Can Outpatient Rehabilitation Be Continued During the COVID-19 Pandemic? A Report from a Japanese Regional Medical University Hospital.

Objective: To describe the operation of an outpatient rehabilitation practice at a Japanese hospital severely affected by the coronavirus disease 2019 (COVID-19) pandemic. Design: Analytical observational study. Setting: Outpatient rehabilitation department in Saitama, Japan. Participants: Number (N=953) of outpatients from January 2019 to July 2021. Interventions: Not applicable. Main Outcome Measures: This paper begins with a review of the infection control measures that were initiated after declaration of a state of emergency in April 2020. The effects of the pandemic were then examined by comparing the daily average number of outpatients from January 2020 to July 2021 with that noted for the same duration during 2019. Results: In April 2020, the average daily number of patients decreased by 77.1% compared with the number in 2019 and was further decreased by 65.7% and 63.7% in May and June 2020, respectively. The time limitations on rehabilitation were lifted in June, and the number of patients increased by 82.3% in July 2020. Thereafter, it remained at approximately 80% throughout the rest of the year compared with that noted in 2019. From January 2021 to July 2021, the number of patients approached the number noted during normal practice or was even higher. Conclusions: The implementation of infection control measures, adjustments to procedures, and widespread vaccination permitted the continuation of our outpatient practice.

Quality of life and life-space mobility after total knee arthroplasty in patients with rheumatoid arthritis: a pilot case-controlled study.

[Purpose] The purpose of this study was to identify factors inhibiting improvement in the quality of life after total knee arthroplasty in patients with rheumatoid arthritis. [Participants and Methods] This was a pilot case-control study. The sample comprised of five participants with rheumatoid arthritis and 11 participants with osteoarthritis, who underwent total knee arthroplasty. We compared the groups in terms of physical function, walking ability, Japanese Knee Osteoarthritis Measure, and Life-Space Assessment. Measurements were taken before surgery and at four weeks and five months post-surgery. All patients underwent rehabilitation for five months postoperatively, first as inpatients, and then as outpatients after discharge. [Results] In the period from 4 weeks to 5 months post-surgery, physical function improved similarly in both groups in terms of muscle strength and walking ability. Despite the patients with rheumatoid arthritis being younger, their self-health assessment score by the Japanese Knee Osteoarthritis Measure and measures of life-space mobility by Life-Space Assessment were lower. [Conclusion] It is important to consider exercise therapy, and gait instruction to alleviate anxiety about health status and improve the quality of life and life-space mobility in patients with rheumatoid arthritis who undergo total knee arthroplasty.

Safer return to jazz dance instruction after simultaneous bilateral total hip arthroplasty.

To describe the case of a 48-year-old Japanese female patient with more than two decades of experience in jazz dance instructor returning to work after simultaneous bilateral total hip arthroplasty (SBTHA). We provided her with a tailored postoperative physical therapy programme considering her preoperative activity level and skills using three-dimensional motion analysis for guidance. The patient returned to jazz dance instruction 8 months after undergoing SBTHA, and her disease-specific quality of life assessment score at 1-year postsurgery was almost perfect. Use of three-dimensional motion analysis helped facilitate our assessment of whether her hip angle was within the acceptable range for teaching the compound movements necessary in jazz dance, but her preoperative experience was crucial in determining her full-scale participation in jazz dance. At present, 7 years since the surgery, the patient is able to continue jazz dancing, the THA component remains stable.

Clinical improvements in higher brain function and rapid functional recovery in a case of cerebellar hemorrhage treated by neurocognitive rehabilitation.

Cerebellar stroke rarely causes disorders of higher brain function such as cognitive deficits and emotional dysfunction; hence, the prognosis of these patients is uncertain. We report the case of a 34-year-old patient with cerebellar hemorrhage due to arteriovenous malformation causing higher brain dysfunction who was able to return to full-time employment after neurocognitive rehabilitation. Cerebellar stroke caused by nonatherosclerotic diseases or diaschisis may lead to cognitive deficits but these symptoms can be reversed by appropriate therapy. It is important to assess higher brain function in cerebellar stroke patients and to tailor neurocognitive rehabilitation programs appropriately to promote functional recovery.

Platelet activation is caused not by aging but by atherosclerosis.

Platelet activation increases with age, although it is still controversial whether it derives from aging per se or from atherosclerosis concomitant with aging. The purpose of this study is to clarify the association between platelet activation and aging or atherosclerosis. We studied the ultrastructure of platelets in the elderly subjects with or without atherosclerosis and healthy young subjects. The platelet shape changes were evaluated by transmission electron microscopy and the contents of peroxidase and fibrinogen were assessed using a scoring system based on cytochemical staining and immunogold marking methods. No significant differences in platelet shape changes and the contents of peroxidase and fibrinogen in platelet were observed between healthy young and nonatherosclerotic elderly subjects, although the frequency of pseudopods increased and the content of peroxidase decreased in atherosclerotic elderly patients. It is suggested that platelet activation is not derived from aging but from atherosclerosis, although it is difficult to separate aging from coexisting atherosclerosis.

Is insulin resistance related to recurrence of stroke or incident of ischemic heart disease in patients with stroke? A preliminary report.

Insulin resistance promotes atherosclerosis and has been recognized as an important risk factor for both stroke and ischemic heart disease (IHD). However, the precise relationship between insulin resistance and ischemic stroke recurrence or development of IHD is uncertain. The aim of this study was to investigate the relationship of insulin resistance to ischemic stroke recurrence or IHD in patients with a history of stroke. A total of 32 patients poststroke with hypertriglyceridemia but without a history of diabetes mellitus were asked whether they had experienced stroke recurrence or IHD after discharge. We found that 4 of 32 patients experienced recurrence. Three of these 4 patients had insulin resistance. We classified the subjects into two groups: one group with stroke recurrence and the other group without. We then compared the insulin profiles between these two groups. Although there was no significant relationship between recurrence and insulin resistance, fasting glucose level was higher in patients with recurrence than without. Insulin-resistant patients with recurrence had significantly lower levels of plasma insulin at 120 minutes in the oral glucose tolerance test compared with those without recurrence. This study suggests that insulin resistance in combination with decreased insulin secretion may be associated with ischemic stroke recurrence or IHD.

Successful treatment of pulmonary aspiration due to brain stem infarction by using cough exercise based on swallowing scintigraphy: preliminary observations.

Although dysphagia in stroke may result in lethal chest infection, it can be prevented by coughing. We report on a patient with dysphagia and aspiration who regained oral ingestion by swallowing with voluntary cough. A 54-year-old man with subarachnoidal hemorrhage underwent endovascular coiling and developed brain stem infarction. Scintigraphy showed pulmonary aspiration just after swallowing, but no radioactivity was detected in the lungs 10 min after swallowing with voluntary cough. Swallowing exercise with voluntary cough resulted in a safe swallow without enteral feeding. Even if laryngeal penetration and pulmonary aspiration are observed, chest infection could be prevented by swallowing exercise combined with voluntary cough.

Insulin resistance in patients with stroke is related to visceral fat obesity and adipocytokines.

Insulin resistance is associated with hyperglycemia and dyslipidemia and promotes atherosclerosis. Although insulin resistance is associated with adipocytokines, little is known about the association in patients with stroke without diabetes mellitus. The aim of the current study was to examine the relationship among insulin resistance, visceral fat area, and adipocytokines in patients with stroke. This study design was cross-sectional in a university hospital. We studied 60 patients with stroke and no history of diabetes mellitus who had hyperglycemia or hypertriglyceridemia or reduced fasting plasma high-density lipoprotein cholesterol. We measured insulin resistance, the plasma level of tumor necrosis factor (TNF)-alpha, adiponectin, and the visceral fat area. Insulin resistance was defined by the homeostasis model assessment and the level of insulin at 120 minutes after consuming oral glucose. We classified two groups (insulin sensitive or insulin resistant). In all, 21 of 60 patients (35.0%) had insulin resistance and 35 (58.3%) had hyperinsulinemia. Compared with insulin-sensitive patients with stroke (n = 18), insulin-resistant patients with stroke (n = 21) had significantly wider visceral fat areas and a high level of plasma TNF-alpha. The plasma level of adiponectin in insulin-resistant patients with stroke was similar to that in insulin-sensitive patients. Insulin-resistant patients with stroke in this study had a large amount of visceral fat and increased levels of TNF-alpha. We recommend that obese patients with stroke should be examined for insulin resistance to reduce the risk of the development of atherosclerosis.

Delayed manifestation and slow progression of cerebral infarction caused by polycythemia rubra vera.

BACKGROUND: Polycythemia rubra vera is often found after the manifestation of cerebral infarction, though the pathogenesis is still controversial. We present a case of cerebral infarction secondary to polycythemia rubra vera, which presented a slow expansion on magnetic resonance imaging despite severe hemiplegia. This case suggests a possible mechanism for development of cerebral infarction in polycythemia rubra vera. METHODS: This case report was conducted in a university hospital. Magnetic resonance imaging and diffusion-weighted imaging were performed to assess the evolution of infarction, and the total blood volume and cerebral blood flow were determined with the use of isotopes, Cr and Tc, respectively. Phlebotomy was performed, but intervention was not applicable. The manual muscle test and sensory disturbance were assessed by the same physiotherapist throughout the clinical course. RESULTS: A 64-year-old male patient with polycythemia rubra vera had a cerebral infarction. A subtle change was observed on CT scan on the third day after the onset of infarction, and a small signal was demonstrated on magnetic resonance imaging on the fourth day. The cerebral infarction expanded slowly in size and reached a maximum on day 24. A diagnosis of cerebral infarction secondary to polycythemia rubra vera was made, and treatment by phlebotomy, hydration, and hydroxyurea was begun. Though the hemiplegia remained, he became ambulatory with a brace, as do patients with atherosclerotic infarction. CONCLUSIONS: It is suggested that the delayed manifestation and slow expansion of cerebral infarction caused by elevated hematocrit might be derived from a pathogenesis different from atherosclerotic infarction.

Inhibiting bacteria and skin pH in hemiplegia: effects of washing hands with acidic mineral water.

OBJECTIVE: To evaluate bacterial flora in hemiplegic hands as a possible pathogen of endogenous infection in a rehabilitation unit and to examine the effect of cleansing hands with acidic mineral water on the flora. DESIGN: Case-control study in a university affiliated hospital. Seventy-two patients with hemiplegia caused by cerebrovascular diseases were included in this study. Bacterial flora by the swab method, bacterial frequency on the palm by the stamp method, and skin surface pH were examined before and after single cleansing by immersion in plain or acidic mineral water. RESULTS: The bacterial frequencies of patients with hemiplegia and diabetes were higher than those of normal healthy subjects. After cleansing with acidic mineral water, skin surface pH was decreased and bacterial frequency was markedly decreased. A prolonged decrease in skin surface pH was observed in patients with hemiplegia in contrast to normal healthy subjects who presented a short-term decrease. CONCLUSION: Increased bacterial frequencies were associated with a high skin surface pH caused by disordered skin systems in patients with hemiplegia. Acidic mineral water may be useful for inhibiting bacterial growth in patients with hemiplegia.

Rhabdomyolysis, hepatitis and multiple hematological disorders associated with alcohol abuse: a case report.

A 68-year old Japanese male with alcohol related rhabdomyolysis, hepatitis, and hematological disorders is presented. Biochemical data showed markedly elevated levels of serum hepatobiliary enzymes, lactate dehydrogenase and myoglobin, and decreased levels of serum sodium and phosphate. The serum creatine kinase level was approximately 40 times higher than the normal upper limit with 97% of MM fraction. Clinical manifestations of rhabdomyolysis, such as myalgia, muscle weakness and acute renal failure, were not recognized. Hematological examinations revealed mild neutropenia, lymphopenia, monocytopenia and thrombocytopenia but no anemia or macrocytosis. Initial treatment of an intravenous infusion of saline (30 mL/Kg body weight) and subsequent low sodium diet was successfully completed without severe complications. All the abnormal laboratory data were normalized within three weeks of his hospitalization. We suggest that hyponatremia and hypophosphatemia may be involved in the development of rhabdomyolysis, hepatitis and hematological disorders.