Treatment of Medial Medullary Infarction Using a Novel iNems Training: A Case Report and Literature Review

Abstract

Objective. We describe the case of a 66-year-old Japanese male patient who developed medial medullary infarction along with severe motor paralysis and intense numbness of the left arm, pain catastrophizing, and abnormal physical sensation. We further describe his recovery using a new imagery neurofeedback-based multisensory systems (iNems) training method. Clinical Course and Intervention. The patient underwent physical therapy for the rehabilitation of motor paralysis and numbness of the paralyzed upper limbs; in addition, we implemented iNems training using EEG activity, which aims to synchronize movement intent (motor imagery) with sensory information (feedback visual information). Results. Considerable improvement in motor function, pain catastrophizing, representation of the body in the brain, and abnormal physical sensations was accomplished with iNems training. Furthermore, iNems training improved the neural activity of the default mode network at rest and the sensorimotor region when the movement was intended. Conclusions. The newly developed iNems could prove a novel, useful tool for neurorehabilitation considering that both behavioral and neurophysiological changes were observed in our case.

Evaluation of Intervention Effectiveness of Sensory Compensatory Training with Tactile Discrimination Feedback on Sensorimotor Dysfunction of the Hand after Stroke

“…and "How much do you feel your numb hand is your own body?" The elicited sense of agency and sense of body ownership of the left hand decreased at 2/10 and 3/10, respectively, indicating a decreased awareness of one's own body [29]. The Japanese version of the motor activity log (MAL) [30,31], which is used to evaluate the use of the hand related to ADL and quality of life (QOL), is a questionnaire that consists of items for amount of use (AOU) and quality of motion (QOM) of the hand.…”

“…To assess learnability, we used the NRS to score the sense of agency and body possession in the same manner as the MAL [30,31] was used for ADL and QOL of the hand. An NRS on sense of agency [29] was provided for each MAL questionnaire item, and the relationship between behavior change and sense of agency was also rated. EEG was conducted for neurophysiological evaluation.…”

“…This study was conducted in accordance with the guidelines of the Declaration of Helsinki, and the study was approved by the Kyoto Tachibana University Ethical Review Committee (Approval No. [20][21][22][23][24][25][26][27][28][29][30][31][32][33]. The purpose, content, and procedures of the study were fully explained to the participants orally and in writing, and their consent was obtained.…”

Neurophysiological Examination of the Effects of Behavioral Antecedents on Physical Balance in Older Individuals

“…After calculating the neural activity in each of the three phases under each condition, we used this method to calculate the neural activity value in each brain coordinate region that showed the highest neural activity value in the SMA and right IPL regions in the three phases under the two conditions. Since the SMA acts synchronously on both sides of the brain when creating a motor image [33], that of the right hemisphere, which is more involved in the representation of one's own body in the brain [34], was used in this study. To determine the brain functional activity specialized in the postural perturbations, the data obtained by subtracting the electroencephalogram measurement during the standing motion measured in advance was used.…”

Clinical Usefulness of Real-time Sensory Compensation Feedback Training on Sensorimotor Dysfunction after Stroke

“…For successful rehabilitation of patients with different symptoms, it is important to identify the causative mechanisms of the disability and implement an individually optimized approach [5]. For this reason, it is important to input sensory feedback information properly in relation to motor images and intentions, without any time lag [6]. As a result, the sense of agency (SOA), which is one of the elements of body awareness, -'it is you yourself who moves your hand,'-increases and motor learning advances [7].…”