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Results@#In the early phase after surgery, 71% and 43% of the participants were nonindependent ambulators at 1W and 2W, respectively. Histopathology indicated that patients with solid tumors (ependymoma, astrocytoma, or lipoma) showed significantly lower indices at 1W and 2W than those with vascular tumors (hemangioblastoma or cavernous hemangioma). Regarding tumor location, thoracic cases exhibited poorer lower-limb function at 1W and 2W and poorer walking ability at 2W than cervical cases. According to the receiver operating characteristic (ROC) analysis, 2 WISCI II points at 2W had the highest sensitivity (100%) and specificity (92.2%) in predicting the level of walking independence at 1 year postoperatively (the area under the ROC curve was 0.99 (95% confidence interval, 0.93–1.00). @*Conclusions@#The higher the lower-limb function scores in the early phase, the better the improvement in walking ability is predicted 1 year after ISCT resection.
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Objective：We aimed to determine the impact of the COVID-19 pandemic on the “body function”, “activity”, and “participation” domains of functioning as defined in the International Classification of Functioning (ICF) for individuals with spinocerebellar degeneration (SCD) and multiple system atrophy (MSA).Methods：A questionnaire survey was administered to 1,000 members of the SCD/MSA patient association in Japan between November and December 2020. Questions related to COVID-19 were extracted from the multipurpose data, and the degree of COVID-19-related effects on each life function was assessed using a 7-point scale. Results were stratified into two groups based on age, care needs based on long-term care insurance coverage, and limited opportunities for rehabilitation. The χ2 test was used to examine differences between pairs of groups regarding impacts on functioning.Results：Data from 460 participants with SCD and MSA were analyzed. Participation restriction was reported in 54％ of participants with SCD and 46％ of participants with MSA, and impairment and activity limitation in approximately 20％ of participants with both conditions resulting from the COVID-19 pandemic. Participants with low care needs reported more impairment in SCD and more participation restriction in MSA. About 24％ of subjects reported limited opportunities for rehabilitation. MSA participants with these limitations reported greater impairment.Conclusion：The COVID-19 pandemic has had a particular impact on the participation domain of functioning in participants with SCD and MSA. The domains of body function and participation were found to be affected in participants with low care needs or limited opportunities for rehabilitation.
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Many acute and subacute complications of coronavirus disease 2019 (COVID-19) have been reported. However, the recovery process in severely ill patients is not clear. Here, we report three patients with favorable physical function after severe COVID-19. All three patients were older than 65 years and had comorbidities such as diabetes mellitus, hypertension, and smoking habits. During respiratory failure, they received mechanical ventilation support for more than 4 days. Two patients had undergone tracheostomy, and one had undergone extracorporeal membrane oxygenation (ECMO). At the time of transfer to our hospital, they had lower-limb muscle weakness, respiratory distress on exertion, exercise-induced hypoxemia (EIH), and complications from immobility, such as peroneal nerve palsy. During rehabilitation, we monitored peripheral blood oxygen saturation, adjusted the workload, and administered temporary orthotic therapy. The patients improved within 150 days after the onset of the disease, and they were discharged home and were able to walk as a practical means of transportation. Even after severe COVID-19, the patients achieved good physical function. Interventions for EIH and complications due to immobility were additionally necessary. In the future, we must examine the relationship between improvements in physical function and rehabilitation.
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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.
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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.
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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.