Development of a motion capturing and load analyzing system for caregivers aiding a patient to sit up in bed.

This research was carried out to analyze the actions of caregivers when aiding a patient to sit up in bed. The new system showed that three dimensional analysis could be performed even on points on the subjects' bodies that were hidden from view. We also developed a method to estimate the load on the lumbar region of caregivers based on the kinetic analysis of the human body. Using this system we were able to evaluate the performance of both lay and professional caregivers. We found a clear difference between the performances of the two types of caregivers, and noted that the professional adopted a posture that was safe and did not stress the lumbar vertebrae, whereas the layperson tended to adopt an unsafe posture.

[Intrathecal baclofen treatment for spasticity in childhood . initial report of long-term follow up in Japan].

OBJECTIVE: Initial outcome of intrathecal baclofen (ITB) treatment in Japan is being reported on. METHODS: Chronological change of the Ashworth scale and complications after surgery were analyzed. Data were obtained from 71 children with severe spasticity who had received ITB screening tests by the end of March 2012. RESULTS: Pump implantations for ITB treatment were performed in 43 children out of 62 whose spasticity reduced after baclofen injection at the screening tests. Postoperative evaluations of ITB treatment were carried out within one year and, in some cases, more than 2 years after surgery. Complications related to baclofen were reported on 19 occasions in 12 children within one year of ITB pump implantation, and on 9 occasions in 4 children of the 21 who were followed for more than 2 years. Main complications were hypertonia of muscle, liver dysfunction, and low blood pressure. The frequency of complications was lower than that reported previously. There was no apparent evidence to indicate that complications developed more in children than in adults in this study. The postoperative values of Ashworth scale in the upper and lower extremities were reduced markedly when compared with preoperative levels, and the improvements were statistically significant (P < 0.05). CONCLUSIONS: This is the first report of outcome of ITB for severely disabled children with spasticity in Japan. It was confirmed that ITB for children with severe spasticity is a safe and effective treatment.

Chronic expanding hematoma in the stumps of persons following transfemoral amputation: A report of two cases.

BACKGROUND: Two persons presented with severe stump pain following transfemoral amputation. CASE DESCRIPTION AND METHODS: A 21-year-old female and a 31-year-old male with transfemoral amputation were ambulatory with prostheses and suffered from severe stump pain caused by the presence of masses around the tip of the bone stump. From the clinical courses, imaging studies, and the intraoperative findings, the masses were diagnosed as a relatively rare condition known as chronic expanding hematoma. FINDINGS AND OUTCOME: The two patients were treated successfully with surgical resection. The hematomas were soft cystic masses with a thick capsule containing old blood clots and serous fluid. There were no pathological signs of malignancy. After surgical treatment, the patients achieved walking without stump pain. CONCLUSION: Although chronic expanding hematoma is a rare condition, it should be considered as a possible cause of stump pain. CLINICAL RELEVANCE: Stump pain is caused by many conditions. Although chronic expanding hematoma is a rare condition, it should be considered as a possible cause of stump pain.

Rate of complications among the recipients of intrathecal baclofen pump in Japan: a multicenter study.

OBJECTIVE: To evaluate the incidence of complications of intrathecal baclofen (ITB) therapy for spasticity in Japan, where a unique training course and nationwide registration are required. MATERIALS AND METHODS: An analysis of complications was performed in all patients who underwent ITB in Japan from 2005 to 2011. Prior to surgery, all the doctors involved took a one-day training course, which included hands-on training. Surgical techniques that avoided complications were emphasized. RESULTS: A total of 406 pumps were implanted in 400 patients (277 men, 123 women) having severe spasticity. Because this study is currently in progress, among the 400 patients, 78.3% (313/400) had finished a one-year observation follow-up. There were 369 adult and 31 juvenile (under 17 years old) patients, including 12 patients under nine years old. All-cause adverse events were seen in 148 patients (37%), and 93 (23.3%) of these were regarded as severe. Catheter problems were observed in 34 (8.5%) patients: catheter migration in 25 (6.3%), breakage in 6 (1.5%), obstruction in 2 (0.5%), kinking in 1 (0.3%), and dislodgement in 1 (0.3%). Pump trouble was observed in seven (1.8%) patients: alarm abnormality in one (0.3%), memory error in one (0.3%), delayed recovery in one (0.3%), rotation in one (0.3%), malfunction in one (0.3%), and abnormal infusion rate in two (0.6%). Device-related and surgical wound infection occurred in 12 patients (3%), and nine were regarded as severe. Leakage or subcutaneous accumulation of the cerebrospinal fluid was seen in 13 patients (3.3%). CONCLUSION: The requirement of taking of a training course before starting ITB seemed to reduce complications. Although there were surgery-related complications, the rate of complications in Japan appeared to be lower than those reported in larger series of ITB. However, whether the reported rates can be primarily ascribed to a mandatory training course requires further investigations.

[New treatment for spasticity--intrathecal baclofen therapy].

Since its introduction in the late 1980s, intrathecal baclofen(ITB) therapy has become the standard treatment for severe generalized spasticity of both spinal and cerebral origin. More than 50,000 pumps were implanted in the world. Long term efficacy of ITB therapy is excellent, although it is frequently associated with complications such as infections, catheter malfunctions, and cerebrospinal fluid leaks. There are some reports of death with withdrawal, overdose and infection. For a good results we need to discuss factors involved in selecting the appropriate treatment modalities for the individual. The treatment of these patients is optimized in the setting of a multidisciplinary team.

Cross-cultural adaptation and validation of the Japanese version of the Childhood Health Assessment Questionnaire (CHAQ).

To assess cross-cultural adaptation, and to validate the parent's version of a health-related quality-of-life instrument, the Childhood Health Assessment Questionnaire (CHAQ) was investigated after its translation into Japanese. A total of 132 subjects were enrolled: 63 patients with juvenile idiopathic arthritis (JIA) (34 systemic and 29 polyarticular) and 69 healthy children. The CHAQ distinguished clinically between healthy subjects and the two JIA subtypes of patients. The average disability index (DI) scores for systemic JIA (sJIA) and polyarticular JIA (pJIA) patients and healthy subjects were 1.5, 1.2, and 0.0, respectively. All variables in the questionnaire were shown to be significant (P < 0.001). Patients with pJIA showed better correlation than those with sJIA. Significant correlation was seen in the polyarticular group with CRP, ESR, parents' VAS, the number of joints with pain, and the number of active joints. However, there was even a negative correlation between DI and parent's assessment of overall well-being for the sJIA group. The Japanese version of the CHAQ was a reliable and valid tool for the functional assessment of children with pJIA. Functional ability, as assessed by the CHAQ, may not be the main consideration of sJIA patients' parents when assessing their child's status.