Norihiko Kodama

Gender differences in health‐related quality of life, physical function and psychological status among patients in the early phase following allogeneic haematopoietic stem cell transplantation

The aim of this study was to examine gender differences in quality of life (QOL), physical function and psychological status before and in the early phase after allogeneic haematopoietic stem cell transplantation (allo‐HSCT).

Relationship between corticosteroid dose and declines in physical function among allogeneic hematopoietic stem cell transplantation patients

PurposeThe aim of this study was to investigate the relationship between corticosteroid dose and degree of physical function decrease in allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients during the early stage of recovery. We further investigated the confounding factors affecting loss of physical function.MethodsThe study included 113 patients who underwent allo-HSCT between July 2007 and April 2012 at Hyogo College of Medicine Hospital in Japan. Physical function was assessed using tests for hand-grip strength, knee-extensor strength, and the 6-min walk test (6MWT). Fatigue was measured using the Piper Fatigue Scale. Total corticosteroid dose, frequency of physical therapy, body weight, and nutritional status were also collected from medical records.ResultsTotal corticosteroid dose was correlated with decrease of hand-grip and knee-extensors strength (P < 0.01) but was not correlated with 6MWT performance. Results of multivariate analysis confirmed that low physical function was associated not only with high corticosteroid dose but also with low frequency of physical therapy, increase in fatigue, and body weight loss (P < 0.05). Also, hemoglobin levels were associated with 6MWT (P < 0.05).ConclusionsThis study showed the relationship between corticosteroid dose and declines in physical function and also showed other clinical factors affecting loss of physical function among allo-HSCT patients. Our results indicate that the effectiveness of rehabilitation may be influenced by corticosteroid treatment.

Safety and feasibility of physical therapy in cytopenic patients during allogeneic haematopoietic stem cell transplantation

This study aimed to investigate the safety and feasibility of physical therapy in cytopenic patients undergoing allogeneic haematopoietic stem cell transplantation (allo-HSCT), and to investigate the effect of physical therapy on physiological functions and quality of life (QOL) in allo-HSCT patients. The study cohort included 321 patients who underwent allo-HSCT. To investigate the safety and feasibility of physical therapy during cytopenia, patients were assigned to the physical therapy group (n = 227) or the control group (n = 94). To determine the effects of physical therapy, patients were divided according to the frequency with which they underwent physical therapy (n = 51 per group). Handgrip strength, knee extensor strength and a 6-min walk test were used as measures of physiological function. Short-Form 36 was used to assess QOL. The physical therapy group had higher rate of achieving engraftment and lower death rate than the control group (P < 0.05). After HSCT, the high-frequency physical therapy group showed significantly less decline than the low-frequency physical therapy group with respect to physical functioning of QOL (P < 0.01). Physical therapy is quite beneficial and can be performed safely and feasibly in cytopenic patients during allo-HSCT.

Diffusion tensor imaging in elderly patients with idiopathic normal pressure hydrocephalus or Parkinson’s disease: diagnosis of gait abnormalities

BackgroundGait abnormalities in the elderly, characterized by short steps and frozen gait, can be caused by several diseases, including idiopathic normal pressure hydrocephalus (INPH), and Parkinson’s disease (PD). We analyzed the relationship between these two conditions and their association with gait abnormalities using laboratory test data and findings from diffusion tensor imaging (DTI).MethodsThe study involved 10 patients with INPH, 18 with PD, and 10 healthy individuals (control group). Fractional anisotropy (FA) of five brain areas was measured and compared among the three groups. In addition, the association of INPH and PD with gait capability, frontal lobe function, and FA of each brain area was evaluated.ResultsThe INPH group had significantly lower FA for anterior thalamic radiation (ATR) and forceps minor (Fmin) as compared to the PD group. The gait capability correlated with ATR FA in the INPH and PD groups. We found that adding DTI to the diagnosis assisted the differential diagnosis of INPH from PD, beyond what could be inferred from ventricular size alone.ConclusionsWe expect that DTI will provide a useful tool to support the differential diagnosis of INPH and PD and their respective severities.

Multimodal evoked potentials in Alzheimer's disease and Binswanger's disease

Somatosensory evoked potentials (SEPs), brainstem auditory evoked potentials (BAEPs), visual evoked potentials (VEPs), and auditory event-related potentials (ERPs) were studied in 15 patients with Alzheimers disease (AD), eight patients with Binswangers disease (BD), and 15 normal subjects. Patients with BD showed significant prolongation of the interpeak latency between N13 and N20 (N13-N20) and N20-P40 of SEPs as compared with the normal controls, whereas patients with AD only demonstrated significant prolongation of N20-P40. The interpeak latency between waves I and V of BAEPs in patients with both AD and BD was significantly longer than that of controls. There were no significant differences in P100 latency of VEPs among these three groups. Both groups with dementia showed significant prolongation of N200 and P300 latencies of ERPs compared with normal controls. In addition, patients with AD showed significant prolongation of P200 latency. We conclude that these two dementing diseases have different electrophysiologic features that may be related to their underlying pathogenetic mechanisms. Furthermore, the measurement of multimodal evoked potentials may be helpful in the differential diagnosis of AD and BD.

A Modified Method for Constraint-induced Movement Therapy: A Supervised Self-training Protocol

BACKGROUND Constraint-induced movement therapy (CI therapy) is a rehabilitation treatment that is effective for improving upper extremity function in patients with stroke hemiparesis. In standard protocols, the burdens are great on the patient, therapist, and in terms of health care costs, preventing the wider application of CI therapy. To address this, we developed a protocol based on self-training and examined its effects. METHODS Patients with chronic hemiparesis caused by a stroke (intracerebral hemorrhage or cerebral infarct) 180 days after disease onset were included in this study. We performed before and after comparisons after intervention. We assessed motor impairment in the shoulder, elbow, forearm, wrist, and hand with the Fugl-Meyer Assessment (FMA) and determined training tasks, taking into consideration the patients primary complaint. We established direct supervision by the therapist and self-training to occupy 40% and 60% of the training period, respectively. With this protocol, training was conducted 5 hours per day for 10 consecutive weekdays. We assessed upper extremity function using the FMA, Wolf Motor Function Test (WMFT), and Motricity Index (MI) before and after intervention. RESULTS There were 40 subjects. Before and after intervention, scores for the FMA upper extremity items, WMFT functional ability scale, WMFT performance times, and MI showed significant improvements, from 49.35 ± 10.1 (mean ± SD) to 52.88 ± 8.0 points, 3.48 ± 0.65 to 3.72 ± 0.67 points, 14.37 ± 13.22 to 10.58 ± 11.97 seconds, and 75.0 ± 12.0 to 77.7 ± 12.0 points, respectively. CONCLUSIONS Our self-training-based CI therapy protocol is likely to be as effective for improving upper extremity function as the standard CI therapy. The method may contribute to the wider use of CI therapy.

Motor neuron disease following generalized fasciculations and cramps

We report a case of motor neuron disease in which fasciculations and cramps progressed generally before the development of muscle wasting. After involvement of the upper and lower motor neurons became clinically manifest, widespread fasciculations and cramps persisted and accompanied pseudotetany. The present case suggests that spinal cord pathology of motor neuron disease can cause the abnormal excitability of the motor neurons, resulting in the development of generalized fasciculations and cramps.

Diffusion tensor imaging predicts the outcome of constraint-induced movement therapy in chronic infarction patients with hemiplegia: A pilot study.

PURPOSE To test whether diffusion tensor imaging could evaluate potential motor capability of patients with chronic cerebral infarction. METHODS We used constraint-induced movement therapy (CIMT) as a rehabilitation, which reveals potential motor capability. We also investigated the relationship between the outcome of CIMT and the ratio between fractional anisotropy values (rFA) in affected and unaffected sites of the corticospinal tract before CIMT. Imaging was performed in cerebral infarction patients (n = 14) and the rFA of the posterior limb of internal capsule (PLIC) was measured before CIMT. Patients were evaluated before and after CIMT using the Fugl-Meyer (F-M) assessment, Wolf Motor Function Test, Action Research Arm Test, and Motor Activity Log and association between PLIC- rFA and these scores was determined. RESULTS All patients showed an improvement in mobility following the 10-day CIMT session. Strong positive correlation was found only between F-M after CIMT and PLIC-rFA (r = 0.8098, p = 0.0004). A strong linear relationship was observed after CIMT. CONCLUSION These data support PLIC-rFA as a new marker of the CIMT-induced improvement in motor function (F-M).

A one-year follow-up after modified constraint-induced movement therapy for chronic stroke patients with paretic arm: a prospective case series study

Abstract Background: Despite the confirmed short-term effects of constraint-induced movement therapy, the long-term effects have not been sufficiently verified in terms of functional improvement of the affected arm. Objective: To evaluate the long-term effects and relationship between arm use in activities of daily living and arm improvement with modified constraint-induced movement therapy in chronic stroke patients. Methods: At 1 year after completing modified constraint-induced movement therapy, arm function (Fugl-Meyer Assessment) and amount of daily arm use (motor activity log) were assessed. Results: Fourteen post-stroke patients with mild to moderate impairment of arm function were analyzed. One year after completing modified constraint-induced movement therapy, participants consistently showed improvements in arm function and amount of daily arm use (analysis of variance: Fugl-Meyer Assessment, P < 0.001; Motor Activity Log, P < 0.001). For the Fugl-Meyer Assessment, post-hoc tests detected significant improvements (pre versus post, P = 0.009; pre versus 1 year, P < 0.0001; post versus 1 year, P < 0.036). For the Motor Activity Log, post-hoc tests also detected significant improvements (pre versus post, P = 0.0001; pre versus 1 year, P < 0.0001; post versus 1 year, P = 0.0014). The magnitude of the change in Fugl-Meyer Assessment score correlated significantly with the change in Motor Activity Log score (R = 0.778, P = 0.001). Conclusions: Among post-stroke patients with mild to moderate impairments of arm function, modified constraint-induced movement therapy without any other rehabilitation after intervention may improve arm function and increase arm use for 1 year. In addition, increasing arm use may represent an important factor in improving arm function, and vice versa.

Dressing apraxia in corticobasal degeneration

The present paper considers a patient with corticobasal degeneration and dressing apraxia. A 65‐year‐old woman developed difficulties in housekeeping 3 months prior to admission. Neurological examinations revealed mild dementia and asymmetric parkinsonism; the most conspicuous feature was dressing apraxia with constructive disabilities. Magnetic resonance imaging showed right temporoparietal atrophy. A 3‐D brain perfusion imaging demonstrated a decrease in cerebral blood flow in the right perirolandic and perisylvian regions. These clinical and neuroimaging findings were compatible with corticobasal degeneration. Although various types of apraxia are associated with corticobasal degeneration, dressing apraxia has rarely been reported. Our case indicates that dressing apraxia can manifest as another neuropsychiatric problem in corticobasal degeneration if coexistent movement disorders remain mild early in the stage of the illness.