研究者詳細 - 里宇　明元

論文 - 里宇　明元

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【もう悩まない!100症例から学ぶリハビリテーション評価のコツ】評価のポイント

里宇明元

MEDICAL REHABILITATION 163 1 - 3 2013年

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入門講座　英文論文作成法原著

里宇明元

総合リハビリテーション 41 937 - 942 2013年

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ニューロリハビリテーションの最近のトピックス

里宇明元藤原俊之, 里宇明元

Neurological Surgery 41 663 - 668 2013年

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【神経回路の可塑性とbrain-machine interface】片麻痺上肢に対する新たなリハビリテーション手法の開発

里宇明元

神経内科 79 519 - 525 2013年

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【脳卒中診療の最新情報】脳卒中のリハビリテーション

里宇明元松浦大輔, 里宇明元

臨牀と研究 90 780 - 784 2013年

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【神経障害性疼痛のマネジメント】病態別疼痛マネジメント　帯状疱疹後神経痛のマネジメントとリハビリテーション・アプローチ

里宇明元田代祥一, 里宇明元

Journal of Clinical Rehabilitation 22 660 - 665 2013年

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Brain-Machine Interface(BMI)の現状と展望(Vol.6)　BMIニューロリハビリテーション　片麻痺上肢に対するあらたな治療戦略

里宇明元

医学のあゆみ 245 962 - 968 2013年

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【脳血管障害-予防・診断・治療法の進歩-】ニューロリハビリテーションの現状と未来

里宇明元藤原俊之, 里宇明元

最新医学 68 988 - 994 2013年

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【周術期リハビリテーション】術前・術後のリハビリテーション評価　開胸・開腹術を中心に

里宇明元石川愛子, 里宇明元, 木村彰男

総合リハビリテーション 41 417 - 423 2013年

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Newer challenges to restore hemiparetic upper extremity after stroke

Liu Meigen, Fujiwara Toshiyuki, Shindo Keiichiro, Kasashima Yuko, Otaka Yohei, Tsuji Tetsuya, Ushiba Junichi

Hong Kong Physiotherapy Journal 30 （ 2 ） 83 - 92 2012年12月

Because recovery of upper extremity (UE) functions to a practical level has been considered difficult in many patients with stroke, compensatory approaches have been emphasised. Recently, based on basic and clinical research indicating a greater potential for plastic changes in the brain, approaches directed toward functional restoration are becoming increasingly popular. Meta-analysis has indicated the effectiveness of constraint-induced movement therapy, electromyography biofeedback, electrostimulation, mental practice, and robot exercise to improve UE functions, but not hand functions. Therefore, we devised two new interventions to improve the paretic hand. One is hybrid assistive neuromuscular dynamic stimulation therapy, designed to facilitate daily use of the hemiparetic UE by combining electromyography (EMG)-triggered electrical stimulation with a wrist splint. We demonstrated improvement of motor function, spasticity, functional scores, and neurophysiologic parameters in chronic hemiparetic stroke. With a randomised controlled trial, we also demonstrated its effectiveness in subacute stroke. The other is brain-machine interface neurofeedback training, which provides real-time feedback based on analysis of volitionally decreased amplitudes of sensory motor rhythm during motor imagery involving extension of the affected fingers. This elicited new voluntary EMG activities, and improved finger functions and neurophysiological parameters. These interventions may offer powerful neurorehabilitative tools for improving hemiparetic UE function after stroke. © 2012 Hong Kong Physiotherapy Association Ltd.

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Natural history of lymph pumping pressure after pelvic lymphadenectomy

Okitsu T., Tsuji Tetsuya, Fujii T., Mihara M., Hara H., Kisu I., Aoki D., Miyata C., Otaka Y., Liu M.

Lymphology 45 （ 4 ） 165 - 176 2012年12月

ISSN 0024-7766

Lower limb lymphedema is difficult to prevent and diagnose early because its natural history is unclear. Therefore, the aim of this study was to clarify its pathogenesis and to identify risk factors that may lead to early diagnosis. In 29 patients, aged 25 to 74 years with cervical, uterine, or ovarian cancer who underwent pelvic lymphadenectomy, indocyanine green fluorescence lymphangiography was performed with an infrared camera system, and lymph pumping pressure was measured indirectly preoperatively, and one, two, three, and six months postoperatively. Of these 29 patients, 22 (75.9%) completed the examinations. In the non-lymphedema group, the average lymph pumping pressure did not change significantly at postoperative follow-up compared with preoperative values. On the other hand, lymph pumping pressure increased at various time points in five patients who developed early lymphatic changes with dermal diffusion at the level of the proximal femur. An increase in lymph flow path resistance due to pelvic lymphadenectomy resulted in an initial increase in lymph pumping pressure, followed by a subsequent decrease, in the early lymphatic changes group. This trend in the pressure change signifies that the lymph vessels became dysfunctional as they were overwhelmed by the overload condition and this feature may be a clinically useful signal for the early diagnosis of developing lymphedema.

Comparison of the after-effects of transcranial direct current stimulation over the motor cortex in patients with stroke and healthy volunteers

Suzuki Kanjiro, Fujiwara Toshiyuki, Tanaka Naofumi, Tsuji Tetsuya, Masakado Yoshihisa, Hase Kimitaka, Kimura Akio, Liu Meigen

International Journal of Neuroscience 122 （ 11 ） 675 - 681 2012年11月

ISSN 0020-7454

It is known that weak transcranial direct current stimulation (tDCS) induces persistent excitability changes in the cerebral cortex. There are, however, few studies that compare the after-effects of anodal versus cathodal tDCS in patients with stroke. This study assessed the after-effects of tDCS over the motor cortex in patients with hemiparetic stroke and healthy volunteers. Seven stroke patients and nine healthy volunteers were recruited. Ten minutes of anodal and cathodal tDCS (1 mA) and sham stimulation were applied to the affected primary motor cortex (M1) on different days. In healthy subjects, tDCS was applied to the right M1. Before and after tDCS, motor-evoked potentials (MEPs) in the first dorsal interosseous (FDI) muscle and silent period were measured. Anodal tDCS increased the MEPs of the affected FDI in patients with stroke as well as in healthy subjects. Cathodal tDCS increased the MEPs of the affected FDI in patients with stroke. In healthy subjects, however, cathodal tDCS decreased the MEPs. We found no significant change in the duration of the silent period after anodal or cathodal tDCS. We found that both anodal and cathodal tDCS increased the affected M1 excitability in patients with stroke. It is thought that the after-effects of tDCS are different in patients with stroke compared with healthy subjects. © 2012 Informa Healthcare USA, Inc.

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Real-Time Changes in Corticospinal Excitability during Voluntary Contraction with Concurrent Electrical Stimulation

Yamaguchi Tomofumi, Sugawara Kenichi, Tanaka Satoshi, Yoshida Naoshin, Saito Kei, Tanabe Shigeo, Muraoka Yoshihiro, Liu Meigen

PLoS ONE 7 （ 9 ） 2012年09月

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.

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Modulation of event-related desynchronization during motor imagery with transcranial direct current stimulation (tDCS) in patients with chronic hemiparetic stroke

Kasashima Yuko, Fujiwara Toshiyuki, Matsushika Yayoi, Tsuji Tetsuya, Hase Kimitaka, Ushiyama Junichi, Ushiba Junichi, Liu Meigen

Experimental Brain Research 221 （ 3 ） 263 - 268 2012年09月

ISSN 0014-4819

Electroencephalogram-based brain-computer interface (BCI) has been developed as a new neurorehabilitative tool for patients with severe hemiparesis. However, its application has been limited because of difficulty detecting stable brain signals from the affected hemisphere. It has been reported that transcranial direct current stimulation (tDCS) can modulate event-related desynchronization (ERD) in healthy persons. The objective of this study was to test the hypothesis that anodal tDCS could modulate ERD in patients with severe hemiparetic stroke. The participants were six patients with chronic hemiparetic stroke (mean age, 56.8 ± 9.5 years; mean time from the onset, 70.0 ± 19.6 months; Fugl-Meyer Assessment upper extremity motor score, 30.8 ± 16.5). We applied anodal tDCS (10 min, 1 mA) and sham stimulation over the affected primary motor cortex in a random order. ERD of the mu rhythm (mu ERD) with motor imagery of extension of the affected finger was assessed before and after anodal tDCS and sham stimulation. Mu ERD of the affected hemisphere increased significantly after anodal tDCS, whereas it did not change after sham stimulation. Our results show that anodal tDCS can increase mu ERD in patients with hemiparetic stroke, indicating that anodal tDCS could be used as a conditioning tool for BCI in stroke patients. © Springer-Verlag 2012.

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A pilot study of contralateral homonymous muscle activity simulated electrical stimulation in chronic hemiplegia

Osu Rieko, Otaka Yohei, Ushiba Junichi, Sakata Sachiko, Yamaguchi Tomofumi, Fujiwara Toshiyuki, Kondo Kunitsugu, Liu Meigen

Brain Injury 26 （ 9 ） 1105 - 1112 2012年08月

ISSN 0269-9052

Objective: For the recovery of hemiparetic hand function, a therapy was developed called contralateral homonymous muscle activity stimulated electrical stimulation (CHASE), which combines electrical stimulation and bilateral movements, and its feasibility was studued in three chronic stroke patients with severe hand hemiparesis. Methods: Patients with a subcortical lesion were asked to extend their wrist and fingers bilaterally while an electromyogram (EMG) was recorded from the extensor carpi radialis (ECR) muscle in the unaffected hand. Electric stimulation was applied to the homonymous wrist and finger extensors of the affected side. The intensity of the electrical stimulation was computed based on the EMG and scaled so that the movements of the paretic hand looked similar to those of the unaffected side. The patients received 30-minutes of therapy per day for 2 weeks. Results: Improvement in the active range of motion of wrist extension was observed for all patients. There was a decrease in the scores of modified Ashworth scale in the flexors. Fugl-Meyer assessment scores of motor function of the upper extremities improved in two of the patients. Conclusions: The results suggest a positive outcome can be obtained using the CHASE system for upper extremity rehabilitation of patients with severe hemiplegia. © 2012 Informa UK Ltd.

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Immediate effects of electrical stimulation combined with passive locomotion-like movement on gait velocity and spasticity in persons with hemiparetic stroke

Yamaguchi Tomofumi, Tanabe Shigeo, Muraoka Yoshihiro, Masakado Yoshihisa, Kimura Akio, Tsuji Tetsuya, Liu Meigen

Clinical Rehabilitation 26 （ 7 ） 619 - 628 2012年07月

ISSN 0269-2155

Objective: Research to examine the immediate effects of electrical stimulation combined with passive locomotion-like movement on gait velocity and spasticity.Design: A single-masked, randomized controlled trial design.Subjects: Twenty-seven stroke inpatients in subacute phase (ischemic n=16, hemorrhagic n=11).Interventions: A novel approach using electrical stimulation combined with passive locomotion-like movement.Main measures: We assessed the maximum gait speed and modified Ashworth scale before and 20 minutes after the interventions.Results: The gait velocity of the electrical stimulation combined with passive locomotion-like movement group showed the increase form 0.68±0.28 (mean±SD, unit: m) to 0.76±0.32 after the intervention. Both the electrical stimulation group and passive locomotion-like movement group also showed increases after the interventions (from 0.76±0.37 to 0.79±0.40, from 0.74±0.35 to 0.77±0.36, respectively). The gait velocity of the electrical stimulation combined with passive locomotion-like movement group differed significantly from those of the other groups (electrical stimulation combined with passive locomotion-like movement versus electrical stimulation: P=0.049, electrical stimulation combined with passive locomotion-like movement versus passive locomotion-like movement: P=0.025). Although there was no statistically significant difference in the modified Ashworth scale among the three groups, six of the nine subjects (66.6%) in the electrical stimulation combined with passive locomotion-like movement group showed improvement in the modified Ashworth scale score, while only three of the nine subjects (33.3%) in the electrical stimulation group and two of the nine subjects (22.2%) improved in the passive locomotion-like movement group.Conclusion: These findings suggest electrical stimulation combined with passive locomotion-like movement could improve gait velocity in stroke patients. © The Author(s) 2011.

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Effects of pedaling exercise on the intracortical inhibition of cortical leg area

Yamaguchi Tomofumi, Fujiwara Toshiyuki, Liu William, Liu Meigen

Experimental Brain Research 218 （ 3 ） 401 - 406 2012年05月

ISSN 0014-4819

Pedaling is widely used for rehabilitation of locomotion because it induces similar muscle activity to that observed during locomotion. However, no study has examined the effects of pedaling exercise on intracortical inhibition. The aim of the present study was to investigate the effect of pedaling exercise on short-interval intracortical inhibition (SICI) in the cortical area controlling the tibialis anterior (TA) and soleus (SOL) muscles. Ten healthy adults participated in this study and were instructed to perform 7 min of active and passive pedaling. Paired pulse transcranial magnetic stimulation (TMS) was used to investigate the SICI. Using interstimulus intervals of 2-3 ms, the SICI of TA and SOL muscles was recorded at rest before and after the pedaling and repetitive ankle dorsiflexion tasks. SICI in both TA and SOL muscles decreased immediately after active pedaling. There were no significant changes in SICI after the passive pedaling and repetitive ankle dorsiflexion. A short-term, low-intensity active pedaling exercise decreases the intracortical inhibition of the leg area of the motor cortex. Our results suggest that pedaling has the potential to restore ambulation-inducing cortical reorganization among patients with central nervous system lesions. © Springer-Verlag 2012.

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How did rehabilitation professionals act when faced with the Great East Japan Earth quake and Disaster? Descriptive epidemiology of disability and an interim report of the relief activities of the TEN Rehabilitation -related Organizations

Liu Meigen, Kohzuki Masahiro, Hamamura Akinori, Ishikawa Makoto, Saitoh Masami, Kurihara Masaki, Handa Kazuto, Nakamura Haruki, Fukaura Junichi, Kimura Ryuji, Ito Takao, Matsuzaka Nobuou

Journal of Rehabilitation Medicine 44 （ 5 ） 421 - 428 2012年05月

ISSN 1650-1977

Objective: Inter-organizational coordination is important for rehabilitation disaster relief. The 2011 Great East Japan Earthquake and Disaster was unprecedented, being geographically widespread and multifaceted. Faced with the crisis, rehabilitation professionals established the 10 Rehabilitation- Related Organizations of Rehabilitation Support Service (10-RRO). The objectives of this paper are to provide descriptive epidemiology and assess the activities of 10- RRO. Design: Descriptive. Methods: Epidemiological data on disability were collected, mainly from official sources. Relief activities were reviewed from daily reports, and the preparedness, initial response and functioning of 10-RRO were assessed with a questionnaire directed at 36 executives of individual organizations. Results: The disaster was characterized by a very low ratio of injuries to death of 0.372, and an odds ratio of deaths among disabled persons of 2.32. 10-RRO provided relief activities at 3 shelters. The total number of dispatch days ranged from 107 to 146, and the cumulative number of professionals and evacuees served was 1,202 and 7,300, respectively. Support activities included prevention of immobilization, daily life support, environmental improvement and transition to temporary housing. The questionnaire survey revealed poor preparedness, satisfactory initial response and support activities, and problems of data collection and advocacy. Conclusion: The disaster was characterized by minimal trauma and a great need for preventing immobilization. This first collaborative endeavour was successful. © 2012 Foundation of Rehabilitation Information.

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Contraction level-related modulation of corticomuscular coherence differs between the tibialis anterior and soleus muscles in humans

Ushiyama Junichi, Masakado Yoshihisa, Fujiwara Toshiyuki, Tsuji Tetsuya, Hase Kimitaka, Kimura Akio, Liu Meigen, Ushiba Junichi

Journal of Applied Physiology 112 （ 8 ） 1258 - 1267 2012年04月

ISSN 8750-7587

The sensorimotor cortex activity measured by scalp EEG shows coherence with electromyogram (EMG) activity within the 15- to 35-Hz frequency band (β-band) during weak to moderate intensity of isometric voluntary contraction. This coupling is known to change its frequency band to the 35- to 60-Hz band (γ-band) during strong contraction. This study aimed to examine whether such contraction level-related modulation of corticomuscular coupling differs between muscles with different muscle compositions and functions. In 11 healthy young adults, we quantified the coherence between EEG over the sensorimotor cortex and rectified EMG during tonic isometric voluntary contraction at 10-70% of maximal voluntary contraction of the tibialis anterior (TA) and soleus (SOL) muscles, respectively. In the TA, the EEG-EMG coherence shifted from the β-band to the γ-band with increasing contraction level. Indeed, the magnitude of β-band EEG-EMG coherence was significantly decreased, whereas that of γ-band coherence was significantly increased, when the contraction level was above 60% of maximal voluntary contraction. In contrast to the TA, the SOL showed no such frequency changes of EEG-EMG coherence with alterations in the contraction levels. In other words, the maximal peak of EEG-EMG coherence in the SOL existed within the β-band, irrespective of the contraction levels. These findings suggest that the central nervous system regulates the frequency of corticomuscular coupling to exert the desired levels of muscle force and, notably, that the applicable rhythmicity of the coupling for performing strong contractions differs between muscles, depending on the physiological muscle compositions and functions of the contracting muscle. Copyright © 2012 the American Physiological Society.

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Cortical current source estimation from electroencephalography in combination with near-infrared spectroscopy as a hierarchical prior

Aihara Takatsugu, Takeda Yusuke, Takeda Kotaro, Yasuda Wataru, Sato Takanori, Otaka Yohei, Hanakawa Takashi, Honda Manabu, Liu Meigen, Kawato Mitsuo, Sato Masa aki, Osu Rieko

NeuroImage 59 （ 4 ） 4006 - 4021 2012年02月

ISSN 1053-8119

Previous simulation and experimental studies have demonstrated that the application of Variational Bayesian Multimodal EncephaloGraphy (VBMEG) to magnetoencephalography (MEG) data can be used to estimate cortical currents with high spatio-temporal resolution, by incorporating functional magnetic resonance imaging (fMRI) activity as a hierarchical prior. However, the use of combined MEG and fMRI is restricted by the high costs involved, a lack of portability and high sensitivity to body-motion artifacts. One possible solution for overcoming these limitations is to use a combination of electroencephalography (EEG) and near-infrared spectroscopy (NIRS). This study therefore aimed to extend the possible applications of VBMEG to include EEG data with NIRS activity as a hierarchical prior. Using computer simulations and real experimental data, we evaluated the performance of VBMEG applied to EEG data under different conditions, including different numbers of EEG sensors and different prior information. The results suggest that VBMEG with NIRS prior performs well, even with as few as 19 EEG sensors. These findings indicate the potential value of clinically applying VBMEG using a combination of EEG and NIRS. © 2011 Elsevier Inc..

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