研究者詳細 - 里宇　明元

論文 - 里宇　明元

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脳脳梗塞後の嚥下障害とされた重症筋無力症の一例

里宇明元

Journal of Clinical Rehabilitation 24 310 - 314 2015年

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【電気信号を用いた神経機能再建】 Brain-machine interface(BMI)によるリハビリ支援

里宇明元新藤恵一郎，里宇明元

脳21 18 89 - 93 2015年

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Comparison of three instruments to assess changes of motor impairment in acute hemispheric stroke

Seki Masaru, Hase Kimitaka, Takahashi Hidetoshi, Liu Meigen

Disability and Rehabilitation 36 （ 18 ） 1549 - 1554 2014年08月

ISSN 0963-8288

Purpose: The purpose was to compare the performance of three representative instruments to measure changes of motor recovery with acute hemispheric stroke. Method: In 41 consecutive patients with acute hemispheric infarction, motor recovery was assessed within 3 days of onset and then every 2 weeks until the 12th week with the Stroke Impairment Assessment Set (SIAS), the National Institutes of Health stroke scale (NIHSS) and the Canadian Neurological Scale (CNS). We analyzed the relationships among the corresponding subscales of the three instruments with the Spearman's rank correlation method, and compared their responsiveness by plotting the temporal profiles of scores of each instrument and by testing the significance of changes over time with the Friedman test. Results: High correlations were observed among the three instruments at each examination point. However, the SIAS scores were more widely dispersed at the same NIHSS and CNS scores. Friedman test revealed that the scores changed significantly during the observation period with the SIAS and the CNS but not with the NIHSS. The changes were detected later with the CNS than with the SIAS. Conclusions: Although the assessment results with the three instruments were highly inter-correlated, the SIAS performed better with respect to responsiveness to changes.Implication for RehabilitationWhen providing rehabilitation services to patients with stroke, it is important to document objectively the level of their impairment from the acute stage and during the entire course of rehabilitation with standardized instrument, and to predict their functional outcomes as early and accurately as possible.This study therefore compared three representative instruments with established psychometric properties, the SIAS, the NIHSS and the CNS, with respect to their ability to document motor impairment and their responsiveness to recovery in patients with acute hemispheric stroke.

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Rewiring of regenerated axons by combining treadmill training with semaphorin3A inhibition

Zhang Liang, Kaneko Shinjiro, Kikuchi Kaoru, Sano Akihiko, Maeda Miho, Kishino Akiyoshi, Shibata Shinsuke, Mukaino Masahiko, Toyama Yoshiaki, Liu Meigen, Kimura Toru, Okano Hideyuki, Nakamura Masaya

Molecular Brain 7 （ 1 ） 2014年03月

Background: Rats exhibit extremely limited motor function recovery after total transection of the spinal cord (SCT). We previously reported that SM-216289, a semaphorin3A inhibitor, enhanced axon regeneration and motor function recovery in SCT adult rats. However, these effects were limited because most regenerated axons likely do not connect to the right targets. Thus, rebuilding the appropriate connections for regenerated axons may enhance recovery. In this study, we combined semaphorin3A inhibitor treatment with extensive treadmill training to determine whether combined treatment would further enhance the "rewiring" of regenerated axons. In this study, which aimed for clinical applicability, we administered a newly developed, potent semaphorin3A inhibitor, SM-345431 (Vinaxanthone), using a novel drug delivery system that enables continuous drug delivery over the period of the experiment. Results: Treatment with SM-345431 using this delivery system enhanced axon regeneration and produced significant, but limited, hindlimb motor function recovery. Although extensive treadmill training combined with SM-345431 administration did not further improve axon regeneration, hindlimb motor performance was restored, as evidenced by the significant improvement in the execution of plantar steps on a treadmill. In contrast, control SCT rats could not execute plantar steps at any point during the experimental period. Further analyses suggested that this strategy reinforced the wiring of central pattern generators in lumbar spinal circuits, which, in turn, led to enhanced motor function recovery (especially in extensor muscles). Conclusions: This study highlights the importance of combining treatments that promote axon regeneration with specific and appropriate rehabilitations that promote rewiring for the treatment of spinal cord injury. © 2014 Zhang et al.; licensee BioMed Central Ltd.

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Different strategy of hand choice after learning of constant and incremental dynamical perturbation in arm reaching

Habagishi Chie, Kasuga Shoko, Otaka Yohei, Liu Meigen, Ushiba Junichi

Frontiers in Human Neuroscience 8 （ 1 FEB ） 2014年02月

ISSN 1662-5161

In daily life, we encounter situations where we must quickly decide which hand to use for a motor action. Here, we investigated whether the hand chosen for a motor action varied over a short timescale (i.e., hours) with changes in arm dynamics. Participants performed a reaching task in which they moved a specified hand to reach a target on a virtual reality display. During the task, a resistive viscous force field was abruptly applied to only the dominant hand (DH). To evaluate changes in hand choice caused by this perturbation, participants performed an interleaved choice test in which they could freely choose either hand for reaching. Furthermore, to investigate the effect of temporal changes on arm dynamics and hand choice, we exposed the same participants to another condition in which the force field was introduced gradually. When the abrupt force was applied, use of the perturbed hand significantly decreased and not changed during the training. In contrast, when the incremental force was applied, use of the perturbed hand gradually decreased as force increased. Surprisingly, even though the final amount of force was identical between the two conditions, hand choice was significantly biased toward the unperturbed hand in the gradual condition. These results suggest that time-varying changes in arm dynamics may have a greater influence on hand choice than the amplitude of the resistant force itself. © 2014 Habagishi, Kasuga, Otaka, Liu and Ushiba.

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歩行不可能な患者への理学的鑑別診断法

里宇明元川上途行，里宇明元

日本医事新報 4686 76 - 78 2014年

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Functional recovery from chronic writer’s cramp by brain-computer interface rehabilitation: a case report .

里宇明元

BMC Neurosic 15 103 2014年

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【脳血管疾患最前線】脳血管疾患の最新のリハビリテーション

里宇明元水野勝広, 里宇明元

公衆衛生 78 763 - 770 2014年

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宇宙医学からみたロコモティブシンドローム

里宇明元

東京都医師会雑誌 67 676 - 681 2014年

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【脳のfunctional connectivity network:update】脳のfunctional connectivity network　リハビリテーションの立場から

里宇明元新藤恵一郎，里宇明元

神経内科 81 196 - 203 2014年

【最新臨床脳卒中学[上]-最新の診断と治療-】リハビリテーション　脳卒中リハビリテーションの新たな展開

里宇明元川上途行，里宇明元

日本臨床 72 （増刊5 ） 663 - 667 2014年

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日本のリハビリテーション医学・医療　これまでの50年、これからの50年

里宇明元

北海道リハビリテーション学会雑誌 39 13 - 20 2014年

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【神経診察-そのポイントと次の一手】　その他廃用症候群　臨床医に必要な知識とは?

里宇明元川上途行，里宇明元

Medicina 51 1308 - 1311 2014年

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【ここまで進んだリハビリテーション】脳科学研究と新しい治療法　脳卒中片麻痺上肢の機能回復に向けて

里宇明元

診断と治療 102 361 - 366 2014年

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Rewiring of regenerated axons by combining treadmill training with semaphorin3A inhibition.

里宇明元Zhang L, Kaneko S, Kikuchi K, et al.

Mol Brain 7 14 2014年

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Erratum to

Sakamoto Keizo, Endo Naoto, Harada Atsushi, Sakada Takenori, Tsushita Kazuyo, Kita Kiyoshi, Hagino Hiroshi, Sakai Akinori, Yamamoto Noriaki, Okamoto Tetsunori, Liu Meigen, Kokaze Akatsuki, Suzuki Hiromichi

Journal of Orthopaedic Science 19 （ 2 ） 373 - 374 2014年

ISSN 0949-2658

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Efficacy of brain-computer interface-driven neuromuscular electrical stimulation for chronic paresis after stroke.

Mukaino Masahiko, Ono Takashi, Shindo Keiichiro, Fujiwara Toshiyuki, Ota Tetsuo, Kimura Akio, Liu Meigen, Ushiba Junichi

Journal of rehabilitation medicine 46 （ 4 ） 378 - 382 2014年

Brain computer interface technology is of great interest to researchers as a potential therapeutic measure for people with severe neurological disorders. The aim of this study was to examine the efficacy of brain computer interface, by comparing conventional neuromuscular electrical stimulation and brain computer interface-driven neuromuscular electrical stimulation, using an A-B-A-B withdrawal single-subject design. A 38-year-old male with severe hemiplegia due to a putaminal haemorrhage participated in this study. The design involved 2 epochs. In epoch A, the patient attempted to open his fingers during the application of neuromuscular electrical stimulation, irrespective of his actual brain activity. In epoch B, neuromuscular electrical stimulation was applied only when a significant motor-related cortical potential was observed in the electroencephalogram. The subject initially showed diffuse functional magnetic resonance imaging activation and small electro-encephalogram responses while attempting finger movement. Epoch A was associated with few neurological or clinical signs of improvement. Epoch B, with a brain computer interface, was associated with marked lateralization of electroencephalogram (EEG) and blood oxygenation level dependent responses. Voluntary electromyogram (EMG) activity, with significant EEG-EMG coherence, was also prompted. Clinical improvement in upper-extremity function and muscle tone was observed. These results indicate that self-directed training with a brain computer interface may induce activity- dependent cortical plasticity and promote functional recovery. This preliminary clinical investigation encourages further research using a controlled design.

Cancer Functional Assessment Set: a new tool for functional evaluation in cancer.

Miyata Chieko, Tsuji Tetsuya, Tanuma Akira, Ishikawa Aiko, Honaga Kaoru, Liu Meigen

American Journal of Physical Medicine and Rehabilitation 93 （ 8 ） 656 - 664 2014年

ISSN 0894-9115

OBJECTIVE: The aim of this study was to develop and evaluate the psychometric properties of a new measurement tool, the Cancer Functional Assessment Set (cFAS). DESIGN: A total of 119 inpatients with cancer participated in this prospective cohort study. This study took place in three phases: (1) item generation, literature search, and a round-table discussion by 32 rehabilitation specialists; (2) item reduction and selection of appropriate items from the first item pool; and (3) evaluation of psychometric properties. Concurrent validity (Spearman correlation coefficients with existing scales), internal reliability (Cronbach coefficient alpha), interrater reliability (weighted kappa statistics and intraclass correlation coefficient), cross-validation, and responsiveness (standardized response mean values) were examined. RESULTS: The cFAS consisted of 24 items. Significant correlations were found between the cFAS and existing scales. Cronbach α for the total score was 0.92. Weighted κ values for each item ranged from 0.74 to 1.00. The intraclass correlation for the total score was 0.97. Concurrent validity and internal consistency were similar at two different hospitals. The cFAS was more responsive to changes than the other tools. CONCLUSIONS: The cFAS has acceptable psychometric properties, supporting its broad generalizability. It can be a useful tool in clinical trials and can contribute to the development of cancer rehabilitation. Copyright © 2014 Lippincott Williams & Wilkins.

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Executive dysfunction is related with decreased frontal lobe blood flow in patients with subarachnoid haemorrhage

Uchikawa Ken, Inaba Makoto, Kagami Hiroshi, Ichimura Shinya, Fujiwara Toshiyuki, Tsuji Tetsuya, Otaka Yohei, Liu Meigen

Brain Injury 28 （ 1 ） 15 - 19 2014年

ISSN 0269-9052

Objective: This study evaluated executive dysfunction in patients with subarachnoid haemorrhage (SAH) using the Behavioural Assessment of the Dysexecutive Syndrome (BADS) and correlated the occurrence of executive dysfunction with cerebral blood flow (CBF) reduction in the frontal lobe as assessed by single photon emission computed tomography (SPECT). Design: Correlational study. Subjects: Twenty-Two patients who underwent microsurgical clipping at least 3 months after SAH. Methods: This study evaluated the BADS and the Wechsler Adult Intelligence Scale-III (WAIS-III). In addition, it assessed activities of daily living (ADL). CBF was evaluated using SPECT. The patients were divided into the following groups according to the results of SPECT: (1) those with reduced CBF in the frontal lobe (reduced CBF group, n = 8) and (2) those with intact CBF (intact CBF group, n = 14). Results: The BADS score was significantly lower in the reduced CBF group compared with that of the intact CBF group, while there was no significant difference in the WAIS-III scores and ADL scale between the two groups. Conclusion: Although this result was conducted with a small sample size, executive dysfunction correlates with reduced CBF in the frontal lobes of SAH patients. A detailed evaluation of executive function is suggested in SAH patients, even if the patient's intelligence test and ADL scale reveal no abnormalities. © 2014 Informa UK Ltd. All rights reserved: reproduction in whole or part not permitted.

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Multimodal Sensory Feedback Associated with Motor Attempts Alters BOLD Responses to Paralyzed Hand Movement in Chronic Stroke Patients

Ono Takashi, Tomita Yutaka, Inose Manabu, Ota Tetsuo, Kimura Akio, Liu Meigen, Ushiba Junichi

Brain Topography 28 （ 2 ） 340 - 351 2014年

ISSN 0896-0267

Electroencephalogram-based brain–computer interfaces (BCI) have been used as a potential tool for training volitional regulation of corticomuscular drive in patients who have severe hemiplegia due to stroke. However, it is unclear whether ERD observed while attempting motor execution can be regarded as a neural marker that represents M1 excitability in survivors of severe stroke. Therefore we investigated the association between ERD and the blood-oxygen-level-dependent (BOLD) fMRI signal during attempted movement of a paralyzed finger in stroke patients. Nine chronic stroke patients received BCI training for finger extension movement 1 h daily for a duration of 1 month. The sensorimotor rhythm was recorded from the sensorimotor area of the damaged hemisphere, and ongoing amplitude variations were monitored using a BCI system. Either a visual alert or the action of a motor-driven orthosis was triggered in response to ERD of the sensorimotor rhythm while patients attempted extension movements of the paralyzed fingers. Inter-subject covariance between ERD and the BOLD response in the sensorimotor areas was calculated. After BCI training, an increased ERD over the damaged hemisphere was confirmed in all participants while they attempted extension of the affected finger and this increase was associated with a BOLD response in primary sensorimotor area. Whole-brain MRI revealed that the primary sensorimotor area and supplementary motor area were activated in the damaged hemisphere after 1 month of BCI training. ERD reflects the BOLD responses of the primary motor areas in either hemisphere while patients who have severe chronic hemiplegia due to a stroke attempt an extension movement of the paralyzed fingers. One month of BCI can alter motor-related brain area activation. Combining BCI with other methods to facilitate such changes may help to implement BCI for motor rehabilitation after stroke.

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