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Tanaka S.,National Institute for Physiological science | Tanaka S.,Tokyo Bay Rehabilitation Hospital | Tanaka S.,National Institute of Neuroscience | Takeda K.,ATR Computational Neuroscience Laboratories | And 12 more authors.
Neurorehabilitation and Neural Repair | Year: 2011

Background. Transcranial direct current stimulation (tDCS) of the motor cortex can enhance the performance of a paretic upper extremity after stroke. Reported effects on lower limb (LL) function are sparse. Objective. The authors examined whether tDCS can increase the force production of the paretic quadriceps. Methods. In this double-blind, crossover, sham-controlled experimental design, 8 participants with chronic subcortical stroke performed knee extension using their hemiparetic leg before, during, and after anodal or sham tDCS of the LL motor cortex representation in the affected hemisphere. Affected hand-grip force was also recorded. Results. The maximal knee-extension force increased by 21 N (13.2%, P <.01) during anodal tDCS compared with baseline and sham stimulation. The increase persisted less than 30 minutes. Maximal hand-grip force did not change. Conclusions. Anodal tDCS transiently enhanced knee extensor strength. The modest increase was specific to the LL. Thus, tDCS might augment the rehabilitation of stroke patients when combined with lower extremity strengthening or functional training. © The Author(s) 2011.


Takahashi M.,Terumo Corporation | Takeda K.,ATR Computational Neuroscience Laboratories | Takeda K.,National Hospital Organization | Otaka Y.,ATR Computational Neuroscience Laboratories | And 5 more authors.
Journal of NeuroEngineering and Rehabilitation | Year: 2012

Background: We developed an electroencephalogram-based brain computer interface system to modulate functional electrical stimulation (FES) to the affected tibialis anterior muscle in a stroke patient. The intensity of FES current increased in a stepwise manner when the event-related desynchronization (ERD) reflecting motor intent was continuously detected from the primary cortical motor area. Methods: We tested the feasibility of the ERD-modulated FES system in comparison with FES without ERD modulation. The stroke patient who presented with severe hemiparesis attempted to perform dorsiflexion of the paralyzed ankle during which FES was applied either with or without ERD modulation. Results: After 20 minutes of training, the range of movement at the ankle joint and the electromyography amplitude of the affected tibialis anterior muscle were significantly increased following the ERD-modulated FES compared with the FES alone. Conclusions: The proposed rehabilitation technique using ERD-modulated FES for stroke patients was feasible. The system holds potentials to improve the limb function and to benefit stroke patients. © 2012 Takahashi et al.; licensee BioMed Central Ltd.


PubMed | Ichikawa City Rehabilitation Hospital, Tokyo Bay Rehabilitation Hospital and Keio University
Type: Journal Article | Journal: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association | Year: 2016

To identify the predictors for the resumption of oral feeding at discharge among tube feeding-dependent stroke patients admitted to rehabilitation wards.This study was a retrospective analysis of 107 stroke patients (mean age, 72.1 years) dependent on tube feeds at admission to a rehabilitation ward. Data analyzed included demographic information, severity of impairments, functional independence, body mass index, nutritional and inflammatory laboratory markers at admission, and videofluoroscopic examination findings, if conducted. The variables were compared between the groups with and without resumption of oral intake. The predictive factors for resumption of oral intake were analyzed by using a stepwise multiple logistic regression model.At discharge, 69.2% (74 of 107) of the patients resumed oral intake. There were significant differences in age, the Functional Independence Measure, body mass index, serum albumin, C-reactive protein, white blood cell count, and duration of stroke onset at admission between the 2 groups. Multiple logistic regression analysis identified age (odds ratio [OR] .55; 95% confidence interval [CI] .31-.95), body mass index (OR 1.34; 95% CI 1.12-1.60), and white blood cell count (OR .76; 95% CI .60-.97) as significant predictors for the resumption of oral intake in these patients.Older age, lower body mass index, and higher white blood cell count were significant independent negative predictors for the resumption of oral feeding among stroke patients dependent on tube feeding at admission to rehabilitation wards.


Terada H.,Chiba University | Terada H.,Chiba Central Medical Center | Kurayama T.,Chiba University | Kurayama T.,Tokyo Bay Rehabilitation Hospital | And 3 more authors.
Neuroscience Letters | Year: 2015

Transcranial direct current stimulation (tDCS) has been reported to modify cortical function by inducing alterations in the underlying brain function. P50auditory evoked potentials, as assessed using a paired auditory stimulus (S1 and S2) paradigm, are thought to reflect a sensory gating process in which the functional involvement of the dorsolateral prefrontal cortex (DLPFC) is suggested. P50 sensory gating has also been reported to be associated with the pathogenesis of psychiatric diseases such as schizophrenia and anxiety-related disorders. Here we investigated whether the tDCS over the DLPFC could modulate the cortical function leading to alteration of the P50 sensory gating. P50 gating indices (the S2/S1 ratio and S1-S2 difference) were measured during the tDCS (current 1.0. mA, duration 15. min) over the DLPFC with different conditions (anodal, cathodal and sham). Ten male healthy volunteers were studied on separate days in a single blinded paradigm. We observed that the cathodaltDCS significantly altered the mean P50 gating indices compared to the other two conditions. Our results suggest that sensory gating could be modulated by cathodaltDCS on the left DLPFC but not by anodal/sham tDCS. © 2015 Published by Elsevier Ireland Ltd.


Osu R.,Japan Advanced Telecommunications Research Institute International | Ota K.,Keio University | Fujiwara T.,Keio University | Otaka Y.,Keio University | And 3 more authors.
Journal of NeuroEngineering and Rehabilitation | Year: 2011

Background: To more accurately evaluate rehabilitation outcomes in stroke patients, movement irregularities should be quantified. Previous work in stroke patients has revealed a reduction in the trajectory smoothness and segmentation of continuous movements. Clinically, the Stroke Impairment Assessment Set (SIAS) evaluates the clumsiness of arm movements using an ordinal scale based on the examiner's observations. In this study, we focused on three-dimensional curvature of hand trajectory to quantify movement, and aimed to establish a novel measurement that is independent of movement duration. We compared the proposed measurement with the SIAS score and the jerk measure representing temporal smoothness. Methods. Sixteen stroke patients with SIAS upper limb proximal motor function (Knee-Mouth test) scores ranging from 2 (incomplete performance) to 4 (mild clumsiness) were recruited. Nine healthy participant with a SIAS score of 5 (normal) also participated. Participants were asked to grasp a plastic glass and repetitively move it from the lap to the mouth and back at a conformable speed for 30 s, during which the hand movement was measured using OPTOTRAK. The position data was numerically differentiated and the three-dimensional curvature was computed. To compare against a previously proposed measure, the mean squared jerk normalized by its minimum value was computed. Age-matched healthy participants were instructed to move the glass at three different movement speeds. Results: There was an inverse relationship between the curvature of the movement trajectory and the patient's SIAS score. The median of the -log of curvature (MedianLC) correlated well with the SIAS score, upper extremity subsection of Fugl-Meyer Assessment, and the jerk measure in the paretic arm. When the healthy participants moved slowly, the increase in the jerk measure was comparable to the paretic movements with a SIAS score of 2 to 4, while the MedianLC was distinguishable from paretic movements. Conclusions: Measurement based on curvature was able to quantify movement irregularities and matched well with the examiner's observations. The results suggest that the quality of paretic movements is well characterized using spatial smoothness represented by curvature. The smaller computational costs associated with this measurement suggest that this method has potential clinical utility. © 2011 Osu et al; licensee BioMed Central Ltd.


Fujimoto S.,Tokyo Bay Rehabilitation Hospital | Yamaguchi T.,Tokyo Bay Rehabilitation Hospital | Yamaguchi T.,Keio University | Otaka Y.,Tokyo Bay Rehabilitation Hospital | And 3 more authors.
Clinical Neurophysiology | Year: 2014

Objective: The aim of this study was to test the hypothesis that dual-hemisphere transcranial direct current stimulation (tDCS) over the primary somatosensory cortex (S1) could improve performance in a tactile spatial discriminative task, compared with uni-hemisphere or sham tDCS. Methods: Nine healthy adults participated in this double-blind, sham-controlled, and cross-over design study. The performance in a grating orientation task (GOT) in the right index finger was evaluated before, during, immediately after and 30. min after the dual-hemisphere, uni-hemisphere (1. mA, 20. min), or sham tDCS (1. mA, 30. s) over S1. In the dual-hemisphere and sham conditions, anodal tDCS was applied over the left S1, and cathodal tDCS was applied over the right S1. In the uni-hemisphere condition, anodal tDCS was applied over the left S1, and cathodal tDCS was applied over the contralateral supraorbital front. Results: The percentage of correct responses on the GOT during dual-hemisphere tDCS was significantly higher than that in the uni-hemisphere or sham tDCS conditions when the grating width was set to 0.75. mm (all p<. 0.05). Conclusions: Dual-hemisphere tDCS over S1 improved performance in a tactile spatial discrimination task in healthy volunteers. Significance: Dual-hemisphere tDCS may be a useful strategy to improve sensory function in patients with sensory dysfunctions. © 2013 International Federation of Clinical Neurophysiology.


Otaka Y.,Tokyo Bay Rehabilitation Hospital
Clinical calcium | Year: 2010

Fall-related fracture in elderly is one of the big issues in our aging society. A major cause of fractures in elderly is fall. Therefore, the prevention of falls is essential for the prevention of fractures in elderly. Various risk factors of falls such as physical fragility, cognitive decline and visual problem have been reported. The effective way for prevention of falls is the modification of the risk factors for falls. Especially, exercise has been known effective. In addition to prevention of falls, we should explore the appropriate approach to modify fall direction, defensive reaction, local shock absorption, which are closely related to fall-related fracture risk.


Sato H.,Kitasato University | Ikura D.,Tokyo Bay Rehabilitation Hospital | Tsunoda M.,Shimada Ryoiku Center Hachioji
Disability and Rehabilitation: Assistive Technology | Year: 2015

Using two types of small, lightweight tri-axial accelerometers, we obtained evidence for the effectiveness of an approach for assessing head-trunk symmetrical or asymmetrical positions during sleep. First, we assessed the accuracy of our monitoring system in five healthy young adults (age range, 22-24 years). The participants wore acceleration monitors on the sternum and forehead; then spent 5 min in six different positions. Once accuracy was confirmed, we assessed head-trunk symmetry during night-time sleep in 10 healthy children (age range, 3-13 years) and 10 young adults (age range, 21-26 years) in their home environments. All participants wore the monitors during one night's sleep in their homes. After computing head-trunk positions using the orientation data obtained by the accelerometers, head and trunk symmetry were evaluated. The head and trunk positions were correctly detected: the positional data from the trunk had 99% agreement, and the data from the head had 96% agreement. Both the young adults and children were observed to spend time with the head-trunk in asymmetric positions; however, the subjects changed position frequently so the asymmetrical postures were mobile. We concluded that the proposed monitoring system is a reliable and valid approach for assessing head-trunk symmetry during sleep at home. © 2015 Informa UK Ltd.


Yamaguchi T.,Keio University | Yamaguchi T.,Japan Society for the Promotion of Science | Sugawara K.,Kanagawa University of Human Services | Tanaka S.,Nagoya Institute of Technology | And 5 more authors.
PLoS ONE | Year: 2012

While previous studies have assessed changes in corticospinal excitability following voluntary contraction coupled with electrical stimulation (ES), we sought to examine, for the first time in the field, real-time changes in corticospinal excitability. We monitored motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation and recorded the MEPs using a mechanomyogram, which is less susceptible to electrical artifacts. We assessed the MEPs at each level of muscle contraction of wrist flexion (0%, 5%, or 20% of maximum voluntary contraction) during voluntary wrist flexion (flexor carpi radialis (FCR) voluntary contraction), either with or without simultaneous low-frequency (10 Hz) ES of the median nerve that innervates the FCR. The stimulus intensity corresponded to 1.2× perception threshold. In the FCR, voluntary contraction with median nerve stimulation significantly increased corticospinal excitability compared with FCR voluntary contraction without median nerve stimulation (p<0.01). In addition, corticospinal excitability was significantly modulated by the level of FCR voluntary contraction. In contrast, in the extensor carpi radialis (ECR), FCR voluntary contraction with median nerve stimulation significantly decreased corticospinal excitability compared with FCR voluntary contraction without median nerve stimulation (p<0.05). Thus, median nerve stimulation during FCR voluntary contraction induces reciprocal changes in cortical excitability in agonist and antagonist muscles. Finally we also showed that even mental imagery of FCR voluntary contraction with median nerve stimulation induced the same reciprocal changes in cortical excitability in agonist and antagonist muscles. Our results support the use of voluntary contraction coupled with ES in neurorehabilitation therapy for patients. © 2012 Yamaguchi et al.


PubMed | Sakanoue Geka Hospital, Tokyo Bay Rehabilitation Hospital and Keio University
Type: Journal Article | Journal: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association | Year: 2016

Although genu recurvatum during walking is a well-known issue in stroke rehabilitation, there are no reliable epidemiological data on its prevalence. The aim of the study was to investigate the prevalence of genu recurvatum during walking and associated knee pain among ambulatory community-dwelling patients with chronic hemiplegic stroke.Questionnaires were sent to physical therapists working at 223 adult day care facilities in Chiba Prefecture, Japan. The number of all chronic stroke patients attending the day care who could walk without human assistance, including those who used a walking aid and/or an orthosis; the number of patients with genu recurvatum in the paretic limb during walking; and the number of patients with genu recurvatum who had experienced any knee pain in the last month were investigated. Physical therapists were also asked whether they considered genu recurvatum in stroke patients to be problematic.Sixty-four facilities (28.7%) responded, providing data on 1110 ambulatory stroke patients, of whom 217 (19.5%) showed genu recurvatum. Of the patients with genu recurvatum, 25 (11.5%) experienced knee pain in the paretic limb. Of 45 physical therapists who gave an opinion on whether genu recurvatum was problematic, 26 (57.8%) thought it was problematic whereas 19 thought it was not problematic.Rates of genu recurvatum and associated knee pain were relatively low among ambulatory community-dwelling stroke survivors attending adult day care.

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