大内田 裕

type:Article 文部科学省は,高等教育機関に在籍する障害学生の教育実習について,合理的配慮の在り方についてのさらなる検討が必要であることを示している(2021a)。本研究は,教職課程を置く大学等で障害学生が教育実習に参加するにあたって行われている合理的配慮に基づく配慮や支援などの対応や,その中で見えてきた課題や実態を明らかにすることを目的として,教職課程を置く34大学にアンケート調査を行なった。その結果,大学における合理的配慮は学生本人の申請に基づくものであることから,教育実習に参加する障害学生すべてに行われているわけではなく,個々の対応,個別性が非常に多岐にわたることが明らかになった。また問題点としては,大学内外との連携における担当者の交代による引き継ぎの困難さに懸念を持っている実態が明らかになった。 The Ministry of Education, Culture, Sports, Science and Technology (MEXT) has indicated the need for further examination of reasonable accommodations for practicum experiences for students with disabilities enrolled in higher education institutions (2021). In this study, a questionnaire survey was conducted and analyzed with the aim of clarifying and organizing the current situations of the reasonable accommodations for students with disabilities during educational training at universities. As a result, it became clear that not all students with disabilities participating in educational training receive reasonable accommodation because not all of them did request for reasonable accommodations, which is based on the request of the students themselves, and that the reasonable accommodations given to the students were highly individualized, and that the frequent changes of person in charge of the cooperation with inside and outside the university were happened.

The sense of body ownership, the feeling that one's body belongs to oneself, is a crucial subjective conscious experience of one's body. Recent methodological advances regarding crossmodal illusions have provided novel insights into how multisensory interactions shape human perception and cognition, underpinning conscious experience, particularly alteration of body ownership. Moreover, in post-stroke rehabilitation, encouraging the use of the paretic limb in daily life is considered vital, as a settled sense of ownership and attentional engagement toward the paralyzed body part may promote increased frequency of its use and prevent learned nonuse. Therefore, in addition to traditional methods, novel interventions using neurorehabilitation techniques that induce self-body recognition are needed. This study investigated whether the illusory experience of a patient's ownership alterations of their paretic hand facilitates the enhancement in the range of motion of succeeding imitation movements. An experiment combining a modified version of the rubber hand illusion with imitation training was conducted with chronic hemiplegia. A larger imitation movement of the paretic hand was observed in the illusion-induced condition, indicating that the feeling of ownership toward the observed limb promotes the induction of intrinsic potential for motor performance. This training, using subjective experience, may help develop new post-stroke rehabilitation interventions.

Patients with lower limb amputation experience "embodiment" while using a prosthesis, perceiving it as part of their body. Humans control their biological body parts and receive appropriate information by directing attention toward them, which is called body-specific attention. This study investigated whether patients with lower limb amputation similarly direct attention to prosthetic limbs. The participants were 11 patients with lower limb amputation who started training to walk with a prosthesis. Attention to the prosthetic foot was measured longitudinally by a visual detection task. In the initial stage of walking rehabilitation, the index of attention to the prosthetic foot was lower than that to the healthy foot. In the final stage, however, there was no significant difference between the two indexes of attention. Correlation analysis revealed that the longer the duration of prosthetic foot use, the greater the attention directed toward it. These findings indicate that using a prosthesis focuses attention akin to that of an individual's biological limb. Moreover, they expressed that the prosthesis felt like a part of their body when they could walk independently. These findings suggest that the use of prostheses causes integration of visual information and movement about the prosthesis, resulting in its subjective embodiment.

Learned nonuse is a major problem in upper limb (UL) rehabilitation after stroke. Among the various factors that contribute to learned nonuse, recent studies have focused on body representation of the paretic limb in the brain. We previously developed a method to measure body-specific attention, as a marker of body representation of the paretic limb and revealed a decline in body-specific attention to the paretic limb in chronic stroke patients by a cross-sectional study. However, longitudinal changes in body-specific attention and paretic arm use in daily life (real-world arm use) from the onset to the chronic phase, and their relationship, remain unknown. Here, in a longitudinal, prospective, observational study, we sought to elucidate the longitudinal changes in body-specific attention to the paretic limb and real-world arm use, and their relationship, by using accelerometers and psychophysical methods, respectively, in 25 patients with subacute stroke. Measurements were taken at baseline (T_BL), 2 weeks (T_2w), 1 month (T_1M), 2 months (T_2M), and 6 months (T_6M) after enrollment. UL function was measured using the Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT). Real-world arm use was measured using accelerometers on both wrists. Body-specific attention was measured using a visual detection task. The UL function and real-world arm use improved up to T_6M. Longitudinal changes in body-specific attention were most remarkable at T_1M. Changes in body-specific attention up to T_1M correlated positively with changes in real-world arm use up to T_6M, and from T_1M to T_6M, and the latter more strongly correlated with changes in real-world arm use. Changes in real-world arm use up to T_2M correlated positively with changes in FMA up to T_2M and T_6M. No correlation was found between body-specific attention and FMA scores. Thus, these results suggest that improved body-specific attention to the paretic limb during the early phase contributes to increasing long-term real-world arm use and that increased real-world use is associated with the recovery of UL function. Our results may contribute to the development of rehabilitation strategies to enhance adaptive changes in body representation in the brain and increase real-world arm use after stroke.

BACKGROUND: Imitative learning is highly effective from infancy to old age; however, little is known about the effects of observing errors during imitative learning. This study aimed to examine how observing errors affected imitative learning performance to maximize its effect. METHODS: In the pre-training session, participants were instructed to pinch at a target force (8 N) with auditory feedback regarding generated force while they watched videos of someone pinching a sponge at the target force. In the pre-test, participants pinched at the target force and did not view a model or receive auditory feedback. In Experiment 1, in the main training session, participants imitated models while they watched videos of pinching at either the incorrect force (error-mixed condition) or target force (correct condition). Then, the exact force generated was measured without receiving auditory feedback or viewing a model. In Experiment 2, using the same procedures, newly recruited participants watched videos of pinching at incorrect forces (4 and 24 N) as the error condition and the correct force as the correct condition. RESULTS: In Experiment 1, the average force was closer to the target force in the error-mixed condition than in the correct condition. In Experiment 2, the average force in the correct condition was closer to the target force than in the error condition. CONCLUSION: Our findings indicated that observing error actions combined with correct actions affected imitation motor learning positively as error actions contained information on things to avoid in the target action. It provides further information to enhance imitative learning in mixed conditions compared to that with correct action alone.

<p>One of the factors declining the function of a paretic limb of stroke patients in chronic stage is a learned nonuse phenomenon, learning the disuse of the paretic limb due to clumsiness in daily-life usage of it.Learned non-use causes "negative" use-dependent plasticity in the brain, hence the brain area involved in motor control of the hemiplegic limb shrinks, leading to further functional decline of the hemiplegic limb, which in turn, makes recovery from paralysis more difficult. To resolve this issue, we designed a new rehabilitation system aiming to prevent the learned nonuse of the paretic limb in stroke patients by monitoring the usage of the paretic limb in daily life. As an initial step, the purpose of this study is to quantitatively evaluate the muscle activities of upper limbs in daily-life activities by using a wearable electromyograph (EMG) sensor system.</p>

The right inferior fronto-parietal network monitors the current status of the musculoskeletal system and builds-up and updates our postural model. The kinesthetic illusion induced by tendon vibration has been utilized in experiments on the modulation of body awareness. The right inferior fronto-parietal cortices activate during the kinesthetic illusion. We aimed to determine the relationship between the right inferior fronto-parietal cortices and body awareness by applying transcranial alternating current stimulation (tACS) to exogenously modulate oscillatory neural activity in the right fronto-parietal cortices during the kinesthetic illusion. Sixteen young adults participated in this study. We counterbalanced the order in which participants received the three types of tACS (55 Hz enveloped by 6 Hz; synchronous, desynchronous, and sham) across the subjects. The illusory movement perception induced by tendon vibration of the left extensor carpi ulnaris muscle was assessed before and during tACS. Application of synchronous tACS over the right inferior fronto-parietal cortices significantly increased kinesthetic illusion compared with sham tACS. The kinesthetic illusion during desynchronous tACS decreased from baseline. There was no change in vibration sensation during any tACS condition. The modulation of oscillatory brain activity between the right fronto-parietal cortices alters the illusory movement perception without altering actual vibration sensation. tACS over the right inferior fronto-parietal cortices is considered to modulate the neural processing involved in updating the postural model when the stimulated muscle spindle sends kinesthetic signals. This is the first study that reveals that rhythmic communication between the right inferior fronto-parietal cortices has a causal role in body awareness.

OBJECTIVE: To examine whether reduced body-specific attention to a paretic limb is found in chronic stroke patients in a time-dependent manner. METHODS: Twenty-one patients with chronic hemiparesis (10 left and 11 right hemiparesis) after subcortical stroke and 18 age-matched healthy controls were recruited in this study. Standard neuropsychological examinations showed no clear evidence of spatial neglect in any patient. In order to quantitatively measure spatial attention to the paretic hand, a visual detection task for detecting a target appearing on the surface of either a paretic or dummy hand was used. This task can measure the body facilitation effect, which makes faster detection of a target on the body compared with one far from the body. RESULTS: In stroke patients, there was no difference in the reaction time for a visual target between the paretic and the dummy hands, while the healthy participants showed faster detection for the visual target on the real hand than on the dummy one. The index of the body facilitation effect, subtracting the reaction time for the target-on-paretic hand from that for the target-on-dummy one, was correlated with the duration since onset and with finger function test on the Stroke Impairment Assessment Set. CONCLUSIONS: The reduction of the body facilitation effect in the paretic limb suggests the decline of body-specific attention to the paretic one in patients with chronic hemiparesis. This decline of body-specific attention, leading to neglect for the paretic limb, will be one of the most serious problems for rehabilitation based on use-dependent plasticity.

The aim of the study was to investigate the effect of cathodal transcranial direct current stimulation to the supplementary motor area to inhibit involuntary movements of a child. An 8-year-old boy who developed hypoxic encephalopathy after asphyxia at the age of 2 had difficulty in remaining standing without support because of involuntary movements. He was instructed to remain standing with his plastic ankle-foot orthosis for 10 s at three time points by leaning forward with his forearms on a desk. He received cathodal or sham transcranial direct current stimulation to the supplementary motor area at 1 mA for 10 min. Involuntary movements during standing were measured using an accelerometer attached to his forehead. The low-frequency power of involuntary movements during cathodal transcranial direct current stimulation significantly decreased compared with that during sham stimulation. No adverse effects were observed. Involuntary movement reduction by cathodal stimulation to supplementary motor areas suggests that stimulations modulated the corticobasal ganglia motor circuit. Cathodal stimulation to supplementary motor areas may be effective for reducing involuntary movements and may be safely applied to children with movement disorders.

Fumiko Anzaki, Yoshimi Suzukamo, Yutaka Oouchida, Takeo Kondo, Shin-Ichi Izumi, 2012, &#039;Lesions responsible for phonological paraphasia and auditory–verbal short-term memory disturbances in aphasia&#039;, &lt;i&gt;The Official Journal of the Polish Neuropsychological Society&lt;/i&gt;, vol. 10, no. 1