Physiotherapy management focusing on proprioceptive impairment in a patient with gait and balance impairments following stroke: A case report.

BACKGROUND: Proprioceptive impairment contributes to gait and balance impairments in patients with stroke. Diagnosis functional impairments and evaluation treatment efficacy require quantitative proprioception assessment. However, proprioception assessment has remained limited to ordinal scale measurement, with a lack of ratio scale measurements. PURPOSE: This case report describes a physiotherapy management program focusing on proprioceptive impairment in patients with stroke using quantitative tests such as Threshold to Detect Passive Motion (TDPM) and Joint Position Sense (JPS). CASE DESCRIPTION: A63-year-old male patient with an acute pontine lacunar infarction was admitted to our hospital. His muscle strength, selective movement, and trunk activity were preserved. However, the Berg Balance Scale (BBS) and Gait Assessment andIntervention Tool (GAIT) score were 42 and 9 points, observing balance impairment and the buckling knee pattern with hip ataxia during gait. Based on these, TDPM and JPS using image capture were performed. In physiotherapeuticdiagnosis, proprioceptive impairments in the hip and knee joints were the primary functional impairments related to balance and gait. To address these proprioceptive impairments, a 13-day treatment protocol incorporating transcutaneous electrical nerve stimulation (intensity: sensory threshold, frequency: 100 Hz) targeting the quadriceps femoris was performed. OUTCOMES: The patient was discharged after achieving independent ambulation and improvement in BBS (56 points) and GAIT (2 points) scores, exceeding the minimum clinically important difference. Recovery of proprioceptive impairment corresponded withimproved balance and gait ability. CONCLUSION: Quantitatively evaluating proprioceptive impairments may provide novel rehabilitation for patients with stroke who have proprioceptive impairments and contribute to clinical decision-making.

Lifecorder: a new device for the long-term monitoring of motor activities for Parkinson's disease.

OBJECTIVE: To quantitatively evaluate motor activity, its fluctuations, and drug effects in patients with Parkinson's disease (PD), the Lifecorder, a new monitoring device, was attached to a group of patients for several weeks. This enabled the continuous recording of motor activity in ten scaled magnitudes at two-minute intervals for 6 weeks. PATIENTS AND METHODS: Thirteen patients with PD who required dopamine receptor agonist therapy were monitored with Lifecorder, and seven healthy subjects served as the control group. The data obtained with this device correlated well with the Unified Parkinson's Disease Rating Scale (UPDRS) and Hoehn-Yahr grading. The dose of cabergoline, a D2-receptor agonist, was increased every 2 weeks, until optimum improvement was achieved. RESULTS: By adding cabergoline, the mean UPDRS improved from 40.5 to 28.4, which was significant. In parallel, the mean daily walking count (WC) also increased from 2,459 to 3,315 steps (p < 0.01) and movement-related calorie consumption (MCC) increased from 56 to 74 kcal (p < 0.05). UPDRS thus correlated well with WC and MCC (p < 0.05) obtained with this device. The improvement ratio of WC and MCC of each individual patient was compared with that of UPDRS. WC, and MCC shifted in parallel with UPDRS with one exception. The daily time-dependent fluctuation of motor activity was clearly shown by the Excel-generated graphs to improve with D-agonist therapy. In contrast to enhanced daytime activities, nocturnal restfulness was also clearly documented with this device. CONCLUSION: The unique properties of Lifecorder make this device a useful adjunct to the UPDRS for the objective evaluation of Parkinsonian motor activity. The device has a significant advantage over conventional clinical scales, as daytime as well as nocturnal motor activity can be objectively evaluated over long time periods ranging from one hour to one month, and the magnitude of motor activity is quantifiable in relation to the time-course.

"Anoikis" of oligodendrocytes induced by Wallerian degeneration: ultrastructural observations.

Oligodendrocytes undergo apoptosis in the white matter tracts remote from the experimental cord injury, although its significance is not understood. Our ultrastructural study, however, enabled us to speculate on its neurobiological implications. The spinal cords of male Wistar rats (4 week-old) were transected at Th11 level. At 4, 5, and 7 days after surgery the animals were transcardially perfusion-fixed. The removed cord was embedded in epoxy resin and examined by electron microscopy. Post-embedding terminal deoxynucleotidyl transferase-mediated biotinylated deoxyuridine triphosphate nick end labeling (TUNEL) method was also performed. In the degenerative dorsal column above the transection, profiles of apoptotic oligodendrocytes were always found, embedded in a space formed by dilated degenerative myelin lamellae. Often, the dilated space in the myelin sheath lacked any apparent background proteinaceous matrix. In the electron microscopic TUNEL method, these apoptotic cells were electron dense in accordance with nuclear heterochromatinization. In conclusion, in the process of Wallerian degeneration, we observed the apoptosis of oligodendrocytes in a space formed by the split myelin sheath. These degenerative cells, which were enclosed in an ultrafiltrate-filled space formed by split myelin lamellae, were reminiscent of "anoikis."

[Marked thickening of the peripheral nerves in chronic inflammatory polyradiculoneuropathy associated with HCV infection].

We report a case of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) in a middle-aged patient with hepatitis C virus (HCV) infection. A 49-year-old man presented chronic progressive distal motor weakness and sensory disturbances. Laboratory findings indicated chronic liver dysfunction due to HCV infection, transient positive serum cryoglobulinemia and marked decreased motor and sensory conduction velocities in electrodiagnosis. Lumbar MRI showed marked hypertrophy of the bilateral lumbar radicular nerve roots. Steroid treatment, not IVIg, improved neurological manifestation of this patient, but the serum HCV-RNA level was extremely increased after this treatment. Choice of treatment for patients suffered from CIDP associated with HCV infection is still controversial. Newly discovered patients with HCV infection are increased in Japan in number according to the routine check their anti-HCV antibodies. It is important to monitor carefully the serum HCV-RNA level in CIDP patients associated with HCV infection when steroid treatment is initiated.

[Recurrent multiple cerebral hemorrhages complicated with polyarteritis nodosa].

In January 2001, a 72-year-old woman, who had been treated for polyarteritis nodosa, and vasculitic neuropathy, was admitted in somnolent state. She was monoparetic in her right leg, and disoriented. Neuroimaging studies revealed multiple superficial parenchymal hemorrhages in the bilateral hemispheres with dural Gd enhancement and parenchymal thickenings. No evidence of intracranial vasculitis was seen in visible arterial branches and veins by MRV and helical CTs. While in the hospital, intracerebral hemorrhage recurred three times. In April 2001, the third large intracerebral hemorrhage occurred, for which the removal of hematoma was carried out and brain biopsy was done. The specimens showed an evidence of cerebrovascular amyloidosis, but no inflammation. In view of the absence of angitis in the parenchymal and pial blood vessels, despite the presence of pachymeningitis, the cortical and bridging veins which drained into the venous sinuses, were likely involved in inflammation. Impaired venous drainage due to pachymeningitis might be a mechanism by which recurrent multiple cerebral hemorrhages have taken place in the presence of amyloid angiopathy.