ABSTRACT
Intracranial germ cell tumor is more common in Asian countries, including Japan, than in Western countries. The disease is characterized by juvenile onset with a mean age at diagnosis of 18 years. Most patients with intracranial germ cell tumors in the basal ganglia manifest paralytic symptoms, but few of these patients have been reported to have long-term progression of motor paralysis and rehabilitation interventions.A young male patient was diagnosed as having right basal ganglia germinoma and left hemiplegia at the age of 10 years. He received intervention and long-term follow-up for upper limb function. He underwent hybrid assistive neuromuscular dynamic stimulation therapy at the age of 14 years and modified constraint-induced movement therapy (modified CI therapy) at the age of 20 years. With such a gradual neurorehabilitation intervention, the Fugl-Meyer assessment score for the upper limb improved from 41 to 58 points, and the frequency of use of the paralyzed hand also improved. We hope that this report will provide guidance when considering treatment options for similar diseases in the future.
ABSTRACT
Spinal cord stimulation (SCS) has been reported to be effective for complex regional pain syndrome (CRPS). This is a case report of a patient with CRPS who was successfully treated with a combination of temporary SCS lead placement and physical therapy. A 19-year-old man presented with severe pain for a few months since receiving plaster cast fixation as treatment for an ankle sprain injury at the previous hospital. At his first visit to our pain center, he could not walk without crutches because of severe pain accompanied by symptoms such as allodynia, decreased skin temperature, redness, edema, muscle weakness, and changes in the appearance of the affected area. The symptoms met the diagnostic criteria for CRPS. Temporary SCS lead placement was performed to alleviate the pain and peripheral circulatory disorder, along with physiotherapy to improve the flexibility and restore the normal appearance of the affected limb. The interdisciplinary treatment effectively improved our patient's leg edema and walking ability, which consequently led to pain relief.
ABSTRACT
Spinal cord stimulation (SCS) has been reported to be effective for complex regional pain syndrome (CRPS). This is a case report of a patient with CRPS who was successfully treated with a combination of temporary SCS lead placement and physical therapy. A 19-year-old man presented with severe pain for a few months since receiving plaster cast fixation as treatment for an ankle sprain injury at the previous hospital. At his first visit to our pain center, he could not walk without crutches because of severe pain accompanied by symptoms such as allodynia, decreased skin temperature, redness, edema, muscle weakness, and changes in the appearance of the affected area. The symptoms met the diagnostic criteria for CRPS. Temporary SCS lead placement was performed to alleviate the pain and peripheral circulatory disorder, along with physiotherapy to improve the flexibility and restore the normal appearance of the affected limb. The interdisciplinary treatment effectively improved our patient's leg edema and walking ability, which consequently led to pain relief.
ABSTRACT
Intracranial germ cell tumor is more common in Asian countries, including Japan, than in Western countries. The disease is characterized by juvenile onset with a mean age at diagnosis of 18 years. Most patients with intracranial germ cell tumors in the basal ganglia manifest paralytic symptoms, but few of these patients have been reported to have long-term progression of motor paralysis and rehabilitation interventions.A young male patient was diagnosed as having right basal ganglia germinoma and left hemiplegia at the age of 10 years. He received intervention and long-term follow-up for upper limb function. He underwent hybrid assistive neuromuscular dynamic stimulation therapy at the age of 14 years and modified constraint-induced movement therapy (modified CI therapy) at the age of 20 years. With such a gradual neurorehabilitation intervention, the Fugl-Meyer assessment score for the upper limb improved from 41 to 58 points, and the frequency of use of the paralyzed hand also improved. We hope that this report will provide guidance when considering treatment options for similar diseases in the future.
ABSTRACT
Objective：This study aimed to identify the characteristics of daily rehabilitation in patients with spinocerebellar degeneration (SCD), including those with multiple system atrophy, with a focus on physical status and social background.Methods：We analyzed questionnaire responses from 914 patients in Japan and conducted inter-group comparisons of backgrounds and rehabilitation-related information by dividing patients into a rehabilitation group, a self-directed exercise group, and a non-rehabilitation group.Results：Among all subjects, the rehabilitation group accounted for 67.9％, the self-directed exercise group for 17.7％, and the non-rehabilitation group for 14.3％．In the rehabilitation group, the percentage receiving services increased with a decline in the level of independent living and increase in coverage by long-term care insurance. The frequency and duration of rehabilitation showed a maximum distribution of 2-3 sessions/week for 40 minutes per session in the rehabilitation group and 7 sessions/week for 20 minutes per session in the self-directed exercise group. The intent to continue in the rehabilitation group was significantly greater than in the self-directed exercise group (p＝0.018), although subjective changes with rehabilitation showed no difference between groups.Conclusion：The percentage of SCD patients who participated in rehabilitation programs including self-directed exercise was high. However, the subjective effect was not clear. We consider it necessary to develop an environment in which experts can provide rehabilitation to all SCD patients, irrespective of the disease stage.
ABSTRACT
Objective：This study aimed to identify the characteristics of daily rehabilitation in patients with spinocerebellar degeneration (SCD), including those with multiple system atrophy, with a focus on physical status and social background.Methods：We analyzed questionnaire responses from 914 patients in Japan and conducted inter-group comparisons of backgrounds and rehabilitation-related information by dividing patients into a rehabilitation group, a self-directed exercise group, and a non-rehabilitation group.Results：Among all subjects, the rehabilitation group accounted for 67.9％, the self-directed exercise group for 17.7％, and the non-rehabilitation group for 14.3％．In the rehabilitation group, the percentage receiving services increased with a decline in the level of independent living and increase in coverage by long-term care insurance. The frequency and duration of rehabilitation showed a maximum distribution of 2-3 sessions/week for 40 minutes per session in the rehabilitation group and 7 sessions/week for 20 minutes per session in the self-directed exercise group. The intent to continue in the rehabilitation group was significantly greater than in the self-directed exercise group (p＝0.018), although subjective changes with rehabilitation showed no difference between groups.Conclusion：The percentage of SCD patients who participated in rehabilitation programs including self-directed exercise was high. However, the subjective effect was not clear. We consider it necessary to develop an environment in which experts can provide rehabilitation to all SCD patients, irrespective of the disease stage.
ABSTRACT
Objective : The Balance Evaluation Systems Test (BESTest) is a new balance assessment set based on systems theory. The purpose was to examine the validity of the Japanese version of the BESTest (J-BESTest) that we translated. Methods : The J-BESTest was produced using a translation and back translation method referenced from a guideline proposed by Guillemin et al. We tested 20 patients with balance dysfunction due to various diseases and 5 healthy persons with the J-BESTest, the Berg Balance Scale (BBS), the Falls Efficacy Scale-International (FES-I) and the Activities-specific Balance Confidence Scale (ABC Scale). We assessed the concurrent validity of the J-BESTest by comparing it with the other measures using Spearman's correlation method. Furthermore, we compared the ability of the J-BESTest to discriminate balance dysfunction with that of the BBS using receiver operating characteristic (ROC) analyses. Results : The J-BESTest was highly correlated with BBS (<i>r</i>=0.84, <i>p</i><0.01), FES-I (<i>r</i>=-0.61, <i>p</i><0.01) and ABC Scale (<i>r</i>=0.63, <i>p</i><0.01). The distribution of the BBS score was more skewed compared with the J-BESTest and had a ceiling effect (6 participants had perfect scores with BBS versus none with the J-BESTest). The area under the ROC curve (AUC) of the J-BESTest was significantly larger than that of BBS (BBS 0.75, 95% confidence interval 0.56-0.94 versus J-BESTest 0.94, 95% confidence interval 0.84.1.0, <i>p</i><0.05). Conclusion : The J-BESTest was suggested as a clinically useful tool, with good concurrent validity and better sensitivity and specificity than BBS, to identify people with mild balance dysfunction.
ABSTRACT
Objective : The Mini-Balance Evaluation Systems Test (Mini-BESTest) is an assessment tool for dynamic balance dysfunction developed by simplifying the Balance Evaluation Systems Test (BESTest). The purpose of our study was to examine the validity of the Japanese version of the Mini-BESTest (J-Mini-BESTest) we translated. Methods : The J-Mini-BESTest was produced using a translation and back translation method referring to a guideline proposed by Guillemin et al. We tested 20 patients with balance dysfunction due to various diseases and 7 healthy persons with the J-Mini-BESTest, the Berg Balance Scale (BBS), the Falls Efficacy Scale-International (FES-I) and the Activities-specific Balance Confidence Scale (ABC Scale). We assessed the concurrent validity of the J-Mini-BESTest by comparing it with the other measures using the Spearman's correlation method. Results : The average assessment time when using the J-Mini-BESTest was 20.0 minutes. The J-Mini-BESTest was correlated with the BBS (<i>r</i>=0.82, <i>p</i><0.01), FES-I (<i>r</i>=-0.72, <i>p</i><0.01) and ABC Scale (<i>r</i>=0.80, <i>p</i><0.01). The distribution of the BBS scores was more skewed compared to the J-Mini-BESTest (BBS skewness=-1.30 vs. J-Mini-BESTest skewness=-0.47) and the BBS also had a ceiling effect (9 participants had a perfect score in the BBS versus none in the J-Mini-BESTest). Conclusion : The J-Mini-BESTest was suggested as a clinically useful tool for detecting subtle dynamic balance deficits with good concurrent validity.
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Objective : The aim of this study was to assess the effects of using a motor point block with 5% phenol on spasticity and gait in patients with chronic hemiparesis. Methods : Participants were 13 patients with chronic hemiparesis after stroke, brain injury or brain tumor. We performed motor point block (MPB) with 5% phenol to the spastic muscles of the lower extremity that caused talipes varus or talipes equinus (i.e. gastrocnemius, soleus, and tibialis posterior). Before and after the MPB, we assessed modified Ashworth scale (MAS), brace wear scale (BWS) and goal attainment scale (GAS). Walking ability was measured using a 30-m walking timed test and 6-minute duration walking test. The step length, foot area during walking and body weight bearing ratio of the paretic side were measured with force plates. Results : We found significant changes in MAS of the plantar flexors (<i>p</i>=0.007), ankle inverters (<i>p</i>=0.006), walking speed (30-m walking time (<i>p</i>=0.046), 6-minute walking test <i>p</i>=0.016), foot area during the stance phase (<i>p</i>=0.006), and body weight bearing ratio of the paretic side (<i>p</i>=0.007)) and BWS (<i>p</i>=0.002). GAS also showed favorable appraisal of MPB by the participants. Conclusion : MPB with 5% phenol can reduce the spasticity and improve gait speed and stability.
ABSTRACT
Purpose : This study aims to measure the peak cough flow (PCF) in patients with subacute myelo-optic neuropathy (SMON) and study its relation with muscle strength, functional ability and vocal cord function. Methods : We performed a cross-sectional study in 7 patients with SMON (2 men and 5 women, mean age (SD) 81.6 (7.2) years) and in 7 age- and gender-matched patients with orthopedic problems as a control group. Their PCF, ability to walk, the Barthel Index, grip strength and maximum phonation time were assessed. Results : Mean PCF was 218.6± 66.2 L/min (110-300) for the SMON group and 267.1±76.3 L/min (170-360) for the control group (ns). The PCF was correlated with the maximum phonation time (<i>r</i> = 0.91 ; <i>p</i><0.01), but not with grip strength, the Barthel Index or the ability to walk scale. Conclusion : The PCF in patients with SMON tended to be lower compared to the control group. Therefore, evaluating PCF is suggested to be necessary to assess the risk of pneumonia.
ABSTRACT
The 9.0-magnitude under sea megathrust earthquake and the subsequent extremely destructive tsunami waves on March 11 2011 brought an extensive and severe disaster to the Tohoku and Kanto areas. This natural disaster has been markedly complicated by a series of nuclear power plant failures, leading to radioactive contamination, power shortages and ungrounded rumors. Faced with this most difficult crisis, the JARM set up an earthquake disaster headquarters, and has so far taken the following actions, with an emphasis on supporting its members in the disaster stricken areas, preventing immobilization syndromes and providing necessary rehabilitation services for the frail elderly and persons with disabilities, in collaboration with other specialists organizations, local and central governments : 1) Activities in the disaster zone including support of the physiatrists there, dispatch of JARM members, medical caravans for isolated home-dwelling persons with disabilities, and relief activities as a part of multidisciplinary specialists teams ; 2) Organizing a nation-wide system for transferring persons needing rehabilitation and care services ; 3) Activities in the non-disaster areas for victims relocated from the disaster zone ; 4) Information support services to collect and provide useful information ; 5) Proposals to the government for enlightenment of the importance of rehabilitation disaster relief and for relaxation of regulations for eligibility for rehabilitation and care services. The scope of the disaster is too extensive, both in magnitude and geographical area, and too complex. The situation on the ground and the needs of affected persons are constantly changing. Therefore, well-coordinated, creative, and long-term efforts will be needed, and the JARM is determined to be actively involved in the reconstruction process.
ABSTRACT
Objective : Little is known about the energy demands of stroke patients in the rehabilitation phase, information essential to both appropriate clinical and nutritional management. The aims of this study were to determine the resting energy expenditure (REE) of stroke patients in the rehabilitation phase, and to evaluate whether REE estimation using the Harris-Benedict equation (HBE) requires the addition of a “stress factor” to capture possible additional REE imposed by stroke. Method : We measured REE with a portable calorimeter, MetavinTR, and compared it with basal energy expenditure (BEE) calculated with HBE in 76 stroke patients admitted to a rehabilitation ward. We then analyzed its relationship with sex, stroke type, paretic side, severity of paralysis, the Functional Independence Measure (FIM) score and dysphagia. Results : Mean REE and REE/BEE (%) were 1231.3±245.7 kcal/day and 104.3±16.4%. A comparison showed no significant difference. Sex, stroke type, paretic side, severity of paralysis, FIM and dysphagia were not significantly related with REE/BEE (%). Conclusion : The REE of stroke patients was not significantly different from that predicted with HBE. This information would be useful in planning appropriate nutritional management.
ABSTRACT
It has been pointed out that a biased perception of the subjective visual vertical (SVV) in stroke patients might be related to balance deficits and impaired activities of daily living (ADL). The relationship between SVV and static balance in stroke patients, however, still remains unclear. Thus we examined the relationship between SVV and standing balance in 29 hemiparetic patients with a first-ever supratentorial stroke. We measured the rotation angle formed by a subjective vertical and the gravitational vertical (rotation to the non-paretic side was set as positive) 8 times, and employed the mean value as the SVV value. We also calculated the absolute rotation angle for each time and employed the mean value as the absolute SVV value. Then we evaluated postural balance using four stabilometer parameters : length of center of pressure per time (LNG/T), envelopment area (ENV), root mean square (RMS) and weight-bearing asymmetry (WBA) during standing. The relationship between the SVV values or the absolute SVV values and the four stabilometer parameters were analyzed using the Spearman's rank correlation coefficient. The mean values for SVV and absolute SVV of all participants were -0.3±2.3° and 2.0±1.5°, respectively. The absolute SVV value and each of the four parameters were positively correlated with statistical significance (LNG/T ; <i>r</i>=0.44, ENV ; <i>r</i>=0.41, RMS ; <i>r</i>=0.46, WBA ; <i>r</i>=0.40), while there was no statistically significant correlation between the SVV value and each of them. These results suggest that the SVV bias size is possibly related to standing balance in stroke patients.
ABSTRACT
Severe burn injuries often result in significant long-term physical complications with scarring and contractures, but cancers associated with chronic burn scars are relatively rare. We report a case of a 58-year-old man with skin cancer arising from a healed burn scar. He initially suffered from an extensive fire burn on both lower limbs as a child. The burn scars extended from his upper thighs to his toes bilaterally and caused severe contractures which immobilized the ankles in plantar flexion. Two years ago, he noticed a small ulcerated lesion on the right heel and self-treated it with topical ointments. However, the ulcer increased in size and became malodorous. He presented to a clinic with a large, ulcerated, tumorous lesion, and histology proved it to be squamous cell carcinoma. He subsequently underwent a right below-the-knee amputation, and the previous scars presented on the stump. Thus the patient received a total surface bearing prosthesis with an Icelandic roll-on silicone socket system, which is ideal for patients with extensive scarring at the stump because it may reduce prosthesis-induced stump injuries by evenly distributing the patient's weight in the socket. After he left the hospital, he walked so far with the prosthesis every day that small ulcers often developed at the right popliteal fossa. However, he did not take care to treat these lesions properly, so we had to educate him on how to treat them. Patients such as these will often require education for self-management, family involvement and regular follow-up to monitor scar ulceration and watch out for any malignant transformation.
ABSTRACT
Patients with focal hand dystonia demonstrate abnormally increased corticospinal excitability, which has been reported to be ameliorated, at least for a short term, with low frequency repetitive transcranial magnetic stimulation (rTMS). Transcranial direct current stimulation (tDCS), which is less costly and easier to apply than rTMS, is also known to modulate cortical excitability. Especially with cathodal tDCS, cortical excitability can be reduced. On the other hand, upper extremity splinting is also known to reduce dystonic symptoms by inhibiting abnormal movement. We therefore combined cathodal tDCS with finger splinting to treat focal hand dystonia in a 34-year-old man with traumatic brain injury who showed involuntary movement of his right fingers during writing and chopsticks use. After 5 days of cathodal tDCS sessions (1mA, 10min), he was encouraged to use interphalangeal joint splints for his thumb and index finger during these activities. We assessed computer-rated handwriting, reciprocal inhibition and intracortical inhibition before, 24 hours and 3 months after the 5-day tDCS sessions. Before the treatment, his flexor pollicis longus (FPL) and first dorsal interosseous (FDI) muscles showed 4Hz rhythmic hyperactivity during writing, and reciprocal inhibition at interstimulus intervals (ISI) of 20 and 100 ms were lost. Paired pulse TMS also revealed disinhibited short interval intracortical inhibition (SICI) at an ISI of 2 and 3 ms. The 5-day tDCS sessions reduced FPL and FDI EMG activities, and SICI and RI at 20 and 100 ms were also restored. Wearing the finger splints, these improvements were maintained at the 3-month follow-up. This case report is the first to demonstrate the possible long-term effects of tDCS combined with splinting for focal hand dystonia. It is supposed that splinting after tDCS plays an important role in making the tDCS aftereffects last longer.
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The aim of this study is to investigate the relationship between wheelchair type and impairments among patients with Duchenne muscular dystrophy (DMD). Participants were 52 patients with DMD who used wheelchairs for daily locomotion. We assessed muscle strength, spinal deformity, sitting balance, respiratory function and ADL among 4 groups using different types of wheelchairs (manual wheelchair, manual wheelchair attached with powered component, powered wheelchair, and assist type wheelchair). Spinal deformity was related with wheelchair type. Muscle strength, peak flow and FIM motor score were significantly different among the four groups. The duration of daily use of ventilators was significantly different between the powered wheelchair users and the completely dependent group.
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Objective : To evaluate the reliability and the validity of the Japanese version of the Spinal Cord Independence Measure (SCIM) in patients with cervical spinal cord injury. Design : Cross-sectional, observational study. Setting : Rehabilitation ward for spinal cord injury in Japan. Patients and Methods : 26 inpatients with traumatic and non-traumatic cervical spinal cord injury, with an average age of 60.3, were included to examine the internal consistency of the subscales (subscores in each domain) and the whole scale, and to determine concurrent validity of the SCIM and the Functional Independence Measure (FIM) motor subscores. To examine interrater reliability, 12 of these patients were assessed by 2 physiatrists independently and intraclass correlation coefficients (ICC) for total scores and weighted kappas for individual item scores were calculated. Results : The ICC for total SCIM score was 0.99, and the weighted kappas for individual item scores showed moderate to strong agreement (kappa=0.54-1.00). The Cronbach's alpha coefficients for domain subscores and total score were above 0.71, demonstrating appropriate internal consistency of the SCIM. The total SCIM scores significantly correlated with the FIM motor subscores (Spearman's rho=0.95), however, there were some variations with the SCIM scores in patients who were rated as 6 (modified independence) with the FIM in such items as bladder management and indoor mobility. Conclusion : The results supported the internal consistency, interrater reliability and concurrent validity of the SCIM in patients with cervical spinal cord injury. The SCIM may be a potential measure to evaluate certain functional aspects that cannot be assessed by the FIM alone.
ABSTRACT
Depression is a common complication of stroke. Reported prevalence ranges from 23 to 40% of patients with stroke. The range is very wide, because there are methodological differences between the different studies (e.g. diagnostic criteria, type of rating scales used, timing of evaluation and wide range of patient selection). Poststroke depression (PSD) has a negative impact on functional recovery, activities of daily living (ADL), and quality of life, and can impede the process of rehabilitation. Furthermore, PSD leads to increased morbidity and mortality. It is therefore important to identify and treat depression in its early stages. In this paper, we reviewed the diagnosis and treatment of PSD. Many studies used diagnostic tools that are routinely employed for the diagnosis of major depression and other depressive disorders. Diagnosis is hindered by problems related with self-reporting in patients with cognitive and communicative deficits following stroke, and is confounded by the fact that many of the somatic symptoms of depression can also arise directly from stroke itself. There is therefore a concern about the validity of regular diagnostic tools in assessing poststroke patients. Different approaches and diagnostic criteria used to assess neuropsychiatric disorders in different studies make it difficult to compare their results and to interpret neuropsychiatric phenomena. The effects of treatment of poststroke depression have been examined and confirmed in several trials with tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRI). There is currently no evidence that exercise, whose effectiveness has been demonstrated in major depression, may reduce depression in stroke patients. This is an area to be further explored in rehabilitation settings.