Shinichiro Oka

The Control of Postural Stability during Standing is Decreased in Stroke Patients during Active Head Rotation

[Purpose] The aim of this study was to evaluate the effect of active head rotation on postural control in stroke patients during standing as compared with age-matched healthy subjects. [Subjects and Methods] In total, 46 stroke patients and 37 age-matched healthy subjects were recruited for the study. A stabilometer was used to assess postural stability in participants during standing, with or without active head rotation, and with their eyes open or closed. Subjects were asked to stand on a force plate while rotating their head in the yaw plane at a frequency of 1.0 Hz. A metronome was used to maintain the head rotation frequency, and the head rotation range was maintained at a total of 70° during the postural stability examinations. [Results] The control of postural stability during standing with active head rotation was significantly decreased in the stroke group as compared with the healthy group with both the eyes open and closed. No significant differences in relation to standing without head motion were observed between groups. [Conclusion] The findings suggest that postural instability is increased in stroke patients during active head rotation, and therefore, vestibular function in relation to head rotation might be reduced in stroke patients.

Greater Cervical Muscle Fat Infiltration Evaluated by Magnetic Resonance Imaging is Associated With Poor Postural Stability in Patients With Cervical Spondylotic Radiculopathy.

Study Design. A population-based, cross-sectional study. Objective. The aim of this study was to quantitatively evaluate the relationship between static postural stability and fat infiltration within cervical multifidus muscle in patients with cervical spondylotic radiculopathy (CSR). Summary of Background Data. CSR causes denervation by compression of nerve roots. This denervation is detected by fatty infiltration or results in fatty infiltration within muscles. Proprioceptive information in cervical multifidus muscle plays an important role in coordinated movement of postural stability; however, there have been few studies evaluating the relationship between postural stability and fat infiltration within cervical multifidus muscle among CSR patients. Methods. Sixteen CSR patients with C6 injuries and 25 age-matched healthy controls underwent magnetic resonance images to examine bilateral cervical multifidus muscle. For evaluation of fat within muscle, a muscle fat index (MFI) was calculated by using both measurement of cervical multifidus muscle and intermuscular fat. Participants’ postural stability at upright position with eyes-opened and eyes-closed for 60 seconds was examined by a platform. Two parameters, the total length and the area of the center of pressure (COP), were used for evaluation. Results. The CSR group showed significantly poorer postural stability than the control group (eyes-opened the total length; P < 0.05, eyes-closed the total length; P < 0.05, eyes-closed the area; P < 0.05). There were significant group differences at C4, C5, and C6 MFI (P < 0.05). In the CSR group, a correlation analysis demonstrated that the age, C4, C5, and C6 MFI values were significantly associated with the eyes-closed the total length of the COP (P < 0.05). Conclusions. Fat infiltration within muscle could lead to inhibition of normal activity of musculature. The present study suggests that fat within cervical multifidus muscle could directly cause postural instability in static standing, even though the proprioceptive information has normal lower limbs. Level of Evidence: 3

Effects of vestibular rehabilitation on gait performance in poststroke patients: a pilot randomized controlled trial

The effects of vestibular rehabilitation on poststroke patients are unknown. This study aimed to investigate whether or not vestibular rehabilitation would improve both the vestibulo–ocular reflex and gait performance of patients with poststroke hemiparesis. Twenty-eight patients with stroke were assigned randomly to either an experimental group (N=14) or a control group (N=14). The experimental group performed the conventional physical therapy for 40 min and vestibular rehabilitation for 20 min, as a 60 min session, during the first 3 weeks and then completed only the conventional intervention for 60 min for the following 3 weeks. The control group performed only the 60 min conventional physical therapy for 6 weeks. Both groups were measured using the gaze stabilization test, the 10 m walking test, the timed up and go test, and the dynamic gait index. Patients were assessed at baseline, and at 3 and 6 weeks. Although the control group showed no significant difference in any outcome measures, the experimental group showed an improvement in gaze stabilization test scoring, which increased significantly after 3 weeks compared with the baseline (P=0.030). The dynamic gait index was also significantly increased after 3 and 6 weeks compared with the baseline (P=0.049 and 0.024, respectively). This study indicated that vestibular rehabilitation might improve poststroke patients’ vestibulo–ocular reflex. Moreover, patients might show improved gait performance at least up to 3 weeks after the vestibular intervention by the sensory reweight to coordinate vestibular input.

Effect of limbering up of the muscles attached to the pelvis on the strength of upper and lower extremity and trunk muscles through the transitional network

[Purpose] To study the effect that limbering up of the muscles attached to the pelvis has on muscle strength of the trunk and upper and lower extremities, which are not being exercised, and to investigate the possibilities for clinical application. [Subjects and Methods] A total of 152 healthy adult men. Sthenometry was conducted using a handheld dynamometer to assess the effect of limbering up of the upper gluteus maximus, hamstrings, and internal abdominal oblique muscles attached to thoracolumbar fascia on the trunk and upper and lower extremities. The exercises were slowly performed 20 repetitions. Subjects were divided into AB group (n=49) measuring abdominal and back muscle strength, K group (n=42) measuring knee flexor and extensor strength, and S group (n=61) measuring shoulder flexor and external rotator strength and compared to non-exercising controls. [Results] In the exercise groups, exercising either gluteus maximus or hamstrings significantly increased the strength of abdominal and back muscles; exercising gluteus maximus increased knee extensor strength, and exercising the abdominal internal oblique muscle significantly increased knee flexor strength; and shoulder flexor strength significantly increased after exercising gluteus maximus versus controls. [Conclusion] This may be useful in rehabilitation of injuries to the trunk and upper and lower extremities.

Poor gait performance is influenced with decreased vestibulo-ocular reflex in poststroke patients

The vestibulo-ocular reflex (VOR) exerts a significant influence on gait performance. Therefore, a decrease in VOR function could worsen gait impairments in patients with poststroke hemiparesis. The effects of decreased VOR function on gait performance could be further exacerbated by aging-related physical weakness and impaired motor function of the hemiparetic lower limb. The aim of our study was to evaluate the possible synergistic effect of aging and impairment in lower extremity function and the VOR on walking ability of poststroke hemiplegic patients. The VOR was evaluated, using the gaze-stabilization test (GST), in 75 patients with a poststroke hemiplegia. Lower extremity function was assessed using the Fugl-Meyer assessment (FMA-LE). Gait performance was evaluated using the 10-m walking test, the timed up-and-go, and the dynamic gait index (DGI). The relationships between gait performance and age, FMA-LE and GST, as well as whether age, FMA-LE, and/or GST were significant predictors of gait performance were evaluated. The 10-m walking test, timed up-and-go and DGI were significantly correlated to the FMA-LE and GST (P<0.05). On stepwise multiple regression analysis, the GST remained a significant predictor of the DGI (P<0.001). The present study indicates that decreased VOR function after stroke contributes to impairments in gait both in simple and in dual-task walking tests.

Changes in Cerebral Blood Flow of the Sensory-motor Area during the Motor Imagery Task : A Study Using Dexterity Movement and Gross Movement

[Purpose] We examined the differences in brain activities of motor imagery between dexterity movement (DM, finger-to-thumb opposition movement tasks) and gross movement (GM, rotary motion tasks of the shoulder joint). [Subjects] Ten healthy young adults participated in this study (mean age 21.3±1.1). [Method] The participants performed DM and GM. These tasks were performed by motor imagery and voluntary movement (selfinitiated movement and externally triggered movement). The changes of blood flow volume in the sensory-motor related areas were observed using near-infrared spectroscopy (NIRS). [Results] The motor imagery of DM did not significantly change in comparison with those of voluntary movements in any of the areas. The motor imagery of DM significantly increased in comparison with those of GM in the area of the premotor cortex and the sensory-motor cortex. [Conclusion] These results suggest the possibility that motor imagery of DM led to increases in neuronal activity that were greater than those of GM.

49. Evaluation of right and left vestibular modulations induced by the transcranial direct current stimulation (tDCS) in the health subjects

cortical excitability. Both OPS and QPS induced sustained bidirectional excitability changes of M1 depending on the stimulation frequency as compared with sham stimulation. Moreover, the duration of aftereffects was longer after OPS compared to QPS. In conclusion, OPS and QPS induce powerful bidirectional plasticity of M1. The number of stimuli within one burst may be of particular importance for the duration of the induced plasticity.