[Management of secondary normal pressure hydrocephalus and assessment of cortical reorganization using fMRI].

We assessed the motor recovery and cortical reorganization associated with intracranial pressure (ICP) control in a secondary normal pressure hydrocephalus (sNPH) patient. A 32-year-old man with sNPH resulting from a head injury presented with left hemiplegia. A ventricular-peritoneum shunt (VP shunt) was surgically inserted for the sNPH using a Codman Hakim Programmable Valve, and his ICP was controlled according to the ventricular size by CT scanning. The motor function of the patient was evaluated by functional MRI (fMRI) during ICP control in our hospital. The fMRI was performed at 3.0 T with timed dorsal flexion-extension movement of the foot. After 3 months of shunt valve pressure control, the primary sensorimotor cortex (SM1) was activated during the affected (left) foot movement, an area that had not been able to be activated just after admission. His walking ability also recovered markedly to the point of free independent walking. The motor function of the affected lower extremity appeared to recover to almost the some degree the original motor area after control of the ICP. This finding may reflect functional reorganization of the motor pathway following ICP normalization.

[Review of the approach to exercise behavior modification from the viewpoint of preventive medicine].

The purpose of this study was to summarize the approaches to behavior modification for exercise from the viewpoint of preventive medicine. Articles were searched according to the particular field of preventive medicine, i.e., primary prevention, secondary prevention, tertiary prevention, and other fields of prevention. In the field of primary prevention for elderly people living at home, many fall prevention programs were found to have been carried out. In these studies, various programs were found to be effective if the exercise proved to be sufficient. Although some approaches were observed to be based on the productive aging theory and social capital, the number of such studies was small. In the field of secondary prevention, illness and functional disorders are prevented from becoming worse. It is therefore important for each individual to exercise by himself/herself and also acquire sufficient self-monitoring skills. Social capital is useful for learning good exercise habits. In the field of tertiary prevention, although exercise therapy is effective for improving physical functions and preventing disease recurrence in patients with chronic disease, some patients nevertheless find it difficult to continue such an exercise therapy. The approaches to behavior modification were extremely effective for patients with chronic disease. In other fields of preventive medicine, daily exercises such stair climbing are effective methods for reducing the risk of chronic disease and such a behavior modification may lead to a considerable public health gain. In the future, further studies with a many lines of evidence should be performed, and approaches based on behavioral science should be established.