谷川 広樹

Objective To determine the effects of repetitive peripheral magnetic stimulation in a patient with chronic stroke. Design Case report. Patients A man in his 70s presented with left hemiplegia secondary to cerebral hemorrhage. Methods An AB design was used: phase A (sham stimulation) and phase B (active stimulation). Magnetic stimulation was applied using a peripheral magnetic stimulator (Pathleader™, IFG, Sendai, Japan). Outcomes were assessed at four points: before the intervention, after phase A, after phase B, and at follow-up (3 weeks after phase B) using the Modified Ashworth Scale, range of motion, Fugl-Meyer Assessment, Simple Test for Evaluating Hand Function, and Canadian Occupational Performance Measures. Results The Modified Ashworth Scale score for the wrist extensor remained unchanged in phase A but improved after phase B and was sustained at follow-up. The range of motion showed no change. The Fugl-Meyer Assessment scores were 40, 41, 44, and 45, respectively, and the Simple Test for Evaluating Hand Function scores were 1, 4, 3, and 5, respectively, at the four time points. One Canadian Occupational Performance Measure item improved after phase B and remained stable. Conclusion In patients with chronic stroke and severe hemiplegia, repetitive peripheral magnetic stimulation may be effective in reducing spasticity and improving motor function.

Objectives This study aimed to evaluate the effect of repetitive peripheral magnetic stimulation on edema of the hemiparetic hand in patients with stroke. Methods This single-center, open-label, crossover, randomized controlled trial was registered with the Japan Registry of Clinical Trials, included 18 post-stroke patients in the convalescent rehabilitation ward. Patients were randomly assigned to two groups and received either conventional rehabilitation (control) or conventional rehabilitation plus repetitive peripheral magnetic stimulation (intervention) for 2 weeks, followed by 2 weeks of the other treatment. The repetitive peripheral magnetic stimulation intervention consisted of 6,000 pulses per day at a frequency of 30 Hz, 5 days per week. The primary outcome was changes in hand edema. The secondary outcomes were circumference of the hand, passive range of motion of flexion and extension of the metacarpophalangeal joint, hand pain and numbness, and grip strength. The outcomes were analyzed using mixed-effects models for repeated measures. Results Sixteen patients who completed the whole phase were included in the analysis. The changes in hand edema showed significant differences between the groups ( p < .01). Metacarpophalangeal joint flexion also had significant differences between the groups ( p < .01). The left-right difference in hand volume increased from 48.8 ± 27.6 mL to 59.1 ± 26.3 mL after the control but significantly decreased from 56.3 ± 31.6 mL to 39.7 ± 30.2 mL after the intervention ( p < .01). Conclusions Repetitive peripheral magnetic stimulation is effective in reducing hemiparetic hand edema and increasing metacarpophalangeal joint flexion after stroke.

UNLABELLED: Itoh S, Tanikawa H, Kondo H, Ozeki S, Ito T, Fujimura K, Teranishi T. Minimal Detectable Change in Muscle Strength Measurements Obtained Using a Hand-Held Dynamometer in Patients with Stroke. Jpn J Compr Rehabil Sci 2025; 16: 9-18. OBJECTIVE: The current study aimed to evaluate the reliability of muscle strength measurements using a hand-held dynamometer (HHD) in patients with chronic stroke. Further, it examined the minimal detectable change (MDC95). METHODS: Patients who presented with chronic stroke hemiplegia for > 180 days post-stroke onset were analyzed. Muscle strength in the paretic lower limb was assessed using an HHD, and gait speed was evaluated. RESULTS: For hip flexion, hip adduction, hip abduction, knee extension, ankle dorsiflexion, and ankle plantarflexion, the intra-rater reliability of the muscle strength measurements, as assessed using the intraclass correlation coefficient (ICC), ranged from 0.989 to 0.998. The inter-rater reliability, as assessed using ICC, ranged from 0.886 to 0.939. Bland-Altman analysis did not indicate systematic errors, and the MDC95 of each joint movement was calculated. Muscle strength in hip flexion, hip adduction, knee extension, ankle dorsiflexion, and ankle plantarflexion were significantly associated with gait speed, but not with hip abduction strength. The MDC95 of each muscle strength measurement was established, thereby providing a criterion for detecting actual changes that exceed the measurement error. CONCLUSIONS: The HHD had a high reliability in measuring lower limb muscle strength in patients with chronic stroke hemiplegia. Moreover, an association was found between individual muscle strength and gait ability. Based on this study, specific target muscles for interventions that aim to improve gait speed can be identified. Further, the use of MDC95 allows for a more accurate assessment of the intervention effects.

Objective: To demonstrate the long-term efficacy of repeated botulinum toxin A injections into the same muscles for ameliorating lower limb spasticity and gait function.Design: Single-case studyPatient: A 36-year-old woman with right cerebral haemorrhage received her first botulinum toxin A injection 1,296 days after onset. The patient underwent 30 treatments over 12 years after the first injection to improve upper and lower limb spasticity and abnormal gait patterns. The mean duration between injections was 147 days.Methods: The Modified Ashworth Scale, passive range of motion, gait velocity, and degree of abnormal gait patterns during treadmill gait were evaluated pre-injection and at 2, 6, and 12 weeks after every injection.Results: The follow-up period showed no injection-related adverse events. Comfortable overground gait velocity gradually improved over 30 injections. The Modified Ashworth Scale and passive range of motion improved after each injection. Pre-injection values of the degree of pes varus, circumduction, hip hiking, and knee extensor thrust improved gradually. However, the degree of contralateral vaulting, excessive lateral shift of the trunk, and insufficient knee flexion did not improve after 30 injections.Conclusion: Repeated botulinum toxin A injections effectively improve abnormal gait patterns, even when a single injection cannot change these values.