Attitudes, knowledge and behavior of Japanese physical therapists with regard to evidence-based practice and clinical practice guidelines: a cross-sectional mail survey.

[Purpose] This study aimed to investigate Japanese physical therapists' attitudes of evidence-based practice and clinical practice guidelines. [Subjects and Methods] In 2014, a cross-sectional postal mail survey using a self-administered questionnaire was conducted. Of 2,982 physical therapists belonging to the Chiba Prefecture Physical Therapist Association, 1,000 were randomly selected. The questionnaire comprised 42 items pertaining to the attitudes of and behavior toward evidence-based practice and clinical practice guidelines. It was investigated to reveal the relationship between clinical practice guidelines/evidence-based practice and therapist characteristics. [Results] The response rate was 39.6%, and 384 questionnaires were available. The main results were as follows: 83.3% participants agreed to the importance of evidence-based practice, 77.1% agree to that evidence-based practice supports clinical decision of physical therapists, and about 11% agreed to have been educated about evidence-based practice. Then, 29.2% used, 54.9% agreed to the importance of, and 13.3% agreed to the utility of clinical practice guidelines. An important factor related mostly to a positive attitude, knowledge and behavior of evidence-based practice and clinical practice guidelines was participating in research activities. [Conclusion] Many of physical therapists do not use and understand the importance of clinical practice guidelines. Participating in research activities may partially contribute to improving these conditions.

Referred sensations induced by a mirror box in healthy subjects.

Twenty-one healthy subjects were instructed to observe the mirror image of the tactile stimulation of their own hand (control condition) or an assistant's hand (experimental condition) while being queried about the referred sensation (RS) in their own masked hand behind the mirror. The rated intensity of the RS under the experimental condition was significantly stronger than that under the control condition. In a second experiment, the experimental condition was replaced with the tactile stimulation of a prosthetic (rubber) hand, and was compared with the tactile stimulation of the subject's own hand (control condition). In both of the experiments, the rated intensity of RS was significantly stronger under the experimental condition than under the control condition. The qualitative characteristics of the induced RS on the mirror image hand--including the location, sense of ownership, and various subjective feelings--were also found to vary among subjects. In conclusion, an RS could be induced in healthy subjects on the mirror image of the hand by tactile stimulations, although this effect differed substantially among individuals.

Changes in the brain activation balance in motor-related areas after constraint-induced movement therapy; a longitudinal fMRI study.

PRIMARY OBJECTIVE: This study investigated the longitudinal changes in brain activation balance in motor-related areas after Constraint-Induced Movement Therapy (CIMT). METHODS AND PROCEDURES: The subjects included seven ischemic stroke patients with mild right hemiparesis. Eight normal subjects were also included. The patients underwent functional MRI and motor function tests (Fugl-Meyer Assessment; FMA, modified Wolf Motor Function Test; mWMFT) both before and immediately after CIMT and also after a 3-month follow-up. RESULTS: The motor function test scores improved immediately after CIMT; moreover, these scores were either maintained or improved even at the 3-month follow-up. In a comparison of the chronological data of the contralaterality index of the affected hand movement, the cerebellar activity changed significantly to ipsilateral activation immediately after CIMT and thereafter the cerebellar activity further changed to ipsilateral activation at the 3-month follow-up. A correlation was observed among the contralateral activation, FMA and mWMFT scores in SM1 and the ipsilateral activation and in the mWMFT scores in the cerebellum at the 3-month follow-up examinations. CONCLUSION: The participation of the contralateral SM1 and the ipsilateral cerebellum is thus considered to play an important role in the satisfactory recovery of the motor function after CIMT intervention.

Effect of modified constraint-induced movement therapy on lower extremity hemiplegia due to a higher-motor area lesion.

BACKGROUND: Modified CIT (mCIT) was performed in a stroke patient with a lesion in the left medial frontal region including the supplementary motor area (SMA), which is part of the higher-motor area, and whose primary symptom was motor ignition difficulty observed at the start of voluntary movement of the right leg. CASE STUDY: mCIT was performed from awakening to bedtime (not including bath time) with his non-affected limb fixed with a knee splint while he was in the hospital ward. Two days (the total time he wore the appliance was 19.5 hours) after the intervention was introduced, voluntary movement of the right leg occurred, and functional improvement was observed. CONCLUSIONS: These findings are speculated to be related to the facts that the unilateral SMA strongly contributes to movement of the ipsilateral limb and that the plasticity of the SMA, which is a higher-motor area, is greater than that of primary areas. It is probable that different regions of the brain have different plasticity, resulting in differences in the process of functional recovery and the level of recovery.

Mirror observation of finger action enhances activity in anterior intraparietal sulcus: a functional magnetic resonance imaging study.

Mirror therapy can be used to promote recovery from paralysis in patients with post-stroke hemiplegia, There are a lot of reports that mirror-image observation of the unilateral moving hand enhanced the excitability of the primary motor area (M1) ipsilateral to the moving hand in healthy subjects. but the neural mechanisms underlying its therapeutic effects are currently unclear. To investigate this issue, we used functional magnetic resonance imaging to measure activity in brain regions related to visual information processing during mirror image movement observation. Thirteen healthy subjects performed a finger-thumb opposition task with the left and right hands separately, with or without access to mirror observation. In the mirror condition, one hand was reflected in a mirror placed above the abdomen in the MRI scanner. In the masked mirror condition, subjects performed the same task but with the mirror obscured. In both conditions, the other hand was held at rest behind the mirror. A between-task comparison (mirror versus masked mirror) revealed significant activation in the ipsilateral hemisphere in the anterior intraparietal sulcus (aIP) while performing all tasks, regardless of which hand was used. The right aIP was significantly activated while moving the right hand. In contrast, in the left aIP, a small number of voxels showed a tendency toward activation during both left and right hand movement. The enhancement of ipsilateral aIP activity by the mirror image observation of finger action suggests that bimodal aIP neurons can be activated by visual information. We propose that activation in the M1 ipsilateral to the moving hand can be induced by information passing through the ventral premotor area from the aIP.