Effects of robot-assisted gait training on cardiopulmonary fitness in subacute stroke patients: a randomized controlled study.

BACKGROUND: . Robot-assisted gait training has the potential to improve cardiopulmonary fitness after stroke, even for patients who are in the early stages of recovery and not independent ambulators. The authors compared the effects of robot-assisted gait training and conventional physical therapy on cardiopulmonary fitness. METHODS: . A prospective single-blinded, randomized controlled study of 37 patients receiving inpatient rehabilitation was performed within 1 month after stroke onset. The robot-assisted gait training group (n = 20) received 40 minutes of gait training with Lokomat and 60 minutes of conventional physical therapy each day, whereas the control group (n = 17) received 100 minutes of conventional physical therapy daily. Using a semirecumbent cycle ergometer, changes in cardiopulmonary fitness were investigated using incremental exercise testing. Motor and gait functional recovery was measured according to changes in the lower-extremity score of the Fugl-Meyer Assessment Scale (FMA-L), leg score of the Motricity Index (MI-L), and the Functional Ambulation Category (FAC). RESULTS: . Compared with the control group, the robot group showed 12.8% improvement in peak VO(2) after training (P < .05). Compared with the control group, the robot group also improved in FMA-L score (P < .05). CONCLUSION: . Patients can be trained to increase their VO(2) and lower-extremity strength using a robotic device for stepping during inpatient rehabilitation. This training has the potential to improve cardiopulmonary fitness in patients who are not yet independent ambulators, but that may require more than 2 weeks of continued, progressive training.

Neural correlates of donepezil-induced cognitive improvement in patients with right hemisphere stroke: a pilot study.

Donepezil has been proven effective in the treatment of Alzheimer's disease and vascular dementia. However, its effects on the cognitive neural network have not been fully investigated. The purpose of this study was to evaluate the effect of donepezil on reorganisation of the cognitive neural network in patients with post-stroke cognitive impairment using functional MRI (fMRI). Fourteen patients with stroke in the right hemisphere were enrolled. Participants were randomly assigned to the experimental or the control group. Donepezil (5 mg) or placebo was administered daily for four weeks. Cognitive function assessment was performed before and immediately after treatment, and repeated one month after cessation of treatment. fMRI was performed before and after treatment. Ten out of 14 patients (six in the experimental group, four in the control group) successfully completed all experimental processes. The experimental group showed significant improvements in the Mini-Mental Status Examination during the post-treatment evaluation and one-month follow-up compared to the pre-treatment evaluation (p < .05). No improvement was observed in the control group. In the experimental group fMRI showed increased activation in both prefrontal areas, both inferior frontal lobes, and in the left inferior parietal lobe. Increased recruitment of the parieto-frontal networks in the selected patients was considered to be a neural correlate of cognitive improvement induced by donepezil.

Defining physiatry and future scope of rehabilitation medicine.

To identify the 'physiatry' in a single word is difficult. This may be due that physiatry originated from two different fields, physical medicine and rehabilitation and focuses on assisting the general improvement of functional recovery in disabled patients. In addition, physiatry has new markets to develop; health and welfare. Therefore, the identity of physiatry will change depending on how physiatrists act in these fields. We attempt to define the physiatry from several aspects.

Long-term effects of rTMS on motor recovery in patients after subacute stroke.

OBJECTIVE: Repetitive transcranial magnetic stimulation (rTMS) has been recognized as a promising intervention for treatment of stroke patients. However, most previous reports have described the short-term effects of rTMS on motor performance. We conducted a sham-controlled trial to evaluate long-term effects of high-frequency rTMS on motor recovery in subacute stroke patients. METHODS: Twenty-eight patients were randomly divided into two groups, and received either real or control rTMS. Both treatments were accompanied by motor practice. A daily dose of 1000 pulses of subthreshold 10 Hz rTMS was applied over the primary motor cortex of the affected hemisphere for 10 days within one month after onset of stroke. Motor function was assessed before and after treatment, and 3 months after the stroke. RESULTS: Motor function improved in both groups after treatment; however, patients who received real rTMS experienced additional improvement in motor function of the affected upper limb. Over 3 months after the stroke, the time and type of intervention for the Motoricity Index of the affected upper extremity showed significant interaction. CONCLUSION: Positive long-term effects on motor recovery could be achieved after 10 daily sessions of high-frequency rTMS in conjunction with motor practice during the sub-acute period of stroke.

Facilitating visuospatial attention for the contralateral hemifield by repetitive TMS on the posterior parietal cortex.

Previous studies have demonstrated that repetitive transcranial magnetic stimulation (rTMS) could modulate the visuospatial functions. In this study, we investigated the effect of off-line high frequency subthreshold rTMS, when applied over the right or left posterior parietal cortex (PPC), on the visuospatial attention of the bilateral hemispaces. The subjects underwent visuospatial tasks before and immediately after receiving 1000 pulses of 10 Hz rTMS for a period of 20 min, and their responses were recorded. Our results demonstrated that the high frequency rTMS applied over the PPC produced facilitative effects on the visuospatial attention to the contralateral hemispace. The inhibitory effect to the ipsilateral hemispace was noticeable only in the left PPC.

Facilitative effect of high frequency subthreshold repetitive transcranial magnetic stimulation on complex sequential motor learning in humans.

We investigated the effect of repetitive transcranial magnetic stimulation (rTMS) applied to the motor cortex, on the motor learning of sequential finger movements. Fifteen healthy subjects were trained to perform seven sequential finger movements of the left hand. Ten Hertz or sham rTMS with a resting motor threshold of 80% was applied to each subject during the task period. Stimulation with 10Hz rTMS produced a better learning performance in terms of target score and execution time than sham stimulation. We conclude that high-frequency rTMS may modulate the excitability of the motor cortex and facilitate the sequential motor learning process in normal subjects. These findings may provide a basis for the development of therapeutic applications of rTMS in patients with impaired motor skill.

Plastic changes of motor network after constraint-induced movement therapy.

The effects of short-term constraint-induced movement (CIM) therapy on the activation of the motor network were investigated with functional magnetic resonance imaging (fMRI). Movement of the less-affected arms of five patients was restricted and intensive training of the affected upper limb was performed. Functional MRI was acquired before and after two-weeks of CIM therapy. All patients showed significant improvement of motor function in their paretic limbs after CIM therapy. For three patients, new activation in the contralateral motor/premotor cortices was observed after CIM therapy. Increased activation of the ipsilateral motor cortex and SMA was observed in the other patient. Our results demonstrated that plastic changes of the motor network occurred as a neural basis of the improvement subsequent to CIM therapy following brain injury.

Effect of muscle activity and botulinum toxin dilution volume on muscle paralysis.

The purpose of this study was to evaluate the effects of botulinum toxin A (BTX-A, Botox) dilution volume and post-injection exercise with electrical stimulation on muscle paralysis. We injected 10 units of BTX-A diluted with 0.1 ml (B1, n=8) or 0.5 ml (B5, n=8) normal saline into both gastrocnemius muscles of 16 New Zealand white rabbits; two controls received no BTX-A. After BTX-A injection, all rabbits received calf muscle stretching exercise and electrical stimulation for 2 hours on the left leg. The compound muscle action potential (CMAP) decrease was most pronounced at 1 week and progressive recovery was observed (i.e. recovery from paralysis, increase of CMAP). There was a significant decrease of CMAP amplitudes in the B5 group compared with the B1 group at week 1 and week 4 (p<0.001). Left limbs with stretching exercise and electrical stimulation showed lower CMAP amplitudes compared with control right limbs of all rabbits. To maximize the muscle paralysis effect of BTX-A, increasing dilution volume and performing post-injection stretching exercise with electrical stimulation may be a promising strategy for increasing the beneficial effect of BTX-A treatment. Future studies are needed to investigate the clinical application of this finding.

Localization of the motor nerve branches and motor points of the triceps surae muscles in korean cadavers.

OBJECTIVE: To identify the precise locations of the muscular branches (MBs) and motor points (MPs) of triceps surae muscles in relation to the bony landmarks. DESIGN: Thirty-six limbs from 22 adult cadavers were anatomically dissected. The location and the number of MPs and MBs from the tibial nerve to the triceps surae muscles were defined relative to four bony landmarks. Locations of the MBs and the MPs were expressed as a percentage of the lower leg length and the percentage of the lower leg width. RESULTS: One MB was identified from the posterior tibial nerve to the soleus muscle, one or two branches to the medial gastrocnemius muscle, and up to four branches to the lateral gastrocnemius muscle. One to four MPs were identified in the triceps surae muscles. CONCLUSION: Estimation of the locations of the MBs and the MPs, when combined with our anthropometric observations, could increase the ease and accuracy with which MB or MP blocks can be applied to the triceps surae muscles.