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Objective To investigate the factors affecting the discharge destination of patients with spinal bone metastases. Methods We reviewed the medical records of patients admitted to our institute with a diagnosis of skeletalrelated events secondary to malignant disease. Exclusion criteria comprised decreased cognitive function and hypercalcemia, brain metastasis, peritoneal dissemination, and pleural dissemination. The factors examined included the discharge destination, age, sex, the Barthel Index (BI) at admission and discharge, pain at admission and discharge, number of co-resident household members, length of hospital stay, treatment strategy, spinal instability neoplastic score, vertebral body collapse, spinal level of bone metastases, and motor paralysis. For the discharge destination, patients at discharge were grouped into two categories. The home group included patients discharged to their own homes, and the non-home group included patients discharged to other hospitals. Results Of 140 patients, the home group comprised 120 patients and the non-home group comprised 20 patients. Activities of daily living (ADL) and pain at rest and during motion improved significantly in the home group, whereas only pain at rest and during motion improved significantly in the non-home group. The results indicated that discharge BI and motor paralysis were the best predictors of the discharge destination; a BI cut-off value of 72.5 predicted discharge to home. Conclusion This study showed that the ADL level on discharge and motor paralysis affected the discharge destination of patients with spinal bone metastases. These results are likely to be helpful in predicting the discharge destination of patients with spinal bone metastases.

Recovery from motor paralysis is facilitated by affected patients' recognition of the need for and practice of their own exercise goals. Neurorehabilitation has been proposed and used for the treatment of motor paralysis in stroke, and its effect has been verified. If an expected score for the neurorehabilitation effect can be calculated using the Fugl-Meyer Motor Assessment (FMA), a global assessment index, before neurorehabilitation, such a score will be useful for optimizing the treatment application criteria and for setting a goal to enhance the treatment effect. Therefore, this study verified whether the responsiveness to a treatment method, the NovEl intervention using repetitive transcranial magnetic stimulation and occupational therapy (NEURO), in patients with post-stroke upper extremity (UE) motor paralysis could be predicted by the pretreatment FMA score. No control group was established in this study for NEURO treatment. To analyze the recovery of the motor function in the UE, delta-FMA was calculated from the pre- and post-FMA scores obtained during NEURO treatment. The probability of three levels of treatment responsiveness was evaluated in association with delta-FMA score (

In patients with severe motor paralysis, increasing the excitability of the supplementary motor area (SMA) in the non-injured hemisphere contributes to the recovery of lower limb motor function. However, the contribution of transcranial direct current stimulation (tDCS) over the SMA of the non-injured hemisphere in the recovery of lower limb motor function is unclear. This study aimed to examine the effects of tDCS on bilateral hemispheric SMA combined with assisted gait training. A post-stroke patient with severe motor paralysis participated in a retrospective AB design. Assisted gait training was performed only in period A and tDCS to the SMA of the bilateral hemisphere combined with assisted gait training (bi-tDCS) was performed in period B. Additionally, three conditions were performed for 20 min each in the intervals between the two periods: (1) assisted gait training only, (2) assisted gait training combined with tDCS to the SMA of the injured hemisphere, and (3) bi-tDCS. Measurements were muscle activity and beta-band intermuscular coherence (reflecting corticospinal tract excitability) of the vastus medialis muscle. The bi-tDCS immediately and longitudinally increased muscle activity and intermuscular coherence. We consider that bi-tDCS may be effective in recovering lower limb motor function in a patient with severe motor paralysis.

Abstract Background Motor conversion disorders are characterized by movement symptoms without a neurological cause. A psychogenic etiology is presumed for these disorders, but little is known about their underlying neural mechanisms. Functional magnetic resonance imaging (fMRI) has been utilized to understand the mechanisms associated with unexplained motor symptoms. Here, we used fMRI to investigate the cerebral response to motor stimulation in a patient with conversion disorder with motor paralysis to determine the underlying neural mechanisms of this disorder. Methods Brain activation induced by movements of the bilateral ankle joints (repeated plantar flexion and dorsiflexion) was recorded using fMRI in a patient with conversion disorder with unexplained motor paralysis. We acquired 2 types of imaging data: (i) data obtained while motor paralysis remained present and (ii) data obtained after motor paralysis had completely improved. We used a within‐subject fMRI block design to compare the patient's brain activities during the motor task and at rest. Results Cerebral motor areas were significantly activated during the motor task relative to at rest, both when motor paralysis remained present and when paralysis had improved (FWE‐corrected P