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Meng L, Liang Q, Yuan J, Li S, Ge Y, Yang J, Tsang RCC, Wei Q. Vestibular rehabilitation therapy on balance and gait in patients after stroke: a systematic review and meta-analysis. BMC Med 2023; 21:322. [PMID: 37626339 PMCID: PMC10464347 DOI: 10.1186/s12916-023-03029-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND There is limited evidence to support the use of vestibular rehabilitation therapy (VRT) on improving balance and gait in patients after stroke. This systematic review aimed to evaluate the effects of VRT in addition to usual rehabilitation compared with usual rehabilitation on improving balance and gait for patients after stroke. METHODS This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis statement guidelines. Ten electronic databases were searched up to 1 June 2023 without restrictions in language and publication status. The PEDro scale and the Grading of Recommendations Assessment Development, and Evaluation were used to evaluate the risk of bias and the certainty of evidence. The meta-analysis was conducted with Review Manager 5.3. RESULTS Fifteen randomised controlled trials with 769 participants were included. PEDro scale was used to assess the risk of bias with a mean score of 5.9 (0.7). VRT was effective in improving balance for patients after stroke (SMD = 0.59, 95% CI (0.40, 0.78), p < 0.00001), particularly for patients after stroke that occurred within 6 months (SMD = 0.56, 95% CI (0.33, 0.79), p < 0.00001) with moderate certainty of evidence. Subgroup analysis showed that VRT provided as gaze stability exercises combined with swivel chair training (SMD = 0.85, 95% CI (0.48, 1.22), p < 0.00001) and head movements (SMD = 0.75, 95% CI (0.43, 1.07), p < 0.00001) could significantly improve balance. Four-week VRT had better effect on balance improvement (SMD = 0.64, 95% CI (0.40, 0.89), p < 0.00001) than the less than 4-week VRT. The pooled mean difference of values of Timed Up-and-Go test showed that VRT could significantly improve gait function for patients after stroke (MD = -4.32, 95% CI (-6.65, -1.99), p = 0.0003), particularly for patients after stroke that occurred within 6 months (MD = -3.92, 95% CI (-6.83, -1.00), p = 0.008) with moderate certainty of evidence. CONCLUSIONS There is moderate certainty of evidence supporting the positive effect of VRT in improving balance and gait of patients after stroke. TRIAL REGISTRATION PROSPERO CRD42023434304.
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Affiliation(s)
- Lijiao Meng
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, Sichuan, 610041, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, Sichuan, 610041, China
| | - Qiu Liang
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, Sichuan, 610041, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, Sichuan, 610041, China
| | - Jianrong Yuan
- Department of Rehabilitation Medicine, Chongqing University Three Gorges Hospital, No. 165. Xin Cheng Road, Chongqing, China
| | - Siyi Li
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, Sichuan, 610041, China
| | - Yanlei Ge
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, Sichuan, 610041, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, Sichuan, 610041, China
| | - Jingyi Yang
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, Sichuan, 610041, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, Sichuan, 610041, China
| | - Raymond C C Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, No. 11 Yuk Choi Road, Hung Hom, Kowloon, Hong Kong, China
| | - Quan Wei
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, Sichuan, 610041, China.
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, Sichuan, 610041, China.
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Hirai H, Fujishiro T, Yano T, Obo T, Mizutani M, Usami Y, Hayama S, Nakaya Y, Nakano A, Neo M. Studies in the Falls Efficacy Scale-International for patients with cervical compressive myelopathy: Reliability, validity, and minimum clinically important difference. J Spinal Cord Med 2023:1-11. [PMID: 36977312 DOI: 10.1080/10790268.2023.2192849] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
CONTEXT Patients with cervical compressive myelopathy (CCM) often complain of body balance problems, such as fear of falling and bodily unsteadiness. However, no accepted patient-reported outcome measures (PROMs) for this symptomatology exist. The Falls Efficacy Scale-International (FES-I) is one of the most widely used PROMs for evaluating impaired body balance in various clinical fields. OBJECTIVE To examine reliability, validity, and minimum clinically important difference (MCID) of the FES-I for the evaluation of impaired body balance in patients with CCM. METHODS Patients who underwent surgery for CCM were retrospectively reviewed. The FES-I was administered preoperatively and at 1 year postoperatively. Further, cJOA-LE score (subscore for lower extremities in the Japanese Orthopaedic Association score for cervical myelopathy) and stabilometric data, obtained at the same time points of the FES-I administration, were analyzed. Reliability was examined through internal consistency with Cronbach's alpha. Convergent validity was studied using correlation analysis. The MCID was estimated using anchor- and distribution-based methods. RESULTS Overall, 151 patients were included for analysis. Cronbach's alpha coefficient was the acceptable value of 0.97 at both baseline and 1 year postoperatively. As for convergent validity, the FES-I had significant correlations with the cJOA-LE score and stabilometric parameters both at baseline and 1 year postoperatively. The MCID calculated using anchor- and distribution-based methods was 5.5 and 10, respectively. CONCLUSION FES-I is a reliable and valid PROM to evaluate body balance problems for the CCM population. The established thresholds of MCID can help clinicians recognize the clinical significance of changes in patient status.
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Affiliation(s)
- Hiromichi Hirai
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Takashi Fujishiro
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Toma Yano
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Takuya Obo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Masahiro Mizutani
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yoshitada Usami
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Sachio Hayama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yoshiharu Nakaya
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Atsushi Nakano
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
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Mitsutake T, Imura T, Tanaka R. The Effects of Vestibular Rehabilitation on Gait Performance in Patients with Stroke: A Systematic Review of Randomized Controlled Trials. J Stroke Cerebrovasc Dis 2020; 29:105214. [PMID: 33066892 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/21/2020] [Accepted: 07/26/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Patients with post-stroke hemiparesis have poor postural stability; nevertheless, it is unclear whether vestibular rehabilitation affects gait performance after a stroke or not. We performed a systematic review of randomized controlled trials to investigate the effects of vestibular rehabilitation on gait performance in patients with post stroke. METHODS The Medline, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and Cumulative Index to Nursing and Allied Health Literature databases were comprehensively searched. All literature published from each source's earliest date to June 2019 was included. Study selection and data extraction were performed independently by paired reviewers. Outcomes of gait performance were the 10-Meter Walking Test, Timed Up and Go Test, and Dynamic Gait Index. We applied the Physiotherapy Evidence Database scale to evaluate the risk of bias and the Grading of Recommendations Assessment, Development and Evaluation system to evaluate the quality of a body of evidence. RESULTS Three studies were included, and two out of three trials showed beneficial effects of vestibular rehabilitation in post-stroke patients. Quality assessment using the Grading of Recommendations Assessment, Development and Evaluation criteria found very low-quality evidence of all included studies due to inadequate allocation concealment, low participant numbers, and lack of blinding. CONCLUSION This review found beneficial effects of vestibular rehabilitation on gait performance in patients with stroke. However, due to the very low-quality evidence of previous randomized controlled trials as assessed by the Grading of Recommendations Assessment, Development and Evaluation criteria, definitive conclusions on the effectiveness of vestibular rehabilitation cannot be made. Hence, more high-quality and large-scale randomized controlled trials of vestibular rehabilitation after stroke are needed.
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Affiliation(s)
- Tsubasa Mitsutake
- Department of Physical Therapy, Fukuoka International University of Health and Welfare, Fukuoka 814-0001, Japan.
| | - Takeshi Imura
- Department of Rehabilitation, Faculty of Health Sciences, Hiroshima Cosmopolitan University, Hiroshima, Japan
| | - Ryo Tanaka
- Graduate School of Integrated Arts and Sciences, Hiroshima University, Hiroshima, Japan
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Albalwi AA, Johnson EG, Alharbi AA, Daher NS, Cordett TK, Ambode OI, Alshehri FH. Effects of head motion on postural stability in healthy young adults with chronic motion sensitivity. Arch Physiother 2020; 10:6. [PMID: 32257386 PMCID: PMC7106606 DOI: 10.1186/s40945-020-00077-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 03/20/2020] [Indexed: 11/17/2022] Open
Abstract
Background Motion sensitivity, or motion sickness, is common in modern vehicular and visually stimulating environments. Several studies have shown a relationship between motion sensitivity and decreased postural stability. We aimed to evaluate the effects of head motion (horizontal and vertical) on postural stability in healthy adults with and without chronic motion sensitivity (CMS). Methods Sixty healthy adult men and women (age, 20–40 years) with CMS (CMS group, n = 30) and without CMS (non-CMS group, n = 30) participated in the study. Postural stability was assessed during three conditions (static, horizontal head motion, and vertical head motion) using computerized dynamic posturography. Group and condition-related differences in equilibrium scores were evaluated. Results There was no significant group x condition interaction (F2,114 = 0.9, partial ƞ2 = 0.04, p = 0.35). However, significant condition-related differences in equilibrium scores were observed (F2,114 = 26.4, partial ƞ2 = 0.31, p < 0.001). Equilibrium scores were significantly worse in the horizontal and vertical head motion conditions compared to those in the static condition (p < 0.001), but were comparable in vertical and horizontal head motion conditions (p = 0.27). Conclusions Postural stability was lower in the horizontal and vertical conditions compared to the static condition. However, horizontal and vertical head motions had comparable effects on postural stability in both CMS and non-CMS groups, contrary to our expectations.
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Affiliation(s)
- Abdulaziz A Albalwi
- 1Department of Physical Therapy, Faculty of Applied Medical Sciences, Tabuk University, Duba Road, Tabuk, 71491 Saudi Arabia
| | - Eric G Johnson
- 2Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, CA USA
| | - Ahmad A Alharbi
- 1Department of Physical Therapy, Faculty of Applied Medical Sciences, Tabuk University, Duba Road, Tabuk, 71491 Saudi Arabia
| | - Noha S Daher
- 3Department of Allied Health Studies, School of Allied Health Professions, Loma Linda University, Loma Linda, CA USA
| | - Tim K Cordett
- 2Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, CA USA
| | - Oluwaseun I Ambode
- 2Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, CA USA
| | - Fahad H Alshehri
- 2Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, CA USA
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Mitsutake T, Sakamoto M, Ueta K, Horikawa E. Standing postural stability during galvanic vestibular stimulation is associated with the motor function of the hemiplegic lower extremity post-stroke. Top Stroke Rehabil 2019; 27:110-117. [PMID: 31618124 DOI: 10.1080/10749357.2019.1667662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: The vestibular system is profoundly involved in standing postural stability. Patients with post-stroke hemiparesis have poor postural control function; nevertheless, it is unclear as to how the vestibular system affects postural control after stroke.Objectives: The purpose of this study was to quantitatively evaluate the relationship between galvanic whole-body sway responses and motor function of the hemiplegic lower extremity post-stroke.Methods: Thirty stroke patients and 49 healthy controls underwent standing body sway tests to examine postural control function during vestibular stimulation. Postural stabilization was measured using a C7-mounted accelerometer during galvanic vestibular stimulation. Postural stability was assessed during stimulation while quietly standing with eyes closed. For the stroke group, lower extremity function was measured using the Fugl-Meyer Assessment scale (FMA-LE).Results: The standing body sway test scores during stimulation were lower in the stroke group than the control group (p = .010). In the stroke group, correlation analysis demonstrated that the standing body sway response score was significantly associated with the FMA-LE (r = 0.374, p = .021).Conclusions: Motor dysfunction directly causes standing postural instability during vestibular stimulation, even though sensory information suggests normal peripheral vestibular function. Therefore, motor dysfunction of the hemiplegic lower extremity might lead to inhibition of normal standing postural stability.
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Affiliation(s)
- Tsubasa Mitsutake
- Department of Physical Therapy, Faculty of Medical Science, Fukuoka International University of Health and Welfare, Fukuoka, Japan
| | - Maiko Sakamoto
- Research and Education Center for Comprehensive Community Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Kozo Ueta
- Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Etsuo Horikawa
- Research and Education Center for Comprehensive Community Medicine, Faculty of Medicine, Saga University, Saga, Japan
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Park CS. The test-retest reliability and minimal detectable change of the short-form Barthel Index (5 items) and its associations with chronic stroke-specific impairments. J Phys Ther Sci 2018; 30:835-839. [PMID: 29950775 PMCID: PMC6016316 DOI: 10.1589/jpts.30.835] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 03/15/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To establish the test-retest reliabilities, minimal detectable change of the
Short form Barthel Index and associations with stroke-specific impairments. [Subjects and
Methods] The Short form-Barthel Index assessment was tested on 24 chronic stroke patients
twice, 7 days apart. A relative reliability index (ICC2,1), Weighted Kappa
Coefficients was used to examine the level of agreement of test-retest reliability for
SF-BI, Absolute reliability indices, including the standard error of measurement and the
minimal detectable change. The validity was demonstrated by spearman correlation of SF
BI-total score with Postural Assessment Scale for Storke, Fugl Meyer Assessment. [Results]
There was excellent agreement between test-retest for individual items of BI and total
score ICC2,1=0.91 and it all showed acceptable SEM and MDC were 2.83 score,
7.84 score respectively. The item-to-total correlations were all significant, ranging from
r=0.83–0.92. SF-BI showed good internal consistency. Individual items also possessed high
internal consistency 0.82–0.86. The SF-BI and total score were demonstrated high
concurrent validity with the PASS, FMA. [Conclusion] This study has demonstrated that the
SF-BI is a useful instrument with high test-retest reliability, Absolute reliability
indices, internal consistency and validity.
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Affiliation(s)
- Chang-Sik Park
- Department of Physical Therapy, Howon University: 64 Howondae 3gil, Impimyeon, Gunsan-si 573-932, Republic of Korea
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Abstract
The vestibulo-ocular reflex (VOR) exerts a significant influence on gait performance. Therefore, a decrease in VOR function could worsen gait impairments in patients with poststroke hemiparesis. The effects of decreased VOR function on gait performance could be further exacerbated by aging-related physical weakness and impaired motor function of the hemiparetic lower limb. The aim of our study was to evaluate the possible synergistic effect of aging and impairment in lower extremity function and the VOR on walking ability of poststroke hemiplegic patients. The VOR was evaluated, using the gaze-stabilization test (GST), in 75 patients with a poststroke hemiplegia. Lower extremity function was assessed using the Fugl-Meyer assessment (FMA-LE). Gait performance was evaluated using the 10-m walking test, the timed up-and-go, and the dynamic gait index (DGI). The relationships between gait performance and age, FMA-LE and GST, as well as whether age, FMA-LE, and/or GST were significant predictors of gait performance were evaluated. The 10-m walking test, timed up-and-go and DGI were significantly correlated to the FMA-LE and GST (P<0.05). On stepwise multiple regression analysis, the GST remained a significant predictor of the DGI (P<0.001). The present study indicates that decreased VOR function after stroke contributes to impairments in gait both in simple and in dual-task walking tests.
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Mitsutake T, Sakamoto M, Ueta K, Horikawa E. Transient Effects of Gaze Stability Exercises on Postural Stability in Patients With Posterior Circulation Stroke. J Mot Behav 2017; 50:467-472. [DOI: 10.1080/00222895.2017.1367639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Tsubasa Mitsutake
- Department of Rehabilitation, Shiroishi Kyoritsu Hospital, Saga, Japan
- Research and Education Center for Comprehensive Community Medicine, Faculty of Medicine, Saga University, Japan
| | - Maiko Sakamoto
- Research and Education Center for Comprehensive Community Medicine, Faculty of Medicine, Saga University, Japan
| | - Kozo Ueta
- Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Etsuo Horikawa
- Research and Education Center for Comprehensive Community Medicine, Faculty of Medicine, Saga University, Japan
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Mitsutake T, Sakamoto M, Horikawa E. Effect of neck and trunk rotation speeds on cerebral cortex activity and standing postural stability: a functional near-infrared spectroscopy study. J Phys Ther Sci 2015; 27:2817-9. [PMID: 26504300 PMCID: PMC4616101 DOI: 10.1589/jpts.27.2817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 06/09/2015] [Indexed: 11/29/2022] Open
Abstract
[Purpose] The aim of the present study was to determine whether different neck and trunk
rotation speeds influence standing postural stability or frontal and temporal cortical
activity during rotation in healthy young adults. [Subjects and Methods] Twelve healthy
volunteers participated in this study. A custom turn-table operated by one of the
experimenters was placed on a platform to assess postural perturbation. Subjects were
asked to stand barefoot on the turn-table in an upright position with their feet together,
and measurements were obtained during high- and low-speed rotations. Postural stability
was tested using a force platform and a head sensor. Cerebral cortex activity was measured
using functional near-infrared spectroscopy. Brain activity, center of pressure, and head
perturbation were measured simultaneously for each subject. [Results] Significant
differences were found in the center of pressure and the head angular velocity between
high- and low-speed rotations. However, compared to baseline, oxygenated hemoglobin levels
were not significantly different during high- or low-speed rotations. [Conclusion]
Automatic postural responses to neck and trunk rotation while standing did not
significantly activate the cerebral cortex. Therefore, the response to stimuli from the
feet may be controlled by the spinal reflex rather than the cerebral cortex.
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Affiliation(s)
- Tsubasa Mitsutake
- Department of Rehabilitation, Shiroishi Kyoritsu Hospital, Japan ; Division of Cognitive Neuropsychology, Graduate School of Medicine, Saga University, Japan
| | - Maiko Sakamoto
- Division of Cognitive Neuropsychology, Graduate School of Medicine, Saga University, Japan
| | - Etsuo Horikawa
- Division of Cognitive Neuropsychology, Graduate School of Medicine, Saga University, Japan
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