Spasticity Exacerbation Due to a Giant Bladder Diverticulum ― A Case of Adult Cerebral Palsy / The Japanese Journal of Rehabilitation Medicine

<p>　A 34-year-old woman with cerebral palsy was admitted to our hospital because of increased spasticity. She showed spastic quadriparesis with partially inhibited range of motion of the lower limbs. Her modified Ashworth Score (MAS) was 2 for the upper limbs and 3 for the lower limbs. Radiography showed mild scoliosis, but magnetic resonance imaging did not show any compression of the spinal cord. An abdominal computed tomography scan revealed urinary retention and a large bladder diverticulum. A urological assessment was performed, and an indwelling catheter was placed in the bladder. In addition to urological management, non-invasive spasticity management was performed, and her MAS was reduced to 1＋and 2 for the upper and lower limbs, respectively. After these treatments, the patient was able to resume self-care activities.</p>

Developing a Weighted Disuse Risk Factor Evaluation and Disuse Risk Score Rating for Disuse Syndrome / The Japanese Journal of Rehabilitation Medicine

Objective: To develop a weighted disuse risk score rating. Design : Based on specified selection criteria, items of the disuse risk factor were chosen. Then, a conjoint questionnaire for physicians was created using orthogonal cards with ordinal disuse risk grade. Conjoint analysis (SPSS 15.0) was performed, weighting each item and making a formula for calculating the disuse risk score. Setting : The Rehabilitation Department of a University Hospital. Participants : Forty-one physician respondents and 129 consecutive inpatients referred to the rehabilitation department. Main outcome measures : Agreement of the rated disuse risk grade with the calculated disuse risk score, and the reliability of the calculated disuse risk score of the 129 inpatients. Results : Eleven disuse risk factor items were selected ; age, malignant tumor, heart impairment, respiratory impairment, kidney impairment, pain, gait disorder, psychiatric impairment, intellectual disability, dementia, and body mass index. Forty-one physicians completed and returned a postal questionnaire. Cronbach's a of the rated disuse risk grade was 0.948. The correlation coefficient of the average rated disuse risk grade to the calculated disuse risk score was 0.985 (<i>p</i>=0.000). Items of high overall importance (%) were gait disorder (14.0%), malignant tumor (11.5%), and respiratory impairment (11.0%). Those of low overall importance (%) were body mass index (6.8%), kidney impairment (6.6%), and psychiatric impairment (6.1%). For the 129 patients, the calculated disuse risk score of the 11-item was correlated to that of the 9-item weighted disuse risk factor (<i>R</i>=0.930, <i>p</i>=0.000). Conclusions : Both the 11-item disuse risk factor and the weighted disuse risk score rating were considered reliable and useful.