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

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.