論文 - 里宇　明元

Individual difference in b-band corticomuscular coherence and its relation to force steadiness during isometric voluntary ankle dorsiflexion in healthy humans.

里宇 明元

Clinical Neurophysiology 128   303 - 311 2017年

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Transcranial direct current stimulation improves audioverbal memory in stroke patients.

里宇 明元

Am J Phys Med Rehabil 96 （ 8 ） 565 - 571 2017年

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Nitrogen balance in patients with hemiparetic stroke during the subacute rehabilitation phase.

里宇 明元

J Human Nutrition and Dietetics 30 （ 3 ） 302 - 308 2017年

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A comparison of swallowing dysfunction in Becker muscular dystrophy and Duchenne muscular dystrophy

里宇 明元

Disability and Rehabilitation （Disability and Rehabilitation）  40 （ 12 ） 1421 - 1425 2017年

共著,  ISSN  09638288

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© 2017 Informa UK Limited, trading as Taylor & Francis Group. Purpose: Swallowing dysfunction has been reported in Duchenne muscular dystrophy (DMD), but has not been studied in Becker muscular dystrophy (BMD). The aims of this study were to report the characteristics of swallowing dysfunction in BMD compared with DMD. Materials and methods: The study participants were 18 patients with BMD and 18 patients with DMD. All the patients were examined using videofluorography during swallowing of 5 mL of fluid. The penetration–aspiration scale (P–A scale) and the videofluorographic dysphagia scale (VDS) were used to evaluate dysphagia. Results: Swinyard functional ability stage was not significantly different between the BMD and DMD groups. Rate of aspiration, P–A scale score, and total VDS score did not differ across groups, but the VDS item score for laryngeal elevation was lower in the BMD group than in the DMD group (median scores 4.5 and 9, respectively; p < 0.001). In the BMD group, total VDS score significantly correlated with Swinyard stage (r = 0.78, p < 0.001), but not with age or lung function. Conclusion: Patients with BMD have swallowing problems similar to those observed in patients with DMD when matched according to physical functional status. These patients should be evaluated and followed-up for the duration of their disease. Implications for rehabiliation Dysphagia is one of the most critical problems in patients with progressive neuromuscular disease but dysphagia in patients with Becker muscular dystrophy (BMD) was not well known. Eighteen patients with BMD and 18 patients with Duchenne muscular dystrophy were examined with videofluorography. Patients with BMD have swallowing problems similar to those observed in patients with DMD.

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Contribution of propriospinal neurons to recovery of hand dexterity after corticospinal tract lesions in monkeys.

里宇 明元

Proceedings of the National Academy of Sciences 114 （ 3 ） 604 - 609 2017年

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Swallowing dysfunction and postoperative pneumonia in elderly patients undergoing transcatheter aortic valve implantation: a preliminary prospective cohort study.

里宇 明元

Top in Geriat Rehabil 32 （ 2 ） 114 - 118 2016年

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The effects of anodal transcranial direct current stimulation and patterned electrical stimulation on spinal inhibitory interneurons and motor function in patients with spinal cord injury.

里宇 明元

Exp Brain Res 120   1 - 10 2016年

A new therapeutic application of brain-machine interface (BMI) training followed by hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy for patients with severe hemiparetic stroke

里宇 明元

Restor Neurol Neurosci 34 （ 5 ） 789 - 797 2016年

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Investigating the course and predictors of desire to void after stroke with the new desire to void scale: A prospective cohort study.

里宇 明元

Brain Impairment 17 （ 2 ） 162 - 170 2016年

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BDNF Induced by Treadmill Training Contributes to the Suppression of Spasticity and Allodynia After Spinal Cord Injury via Upregulation of KCC2

Tashiro Syoichi, Shinozaki Munehisa, Mukaino Masahiko, Renault-Mihara François, Toyama Yoshiaki, Liu Meigen, Nakamura Masaya, Okano Hideyuki

Neurorehabilitation and Neural Repair 29 （ 7 ） 677 - 689 2015年08月

ISSN  1545-9683

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<p>Background. Spasticity and allodynia are major sequelae that affect the quality of life and daily activities of spinal cord injury (SCI) patients. Although rehabilitation ameliorates spasticity and allodynia, the molecular mechanisms involved in these processes remain elusive. Objective. To investigate the molecular mechanisms by which rehabilitation ameliorates spasticity and allodynia after SCI in rats. Methods. The expression levels of brain-derived neurotrophic factor (BDNF) and potassium-chloride cotransporter-2 (KCC2), as well as the localization of KCC2, were examined in the lumbar enlargements of untrained and treadmill-trained thoracic SCI model rats. Spasticity and allodynia were determined via behavioral and electrophysiological analyses. The effects of BDNF on spasticity, allodynia, and KCC2 activation were determined by inhibition of BDNF signaling via intrathecal administration of TrkB-IgG. The effects of SCI and training on the expression levels of functional phospholipase C-γ in the lumbar enlargement were also examined. Results. Treadmill training after SCI upregulated endogenous BDNF expression and posttranslational modification of KCC2 in the lumbar enlargement significantly. There were also significant correlations between increased KCC2 expression and ameliorated spasticity and allodynia. Administration of TrkB-IgG abrogated the training-induced upregulation of KCC2 and beneficial effects on spasticity and allodynia. The expression level of functional phospholipase C-γ was reduced significantly after SCI, which may have contributed to the change in the function of BDNF, whereby it did not trigger short-term downregulation or induce long-term upregulation of KCC2 expression secondary to training. Conclusions. BDNF-mediated restoration of KCC2 expression underlies the suppression of spasticity and allodynia caused by rehabilitation.</p>

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Clinical usefulness and validity of robotic measures of reaching movement in hemiparetic stroke patients

Otaka Eri, Otaka Yohei, Kasuga Shoko, Nishimoto Atsuko, Yamazaki Kotaro, Kawakami Michiyuki, Ushiba Junichi, Liu Meigen

Journal of NeuroEngineering and Rehabilitation 12 （ 1 ） 1 - 10 2015年08月

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<p>Abstract Background: Various robotic technologies have been developed recently for objective and quantitative assessment of movement. Among them, robotic measures derived from a reaching task in the KINARM Exoskeleton device are characterized by their potential to reveal underlying motor control in reaching movements. The aim of this study was to examine the clinical usefulness and validity of these robot-derived measures in hemiparetic stroke patients. Methods: Fifty-six participants with a hemiparetic arm due to chronic stroke were enrolled. The robotic assessment was performed using the Visually Guided Reaching (VGR) task in the KINARM Exoskeleton, which allows free arm movements in the horizontal plane. Twelve parameters were derived based on motor control theory. The following clinical assessments were also administered: the proximal upper limb section in the Fugl-Meyer Assessment (FMA-UE(A)), the proximal upper limb part in the Stroke Impairment Assessment Set (SIAS-KM), the Modified Ashworth Scale for the affected elbow flexor muscles (MAS elbow), and seven proximal upper limb tasks in the Wolf Motor Function Test (WMFT). To explore which robotic measures represent deficits of motor control in the affected arm, the VGR parameters in the paretic arm were compared with those in the non-paretic arm using the Wilcoxon signed rank test. Then, to explore which VGR parameters were related to overall motor control regardless of the paresis, correlations between the paretic and non-paretic arms were examined. Finally, to investigate the relationships between the robotic measures and the clinical scales, correlations between the VGR parameters and clinical scales were investigated. Spearman's rank correlation coefficients were used for all correlational analyses. Results: Eleven VGR parameters on the paretic side were significantly different from those on the non-paretic side with large effect sizes (|effect size| = 0.76-0.87). Ten VGR parameters correlated significantly with FMA-UE(A) (|r| = 0.32-0.60). Eight VGR parameters also showed significant correlations with SIAS-KM (|r| = 0.42-0.49), MAS elbow (|r| = 0.44-0.48), and the Functional Ability Scale of the WMFT (|r| = 0.52-0.64). Conclusions: The robot-derived measures could successfully differentiate between the paretic arm and the non-paretic arm and were valid in comparison to the well-established clinical scales.</p>

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Transcranial direct current stimulation enhances mu rhythm desynchronization during motor imagery that depends on handedness

Kasuga Shoko, Matsushika Yayoi, Kasashima-Shindo Yuko, Kamatani Daiki, Fujiwara Toshiyuki, Liu Meigen, Ushiba Junichi

Laterality 20 （ 4 ） 453 - 468 2015年07月

ISSN  1357-650X

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<p>Transcranial direct current stimulation (tDCS) can modulate the amplitude of event-related desynchronization (ERD) that appears on the electroencephalogram (EEG) during motor imagery. To study the effect of handedness on the modulating effect of tDCS, we compared the difference in tDCS-boosted ERD during dominant and non-dominant hand motor imagery. EEGs were recorded over the left sensorimotor cortex of seven healthy right-handed volunteers, and we measured ERD induced either by dominant or non-dominant hand motor imagery. Ten minutes of anodal tDCS was then used to increase the cortical excitability of the contralateral primary motor cortex (M1), and ERD was measured again. With anodal tDCS, we observed only a small increase in ERD during non-dominant hand motor imagery, whereas the same stimulation induced a prominent increase in ERD during dominant hand motor imagery. This trend was most obvious in the participants who used their dominant hand more frequently. Although our study is preliminary because of a small sample size, these results suggest that the increase in ERD by applying anodal tDCS was stronger on the dominant side than on the non-dominant side. The background excitability of M1 may determine the strength of the effect of anodal tDCS on ERD by hand motor imagery.</p>

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Spatial and temporal dynamics of visual search tasks distinguish subtypes of unilateral spatial neglect

Mizuno Katsuhiro, Kato Kenji, Tsuji Tetsuya, Shindo Keiichiro, Kobayashi Yukiko, Liu Meigen

Neuropsychological Rehabilitation 2015年06月

ISSN  0960-2011

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<p>We developed a computerised test to evaluate unilateral spatial neglect (USN) using a touchscreen display, and estimated the spatial and temporal patterns of visual search in USN patients. The results between a viewer-centered USN patient and a stimulus-centered USN patient were compared. Two right-brain-damaged patients with USN, a patient without USN, and 16 healthy subjects performed a simple cancellation test, the circle test, a visuomotor search test, and a visual search test. According to the results of the circle test, one USN patient had stimulus-centered neglect and a one had viewer-centered neglect. The spatial and temporal patterns of these two USN patients were compared. The spatial and temporal patterns of cancellation were different in the stimulus-centered USN patient and the viewer-centered USN patient. The viewer-centered USN patient completed the simple cancellation task, but paused when transferring from the right side to the left side of the display. Unexpectedly, this patient did not exhibit rightward attention bias on the visuomotor and visual search tests, but the stimulus-centered USN patient did. The computer-based assessment system provided information on the dynamic visual search strategy of patients with USN. The spatial and temporal pattern of cancellation and visual search were different across the two patients with different subtypes of neglect.</p>

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Sensorimotor event-related desynchronization represents the excitability of human spinal motoneurons

Takemi M., Masakado Y., Liu M., Ushiba J.

Neuroscience 297   58 - 67 2015年06月

ISSN  0306-4522

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<p>Amplitudes of mu and beta (7-26. Hz) oscillations measured by electroencephalography over the sensorimotor areas are suppressed during motor imagery as well as during voluntary movements. This phenomenon is referred to as event-related desynchronization (ERD) and is known to reflect motor cortical excitability. The increased motor cortical excitability associated with ERD during hand motor imagery would induce a descending cortical volley to spinal motoneurons, resulting in facilitation of spinal motoneuronal excitability. Therefore, in the present study, we tested the association of ERD during motor imagery with the excitability of spinal motoneurons in 15 healthy participants. Spinal excitability was tested using the F-wave recorded from the right abductor pollicis brevis muscle. The F-wave results from antidromic activation of spinal motoneurons and is induced by peripheral nerve stimulation. Participants performed 5. s of motor imagery of right thumb abduction following 7. s of rest. The right median nerve was stimulated at wrist level when the ERD magnitude of the contralateral hand sensorimotor area exceeded predetermined thresholds during motor imagery. The results showed ERD magnitude during hand motor imagery was associated with an increase in F-wave persistence, but not with the response average of F-wave amplitude or F-wave latency. These findings suggest that the ERD magnitude may be a biomarker representing increases in the excitability of both cortical and spinal levels.</p>

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Psychometric properties of the simple test for evaluating hand function in patients with stroke

Shindo Keiichiro, Oba Hideki, Hara Joji, Ito Mari, Hotta Fujiko, Liu Meigen

Brain Injury 29 （ 6 ） 772 - 776 2015年06月

ISSN  0269-9052

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<p>Objective: The simple test for evaluating hand function (STEF) is widely used for clinical evaluation of upper extremity function in Japan. However, except for test-re-test reliability, its psychometric properties have not been investigated. The aim of this study is to explore its internal consistency, concurrent validity and responsiveness in patients with sub-acute stroke. Design: This was a prospective longitudinal study. Patients: Thirty-four inpatients who had suffered hemiparetic stroke within 60 days of participation were enrolled. Methods: To investigate its internal consistency and responsiveness, they were assessed with the STEF and Action Research Arm Test (ARAT) at admission and 3 weeks later. To explore its concurrent validity, the Fugl-Meyer Assessment (FMA), Motor Activity Log (MAL) and Functional Independence Measure (FIM™) were also evaluated at admission. Results: The Cronbach's alpha for the STEF was 0.98-0.99, indicating excellent internal consistency. The STEF score strongly correlated with the ARAT, FMA and MAL scores and moderately with the FIM™ score. Effect sizes and the standardized response mean were 0.27 and 0.52 for the STEF and 0.30 and 0.95 for the ARAT, respectively. Conclusion: This study indicates that the STEF is reliable, valid and sensitive to changes when applied to patients with sub-acute stroke.</p>

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Resting energy expenditure in patients with stroke during the subacute phases - Relationships with stroke types, location, severity of paresis, and activities of daily living

Kawakami Michiyuki, Liu Meigen, Wada Ayako, Otsuka Tomoyoshi, Nishimura Atsuko

Cerebrovascular Diseases 39 （ 3-4 ） 170 - 175 2015年05月

ISSN  1015-9770

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<p>Background: The energy demands in patients with stroke during the subacute phases are unclear. However, this information is essential for appropriate clinical and nutritional management. The aims of this study were to determine the resting energy expenditure (REE) during the subacute phases, examine its relationships with stroke types, location, severity of hemiparesis, and activities of daily living (ADL), and evaluate whether estimation of REE from the Harris-Benedict equation (HB) requires the addition of a 'stress factor' to capture possible additional REE imposed by stroke. Methods: We measured REE in 95 patients with subacute stroke (53.5 ± 16.6 days post-stroke) with indirect calorimetry, and compared it with predicted values of energy expenditure estimated from the HB (expressed as percentage). Patients were admitted for rehabilitation of their first ischemic or nonsurgical hemorrhagic stroke. The severity of hemiparesis was assessed with the motor items of the Stroke Impairment Assessment Set (SIAS). The ADL was assessed with the Functional Independence Measure (FIM). We compared REE and %HB of the two groups divided by hemiparesis severity and ADL limitation using the Student's t-test, and those of the five groups divided by stroke location. The correlations between REE and the motor items of the SIAS and the FIM score were assessed with the Spearman rank correlation test. A multiple regression analysis for REE was conducted. Results: The average body weight (BW) was 57.1 ± 11.3 kg. The average body mass index (BMI) was 22.5 ± 4.0. The mean REE (%HB) was 1,271 ± 284 kcal/day (106.0 ± 17.3%). REE and %HB of the low ADL group was less than that of the high ADL group (p &lt; 0.05). The REE had a positive correlation with the FIM score (rs = 0.51, p &lt; 0.01). The motor items of the SIAS were not significantly correlated with REE. BW, FIM, and stroke location were independent predictors of REE. Conclusions: Analysis of energy expenditure suggests that stroke patients are not hypermetabolic during the subacute phase. The 'stress factor' in stroke patients during the subacute phase was 1.0-1.1. This finding provides important information for improving nutritional management during the subacute phase in patients with stroke.</p>

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Alteration of a motor learning rule under mirror-reversal transformation does not depend on the amplitude of visual error

Kasuga Shoko, Kurata Makiko, Liu Meigen, Ushiba Junichi

Neuroscience Research 94   62 - 69 2015年05月

ISSN  0168-0102

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<p>Human's sophisticated motor learning system paradoxically interferes with motor performance when visual information is mirror-reversed (MR), because normal movement error correction further aggravates the error. This error-increasing mechanism makes performing even a simple reaching task difficult, but is overcome by alterations in the error correction rule during the trials. To isolate factors that trigger learners to change the error correction rule, we manipulated the gain of visual angular errors when participants made arm-reaching movements with mirror-reversed visual feedback, and compared the rule alteration timing between groups with normal or reduced gain. Trial-by-trial changes in the visual angular error was tracked to explain the timing of the change in the error correction rule. Under both gain conditions, visual angular errors increased under the MR transformation, and suddenly decreased after 3-5 trials with increase. The increase became degressive at different amplitude between the two groups, nearly proportional to the visual gain. The findings suggest that the alteration of the error-correction rule is not dependent on the amplitude of visual angular errors, and possibly determined by the number of trials over which the errors increased or statistical property of the environment. The current results encourage future intensive studies focusing on the exact rule-change mechanism.</p>

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Brain-computer interface training combined with transcranial direct current stimulation in patients with chronic severe hemiparesis

Kasashima-Shindo Yuko, Fujiwara Toshiyuki, Ushiba Junichi, Matsushika Yayoi, Kamatani Daiki, Oto Misa, Ono Takashi, Nishimoto Atsuko, Shindo Keiichiro, Kawakami Michiyuki, Tsuji Tetsuya, Liu Meigen

Journal of Rehabilitation Medicine 47 （ 4 ） 318 - 324 2015年04月

ISSN  1650-1977

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<p>Objective: Brain-computer interface technology has been applied to stroke patients to improve their motor function. Event-related desynchronization during motor imagery, which is used as a brain-computer interface trigger, is sometimes difficult to detect in stroke patients. Anodal transcranial direct current stimulation (tDCS) is known to increase event-related desynchronization. This study investigated the adjunctive effect of anodal tDCS for brain-computer interface training in patients with severe hemiparesis. Subjects: Eighteen patients with chronic stroke. Design: A non-randomized controlled study. Methods: Subjects were divided between a brain-computer interface group and a tDCS-brain-computer interface group and participated in a 10-day brain-computer interface training. Event-related desynchronization was detected in the affected hemisphere during motor imagery of the affected fingers. The tDCS-brain-computer interface group received anodal tDCS before brain-computer interface training. Event-related desynchronization was evaluated before and after the intervention. The Fugl-Meyer Assessment upper extremity motor score (FM-U) was assessed before, immediately after, and 3 months after, the intervention. Results: Event-related desynchronization was significantly increased in the tDCS-brain-computer interface group. The FM-U was significantly increased in both groups. The FM-U improvement was maintained at 3 months in the tDCS brain-computer interface group. Conclusion: Anodal tDCS can be a conditioning tool for brain-computer interface training in patients with severe hemiparetic stroke.</p>

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Echocardiographic abnormalities in patients with stroke during the subacute rehabilitation phase

Tsujikawa Masahiro, Otaka Yohei, Hasegawa Rei, Kondo Kunitsugu, Liu Meigen

Journal of Rehabilitation Medicine 47 （ 1 ） 38 - 44 2015年01月

ISSN  1650-1977

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<p>OBJECTIVE: To evaluate cardiac function using echocardiography in patients with stroke admitted to subacute rehabilitation units.</p><p>DESIGN: Retrospective, cross-sectional study.</p><p>PARTICIPANTS: A total of 750 consecutive patients with stroke who were admitted to a suburban rehabilitation hospital. Mean age 67.5 years (standard deviation (SD) 12.3 years). Mean time since stroke 36.7 days (SD 13.2 days).</p><p>METHODS: Patients were assessed using transthoracic echocardiography within 7 days of admission. The prevalence of echocardiographic abnormalities was analysed and compared between cerebral infarction and haemorrhage using the Mantel-Haenszel method controlled for age.</p><p>RESULTS: Arrhythmias were found in 13.7% of the patients, 94.2% of whom had atrial fibrillation. Left atrial enlargement and left ventricular hypertrophy were found in 20.4% and 19.5% of all patients, respectively. Left ventricular asynergy was detected in 6.1% of all patients, but 47.8% of them had no history of myocardial infarction. Left ventricular ejection fraction was low in 12.2% of all patients. Abnormal rhythms and left atrial enlargement were significantly more frequent in patients with cerebral infarction than in those with cerebral haemorrhage (p &lt; 0.01).</p><p>CONCLUSION: The prevalence of cardiac problems is high among patients with subacute stroke regardless of a history of heart disease, and this should be taken into account when planning rehabilitation programmes.</p>

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【脳と循環の20年】 脳卒中とリハビリテーション

里宇 明元大高 洋平，里宇 明元

脳と循環 20   45 - 49 2015年

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