Tsunehiko Suzuki

Cortical mapping of gait in humans: a near-infrared spectroscopic topography study.

While we have a fair understanding of how and where forelimb-hand manipulative movements are controlled by the neocortex, due to functional imaging studies, we know little about the control of bipedal movements such as walking because of technical difficulties. We succeeded in visualizing cortical activation patterns of human gait by measuring relative changes in local hemoglobin oxygenation using a recently developed near-infrared spectroscopic (NIRS) topography technique. Walking activities were bilaterally associated with increased levels of oxygenated and total hemoglobin in the medial primary sensorimotor cortices and the supplementary motor areas. Alternating foot movements activated similar but less broad regions. Gait imagery increased activities caudally located in the supplementary motor areas. These findings provide new insight into cortical control of human locomotion. NIRS topography might be also useful for evaluating cerebral activation patterns during pathological gait and rehabilitative intervention.

Premotor cortex is involved in restoration of gait in stroke

Cortical activation during hemiplegic gait was assessed in six nonambulatory patients with severe stroke (four men, two women; four with right and two with left hemiplegia; 57 years old and 3 months after stroke on average), using a near‐infrared spectroscopic imaging system. Each patient performed tasks of treadmill walking (0.2km/hr), alternated with rest every 30 seconds for four repetitions, under partial body weight support, either with mechanical assistance in swinging the paretic leg control (CON) or with a facilitation technique that enhanced swinging of the paretic leg (FT), provided by physical therapists. Gait performance was associated with increased oxygenated hemoglobin levels in the medial primary sensorimotor cortex in the unaffected hemisphere greater than in the affected hemisphere. Both cortical mappings and quantitative data showed that the premotor activation in the affected hemisphere was enhanced during hemiplegic gait. There was also a prominent activation in the presupplementary motor area. Overall cortical activations and gait performance were greater in walking with FT than with CON. These indicate that multiple motor areas including the premotor cortex and presupplementary motor area might play important roles in restoration of gait in patients with severe stroke.

Middle Cerebral Artery Stroke That Includes the Premotor Cortex Reduces Mobility Outcome

BACKGROUND AND PURPOSE The premotor cortex (PMC) (Brodmann 6) contributes uniquely to proximal upper and lower limb power and plays a role in the organization of motor behaviors. We assessed the degree to which PMC damage affected functional outcome. METHODS We prospectively compared the functional outcome of patients with a first stroke in the middle cerebral artery distribution that either left the PMC intact (PMC-; n=19) or damaged the PMC (PMC+; n=12). The Functional Independence Measure for disability and the motor score of the Stroke Impairment Assessment Set for impairment assessed outcome. RESULTS Demographic and clinical features and lesion volume were comparable for the PMC+ and PMC- groups. However, the PMC- group demonstrated significant gain in mobility and in proximal leg movement. This focal improvement contributed to the trend in the PMC- group toward greater independent ambulation. CONCLUSIONS Decreased motor recovery of proximal lower limbs in humans with PMC damage supports the idea that it is the origin of corticoreticulospinal pathways that subserve proximal lower extremity function. Furthermore, persistent proximal weakness after PMC damage may amplify other motor impairments, which include defects in planning, initiating, and sequencing. Neurorehabilitation outcomes may contribute to a more detailed functional anatomy after stroke and partial recovery.

Benefit of inpatient multidisciplinary rehabilitation up to 1 year after stroke

OBJECTIVE To analyze the benefit of inpatient multidisciplinary rehabilitation up to 1 year after stroke. DESIGN Retrospective cohort study. SETTING Inpatient rehabilitation hospital in Japan. PARTICIPANTS A total of 1056 patients with stroke were divided into 3 groups based on the interval between stroke onset and admission to the rehabilitation hospital: group I, within 90 days (n=507, 48%); group II, 91 to 180 days (n=377, 36%); and group III, more than 180 days (n=172, 16%). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Functional outcome (A to D; independent to totally dependent) in walking, affected upper extremity, and activities of daily living (ADLs) and discharge disposition. RESULTS Walking status improved in 70.9% of nonambulatory patients in group I, in 54.8% in group II, and in 43.9% in group III. Similarly, ADLs improved in 66.7% of the totally dependent patients in group I and in approximately 50% in groups II and III. Functional gain in those with a totally nonfunctional upper extremity at admission was poor (29.7%). Initial functional categories affected each outcome (P<.0001). On discharge, 73.8% in group I and approximately 60% in groups II and III went home. CONCLUSION Approximately half of all patients regained their abilities in walking and ADLs after inpatient multidisciplinary rehabilitation up to 1 year after stroke. However, there was considerable limitation in functional recovery of the affected upper extremity.

Improved Functional Outcome in Patients With Hemorrhagic Stroke in Putamen and Thalamus Compared With Those With Stroke Restricted to the Putamen or Thalamus

BACKGROUND AND PURPOSE We analyzed the effect of late intensive inpatient rehabilitation on the functional outcome of patients with subcortical hemorrhagic stroke. METHODS Patients who were nonambulatory with hemorrhagic stroke in the internal capsule and putamen (n=55), the thalamus (n=24), or all 3 regions (n=15) underwent intensive inpatient rehabilitation. Patients with surgical intervention or an episode of ventricular hemorrhage were excluded. Lesion location was evaluated by MRI 4 months after the ictus. RESULTS Demographic data, initial disability, and impairment measures were comparable in the 3 groups. Functional outcome demonstrated significant differences in mobility subscores (P<0.05) of the Functional Independence Measure such that patients with injury in the 3 regions were more likely to ambulate independently than were patients in the other groups. Lesion location data demonstrated that the ventral anterior nucleus of the thalamus was always spared; the ventral posterior (lateral and medial) nucleus was always damaged, and the ventral lateral nucleus was frequently damaged. Putaminal damage always included the postcommissural area. In addition, the entire posterior half limb of the internal capsule was always damaged. CONCLUSIONS Subcortical lesions to multiple structures in the basal ganglia-thalamocortical motor circuits permitted enhanced motor recovery. Lesion location predicted the level of independent ambulation and the rate of recovery in patients with stroke who were nonambulatory before neurorehabilitation therapy.

Wallerian degeneration of the pyramidal tract does not affect stroke rehabilitation outcome

Objective: To test whether Wallerian degeneration (WD) of the pyramidal tract as signaled by MRI affects rehabilitation outcome in patients with subcortical infarction (internal capsule or corona radiata). Background: Recent radiologic evidence suggests that WD occurs no earlier than 3 months after a subcortical infarction. Methods: A total of 77 consecutive patients with pure motor hemiparesis due to an initial subcortical infarction were assessed on admission and discharge with the Functional Independence Measure (FIM) for disability and Stroke Impairment Assessment Set (SIAS, full = 25) for impairment. WD was defined by a high-intensity area detected along the pyramidal tract below the level of lesion on T2-weighted MR image (WD+). Results: Age, sex, side of stroke, Mini-Mental State Examination score, and volume of lesion were comparable for each group. Length of stay (LOS) was significantly longer (p < 0.05) in WD+ (130 days) than in WD- (105 days). There was no difference in the change of FIM (WD+, 99 to 111; WD-, 95 to 107) or SIAS measures (WD+, 12 to 16; WD-, 13 to 16) made on admission and discharge, nor was there any effect of the timing of the rehabilitation experience (≤90 days or >90 days after stroke). Conclusions: After stroke, apparent WD of the pyramidal tract may slow functional recovery but does not limit final rehabilitation outcome of pure motor hemiparesis. Study of the mechanisms of compensation for this delayed pyramidal tract degeneration will enhance the scientific basis for rehabilitation.

Functional Outcome of Multidisciplinary Rehabilitation in Chronic Stroke

Background and Purpose: To test whether multidisciplinary rehabilitation (MDR) is effective in improving functional outcome in chronic stroke. Methods: Retrospective review of functional outcome of MDR in 136 consecu tive patients with first single stroke. Patients were divided into early group (E: days after stroke ( 90, n = 47) and late group (L: > 90, n = 89). Outcome was assessed by using the Functional Independence Measure (FIM) and the Stroke Impairment As sessment Set (SIAS). Results: Both groups were comparable in terms of age, gender, type of stroke, and side of stroke. The mean length of stay was significantly longer (p < 0.05) in E (138 days) than in L (114 days). The mean FIM (admission/discharge) was 88/103 in E and 88/97 in L. The mean SIAS was 11/14 in E and 10/13 in L. There was no signif icant difference in gain of FIM and SIAS score between the groups. There was also no difference in gain of FIM between E and L in three subgroups based on admission FIM score (severe disability: 18-53, moderate: 54-89, mild: 90-126). Conclusions: MDR is effective in improving functional outcome of stroke patients regardless of starting point of MDR or initial severity of disability. Key Words: Stroke—Rehabilitation—Functional Independence Measure (FIM)—Stroke Impair ment Assessment Set (SIAS).

A novel spinal brace in management of scoliosis due to cerebral palsy. Radiological and subjective clinical results after at least one year of treatment

Background Severe scoliosis in patients with cerebral palsy (CP) causes difficulty in sitting balance and creates increased nursing demands. Surgical stabilization has proven to be a valuable method to stop the progression of scoliosis [1]. However, the complication rate after such surgery is substantial[2]. Additionally, many patients with quadriplegia and large curvatures of the spine have impaired general health, epilepsy and reduced respiratory capacity, making them poor candidates for major surgery like spine fusion. Therefore, other treatment alternatives should be available. We have recently developed a spinal brace named Dynamic Spinal Brace (DSB), which is a custom-molded, polycarbonate orthosis characterized by lightness and flexibility. Unlike the other underarm orthoses, DSB does not fix the pelvic girdle rigidly and, thus, potentially contributes to good compliance with bracing.

Motor-evoked potentials following transcranial magnetic stimulation during recovery after a stroke

Abstract In general, during the course of rehabilitation, it is essential to assess the physical state of the patients in terms of the functional disturbances and disabilities on the activities of daily living (ADL). However, the quality of motor recovery is difficult to predict on the basis of only having clinical data. While various degrees of motor improvement are frequently observed in the patients affected by a stroke, the mechanisms underlying the recovery processes have not yet been fully identified. This study investigated the reorganization of motor maps after a vascular mono-hemispheric lesion with transcranial magnetic stimulation (TMS) and applied TMS to diagnostic and prognostic use for the chronic stage of hemiparesis, as well as the acute stage after a stroke. The results demonstrated several specific patterns of motor-evoked potentials (MEP) in 19 stroke patients due to the excitability changes of motocortical areas that accompany the chronic recovery processes. Our results suggest that greater emphasis should be placed on handedness in determining the reorganization in the motocortical areas. Handedness may also prove useful when considering the specific training regimes during neuro-rehabilitation.

2907 Wallerian degeneration of the pyramidal tract does not affect functional outcome in chronic stroke

Koichi Ohara’ , Yasuo Suzuki1 , Norio Mori’ , Him-Din Xu2, Dong-Sheng Xu2, Kenshiro Ohara’ , Zu-Cheng Wang1 Anticipation, i.e., a decrease in the age of onset and/or an increase in the severity of a disease in subsequent generations, and imprinting, i.e., different modes of parental transmission, have been suggested in trinucleotide repeat (TNR) expansion diseases. The purpose of this study was to determine if anticipation and imprinting are associated with familial schizophrenia. We studied 49 schizophrenics from 24 families. The age of onset was significantly lower in the offspring generation. although there was no difference in the severity between the two generations. The mean negative symptom scores and clinical course scores in the offspring generation for paternal transmission were significantly higher than those for maternal transmission. Our results suggest the presence of anticipation and imprinting. Some families with schizophrenia may be included in TNR expansion diseases.