-handed Japanese man manifested palilalia as well as unilateral spatial neglect following a subcortical haemorrhage in the frontal lobe. CT and SPECT showed the lesions to be localized in the right frontal lobe, with no obvious involvement of the basal ganglia. At an early stage this patient exhibited a combination of an exploratory-motor and a perceptual-sensory neglect, which later changed to exploratory-motor neglect alone. The palilalia, which persisted for 1 year, was characterized by the repetition of words or phrases, not single syllables. While it seemed that the palilalia and unilateral spatial neglect were induced by the same lesion, their clinical courses differed; thus they were probably produced by differing mechanisms.