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Brain activity during observation and imagery of gait was investigated. Sixteen subjects were scanned with a 3-Tesla MRI scanner while viewing six types of video clips: observation of gait movement (GO) from the third-person perspective, observation of stepping movement, observation of standing posture, “virtual walking” (VW) that was observation of visual scenes mimicking the visual afferent during walking, and the scrambled version of the GO and VW stimuli. In the VW condition, moving scenes provided a virtual visual environment in which subjects easily imagined as if they were actually walking from the first-person perspective. A behavioral experiment revealed a correlation of cadence during actual walking with that during imaginary walking under the influence of the VW stimuli, indicating that a gait planning mechanism was shared by actual walking and gait imagery. The VW condition activated the dorsal premotor cortex (PMd), supplementary motor area/cingulate motor area (SMA/CMA), parahippocampal gyrus, and subcortical nuclei. The GO stimuli yielded activation of the SMA, PMd, inferior frontal gyrus, and inferior parietal lobule. Moreover, the conjunction null test of GO and VW revealed common activity in the SMA/CMA and PMd, which were reportedly active during actual gait movement, in addition to visual areas. Detailed analyses of activity during stepping or standing observation supported the specificity of the SMA and PMd to GO. These findings suggest that motor planning centers of gait, including the SMA and PMd, are activated during both imagination (first-person perspective) and observation (third-person perspective) of gait behaviors.

Purpose Late-onset non-infectious pulmonary complications (LONIPCs) after allogeneic hematopoietic stem cell transplantation are fatal; however, lung transplantation might achieve good survival. Nevertheless, improving the health-related quality of life (HRQoL) is still a major concern. This study aimed to investigate, in detail, the recovery in HRQoL and social reintegration status after lung transplantation in patients with LONIPC after allo-HSCT. Methods This prospective cohort study involving 18 patients examined changes in the health and social reintegration status after lung transplantation following LONIPC. Results Physical function and HRQoL were lowest before lung transplantation. Two years after lung transplantation, the dyspnea scores and performance status improved. Most patients had made a successful return to society, and patients who achieved social reintegration were significantly younger and had a good performance status. However, their Physical Functioning score and Physical Component Summary did not show significant improvement after lung transplantation. Moreover, recipients who were unemployed before lung transplantation were likely to remain unemployed and continued to show poor HRQoL. Conclusions These results showed poor recovery of HRQoL, especially in terms of physical function, and the likelihood of failure to reintegrate into society within 2 years after lung transplantation. It is necessary to consider long-term follow-up and physical training to improve social reintegration and HRQoL.

Alcohol use disorders can cause peripheral and central neurological disorders with symptoms such as pain, numbness, paresthesia, and dysesthesia, often impairing walking ability. However, effective treatments for alcohol-related peripheral neuropathy are yet to be identified. This case report highlights the successful use of dysesthesia-matched transcutaneous electrical nerve stimulation (DM-TENS) and aerobic exercise in a 53-year-old woman with alcohol-related peripheral neuropathy who presented with severe pain and walking difficulties. Initially, her pain and numbness were scored 8-9 on the numerical rating scale (NRS), and her timed up-and-go test (TUG) time was 23.00 seconds. DM-TENS reduced her symptoms (NRS: 3), and the introduction of aerobic exercise further enhanced her recovery. After six days, her pain and numbness improved (NRS: 5), and her walking ability markedly increased (TUG: 10.94 s). By day 10, her symptoms had significantly resolved (NRS: 1). This case suggests that combining DM-TENS and aerobic exercise can effectively reduce pain, improve mobility, and offer a promising therapeutic approach to alcohol-related peripheral neuropathy.

PurposeLate-onset noninfectious pulmonary complications (LONIPCs) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) are fatal, and lung transplantation is the only curative treatment. Although lung transplantation for LONIPCs may confer good survival rates, it is unclear whether or how impaired physical functioning is restored. Thus, this study aimed to investigate the long-term course and associated changes in physical functions after lung transplantation in patients with LONIPCs after allo-HSCT.MethodsThis prospective cohort study enrolled 15 patients who received lung transplantation for LONIPCs after allo-HSCT between 2012 and 2018. Dyspnea scores, performance status, physical function, and exercise tolerance were assessed before lung transplantation and up to 2 years after transplantation.ResultsTwo years after lung transplantation, the dyspnea scores and performance status improved, but did not recover completely. Physical function was assessed using the knee extensor strength (KES) and 6-min walk test (6MWT); the results were poor until 3 months after transplantation but improved over 2 years. The 6MWT distance showed improvement to a nearly healthy level (562.7 m). Recovery of exercise tolerance was associated with recovery in % vital capacity (%VC; r=0.5) and KES (r=0.4) from 3 months to 2 years after lung transplantation. Furthermore, a flat thorax, which is a characteristic of patients with LONIPCs, affected the %VC at 2 years after transplantation (r=0.8).ConclusionLung transplantation for LONIPCs may restore impaired physical function. A multifaceted rehabilitation program should be considered, especially to improve muscle weakness and pulmonary function.

Awake craniotomy enables mapping and monitoring of brain functions. For successful procedures, rapid awakening and the precise evaluation of consciousness are required. A prospective, observational study conducted to test whether intraoperative hand strength could be a sensitive indicator of consciousness during the awake phase of awake craniotomy. Twenty-three patients who underwent awake craniotomy were included. Subtle changes of the level of consciousness were assessed by the Japan Coma Scale (JCS). The associations of hand strength on the unaffected side with the predicted plasma concentration (Cp) of propofol, the bispectral index (BIS), and the JCS were analyzed. Hand strength relative to the preoperative maximum hand strength on the unaffected side showed significant correlations with the Cp of propofol (ρ =  − 0.219, p  = 0.007), the BIS (ρ = 0.259, p  = 0.002), and the JCS (τ =  − 0.508, p  = 0.001). Receiver operating characteristic curve analysis for discriminating JCS 0–1 and JCS ≥ 2 demonstrated that the area under the curve was 0.76 for hand strength, 0.78 for Cp of propofol, and 0.66 for BIS. With a cutoff value of 75% for hand strength, the sensitivity was 0.76, and the specificity was 0.67. These data demonstrated that hand strength is a useful indicator for assessing the intraoperative level of consciousness during awake craniotomy.

As the proportion of long-term survivors after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is on the rise, it is essential to consider the significance of quality of life (QOL), including reintegration with society (returning to school or work). This retrospective cohort study aims to illustrate the precise epidemiology of social reintegration later after allo-HSCT and determine its predictive indicators. We enrolled 56 patients, and 40 patients (71%) attained social reintegration at 2 years post-HSCT. Reintegration failure markedly correlated with an inferior performance status and concurrent chronic graft-versus-host disease. In non-reintegrated patients, the physical function at discharge measured by the 6-min walking distance (6MWD) was markedly decreased. On the multivariate risk analyses, sex (female; odds ratio (OR) 0.07; 95% confidence interval (CI) 0.01–0.54; p  = 0.01), HCT-CI (≥ 2; OR 0.10; 95% CI 0.01–0.84; p  = 0.03), and change in 6MWD (per 5% increase; OR 1.47; 95% CI 1.01–2.13; p  = 0.04) were significant predictors of later social reintegration. This study suggests that a multidisciplinary strategy including rehabilitation is essential, especially in patients with poor predictive markers at an early phase, and we should consider suitable rehabilitation programs to prevent a decline in exercise tolerance and improve social reintegration and overall QOL in patients after allo-HSCT.

This study investigated the link between pre-stroke and acute-stage physical activity (PA) and sedentary behavior. Forty individuals with stroke (aged 73.6 ± 8.9 years) were enrolled. Post-stroke activity, including metabolic equivalents (METs), sedentary behavior, light PA, and moderate-to-vigorous PA (MVPA), was measured using a tri-axial accelerometer (ActiGraph wGT3X-BT) over 11 consecutive days starting from the 4th day post-stroke. Pre-stroke PA levels were assessed using the International Physical Activity Questionnaire (IPAQ). We measured skeletal muscle mass index (SMI) and phase angle using a bioelectrical impedance analyzer (Inbody S10) upon admission. Physical therapists assessed the Brunnstrom recovery stage (BRS) within 3 days post-stroke. Total daily activity averaged 1.05 ± 0.05 METs. Throughout the day, 91.2 ± 5.1, 7.6 ± 4.1, and 1.2 ± 1.3% was spent in sedentary behavior, light PA, and MVPA, respectively. Only pre-stroke PA was independently associated with METs (β = 0.66), sedentary behavior (β = −0.58), light PA (β = 0.50), and MVPA (β = 0.71) after adjusting for age, sex, stroke severity, and activities of daily living. This suggests that pre-stroke PA might play a crucial role in reducing sedentary behavior and promoting PA during the acute phase.

The association between neurocognitive function (NCF) impairment and brain cortical functional connectivity in glioma patients remains unclear. The correlations between brain oscillatory activity or functional connectivity and NCF measured by the Wechsler Adult Intelligence Scale full-scale intelligence quotient scores (WAIS FSIQ), the Wechsler Memory Scale-revised general memory scores (WMS-R GM), and the Western aphasia battery aphasia quotient scores (WAB AQ) were evaluated in 18 patients with left frontal glioma using resting-state electroencephalography (EEG). Current source density (CSD) and lagged phase synchronization (LPS) were analyzed using exact low-resolution electromagnetic tomography (eLORETA). Although 2 and 2 patients scored in the borderline range of WAIS FSIQ and WMS-R GM, respectively, the mean WAIS FSIQ, WMS-R GM, and WAB AQ values of all patients were within normal limits, and none had aphasia. In the correlation analysis, lower WMS-R GM was associated with a higher LPS value between the right anterior prefrontal cortex and the left superior parietal lobule in the beta1 band (13–20 Hz, R = − 0.802, P  = 0.012). These findings suggest that LPS evaluated by scalp EEG is associated with memory function in patients with left frontal glioma and mild NCF disorders.

Motor function deterioration is a common postoperative complication in glioma patients, affecting daily activities. Although continuous rehabilitation is essential for motor recovery, the underlying cause of postoperative decline remains unclear. This case study investigates the temporal relationship between motor function, corticospinal tract (CST) fractional anisotropy (FA), and edema in a glioma patient following awake craniotomy. A 43-year-old Japanese man with recurrent left parietal glioma and right spastic hemiparesis underwent seven tumor resections over 12 years, culminating in an awake craniotomy. He experienced postoperative motor decline and underwent continuous rehabilitation. FA values of the CST and motor function were assessed preoperatively and on postoperative days 12, 29, and 134. Magnetic resonance imaging (MRI), T2 fluid-attenuated inversion recovery (FLAIR) was used to monitor edema progression. On postoperative day 12, a significant increase in edema was observed in the frontoparietal region, coinciding with a decline in FA and motor function. However, by postoperative days 29 and 134, edema had decreased, and both FA and motor function improved. The findings suggest that vasogenic edema contributed to the transient motor decline, as evidenced by the reversible FA changes, suggesting that CST integrity assessment via FA and edema monitoring may guide postoperative rehabilitation strategies.

Purpose The purpose of this study was to retrospectively investigate the effect of the severity of acute graft-versus-host disease (GVHD) on physical function after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods 76 patients were included as subjects of this study. Severity of acute GVHD was classified according to the method defined by Grucksberg. To evaluate physical function, the knee extensor strength and six-minute walk distance (6MWD) were performed. Results Among these patients, 54% developed acute GVHD; of these, 32%, 54%, and 15% of patients had grade I, grade II, and grades III–IV GVHD, respectively. In the grade I–II groups, mild acute GVHD following allo-HSCT resulted in a gradual decline in physical function, which improved at discharge. However, in cases of severe acute GVHD, physical function deteriorated, implementation of rehabilitation became difficult, and the decline in physical function persisted even at discharge. Conclusion These results indicate that severe acute GVHD negatively affects physical function leading to longer hospital days because of inadequate rehabilitation interventions.