Hideki Nakano

By Takayuki Kodama and Hideki Nakano

Hitherto, physical therapy for rehabilitating patients with cerebral dysfunction has focused on acquiring and improving compensatory strategies by using the remaining functions; it has been presumed that once neural functions have been lost, they cannot be restored. However, neuroscience-based animal research and neuroimaging research since the 1980s have demonstrated that recovery arises from plastic changes in the central nervous system and reconstruction of neural networks; this research is ushering in a new age of neuroscience-based rehabilitation as a treatment for cerebral dysfunction (such as stroke). In this paper, in regard to mental practices using motor imagery and kinaesthetic illusion, we summarize basic discoveries and theories relating to motor function therapy based on neuroscientific theory; in particular, we outline a novel rehabilitation method using kinaesthetic illusion induced by vibrational stimulus, which the authors are currently attempting in stroke patients.

Part of the book: Neurological Physical Therapy

By Hideki Nakano and Takayuki Kodama

Motor imagery and action observation facilitate motor recovery of patients because both the motor imagery and the action observation share the activation of cortical neural networks implicated in movement execution. Specifically, imagery, observation, and execution activate the medial parietal area of the brain located between the parieto‐occipital sulcus and the posterior end of the cingulate sulcus. This chapter reviews the neural mechanisms and clinical studies of motor imagery and action observation and discusses the applications in physical therapy.

Part of the book: Neurological Physical Therapy

By Hideki Nakano and Takayuki Kodama

Action observation is a useful approach for improving human motor skill acquisition. This process involves the mirror neuron system that consists of the ventral premotor area, inferior parietal lobule, and superior temporal sulcus. The interaction between these areas produces the effect of action observation. This chapter presents neurophysiological and brain imaging studies of action observation, and their application to human motor learning. For action observation, the mirror system appears to map the intention in the ventral premotor area and the goal in the inferior parietal lobule. These features of action representation may be useful for refining conditions of practice, based on the mirror system, for acquiring new motor skills.

Part of the book: Electroencephalography

By Hideki Nakano

In recent years, neuroscience-based rehabilitation, also known as neurorehabilitation, has been attracting increasing attention worldwide. Electroencephalography (EEG) has been widely used in clinical practice as a tool for the evaluation and treatment of rehabilitation because of its noninvasive and simple measurement of human brain activity. EEG-electromyography coherence is a method to analyze the synchronization between the motor cortex and muscle activity during movement and to quantitatively assess how the motor cortex controls muscle activity. In addition, recent advances in analysis and measurement techniques have made it possible to estimate the source of EEG signals, thus serving as a method to evaluate rehabilitation. The brain-machine interface, which integrates medicine and engineering, has been widely applied in the treatment of rehabilitation and for improving the quality of life. This chapter provides an overview of EEG, and its uses as a tool for rehabilitation assessment and treatment.

Part of the book: Electroencephalography

By Akiyoshi Matsugi, Kyota Bando, Yutaka Kikuchi, Yuki Kondo and Hideki Nakano

Rehabilitation is an important treatment for spinocerebellar ataxia (SCA). The lack of improvement in ataxia, deficit of motor learning, and unstable balance causes disability for activities of daily living and restricts participation in social activities, further resulting in a disturbance of the restoration of quality of life. This narrative review describes physical rehabilitation, including measurement of movement disorder, associated with ataxia and possible interventions. Several lines of evidence suggest that high-intensity individualized physical rehabilitation programs, especially for gait and balance training, improve motor function. Continuous exercise at home contributes to the maintenance of the gait and balance function. Moreover, videography and mechanical technology contribute to the evaluation of ataxia and motor learning ability, and assistive robotic systems may improve gait stability. Neuromodulation montages, such as repetitive transcranial magnetic stimulation and transcranial electrical stimulation, can enhance the effect of physical rehabilitation. Further research aimed at developing a more-effective physical rehabilitation for these patients is expected.

Part of the book: Spinocerebellar Ataxia

By Shun Sawai, Shoya Fujikawa, Ryosuke Yamamoto and Hideki Nakano

Attention focus plays an essential role in promoting motor performance and motor learning. There are two types of attention focus: internal focus and external focus. Internal focus refers to direct attention inside the body while external focus refers to direct attention outside the body. Several studies have reported that external focus positively affects motor performance and motor learning by promoting automatic control. The mechanisms of attention focus have been examined using electromyography (EMG), electroencephalography (EEG), and functional magnetic resonance imaging (fMRI). During rehabilitation, therapists promote patients’ movement acquisition and motor learning. This chapter reviews the application of attention focus in rehabilitation to promote motor performance and motor learning in patients.

Part of the book: Neurorehabilitation and Physical Therapy

By Ryu Ushio, Kousuke Tamura, Shoya Fujikawa, Chihiro Ohsumi, Shun Sawai, Ryosuke Yamamoto and Hideki Nakano

Repetitive peripheral magnetic stimulation (rPMS) is a noninvasive method involving the repetitive magnetic stimulation of peripheral nerves and muscles. Recently, its potential as a new neuromodulation technique for sensory motor disorders has been recognized. Its advantages include less pain than with electrical stimulation and that neuromuscular stimulation can be performed over clothing. These advantages make it a practical and straightforward adjunct tool widely used in clinical practice. In particular, the combination of rPMS and general rehabilitation reportedly promotes functional improvement in stroke patients with difficult involuntary contractions. This chapter reviews rPMS and its potential clinical applications in rehabilitation.

Part of the book: Neurorehabilitation and Physical Therapy

By Shoya Fujikawa, Chihiro Ohsumi, Ryu Ushio, Kousuke Tamura, Shun Sawai, Ryosuke Yamamoto and Hideki Nakano

Improving standing posture balance is an essential role of rehabilitation to prevent falls in the elderly and stroke victims. Recently, motor imagery has been reported to be an effective method to improve standing posture balance. Motor imagery is a simulation of a movement in the brain without actual movement. Motor imagery is believed to have a common neural basis with actual movement and is effective in reconstructing motor functions. Recently, it has also been shown that motor imagery can be enhanced through use in combination with neuromodulation techniques. In this chapter, motor imagery contributing to the improvement of standing postural balance and its combination with neuromodulation techniques are reviewed.

Part of the book: Neurorehabilitation and Physical Therapy

By Shun Sawai, Shoya Fujikawa, Ryosuke Yamamoto and Hideki Nakano

Neurofeedback (NFB) is a closed-loop technique in which the patient receives feedback on brain activity to encourage voluntary control of brain activity. NFB promotes neuroplasticity and changes the brain functionally and structurally. Motor imagery-based NFB (MI-NFB) can improve motor imagery ability by providing feedback on brain activity during motor imagery, thereby showing effectiveness in performance and motor learning. Furthermore, the effects of MI-NFB are further enhanced when it is combined with noninvasive brain stimulation and motor exercise. Therefore, MI-NFB is used in the physiotherapy of patients with neurological diseases, such as stroke and Parkinson disease, as well as children with attention deficit-hyperactivity disorder and elderly people. This chapter reviews MI-NFB in physiotherapy practice, thus contributing to the development of effective evidence-based physiotherapy.

Part of the book: Physical Therapy

By Shoya Fujikawa, Shun Sawai, Ryosuke Yamamoto and Hideki Nakano

Interhemispheric inhibition is an inhibitory function of the brain that enables complex human locomotion and plays an important role in motor control. Traditionally, interhemispheric inhibition has been assessed using transcranial magnetic stimulation, functional magnetic resonance imaging, and electroencephalography. However, motor overflow and bimanual coordinated movements have recently attracted attention as behavioral indices involving interhemispheric inhibition. Motor overflow is defined as the presence of involuntary movements or weak muscle activity that appears with voluntary movements and has been found to occur mainly in the elderly, children, and those with central nervous system diseases. In addition, interhemispheric inhibition is involved in bimanual coordinated movements associated with interhemispheric motor control and information processing. This chapter outlines motor overflow and bimanual coordinated movements as new behavioral indices of interhemispheric inhibition and proposes assessment methods that can be performed in physiotherapy clinics.

Part of the book: Physical Therapy