Résumé
Welwalk WW-1000® (WW-1000®) is a gait exercise-assisted robot. Suitable assistance was provided to the patients with hemiplegic legs in both stance and swing phases. In addition，this robot offers various forms of feedback to patients during exercise. We present the case of a patient with multiple sclerosis and left hemiplegia who underwent WW-1000® gait exercise.The 73-year-old patient required maximum assistance with metal ankle foot orthotics (AFO) and a quadruped cane prior to robot-based rehabilitation. The aims of gait exercise with the WW-1000® were as follows；① maintain the verticality of the trunk during the entire gait cycle；②shifting the center of gravity during stance phase on the nonparalytic limb；③stabilizing the swing phase on the paralytic limb, and enhancing support during the stance phase on the paralytic limb. Each aim was modified depending on level of achievement. Assistance with the WW-1000® activated the trunk and Nonparalytic limb (visual feedback was utilized in exercises). On day 9, the patient could walk using a plastic AFO and T-cane supervised by a therapist.The multifunctional WW-1000® is useful for subdividing gait goals, exercise and set stepwise aims consistent with the patient's abilities. Gait exercises using the WW-1000® may efficiently improve gait and helps adapt to changes in conditions in the subacute phase.
Résumé
We present a case report that a longitudinal calf MR evaluation was performed for a patient with Charcot-Marie-Tooth disease who underwent bilateral reconstructive foot surgeries. A 39 years-old female was referred to our department because of severe bilateral cavus foot deformities and difficulty to walk. On radiological findings, severe bilateral cavus foot deformities were confirmed. On MR findings, fatty infiltrations were detected in the wide range of bilateral lower leg compartments. Difficulty to walk aggravated despite of the conservative treatment, so bilateral reconstructive foot surgeries were performed. She acquired plantigrade and better walking function postoperatively. Two years after surgery, no recurrence of cavus foot deformity was observed, but claw toe deformities and fatty infiltrations were mildly progressing. Since CMT is slowly progressive, we need to conduct a careful follow-up.
Résumé
We present a case report that a longitudinal calf MR evaluation was performed for a patient with Charcot-Marie-Tooth disease who underwent bilateral reconstructive foot surgeries. A 39 years-old female was referred to our department because of severe bilateral cavus foot deformities and difficulty to walk. On radiological findings, severe bilateral cavus foot deformities were confirmed. On MR findings, fatty infiltrations were detected in the wide range of bilateral lower leg compartments. Difficulty to walk aggravated despite of the conservative treatment, so bilateral reconstructive foot surgeries were performed. She acquired plantigrade and better walking function postoperatively. Two years after surgery, no recurrence of cavus foot deformity was observed, but claw toe deformities and fatty infiltrations were mildly progressing. Since CMT is slowly progressive, we need to conduct a careful follow-up.
Résumé
We studied five untreated patients with plantar fasciitis, 15 chronic cases treated only with Western medicine (non-Kampo group), and 15 chronic cases treated with Kampo in addition to Western medicine (Kampo group). There was no difference in age and pain VAS at the first visit among the three groups. All the non-treated cases were improved with conventional treatment and the duration of treatment was short. In the case of patients who did not respond well to the initial treatment in our department, Kampo medicine was started from three months after the first visit. Therefore, there were more refractory cases in the Kampo group, with poor pain VAS at the last observation and a long treatment period. Among them, two cased were effective in combination with yokuininto and tsudosan, one case was yokuininto only, and one case was combination of yokuininto, tsudosan and keishibukuryogankayokuinin. Sokeikakketsuto used in three patients was not effective. Thus, chronic planter fasciitis may include physiology of not only wind-dampness, cold, and blood deficiency but also qi stangnation and blood stasis.
Résumé
[Objective]To evaluate the efficacy of the different depth of acupuncture on the motor function and the pain with osteoarthritis of the knee. <BR>[Design]Single blind randomized controlled trial.<BR>[Method]Subjects were randomly allocated to one of two groups. Acupuncture needles were inserted about 3mm in the superficial acupuncture group and 10 to 20 mm in the deep acupuncture group. Subjects in both groups received the treatments for ten minutes on ten tender points. Acupuncture sessions were performed once a week for 8 weeks and without treatment 4 weeks.<BR>[Outcome Measures]Pain intensity (visual analogue scale :VAS) , Objective evaluation of the motor function (Timed Up &Go test, 20m walking time, Time of going up and down stairs) and QOL (Western Ontario and MacMaster Universities osteoarthritis index :WOMAC).<BR>All measurements were recorded at baseline, 4th, 8th and 11thweek.<BR>[Result]Motor function improved significantly only in the superficial acupuncture group(P<0.05). The degree of pain decreased significantly in both groups (P<0.05). <BR>[Conclusion]Superficial acupuncture provided the improvements on pain and motor function and contributed to the QOL improvement. Therefore the superficial acupuncture would be suggested to be one of the most effective method for the acupuncture treatment of OA of the knee.
Résumé
<b>Objective</b><br>The purpose of this trial was to compare the cumulative and sustained effect of repeated acupuncture treatment and repeated local injection of anesthesia for localized low back pain.<br><b>Methods</b><br>A computer program was used to randomly allocate 26 patients with low back pain to either an acupuncture group (n=13) or a local injection group (n=13). Patients in both groups received treatment at the most painful points (from 2 to 5 points) once a week for a total of 4 weeks. For the acupuncture treatment, a 0.18mm diameter stainless steel needle was inserted to a depth of 10 to 20mm and then manual stimulation using the sparrow pecking method (1Hz) was given. For the local injection, injection needle (25G, 0.5mm in diameter) was inserted to a depth of 10 to 20mm before injection of the anesthetic (a mixture of local anesthetic and neurotropin). The visual analog scale (VAS: 100mm) was used to measure subjective pain intensity before and directly after the first treatment, before subsequent treatments, and at two and four weeks after completion of the treatment. The Roland-Morris Disability Questionnaire (RDQ) and Pain Disability Assessment Scale (PDAS) were also used to evaluate Quality of Life (QOL) of the subject at before the first treatment, at the time of completion of treatment, and at two and four weeks after the completion of treatment.<br><b>Results</b><br>There was a significant difference (p=0.0016) in changes in the VAS scores between two groups, with more favorable results in the acupuncture group than in the local injection group. Calculation of the degree of change from the initial scores indicated that acupuncture group showed significantly better results than those in the local injection group at directly after the first treatment (p=0.0348), and there was a significant cumulative effect (at the end of treatment: p=0.0076) and sustained effect (two weeks after treatment: p=0.0096, four weeks after treatment: p=0.0128). Similarly, RDQ and PDAS were also better in the acupuncture group compared to the local injection group.<br><b>Discussion</b><br>Both local injection and acupuncture reduced low back pain. The superior effect of acupuncture directly after treatment and its superior cumulative and sustained effect, indicate that it could be an effective treatment for low back pain. The reason for the disparity between the effects could be due to differences in the mechanisms of pain suppression.