ABSTRACT
Alien hand syndrome (AHS) is a rare neurologic disorder in which movements are performed without conscious will. Cognitive rehabilitation is usually first considered for treating AHS. However, we proposed different modalities for the treatment. This is the first case report showing therapeutic effects of the NEURO-15 program that consists of low-frequency repetitive transcranial magnetic stimulation and intensive occupational therapy on AHS symptoms and upper limb dysfunction caused by a stroke one year and three months before. A 68-year-old male developed right upper limb palsy secondary to cerebral infarction on the medial side of the left frontal lobe. On admission, he exhibited disturbed skilled motor behavior, compulsive grasping of the right upper limb, and dissociated behavior of the right hand independent from the left. The right hand interfered with the actions executed by the left hand. The left hand restricted the right hand in its actions by holding it. Six months after the onset, his Activities of Daily Living improved and he was discharged from hospital to home. However, his compulsive grasping of the right upper limb symptoms remained, and he underwent NEURO-15 one year and three months after the onset. His right upper limb function improved. Compulsive grasping of the right upper limb disappeared, and the contradictory action of the right upper limb was rarely seen. These results suggested that NEURO-15 influenced the neural network including the primary motor cortex and supplementary motor area.
ABSTRACT
A questionnaire was mailed to 236 directors of clinical training hospitals and 164 directors of emergency epartments at university hospitals. A 75.4% response rate for clinical training hospitals and a 78.7% response rate for university hospitals was achieved. About 30% of clinical training hospitals and 80% of university hospitals had established emergency departments and an overall 64% of all institutions surveyed were engaged in public education regarding emergency medicine.<BR>From analysis of patients visiting the emergency room at the Kyoto First Red Cross Hospital in 1993, we concluded that a resident has an on-call clinical emergency medicine experience once every one or two weeks in the initial two-years of postgraduate clinical training. This enabled residents to cover most of the proposed subjects as outlined by the Committee of postgraduate clinical training at the Japanese Ministry of Health and Welfare.<BR>We recommend that the initial two-years of all clinical training programs should include an on-call rotation for emergency medicine.