RESUMO
Post-polio syndrome (PPS) is the term used to describe the symptoms that may develop many years after acute paralytic poliomyelitis( APP). In the case of PPS, the symptoms and signs include progressive muscle wasting and weakness, limb pain, and/or fatigue, occurring one or more decades after maximal recovery from APP. An overuse of enlarged motor units is suspected to cause the deterioration of some nerve terminals or the loss of the motor units themselves. This could in turn induce PPS symptoms such as new muscle weakness and atrophy. Electromyography (EMG) is often a strong tool to diagnose and evaluate PPS. Some studies have shown that mild to moderate intensity muscular strengthening has a positive effect in patients affected by PPS. Rehabilitation for PPS patients should utilize a multiprofessional and multidisciplinary approach. PPS patients should be advised to avoid both inactivity and overuse of the affected muscles. Finally, patient evaluation is often required to access the need of orthoses and assistive devices.
RESUMO
A questionnaire survey was undertaken to investigate the present state of education and clinical training for rehabilitation medicine in Japanese university hospitals. Seventy percent of the 80 university hospital rehabilitation departments or divisions responded to the questionnaire. The educational programs included systematic lectures on rehabilitation medicine and clinical clerkships in 76.8% and 82.1%, respectively, of the schools of medicine. However, only 35.7% of the medical schools surveyed have adopted rehabilitation medicine as an independent course in their clinical clerkships, for which 21.4% spend a one-week program. Most medical students reported finding some small significance of rehabilitation medicine in their clinical clerkships, which would not contribute to their decision on the career to pursue after graduation. For the fiscal years of 2006 to 2010, about 45 new doctors per year entered the various departments of rehabilitation medicine. The factors that contributed to gathering more new doctors appeared to be the independence of the department or division of rehabilitation, the ample staffing for teaching, and the incusion of an independent course of rehabilitation medicine in clinical clerkships. The results of the present survey suggest that more departments of rehabilitation medicine should be set up to raise the level of education and clinical training for rehabilitation medicine to better attract the attention of young doctors.
RESUMO
In this study, we investigated a surface electrode stimulation method to support laryngeal elevation in patients with pharyngeal dysphagia, from the viewpoint of functional electric stimulation (FES). Informed consent was obtained from 15 healthy men and 4 patients with pharyngeal dysphagia. Digastric and stylohyoid muscles were stimulated by silver-textile surface electrodes covering the muscle belly. Laryngeal elevation by the electrical stimulation (ES) during liquid (water, 3ml) swallowing movement was measured by digital video camera. The laryngeal elevation trajectory demonstrated a hysteresis loop. The elevation distance of the larynx increased with a rise of stimulus strength. Laryngeal elevation by ES was 76.0% in the normal subjects and 86.6% in patients when measured during liquid swallowing. Applying FES for laryngeal elevation may assist in improving the swallowing reflex.
RESUMO
We report two cases of paraneoplastic syndrome with sensory polyneuropathy. Case one showed numbness of the upper and lower extremities before a diagnosis of small cell carcinoma was made. Case two showed the same symptoms coincidentally with a recurrence of ovarian cancer. In both cases, Romberg's sign was positive, ataxic gait was noted, and the patient's skill movement was disturbed. Sensory nerve action potentials were not evoked in any of the nerves. Compound muscle action potential and motor conduction velocity were at the lower limits of normal. The neurological abnormalities did not resolve in spite of medical treatments. In these two cases, the loss of sensory neurons due to a lesion of the dorsal root ganglia was suggested. The loss of sensory feedback might lead to muscle weakness and fatigue, so they tend to be disused. For long-term rehabilitation management in these two cases, we suggested a regular exercise program to prevent muscle weakness.