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COVID-19 spread from Wuhan City, People's Republic of China, in December 2019, followed by an explosion of infections worldwide. The number of infected people has also risen dramatically in Japan and has become a major social problem. Patients with severe disease require a long period to return to society due to significant physical weakness even after recovery. We report a patient in his 40s with a history of nephrectomy who was infected with COVID-19 and became critically ill.After being diagnosed with COVID-19 by PCR test, the patient was admitted to our hospital. His respiratory status rapidly worsened and he was temporarily managed by ECMO in the intensive care unit. At the time of his first contact with us (day 31 post-hospitalization), he was unable to hold himself in a standing position for a long time and required a walker. Initially, from the perspective of preventing the spread of infection, we instructed him in self-directed training rather than individual therapy. From day 49, he began to receive physical therapy. He was discharged on day 53 with independence in outdoor walking. He was instructed to consume protein after exercising and he was managed on an outpatient basis. He returned to work. His skeletal muscle mass increased by BIA and his respiratory and motor functions were restored.He received instructions on recovering from severe illness after COVID-19 infection, which focused on nutrition, voluntary training, and monitored individual therapy in accordance with rehabilitation therapy. He was able to return to society with no sequelae.
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We provided inpatient rehabilitation treatment and return-to-school guidance to a junior high school student with medulloblastoma and pervasive developmental disorder (autism spectrum disorder). Here we describe the rehabilitation treatment for patients with physical and developmental disabilities. A 13-year-old boy who was diagnosed with pervasive developmental disorder at 4 years of age was able to perform activities of daily living independently and attend junior high school. However, he was admitted to our hospital with new-onset ataxia. Magnetic resonance imaging revealed a cerebellar tumor. After total tumor excision was performed, pathological analysis revealed medulloblastoma, which was treated initially with radiation therapy and then chemotherapy for 1 year. Rehabilitation was initiated 2 days post-surgery. We evaluated his communication abilities. He showed stereotypical behavior owing to the autism spectrum disorder；therefore, we performed low-intensity repetitive exercises. The functional independence measure score at discharge was 67/126 (motor 44/91, cognitive 23/35). We taught his teachers how to properly assist him, and he successfully returned to school post-discharge. Although this was a case in which the child had multiple disabilities, ataxia caused by the medulloblastoma aggravated his developmental disability. Thus, understanding the characteristics of communication and its strengths was vital in determining a treatment plan that enabled his return to school.
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Objective：We aimed to examine the clinical validity of the Wechsler Adult Intelligence Scale (WAIS)-III for resuming automobile driving in patients with brain injury.Methods：A total of 71 patients who requested to resume driving after brain injuries were included, with 43 and 28 patients categorized in the resumed and non-resumed driving groups, respectively. Statistical analysis was performed by comparing the sub-items of the WAIS-III between the groups. The reference value of accurate determinants was estimated using receiver operating characteristic (ROC) curve analysis.Results：The results of the ROC curve analysis showed that the areas under the curves for full-scale intelligence quotient (FIQ), performance IQ (PIQ), and perceptual organization index (POI) were higher than 0.7 (with moderate predictive accuracy). The cutoff values were as follows with high specificity and low sensitivity：PIQ, 98.5；FIQ, 107；and PO, 107.Conclusion：The cutoff values of the FIQ, PIQ, and POI of the WAIS-III were inadequate predictors for resumption of driving in patients with brain injury. However, if patients had all three scores less than 70, it was suggested that they refrain from driving.
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Introduction：The relationship between the results of a driving simulator test and a paper-based evaluation of higher brain function were examined.Subjects：The subjects of this study were 203 patients with brain injury who received support to resume driving during hospitalization or outpatient treatment at our hospital between April 1, 2014 and December 31, 2018.Methods：The sex, age, and results of various higher brain function tests of the patients were investigated using medical records and the outcomes of the driving resumption support. The performance on a driving simulator test was compared between patients judged able to and those judged unable to resume driving.Results：In the group of 165 patients who passed the paper-based evaluation of higher brain function, 34 were judged unable to resume driving based on a driving simulator test. In the group that did not pass the paper-based evaluation of higher brain function, 4 patients were also judged unable to resume driving based on a driving simulator test. The results of the higher brain function evaluation were significantly better in the group permitted to resume driving compared with the group not permitted to resume driving in all items except for the Visual Reproduction subtest of the Wechsler Memory Scale-Revised.Conclusions：Evaluations of actual automobile driving using driving simulators or other means are important in assessing driving resumption. Driving requires the use of various higher brain functions and the results of this study suggest that a higher level of ability is required for safe driving.
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COVID-19 spread from Wuhan City, People's Republic of China, in December 2019, followed by an explosion of infections worldwide. The number of infected people has also risen dramatically in Japan and has become a major social problem. Patients with severe disease require a long period to return to society due to significant physical weakness even after recovery. We report a patient in his 40s with a history of nephrectomy who was infected with COVID-19 and became critically ill.After being diagnosed with COVID-19 by PCR test, the patient was admitted to our hospital. His respiratory status rapidly worsened and he was temporarily managed by ECMO in the intensive care unit. At the time of his first contact with us (day 31 post-hospitalization), he was unable to hold himself in a standing position for a long time and required a walker. Initially, from the perspective of preventing the spread of infection, we instructed him in self-directed training rather than individual therapy. From day 49, he began to receive physical therapy. He was discharged on day 53 with independence in outdoor walking. He was instructed to consume protein after exercising and he was managed on an outpatient basis. He returned to work. His skeletal muscle mass increased by BIA and his respiratory and motor functions were restored.He received instructions on recovering from severe illness after COVID-19 infection, which focused on nutrition, voluntary training, and monitored individual therapy in accordance with rehabilitation therapy. He was able to return to society with no sequelae.
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We provided inpatient rehabilitation treatment and return-to-school guidance to a junior high school student with medulloblastoma and pervasive developmental disorder (autism spectrum disorder). Here we describe the rehabilitation treatment for patients with physical and developmental disabilities. A 13-year-old boy who was diagnosed with pervasive developmental disorder at 4 years of age was able to perform activities of daily living independently and attend junior high school. However, he was admitted to our hospital with new-onset ataxia. Magnetic resonance imaging revealed a cerebellar tumor. After total tumor excision was performed, pathological analysis revealed medulloblastoma, which was treated initially with radiation therapy and then chemotherapy for 1 year. Rehabilitation was initiated 2 days post-surgery. We evaluated his communication abilities. He showed stereotypical behavior owing to the autism spectrum disorder；therefore, we performed low-intensity repetitive exercises. The functional independence measure score at discharge was 67/126 (motor 44/91, cognitive 23/35). We taught his teachers how to properly assist him, and he successfully returned to school post-discharge. Although this was a case in which the child had multiple disabilities, ataxia caused by the medulloblastoma aggravated his developmental disability. Thus, understanding the characteristics of communication and its strengths was vital in determining a treatment plan that enabled his return to school.
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Sleep apnea syndrome (SAS) is a known risk factor for cerebral stroke and other cardiovascular diseases；approximately 50% of patients with cerebral stroke subsequently develop sleep-related breathing disorders. Obstructive SAS (OSAS) is the most common form of SAS. Concomitant SAS is considered a poor prognostic factor in patients who undergo cerebral stroke rehabilitation；however, many patients remain undiagnosed. We report the case of a 69-year-old woman who was admitted to the convalescent rehabilitation ward with a diagnosis of cerebral hemorrhage. Results of the STOP-Bang questionnaire administered upon admission revealed that the patient was at a high risk for SAS, and she was subsequently diagnosed with OSAS based on simple respiratory function tests. Nighttime continuous positive airway pressure (CPAP) therapy led to improvement in the patient's daytime awakening and nocturnal frequency, and her rehabilitation treatment became easier. In addition to obstruction of the upper airway, nocturnal rostral fluid shift is implicated in the pathophysiology of OSAS-induced nocturia (polyuria), and the combination of exercise and CPAP therapy may serve as a useful treatment strategy in such cases.
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Objective：This study was aimed at investigating the acquirement of socks-handling ability with hip flex, abduction, and external rotation position (hip open position）in 5 months after the posterior approach to total hip arthroplasty (THA), with consideration of the functional goals by conducting a multicenter cooperative study.Methods：The study included 101 patients (104 hip joints) with hip osteoarthritis. We evaluated patient attribution；ranges of motion of the hip, knee and ankle；hip pain in socks-handling；and upper extremity length, which were evaluated before the operation, upon hospital discharge and at 5 months after the posterior approach to THA. The patients were classified into those who attained and did not attain socks-handling ability in open hip position until 5 months after THA. We investigated the factors for acquiring socks-handling ability by using a multiple logistic regression analysis.Results：We identified three factors that significantly correlated to socks-handling ability as follows：(1) socks-handling ability before the operation, (2) range of hip external rotation before operation, and (3) range of hip abduction before discharge. The goal to acquire socks-handling ability is 27.5° hip external rotation and 17.5° hip abduction.Conclusion：We suggest that socks-handling ability must be acquired before THA and that the target range of hip abduction and external rotation must be attained during the early post-THA stage.
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Objective：This study was aimed at investigating the acquirement of socks-handling ability with hip flex, abduction, and external rotation position (hip open position) in 5 months after the posterior approach to total hip arthroplasty (THA), with consideration of the functional goals by conducting a multicenter cooperative study.Methods：The study included 101 patients (104 hip joints) with hip osteoarthritis. We evaluated patient attribution；ranges of motion of the hip, knee and ankle；hip pain in socks-handling；and upper extremity length, which were evaluated before the operation, upon hospital discharge and at 5 months after the posterior approach to THA. The patients were classified into those who attained and did not attain socks-handling ability in open hip position until 5 months after THA. We investigated the factors for acquiring socks-handling ability by using a multiple logistic regression analysis.Results：We identified three factors that significantly correlated to socks-handling ability as follows：(1) socks-handling ability before the operation, (2) range of hip external rotation before operation, and (3) range of hip abduction before discharge. The goal to acquire socks-handling ability is 27.5°hip external rotation and 17.5°hip abduction.Conclusion：We suggest that socks-handling ability must be acquired before THA and that the target range of hip abduction and external rotation must be attained during the early post-THA stage.
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Purpose：The Southampton Hand Assessment Procedure (SHAP) is a test of upper extremity function composed of 12 movement tasks and 14 activities of daily living tasks, and is used as an assessment battery for upper extremity prostheses. The purpose of this study is to examine its validity in clinical practice.Methods：The study included 143 patients with hemiparesis. The validity of SHAP and an existing assessment battery were compared in this study. Factors influencing the validity of differences between dominant and non-dominant hands were examined.Results：Concomitant validity was shown between the SHAP Japanese version and an existing upper extremity function evaluation method. A strong correlation with the subjective evaluation scale was obtained in cases of dominant hand paralysis.Discussion：These results suggested that SHAP is able to accurately evaluate upper extremity hemiparesis, because the difficulty level in evaluation of upper extremity function is higher than that of the Action Research Arm Test, and a ceiling effect is unlikely. Therefore, SHAP is useful in clinical practice not only for assessment of an artificial hand but also for hemiparesis with stroke. Further study to clarify the characteristics of SHAP as well as verification of reliability and standard values is warranted.
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Purpose：The Southampton Hand Assessment Procedure (SHAP) is a test of upper extremity function composed of 12 movement tasks and 14 activities of daily living tasks, and is used as an assessment battery for upper extremity prostheses. The purpose of this study is to examine its validity in clinical practice.Methods：The study included 143 patients with hemiparesis. The validity of SHAP and an existing assessment battery were compared in this study. Factors influencing the validity of differences between dominant and non-dominant hands were examined.Results：Concomitant validity was shown between the SHAP Japanese version and an existing upper extremity function evaluation method. A strong correlation with the subjective evaluation scale was obtained in cases of dominant hand paralysis.Discussion：These results suggested that SHAP is able to accurately evaluate upper extremity hemiparesis, because the difficulty level in evaluation of upper extremity function is higher than that of the Action Research Arm Test, and a ceiling effect is unlikely. Therefore, SHAP is useful in clinical practice not only for assessment of an artificial hand but also for hemiparesis with stroke. Further study to clarify the characteristics of SHAP as well as verification of reliability and standard values is warranted.
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The Ability for Basic Movement Scale (ABMS) II has been introduced recently in some institutions for assessment of motor function in hemiparesis patients. This scale can estimate 5 important basic movements (turn over from supine position, sit up, remain sitting, stand up and remain standing). However, this scale has not been used in patients with Parkinson's disease (PD). The purpose of this study was to determine the association among ABMS II, lower leg muscle strength, activity of daily living (ADL) and neurological deterioration in PD patients. Forty-nine patients with PD were studied (mean age at evaluation: 73.8 ± 15.9 years; time between onset and evaluation: 33.8 ± 44.2 months, ± standard deviation). All patients underwent assessments with ABMS II, Barthel index (BI), lower limb muscle strength and Unified Parkinson's Disease Rating Scale (UPDRS) Part 3. ABMS II correlated significantly with UPDRS Part 3 and BI, and moderately with lower leg muscle strength. There was no correlation between UPDRS Part 3 and lower leg muscle strength. The study demonstrated that ABMS II score was associated significantly with neurological deterioration, ADL and lower leg muscle strength in patients with PD. We advocate the use of ABMS II by physical therapist for the assessment of PD patients.
Subject(s)
Humans , Activities of Daily Living , Disability Evaluation , Leg , Lower Extremity , Muscle Strength , Paresis , Parkinson Disease , Physical Therapists , Supine PositionABSTRACT
Objective：To investigate the characteristics of studies registered in the field of rehabilitation medicine.Methods：The university hospital medical information network clinical trials registry database was searched for domestic clinical trials associated with rehabilitation medicine that were registered after June 2005. We extracted information about studies and analyzed their registration trends and overall characteristics.Results：Among the 21,410 registered trials, we found 529 trials associated with rehabilitation. The purpose of this study was to investigate efficacy in 65％ of the studies. Among these studies, 54％ were parallel-group comparison studies, 50％ were registered retrospectively, and 85％ did not publish any results. In comparison studies, 86％ were randomized controlled studies, and 47％ were open-label trials.Conclusion：An increasing trend of registration was observed. However, we found several problems in registration. Prospective registration is important to decrease publication and outcome reporting biases. Education for the relevant study protocol and registration might improve the quality of clinical study in domestic rehabilitation medicine.
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Objective：An actual-condition survey was conducted to verify the validity of reference values of higher brain function necessary for patients with brain injury to resume automobile driving. Subjects：Of the 74 patients admitted to the Tokyo Metropolitan Rehabilitation Hospital between November 1, 2008 and November 30, 2012, who underwent evaluation using the hospital's automobile driving resumption system at the time of discharge, 71 patients with brain injury who were judged capable of resuming driving were included in this study. Methods：Questionnaires were sent at least 1 year after discharge, to determine whether the subjects had actually resumed automobile driving. Subjects were classified by admission date into two groups：1）A provisional reference group that included patients admitted between November 2008 and November 2011 who had resumed driving；and 2) verification group that included patients who had been admitted between December 2011 and November 2012 and had resumed driving. The relationship between results on the higher brain function test for the verification group and provisional reference values was investigated. Results：The provisional reference value group included 29 patients, and the verification group included 13 patients. In the verification group, the results of 9 patients with brain injury on the higher brain function test were within provisional reference values. Conclusion：The results of the paper-based test are a reliable predictor of whether a patient is capable of resuming driving, but do not represent an absolute standard. Therefore, the safety of resuming driving should be investigated on a case-by-case basis.
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Patient 1, a 75-year-old woman with a past history of osteoarthritis of the right knee and Parkinson disease, had a subarachnoid hemorrhage. She complained of right knee pain during her rehabilitation. It turned out that she had sustained a right trochanteric fracture after falling out of bed in another hospital. Patient 2, an 86-year-old woman with a past history of rheumatoid arthritis, was treated with the Gamma nail technique for a left trochanteric fracture. She described experiencing pain in the region from the left knee to the lateral side of the left thigh during her rehabilitation, about two months after the hip operation. X-ray and computed tomography images showed varus displacement of the femoral head due to screw cut-out. In each of these cases, it took some time for us to detect the underlying hip diseases. The dermatome shows regions of the skin innervated by each single spinal segment. Similarly, the sclerotome shows regions of bone and periosteum innervated by each single spinal segment. According to Inman and Saunders's sclerotome, the proximal portion of the femur is mainly innervated by L3, L4 and L5. On the other hand, in dermatome perspective, L3, L4 and L5 innervate the knee and region around the knee. It means that hip diseases can cause referred pain to the knee.Untypical pain in distant regions from the hip joint makes it difficult to examine the hip joint and causes delay in an accurate diagnosis, as in the cases just described. Therefore, we should keep in mind that hip diseases can cause referred pain to the knee.
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A multicenter review of the medical records of Japanese post-stroke patients with spastic hemiplegia was conducted to investigate the clinical use of botulinum toxin type A (BoNT/A) by physicians with expertise in the treatment of upper and lower limb spasticity. An analysis of the data from 307 patients treated with BoNT/A during the period January 1, 2012 to November 30, 2013 provided a variety of information on factors relating to BoNT/A injection outcomes, including the total dose of BoNT/A per treatment session, the dose of BoNT/A per muscle, the number of injection sites per muscle, the method used to locate the muscles to be injected, and the dilution of reconstituted BoNT/A. Our analysis indicated that the dose of BoNT/A administered per muscle was usually selected by taking into consideration the severity of spasticity, rather than the patient's body size. Since the technical expertise of experienced clinicians is summarized in this data, it may serve as a useful reference for the use of BoNT/A in routine clinical practice.
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Objectives : In this study, we assessed the muscle contraction pattern of each toe by stimulating the flexor hallucis longus (FHL) and flexor digitorum longus (FDL) muscles in patients with claw foot deformity caused by spasticity in the lower extremity in order to increase the benefit of their botulinum toxin treatments. Subjects and Methods : Fifteen post-stroke patients (11 male and 4 female ; mean age, 62.3 years) were recruited for the study. In this observational study, the muscle contraction patterns of the hallux and digits on electrical stimulation of the FHL or FDL were examined by two doctors, and the data was then analyzed. In addition, the FHL and FDL were identified in 6 feet from 3 cadaver specimens below the ankle to near the end of each muscle on each toe. Results : In muscles that could be observed, muscle contraction was observed in the hallux in every subject and in the second digit in 92.3% subjects when the FHL was stimulated electrically. Muscle contraction was not observed in the second digit in 64.3% of the subjects when the FDL was stimulated electrically. In the cadaver dissections, the tendons of the FHL sent fibers to the FDL tendons in all 6 feet examined. Conclusion : In conclusion, when botulinum toxin is to be injected into the FHL or FDL muscle for treating claw foot deformity in patients with lower extremity spasticity, especially when the treatment target is the second digit, the injection should be performed not only in the FDL muscle, but also in the FHL muscle to increase the effectiveness of the treatment.
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Background : The aim of this study was to assess the effects of repeated injections of botulinum toxin type A (BoNT-A) combined with a rehabilitative program for treating spastic upper limb hemiparesis after stroke. Subjects and methods: Subjects were 112 poststroke hemiparetic patients with spastic upper limb (mean age : 55.5±11.6 years ±SD, mean period between onset and first injection : 5.1±3.5 years). For each patient, BoNT-A (maximum dose of each injection : 240 units) was injected in the spastic muscles of the affected upper limb twice with a minimum interval of 3 months. Following each injection, detailed one-to-one instructions for homebased functional training was provided. At the baseline (before injection) and at 1 and 3 month follow-ups after each injection, the patient's modified Ashworth scale (MAS), the range of motion (ROM) and Fugl-Meyer Assessment (FMA) were evaluated. Results : The total score for the upper limb and the scores of categories A and B of the FMA increased significantly not only after the first injection but after the second injection compared with the second baseline, while the FMA score for category D increased significantly only after the second injection. MAS also decreased significantly not only after the first injection but after the second injection compared to the second baseline. Conclusion : A more significant improvement was found not only in muscle spasticity but also in upper limb motor function after two BoNT-A injections. It is suggested that repeated BoNT-A injections followed by a comprehensive rehabilitative program would be an effective treatment for limb spasticity after a stroke.
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Objective : We conducted a fact-finding survey for the consecutive past 3 years to establish whether inpatients with brain injury who had wished to resume driving after discharge from our hospital had in fact resumed driving after discharge. The survey included both driving status and information about collisions. Methods : Patients who had been evaluated for resumption of driving and were discharged more than 1 year ago were sent a fact-finding survey questionnaire aimed at establishing whether they were currently driving. The patients who had resumed driving (resumers) were compared with those who had not resumed driving (non-resumers). From the questionnaire results we investigated driving status and whether collisions had occurred. Results : We obtained effective responses from 40 of the 54 people (48 males, 6 females) who were sent the questionnaire ; the collection rate was 74.1%. Of these, twenty-nine people had resumed driving, all were male. There were no significant differences between the resumers and non-resumers in higher brain function tests. In regard to driving ability, hemiparesis impairments were significantly milder in the resumers than in the non-resumers. Two respondents had hit posts or walls within the year. All these collisions occurred when parking. One respondent had a collision while driving along a road. Conclusion : We hope to provide patients with useful and appropriate information on resuming driving so that we can support them in a safe return to the driving environment.
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Alien hand syndrome (AHS) is a rare neurologic disorder in which movements are performed without conscious will. Cognitive rehabilitation is usually first considered for treating AHS. However, we proposed different modalities for the treatment. This is the first case report showing therapeutic effects of the NEURO-15 program that consists of low-frequency repetitive transcranial magnetic stimulation and intensive occupational therapy on AHS symptoms and upper limb dysfunction caused by a stroke one year and three months before. A 68-year-old male developed right upper limb palsy secondary to cerebral infarction on the medial side of the left frontal lobe. On admission, he exhibited disturbed skilled motor behavior, compulsive grasping of the right upper limb, and dissociated behavior of the right hand independent from the left. The right hand interfered with the actions executed by the left hand. The left hand restricted the right hand in its actions by holding it. Six months after the onset, his Activities of Daily Living improved and he was discharged from hospital to home. However, his compulsive grasping of the right upper limb symptoms remained, and he underwent NEURO-15 one year and three months after the onset. His right upper limb function improved. Compulsive grasping of the right upper limb disappeared, and the contradictory action of the right upper limb was rarely seen. These results suggested that NEURO-15 influenced the neural network including the primary motor cortex and supplementary motor area.