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Recent non-invasive brain stimulation techniques in combination with motor training can enhance neuroplasticity and learning. It is reasonable to assume that such neuroplasticity-based interventions constitute a useful rehabilitative tool for patients with Parkinson's Disease (PD). Regarding motor skill training, many kinds of tasks that do not involve real motor movements have been applied to PD patients. The purpose of this study is to elucidate whether motor skill training using mirror visual feedback (MVF) is useful to patients with PD in order to improve untrained hand performance dependent on the time course of training; and whether MVF combined with anodal transcranial direct current stimulation (tDCS) over primary motor cortex (M1) causes an additional effect based on increased motor cortical excitability. Eighteen right-handed patients with PD in the off-medication state and 10 age-matched healthy subjects (HS) performed four sessions of right-hand ball rotation using MVF (intervention) on two separate days, 1 week apart (day 1 and day 2). HS subjects received only sham stimulation. The intervention included four sessions of motor-skill training using MVF for 20 min comprised of four sets of training for 30 s each. PD patients were randomly divided into two intervention groups without or with anodal tDCS over the right M1 contralateral to the untrained hand. As the behavior evaluation, the number of ball rotations of the left hand was counted before (pre) and immediately after (post) intervention on both days (pre day 1, post day 1, pre day 2, and post day 2). Motor evoked potential (MEP), input-output function, and cortical silent period were recorded to evaluate the motor cortical excitatory and inhibitory system in M1 pre day 1 and post day 2. The number of ball rotations of the left hand and the facilitation of MEP by intervention were significantly impaired in patients with PD compared to HS. In contrast, if anodal tDCS was applied to right M1 of patients with PD, the number of ball rotations in accordance with I-O function at 150% intensity was significantly increased after day 1 and retained until day 2. This finding may help provide a new strategy for neurorehabilitation improving task-specific motor memory without real motor movements in PD.

Aim Neurological symptom severity is a prognostic factor for post-stroke activities of daily living (ADL). Recently, it has been reported that white matter lesions indicate poor functional prognosis in patients with stroke. The present study investigated the influence of white matter lesions on the ADL of older patients with stroke who have mild neurological symptoms. Method We investigated ADL at discharge in 44 patients with stroke (men, n = 27; women, n = 17; mean age 78 years [range 71–85 years]) aged ≥65 years with National Institutes of Health Stroke Scale scores of ≤5 (cerebral infarction, n = 37; cerebral hemorrhage, n = 7). We used single correlation analysis and multiple regression analysis to investigate factors that correlated with ADL at discharge. ADL at discharge was also evaluated on the basis of white matter lesion severity (Fazekas classification, grades 0–3). Results Single correlation analysis showed that age (r = −0.36, P = 0.016), male sex (r = 0.362, P = 0.016), neurological symptom severity (r = −0.361, P = 0.016), ADL on starting rehabilitation (r = 0.685, P

Introduction Gait disturbance of Parkinsonian syndrome is characterized by dysrhythmic gait cycle including freezing, small steps and slowness. These symptoms are often not sufficiently responsive to dopaminergic therapy. Recently, we developed new rehabilitation system using non-invasive closed–circuit brain stimulation targeting on dysrhythmic gait dysfunction. Methods The objective of this study is to investigate whether the oscillatory closed-circuit brain stimulation mimicking the appropriate gait cycle can modulate the gait speed and cycle in patients with parkinsonian syndrome. Six patients with Parkinsonian syndrome participated in this study. Three were diagnosed as Parkinson’s disease, two as corticobasal syndrome and one as vascular parkinsonism. Before gait rehabilitation, we decided optimal brain stimulation frequency to each subject as 1/averaged gait cycle when they were best on condition. All participants performed gait rehabilitation for total ten days which contained 4 sessions (4 min. walk and 3 min. rest) per each day. During gait rehabilitation, slow oscillatory DC stimulation (current intensity 0–2 mA) was applied over ipsilateral cerebellum as symptom dominant side, which was triggered by their flat foot switch attached to the ipsilateral heels. Closed-circuit system enabled the implementation of the oscillatory brain stimulation with a fixed pre-set phase lag with respect to the intrinsic gait cycle. Ten m gait speed, cadence, laterality of gait cycle and frozen of gait questionnaire (FOGQ) were evaluated before and after gait rehabilitation. Results Gait speed and cadence were significantly increased after gait rehabilitation (speed: 98 ± 39 cm/s before and 116 ± 38 cm/s after, cadence: 114 ± 18 steps/min before and 124 ± 20 steps/min after). Laterality of gait cycle and FOGQ were significantly decreased after the rehabilitation (laterality: 0.07 ± 0.05 before and 0.0021 ± 0.004 after, FOGQ: 10 ± 7 before and 7 ± 5 after). Conclusion Closed-circuit brain stimulation during walking is useful method to parkinsonian gait disturbance possibly by normalizing dysrhythmic and lateralized gait control system in patients with Parkinsonian syndrome. This new system may provide the personalized rehabilitation in patients with Parkinson related disorders.