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Yumi Otaka,1 Yukinori Harada,1 Norio Sugawara,2 Taro Shimizu,1 Norio Yasui-Furukori2 1Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, School of Medicine, Tochigi, Japan; 2Department of Psychiatry, Dokkyo Medical University, School of Medicine, Tochigi, JapanCorrespondence: Norio Yasui-Furukori, Department of Psychiatry, Dokkyo Medical University, School of Medicine, Mibu, Shimotsuga, Tochigi, 321-0293, Japan, Tel +81-282-86-1111, Fax +81-282-86-5187, Email furukori@dokkyomed.ac.jpBackground: Diabetic chorea is a rare complication of diabetes mellitus for which head MRI is the most common diagnostic imaging modality. Cases have been reported where CT and/or MRI findings are inconsistent or clinical symptoms and imaging findings do not appear simultaneously. We aimed to compile the cases in which imaging findings appeared on MRI retests and to examine in a systematic review whether temporal differences in the appearance of imaging findings correlate with clinical characteristics.Case Presentation: An 80-year-old man with type 2 diabetes mellitus came to a hospital with abnormal movements of the left upper and lower extremities. Two days after the first visit, his symptoms flared up, and his head MRI showed an old cerebral infarction and no new lesion. On day 14, he retested T1-weighted imaging and showed a high signal in the right putamen, which was considered diabetic chorea. Blood glucose was controlled with insulin, and the involuntary movements disappeared.Methods: PubMed and ICHUSHI were searched to identify patients with diabetic chorea who had undergone MRI retests. Patients grouped by the temporal change in the presence/absence of imaging findings were compared on age, sex, duration of diabetes mellitus, blood glucose level, HbA1c level, side of involuntary movement, time to first MRI, and follow-up MRI.Results: Of the 64 cases analyzed, 43 (67.2%) were female. The mean age was 69.0 years. 16 (25.0%) had worsening findings upon MRI retesting, 37 (57.8%) had improvement, and 10 (15.6%) had unchanged findings. There were no significant differences in age, sex, mean blood glucose level or HbA1c at onset among the groups.Conclusion: There was no association between the pattern of appearance of imaging findings over time and clinical characteristics, including glucose levels. If initial MRI findings are negative, MRI retesting after a certain time may help diagnose diabetic chorea.Keywords: hyperglycemia, hemichorea, hemiballismus, diabetes, movement disorders

There have been a number of reports of muscle strength in the shoulders of high school baseball players, especially reports of rotation motion (internal and external rotation). This study had two purposes : one was to investigate standard muscle strength in first abduction motion and the other was to compare muscle power between an intact and an injured shoulder. We used orthopaedic tests (SSP test, ISP test, Jobe test impingement test), measured the range of motion for internal and external rotation of the shoulder, and measured muscle strength of the shoulder in first abduction motion using the BIODEX system 3. The maximum torque of first abduction motion was 36.5±4.8N-m for the pain group and 36.1±4.2N-m for the non-pain group. There was no statistically significant difference. This indicates that strength of the shoulder in first abduction motion was not affected by a shoulder disorder. The average muscle strength in first abduction motion for high school baseball players was 10.1±2.0%(kg). This data showed that muscle strength per weight in first abduction in high school baseball players was about 10% (kg) of weight, so that this data was available for sports medical examinations. [ABSTRACT FROM AUTHOR]

PURPOSE: To study the status of contribution by non-English speaking countries to international rehabilitation literature taking Japan as an example, and to suggest recommendations to overcome the language barrier. METHOD: Descriptive study using a systematic MEDLINE search with outcome measures of annual numbers and proportions of articles by Japanese physiatrists published in peer-reviewed English rehabilitation journals, and of categories and types of studies. A database containing 292 relevant articles were used for analysis. RESULTS: The publications have steadily increased annually both in absolute number and in proportion. The number was the largest for Arch Phys Med Rehabil (16.8%), followed by Am J Phys Med Rehabil (12.3%), Prosthet Orthot Int (8.6%), Disabil Rehabil (5.1 %) and so on. The percentage by category was the highest for stroke (26.0%), followed by spinal cord injury (11.6%), neurophysiology (11.6%) and amputation (6.2%), 67.8% of the articles were related to evaluation, 6.5% to outcome studies and 25.7% to therapy. The majority were descriptive studies (45.5%), followed by case control studies (13.0%), before-and-after trials (12.3%), case reports (7.2%) and others. CONCLUSION: The contribution from Japan to international rehabilitation literature is increasing. Measures were suggested to facilitate more scientific contribution by non-English speaking researchers. [ABSTRACT FROM AUTHOR]

Abstract Background We developed an electroencephalogram-based brain computer interface system to modulate functional electrical stimulation (FES) to the affected tibialis anterior muscle in a stroke patient. The intensity of FES current increased in a stepwise manner when the event-related desynchronization (ERD) reflecting motor intent was continuously detected from the primary cortical motor area. Methods We tested the feasibility of the ERD-modulated FES system in comparison with FES without ERD modulation. The stroke patient who presented with severe hemiparesis attempted to perform dorsiflexion of the paralyzed ankle during which FES was applied either with or without ERD modulation. Results After 20 minutes of training, the range of movement at the ankle joint and the electromyography amplitude of the affected tibialis anterior muscle were significantly increased following the ERD-modulated FES compared with the FES alone. Conclusions The proposed rehabilitation technique using ERD-modulated FES for stroke patients was feasible. The system holds potentials to improve the limb function and to benefit stroke patients.

Abstract Background To more accurately evaluate rehabilitation outcomes in stroke patients, movement irregularities should be quantified. Previous work in stroke patients has revealed a reduction in the trajectory smoothness and segmentation of continuous movements. Clinically, the Stroke Impairment Assessment Set (SIAS) evaluates the clumsiness of arm movements using an ordinal scale based on the examiner's observations. In this study, we focused on three-dimensional curvature of hand trajectory to quantify movement, and aimed to establish a novel measurement that is independent of movement duration. We compared the proposed measurement with the SIAS score and the jerk measure representing temporal smoothness. Methods Sixteen stroke patients with SIAS upper limb proximal motor function (Knee-Mouth test) scores ranging from 2 (incomplete performance) to 4 (mild clumsiness) were recruited. Nine healthy participant with a SIAS score of 5 (normal) also participated. Participants were asked to grasp a plastic glass and repetitively move it from the lap to the mouth and back at a conformable speed for 30 s, during which the hand movement was measured using OPTOTRAK. The position data was numerically differentiated and the three-dimensional curvature was computed. To compare against a previously proposed measure, the mean squared jerk normalized by its minimum value was computed. Age-matched healthy participants were instructed to move the glass at three different movement speeds. Results There was an inverse relationship between the curvature of the movement trajectory and the patient's SIAS score. The median of the -log of curvature (MedianLC) correlated well with the SIAS score, upper extremity subsection of Fugl-Meyer Assessment, and the jerk measure in the paretic arm. When the healthy participants moved slowly, the increase in the jerk measure was comparable to the paretic movements with a SIAS score of 2 to 4, while the MedianLC was distinguishable from paretic movements. Conclusions Measurement based on curvature was able to quantify movement irregularities and matched well with the examiner's observations. The results suggest that the quality of paretic movements is well characterized using spatial smoothness represented by curvature. The smaller computational costs associated with this measurement suggest that this method has potential clinical utility.