PMC5317149_01
Brain lesion in computed tomography (CT). Low-density areas (arrows) in the right putamen and temporal lobe are observed.
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fig1
Brain CT scan revealed cerebral infarction of the right putamen and temporal lobe (Figure 1).
Improvement of the patient's grasp reflex. (a) The patient could not open his hand when the examiner inserted his index finger into the patient's palm before BTX-A treatment. (b) The patient could open his hand when the examiner elicited the grasp reflex after BTX-A treatment.
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One week after the BTX-A injections, the spasticity of the left upper limb and the fingers improved and the grasp reflex and involuntary movement nearly disappeared (Figure 2).
Hypothesized mechanism of a newly designed facilitation exercise for the hemiplegic upper limb and fingers. (a) Facilitation for extension of the isolated finger is performed as follows: (1) the finger is quickly flexed by the therapist; this elicits the stretch reflex; (2) the therapist instructs, "Extend" and pushes the proximal phalanx to flex the metacarpophalangeal (MP); and (3) the therapist applies slight resistance against finger extension to maintain extension of the finger. The thick arrow and thin arrow indicate manipulation to induce the stretch reflex and light touch (resistance) to maintain the alpha-gamma linkage, respectively. (b) Descending motor tracts related to the patient's intention to move will respond to excitation of the patient's intention when these neural tracts are excited to a sufficient excitation level by facilitation techniques and result in the realization of movements by the patient's intention. Modified from Figure 1 in Kawahira et al. (2010).
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The hypothesized mechanism of the newly designed facilitation exercises for the fingers is shown in Figure 3.
Effect of continuous electrical stimulation on the patient's ability to carry 5 pegs. The electrodes were attached to the extensor side of the forearm. The patient was instructed to carry each peg from one dish to another dish. The length of time required to carry the 5 pegs improved from 19.4 s without continuous electrical stimulation to 14.5 s with continuous electrical stimulation.
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When low-amplitude continuous NMES was applied to the left wrist and finger extensor muscles with surface electrodes, he could grasp and release objects easily (Figure 4).
Projection of the probes and the channels onto the brain surface, using MRI data and a 3D position detector. Red: source, blue: detector, and yellow: channel.
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The channel is supposed to be set at the midpoint between the two probes 20~30 mm under the scalp (see Figure 5).
The procedure of the pinching task. The patient was instructed to relax for 10 s, and then the operator ordered the patient to start pinching with the left thumb and index finger every 2 s at the operator's command. After 20 s of pinching, the patient was instructed to relax for another 10 s: 5 cycles of 10 s rest, 20 s pinching task, and 10 s rest were performed for averaging. Therefore, there is an interval of 20 s between 2 pinching tasks.
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After 20 s of pinching, the patient was instructed to relax for 10 s; 5 cycles of this 10 s rest, 20 s pinching task, and 10 s rest were performed for averaging (Figure 6).