Effects of unilateral neck muscle vibration on standing postural orientation and spatial perception in healthy subjects based on stimulus duration and simultaneous stimulation of trunk muscles.

Neck muscle vibration (NMV) influences proprioceptive sensations and modulates standing postural orientation and spatial perception. However, the effects of NMV in healthy participants would vary based on the influence of stimulus duration and combination with trunk muscle vibration. Therefore, this study with a cross-over design clarified these effects. Twenty-four healthy participants (mean age, 25.7±3.7 years) were enrolled. To assess standing postural orientation, standing center-of-pressure (COP) measurements were recorded on a COP platform, starting with closed eyes and then with open eyes. The mean mediolateral (ML) and anteroposterior (AP) position [mm] of COP and other parameters were calculated. To assess spatial perception, subjective straight ahead (SSA) measurements were recorded, wherein participants were instructed to point and project the position of the manubrium of sternum on the touch panel using their right index finger with their eyes closed. Measurements were taken before and after four conditions: no vibration (control), left NMV for 30 s, left NMV for 10 min, and left NMV and left lumbar back vibration for 10 min. Vibratory stimulation was performed with the eyes closed at 80 Hz. The measurements under the four conditions were conducted with random cross-over and 5-min resting period between the conditions. COP and SSA values were subtracted before and after each condition for standardized variation and compared. NMV combined with trunk muscle vibration for 10 min resulted in significant deviations of the ML-COP toward the stimulation side and AP-COP toward the anterior side compared to the control condition with closed eyes. SSA showed no significant differences. These findings suggest that NMV-induced nervous system modulation would be amplified by proprioceptive sensory input to trunk muscles. Therefore, this method could provide a new option for clinical trials on postural orientation using NMV. SSA based on proprioceptive sensation may not be biased without visual illusions.

Assessment for resumed driving in stroke patients via Functional Independence Measure1.

BACKGROUND: Some stroke survivors hope to resume driving after hospital discharge. For those who had driven frequently before their stroke, a normal daily life depends on being able to drive. OBJECTIVE: Our objective was to determine whether Functional Independence Measure (FIM) scores predict patient driving ability, which would make them a suitable index for determining if a stroke patient can resume driving. METHODS: This was a retrospective study of 71 patients who suffered from stroke. We divided them into three groups based on their driving status after discharge: (1) resumed driving (Driver), (2) wish to resume driving (Wisher), and (3) no wish to resume driving (Non-wisher). We compared total FIM scores and subcategories of FIM scores across groups. RESULTS: Scores on the Motor-FIM and Cognitive-FIM were highest in the Driver group, followed by the Wisher and Non-wisher groups. Moreover, scores on the 'problem solving' and 'memory' subcategories of the Cognitive-FIM were significantly higher in the Driver group than in the Wisher group. CONCLUSIONS: The FIM could be a useful assessment tool for determining whether or not stroke patients can resume driving. Moreover, among the Cognitive-FIM sub-categories, problem solving and memory ability might be the scores most relevant for this decision.

Pharynx and oesophagus evaluation during the swallow using helical computerized tomography.

PURPOSE: Videofluorography (VF) and endoscopy are commonly used for dynamic imaging (DI) of pharyngeal swallowing but do not offer transverse plane (TP) information. The aim of the present study was to evaluate helical computerized tomography (HCT) to measure the DI capability pharyngeal swallowing in the TP. METHODS: The HCT scan technique used was a single-slice cine mode with scan times of 100 ms. All 15 subjects were studied supine during dry swallow, swallowing of barium sulphate jelly and 3, 10, 15 or 20 ml of a 40% barium sulphate solution. Nine subjects repeated the test twice at more than 1 week's interval to determine the test-retest reliability. RESULTS: Swallowing leads to closure of the vocal folds, pharyngeal constriction and narrowing of the piriform sinuses allowing jelly passage between the sinuses. Laryngeal elevation then occurs with the opening of the pharyngoesophageal segment (PES). Swallowing a bolus of 20 ml produced the maximum anteroposterior and transverse diameters as well as the maximum opening area of the PES. The test-retest intraclass correlation coefficients with liquid deglutition ranged from 0.86 to 0.98. CONCLUSIONS: This study shows that HCT enables visualization of TP of PES complementing VF or endoscopic swallowing studies.

Support for stroke patients in resumption of driving: patient survey and driving simulator trial.

BACKGROUND: Encouragement of stroke patients to resume driving is important to promote their reintegration into the community. Limited rehabilitation has been performed in this regard, owing to lack of specific knowledge on the part of medical staff. To establish an effective support program for stroke patients who wish to resume driving, we propose comprehensive training by medical staff using a driving simulator. METHODS: A survey of stroke patients admitted to the Tokyo Metropolitan Rehabilitation Hospital was first performed. A questionnaire was sent to 525 patients. Of 218 responses, the answers of 118 patients who had been driving before their stroke were analyzed. More than 80% of stroke patients did not obtain enough information about resuming driving during their hospital stay, and 38.1% of patients would have liked to have had driving training with a simulator. From these results, we set out to determine the effect of driving training using a realistic and technically advanced driving simulator. Twenty-four stroke patients and 20 healthy controls were included in the study. RESULTS: Repeat training with the simulator resulted in an increased ability to perform braking and an improvement in driving ability. The majority of stroke patients who had the mental and physical ability to drive a car were likely to be assessed as being able to resume driving as a result of the training program. CONCLUSION: This study indicates that comprehensive support by medical staff and provision of adequate information about resumption of driving and the opportunity for training on a driving simulator are likely to aid resumption of driving by stroke patients, thus enhancing their rehabilitation and social reintegration.

Reliability of quantitative motor unit action potential parameters.

We evaluated the test-retest reliability (reproducibility) of motor unit action potential (MUAP) parameters in multi-MUAP analysis over time. Reproducibility studies are not available for needle quantitative electromyography (QEMG) performed by the same examiner. Fourteen consecutive individuals (10 men and 4 women) had repeat QEMG at 3 hours after the first examination, and seven (5 men and 2 women) had a repeat QEMG after 4-10 days. The intraclass correlation coefficient (ICC) was 87-97% with same-day testing and 52-81% with different-day testing. Size index and firing rate were the most reproducible, suggesting use in follow-up multi-MUAP studies.

Dynamic postural control in patients with hemiparesis.

OBJECTIVE: Decreased postural stability is a common problem associated with hemiparesis secondary to stroke. The purpose of this study was to evaluate dynamic postural control in patients with hemiparesis and in normal subjects matched for age. DESIGN: Quantitative posturography (EquiTest System) was performed to assess the response of subjects to sudden perturbations. A total of 59 patients with hemiparesis and 98 healthy volunteers were evaluated. All the patients were able to walk inside their house without lower limb orthoses. Both the patients and the healthy volunteers were subjected to forward and backward perturbations while standing on a movable force platform. Balance responses were analyzed in terms of weight symmetry, latency, amplitude (relative response strength), and strength symmetry. They were also subjected to toes-up and toes-down perturbations to evaluate their response to a disruptive balance force. RESULTS: The response latency to perturbations was longer and the response strength was weaker on the paretic side of patients with hemiparesis. The dynamic postural control was impaired in patients with hemiparesis as compared with healthy subjects. CONCLUSION: The results suggest that patients with hemiparesis tend to fall easily and that the risk of falls toward the paretic side is high.