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Miyai I.,Neurorehabilitation Research Institute
Clinical Neurology | Year: 2013

It remains to be elucidated whether there is a use- or dose-dependent effect of rehabilitative intervention on impairment and disability of spinocerebellar degeneration since the disease progressively damages cerebellar structure that plays a crucial role in motor learning. Moreover there is a trade-off between functional improvement after rehabilitation and functional deterioration due to disease progression. Recent clinical trials from Germany and Japan have demonstrated that comprehensive intensive rehabilitation focusing on balance function have immediate and lasting effect up to 1 year on ataxia and gait disorder in patients with spinocerebellar degeneration. For sustained gain after the intensive rehabilitation, customized attempts to boost patients' daily activities according to their ability appears to be important. Source

Ilg W.,Hertie Institute for Clinical Brain Research | Bastian A.J.,Kennedy Krieger Institute | Boesch S.,Innsbruck Medical University | Burciu R.G.,University of Duisburg - Essen | And 14 more authors.
Cerebellum | Year: 2014

Treatment of motor symptoms of degenerative cerebellar ataxia remains difficult. Yet there are recent developments that are likely to lead to significant improvements in the future. Most desirable would be a causative treatment of the underlying cerebellar disease. This is currently available only for a very small subset of cerebellar ataxias with known metabolic dysfunction. However, increasing knowledge of the pathophysiology of hereditary ataxia should lead to an increasing number of medically sensible drug trials. In this paper, data from recent drug trials in patients with recessive and dominant cerebellar ataxias will be summarized. There is consensus that up to date, no medication has been proven effective. Aminopyridines and acetazolamide are the only exception, which are beneficial in patients with episodic ataxia type 2. Aminopyridines are also effective in a subset of patients presenting with downbeat nystagmus. As such, all authors agreed that the mainstays of treatment of degenerative cerebellar ataxia are currently physiotherapy, occupational therapy, and speech therapy. For many years, well-controlled rehabilitation studies in patients with cerebellar ataxia were lacking. Data of recently published studies show that coordinative training improves motor function in both adult and juvenile patients with cerebellar degeneration. Given the well-known contribution of the cerebellum to motor learning, possible mechanisms underlying improvement will be outlined. There is consensus that evidence-based guidelines for the physiotherapy of degenerative cerebellar ataxia need to be developed. Future developments in physiotherapeutical interventions will be discussed including application of non-invasive brain stimulation. © 2013 Springer Science+Business Media. Source

Miyai I.,Annual Survey Committee | Miyai I.,Neurorehabilitation Research Institute | Sonoda S.,Annual Survey Committee | Sonoda S.,Mie University | And 7 more authors.
Neurorehabilitation and Neural Repair | Year: 2011

Background. A new interdisciplinary postacute rehabilitation unit, the Kaifukuki (convalescent) rehabilitation ward (KRW), has been incorporated into the Japanese medical insurance system since 2000. More than 57 000 beds (45 beds per 100 000 population) are currently available nationwide. The maximal coverage for therapy sessions increased from 2 to 3 hours per day, 7 days a week, in 2006. Objective. To investigate how changes in policy affected rehabilitation outcomes of KRWs in a retrospective cohort study of 87 917 patients over 10 years. Results. The mean (standard deviation) age of the patients was 73.0 (13.8) years, and 55.4% were women. Diagnoses included stroke (47.9%); orthopedic diseases, including hip fracture (35.2%); and traumatic brain and spinal cord injury (5.4 %). Onset-admission interval (OAI) was 31.5 (18.6) days, length of stay was 75.9 (46.1) days, and 69.1% were discharged home. Daily therapy time was 79.4 (34.5) minutes. Admission/discharge scores of the Barthel Index and the Functional Independence Measure were 49.3 (31.0)/70.4 (31.9) and 75.3 (31.2)/91.7 (31.8), respectively. Year-by-year comparison revealed that older age, greater initial disability, and shorter OAI were coupled with a higher dose of rehabilitative interventions and a higher rate of home discharge. Longitudinal data from a cohort of hospitals implied a small but significant dose-dependent effect of hours of therapy on rehabilitation outcome after stroke. Conclusions. Although the organization of KRWs is in flux as the system of hospitals grows, results over the past 8 years suggest that changes in national insurance policies are affecting the quantity and organization of rehabilitation interventions and improvement in patient outcomes. © The Author(s) 2011. Source

Miyai I.,Neurorehabilitation Research Institute
Cerebellum | Year: 2012

Cerebellar Ataxia Rehabilitation trial tested if intensive rehabilitation improved ataxia, gait, and activities of daily living (ADLs) in 42 patients with degenerative cerebellar diseases. They were randomly assigned to the immediate intervention group or the delayed-entry control group. The immediate group received 1 h physical and 1 h occupational therapy for 4 weeks and delayed-entry control group received the same intervention after 4-week delay. The immediate group showed significantly greater functional gains in ataxia, gait speed, and ADLs than control. The improvements in ataxia and gait speed were sustained at 12 and 24 weeks after the intervention, respectively. Further strategies inducing meaningful gains for a longer period should be investigated. ©Springer Science+Business Media, LLC 2011. Source

Mihara M.,Neurorehabilitation Research Institute
Clinical Neurology | Year: 2011

Recent advance in Brain-Machine interface (BMI) technology, including analysis of brain signal, enable a real-time interaction between patients and environment bypassing their damaged neuromuscular systems. Although most of researches have focused on substituting output function, it has been growing interest in applying this technology for restoring their brain. Several studies have proved that feedback of cortical activities (neurofeedback) enable regulating brain activation voluntarily. According to this notion, we have developed a real-time neurofeedback system mediated by near-infrared spectroscopy (NIRS) as a neurofeedback tool in neurorehabilitation. First, we have evaluated whether real-time cortical oxygenated hemoglobin (OxyHb) feedback signals correlated with reference OxyHb signals analyzed off-line during a motor execution task. Our results showed high correlation between results from two analyses. Second, we investigated whether the self-assessment scores for kinesthetic motor imagery and motor imagery related cortical activation was enhanced by neurofeedback. Our experiment with right handed healthy subjects revealed significant improvement of the imagery scale, and enhanced cortical activations including the contralateral premotor area. These results suggest that the neurofeedback technique may improve the efficacy of mental practice with motor imagery. Source

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