Massage therapy for home care patients using the health insurance system in Japan.

OBJECTIVES: To clarify the status of home care massage services provided to patients. This will help in understanding how many patients utilize this service and the circumstances under which treatment is provided. DESIGN: A retrospective study. SETTING: Fifty-four acupuncture, moxibustion, and massage clinics. Participants were patients who had received home care massage for six months or more. We collected a total of 1587 responses from these 54 massage clinics; of these, 1415 responses (mean age = 79.1 ±â€¯11.5 years) were valid (valid response rate 89.2%). MAIN OUTCOME MEASURES: Actual patients and actual care services. RESULTS: The most common disorder observed among patients who utilized home care massage services was cerebrovascular disease (at approximately 36%), while the second most common were arthropathy-related disorders (16.3%). Although most patients received massage, approximately 30% received manual therapy (e.g. manual correction) and hot fomentation as part of thermotherapy. Notably, only around 10% of patients received massage alone; the majority received treatment in combination with range of motion and muscle-strengthening exercises. CONCLUSIONS: This study helped to clarify the actual state of patients receiving home care massage and the details of the massage services provided. This study clearly showed the treatment effectiveness of massage, which can be used by home medical care stakeholders to develop more effective interventions.

[Efficacy of sanatorium treatment to patients with consequences of cerebrovascular disease].

OBJECTIVE: To estimate the efficacy of the introduction of Russian standard of the sanatorium treatment of patients with cerebrovascular diseases. MATERIAL AND METHODS: We examined 480 neurological patients. Efficacy of treatment was estimated according to conclusions of the physician on the basis of dynamic supervision and the scale "The Rehabilitation Profile of Activity" (Rehabilitation Activities Profile). RESULTS AND CONCLUSION: The general for all patients was physiotherapy exercises and diet therapy. The majority of patients received medical shower (62.9±2.2%), psychotherapy (83.5±1.7%) and used terrainkur (52.1±2.3%). Frequencies of separate methods of treatment effects in groups of patients with positive and negative outcomes did not differ. The reliability of distinction was noted only for frequencies of dry-air bathtubs (36 and 16%), local bathtubs (39 and 14%), medical shower (76 and 52%), sinusoidal modulated currents (36 and 18%), reflex therapy (36 and 18%), massage (58 and 38%), psychotherapy (100 and 76%), naftalan therapy (44 and 24%). The significance of the ratio between sensitivity and specificity of treatment methods is emphasized.

[Home-based rehabilitation in the functional recovery of patients with cerebrovascular disease]. / Rehabilitacion domiciliaria en la recuperacion funcional de los pacientes con enfermedad cerebrovascular.

INTRODUCTION: The study of the effectiveness of rehabilitation treatment applied to patients with sequelae following a cerebrovascular disease (CVD) plays a decisive role nowadays in planning their management in public healthcare and to improve existing guidelines regarding assessment and treatment. AIM: To describe the characteristics presented by patients who have suffered a CVD and were treated in mobile rehabilitation-physiotherapy units (MRPU) and how such treatment affects their functional recovery. PATIENTS AND METHODS: Descriptive, prospective study conducted on 124 patients referred to the MRPUs in the province of Almeria between 2008 and 2011. The variables analysed (both pre- and post-treatment) included personal history and characteristics, Barthel index, Modified Ashworth Spasticity Scale, pain (shoulder) and the Canadian Neurological Scale. RESULTS: The final sample consisted of 106 participants (mean age: 73.72 years). The disabling process was ischaemic in 77.4% and hypertension was the most prevalent risk factor (81%). The mean initial Barthel index was 31.04 and the mean final index was 57.62 (t = -11.75; p < 0.001). The Canadian Neurological Scale showed a favourable progression in the level of consciousness, orientation and language (p < 0.001). Altogether 56.2% of the patients were discharged as a result of the improvement of their condition, and did not require any further outpatient rehabilitation. CONCLUSIONS: The results obtained reflect an important functional improvement in patients treated in the MRPUs. Home-based rehabilitation is considered a necessary tool for persons with greater clinical vulnerability and no access to outpatient care, which provides them with the benefits of effective treatment.

TITLE: Rehabilitacion domiciliaria en la recuperacion funcional de los pacientes con enfermedad cerebrovascular.Introduccion. El estudio de la eficacia en los tratamientos de rehabilitacion aplicados a pacientes con secuelas tras una enfermedad cerebrovascular (ECV) resulta decisivo en la actualidad para planificar su abordaje desde la sanidad publica y mejorar las directrices de evaluacion y tratamiento existentes. Objetivo. Describir las caracteristicas que presentan los pacientes que han sufrido ECV atendidos por las unidades moviles de rehabilitacion-fisioterapia (UMRF) y como influyen estos tratamientos sobre su recuperacion funcional. Pacientes y metodos. Estudio descriptivo prospectivo en 124 pacientes derivados a las UMRF de la provincia de Almeria entre 2008 y 2011. Se analizaron variables (pre y postratamiento) como las caracteristicas y antecedentes personales, indice de Barthel, escala de espasticidad de Ashworth modificada, dolor (hombro) y escala neurologica canadiense. Resultados. La muestra final estuvo compuesta por 106 participantes (edad media: 73,72 años). El proceso discapacitante fue isquemico en un 77,4%, y la hipertension, el factor de riesgo mas prevalente (81%). La media del indice de Barthel inicial fue de 31,04, y la media del indice final, de 57,62 (t = ­11,75; p < 0,001). La escala canadiense mostro una evolucion favorable en el nivel de conciencia, orientacion y lenguaje (p < 0,001). El 56,2% de los pacientes recibio alta por mejoria, sin precisar rehabilitacion ambulatoria adicional. Conclusiones. Los resultados obtenidos reflejan una importante mejora funcional en los pacientes tratados en las UMRF. La rehabilitacion domiciliaria se plantea como una herramienta necesaria para las personas con mayor vulnerabilidad clinica y sin acceso a los cuidados ambulatorios, que logra los beneficios de tratamientos que son efectivos.

[Rehabilitation of the patients presenting with combined pathology: dyscirculatory encephalopathy and climacteric syndrome].

The present paper reports the data on rehabilitation of women presenting with combined pathology: dyscirculatory encephalopathy and climacteric syndrome. It is shown that the introduction of ozonotherapy and klimadynon, a herbal medicine possessed of the estrogen-like action, into combined rehabilitative treatment ensures the significant improvement of the parameters of interest, such as climacteric symptoms, short-term memory, lipid profile, endothelial function, cerebral circulation, and quality of life.

[The effect of ozone therapy on the activity of the autonomic nervous system].

We studied 48 patients, mean age 57 years, 14 men, 34 women, with chronic cerebrovascular disease and autonomic dysfunction. Patients had different types of autonomic response (sympathicotonic or normotonic). Autonomic tone at baseline, autonomic reactivity and autonomic supply of activity were determined. Patients were divided into 2 groups. Patients of the main group received ozone therapy along with standard medications. Patients of the control group received standard medications. Disturbances of vascular-autonomic regulation with the domination of ergotropic sympathetic effects were identified in 69.7% of patients with chronic cerebrovascular disease. Ozone therapy caused a shift of the autonomic balance towards the parasympathetic activity as well as the decrease in the activity of the vasomotor center and the central regulation circuit that indicates the increase in the power of defense mechanisms associated with the normalization of autonomic balance.

[Complex treatment of patients with chronic cerebrovascular insufficiency].

Chronic cerebrovascular insufficiency is the most common manifestation of chronic diseases of the nervous system. Its main causes are hypertension and atherosclerosis. Diseases debut mainly on 5-6th decade of life. The condition prohreiyentnyy, but the degree of progression can be varied--from slow to galloping. Therefore, when studying the effectiveness of treatment programs, in our opinion, it is important to include the medical complex of different methods of reflexology.

Rationale of hyperbaric oxygenation in cerebral vascular insult.

Cerebrovascular diseases and especially ischemic stroke are a leading cause of death. They occur mostly due to an insufficient oxygen (O2) supply to the central neural tissue as a result of thromboembolic events and/or obstructive vessel disease. The primary damage of the brain tissue cannot be restored. However, adequate therapy could minimize secondary impairment of brain tissue and restore neuronal function in the so-called "penumbra region". Apart from reopening occluded vessels, additional O2 supply is essential for survival of malfunctioning neural tissue. Breathing of 100% O2 under hyperbaric conditions, hyperbaric oxygenation (HBO), is the only method to increase the O2 concentration in tissue with impaired blood supply. Experimental as well as clinical studies have reported a positive effect of HBO therapy. Survival rate has increased under HBO therapy and neurological outcome has improved. The optimal levels of pressure as well as duration and numbers of HBO sessions need to be specified to avoid undesirable effects. Unfortunately, many questions remain unanswered before routinely recommending HBO as additional therapy in clinical practice. In this review we consider the (patho-)physiological background of HBO-therapy, the latest results of experimental and clinical studies and stress the evidence in patients with cerebrovascular disease.

[Study of molecular damage in bronchial asthma and cerebrovascular disorders during the course of rehabilitation ]. / Izuchenie molekuliarnykh povrezhdenii pri bronkhial'noi astme i tserebrovaskuliarnykh narusheniiakh v protsesse vosstanovitel'nogo lecheniia.

Drug treatment of cerebrovascular disorders alone and in combination with UV irradiation of autoblood gave rise to a positive trend in clinical and functional parameters more noticeable in the combined treatment. Also, there was a fall in red cell levels of malonic dialdehyde. A course of speleotherapy given to children with bronchial asthma contributed to normalization of free radical oxidation and reestablishment of molecular structure in red cell membranes.

[The hemodynamic effects of transcerebral electro- and electromagnetotherapy in stroke patients]. / Gemodinamicheskie éffekty transtserebral'noi élektro- i élektromagnitoterapii bol'nykh insul'tom.

The results of a 10-year prospective trial of physiotherapeutic factors in 350 convalescents after cerebral stroke are reviewed. Nonspecific aspects of mechanisms of therapeutic action of transcerebral physiotherapy (development of collateral circulation and cerebral hemodynamic reserve) and specific ones seen primarily in extracranial parts of major head arteries are shown.

Quality of life of stroke survivors.

Adaptation to stroke requires complex, long-term change in stroke survivors' lives. This study aimed at identifying those factors that influence quality of life (QOL) of geriatric stroke survivors 1-3 years post-discharge. The objectives were: to describe the overall quality of life of stroke survivors; to examine the relationships between sociodemographic variables, neurological variables, functional status, social support, perceived health status, depression, and overall QOL; and to determine the best predictors of QOL. Data were collected on 50 stroke survivors using a cross-sectional design and standardized questionnaires, including the Quality of Life Index, the Functional Independence Measure, the Social Support Inventory for Stroke Survivors and the Centre for Epidemiologic Studies Depression Scale. The overall quality of life of the study participants was low. The most important predictors of QOL were depression, marital status, quality of social support, and functional status. Depression was the strongest predictor of QOL. By employing a multi-dimensional perspective, this study confirmed that adaptation to stroke involves much more than physical function. Thus, rehabilitation programs for this group would be more effective if they are based upon a holistic approach.

Effect of immobilization on vitamin D status and bone mass in chronically hospitalized disabled stroke patients.

OBJECTIVE: To assess the influence of immobilization upon vitamin D status and bone mass in chronically hospitalized, disabled, elderly patients following stroke. DESIGN: cross-sectional study. SETTING: Department of geriatric neurology in a Japanese hospital. SUBJECTS: 129 chronically hospitalized, disabled, elderly stroke patients and 28 age-matched controls. RESULTS: We observed a deficiency of both 1,25-dihydroxyvitamin D (1,25-[OH]2D; 24.3 pg/ml) and 25-hydroxyvitamin D concentrations (25-OHD; 11.7 ng/ml) in stroke patients compared with controls. A high serum ionized calcium (mean; 2.648 mEq/l) was an independent determinant of the Barthel index (66) and 1,25-[OH]2D. When the patients were categorized into three groups by 25-OHD level (deficient, insufficient and sufficient), there was no difference in the mean 1,25-[OH]2D levels. Parathyroid hormone levels were normal or low and did not correlate with 25-OHD. Serum bone turnover variables and bone mineral density (BMD) of the second metacarpal in patients were significantly decreased compared to control subjects. Independent determinants of BMD included Barthel index, 25-OHD and 1,25-[OH]2D. CONCLUSIONS: 1,25-[OH]2D deficiency in immobilized stroke patients is not caused by substrate (25-OHD) deficiency but by hypercalcaemia. Immobilization-induced hypercalcaemia may inhibit parathyroid hormone secretion and thus 1,25-[OH]2D production, resulting in decreased BMD. Immobilization itself also may be responsible for decreased BMD. Exogenous 1,25-[OH]2D (calcitriol) rather than dietary vitamin D supplementation may be required in disabled elderly stroke patients who have a deficiency of 1,25-[OH]2D in order to prevent hip fractures, which frequently occur in this population.

Multichannel alternate electrostimulation using the new Bulgarian Vita 2007 equipment in post-stroke rehabilitation.

In this study the authors evaluated the effect of a new method--multichannel alternate electrostimulation using the new Bulgarian equipment Vita 2007 for regulating muscular imbalance, breaking the pathological synergic patterns and overcoming motor impairment after stroke. The subjects of the study were 15 patients with hemiparesis secondary to stroke. The beneficial results in accelerating motor recovery and assisting the physical exercise programme for recreating proper patterns of walking and manipulative activity were assigned to the change in the level of spasticity and to the new method of consecutive alternate stimulation of the muscles that take part in the normal movement.

Clinical audit of 5 years provision of the Odstock dropped foot stimulator.

The Odstock dropped foot stimulator (ODFS) is a foot switch controlled single channel neuromuscular stimulator for correction of dropped foot. Following a randomized controlled trial, the ODFS was recommended for use in the United Kingdom's National Health Service and a clinical service established. The patient performance was assessed by measurement of walking speed over 10 m, physiological cost index (PCI), and by questionnaire. After 4.5 months stroke patients (n = 111) showed a mean increase in walking speed of 27% and reduction in PCI of 31% with stimulation and changes of 14% and 19%, respectively, unassisted. Multiple sclerosis patients (n = 21) gained similar orthotic benefit but no carry over. The principal reason cited for using the equipment was that it reduced the effort of walking. The principal reasons identified for discontinuing were an improvement in mobility, electrode positioning difficulties, and deteriorating mobility. A comprehensive clinical follow-up service is essential to achieve the maximum continuing benefit from FES based orthosis.

Multicenter evaluation of electrical stimulation systems for walking.

OBJECTIVE: To test the long-term benefits of several noninvasive systems for functional electrical stimulation (FES) during walking. DESIGN: Forty subjects (average years since injury, 5.4) were studied in four centers for an average time of 1 year. Gait parameters were tested for all subjects with and without FES. Thus, subjects served as their own controls, since the specific effect of using FES could be separated from improvements resulting from other factors (e.g., training). SETTING: Subjects used the devices in the community, but were tested in a university or hospital setting. PATIENTS: Subjects with spinal cord injury (n = 31) were compared to subjects with cerebral damage (n = 9). MAIN OUTCOME MEASURES: Gait parameters (speed, cycle time, stride length). Acceptance was studied by means of a questionnaire. RESULTS: Some initial improvement in walking speed (average increase of >20%) occurred, and continuing gains were seen (average total improvement, 45%). The largest relative gains were seen in the slowest walkers (speeds of <0.3 m/sec). Acceptance of the FES systems was good and improved systems have been developed using feedback from the subjects. CONCLUSIONS: Based on the improvements in speed and the acceptance of these FES systems, a greatly increased role for FES in treating gait disorders is suggested.

Prevention of shoulder subluxation after stroke with electrical stimulation.

BACKGROUND AND PURPOSE: Subluxation is a significant problem in poststroke hemiplegia, resulting in pain and loss of function. Current treatments are not proved and not considered effective. It has been demonstrated that cyclical electrical stimulation of the shoulder muscles can reduce existing subluxation. The purpose of this study was to determine whether electrical stimulation could prevent subluxation in both the short and long terms. METHODS: A prospective, randomized controlled study was used to determine the efficacy of electrical stimulation in preventing shoulder subluxation in patients after cerebrovascular accidents. Forty patients were selected and randomly assigned to a control or treatment group. They had their first assessment within 48 hours of their stroke, and those in the treatment group were immediately put on a regimen of electrical stimulation for 4 weeks. All patients were assessed at 4 weeks after stroke and then again at 12 weeks after stroke. Assessments were made of shoulder subluxation, pain, and motor control. RESULTS: The treatment group had significantly less subluxation and pain after the treatment period, but at the end of the follow-up period there were no significant differences between the 2 groups. CONCLUSIONS: Electrical stimulation can prevent shoulder subluxation, but this effect was not maintained after the withdrawal of treatment.

Optimal control of walking with functional electrical stimulation: a computer simulation study.

Bipedal locomotion was simulated to generate a pattern of activating muscles for walking using electrical stimulation in persons with spinal cord injury (SCI) or stroke. The simulation presented in this study starts from a model of the body determined with user-specific parameters, individualized with respect to the lengths, masses, inertia, muscle and joint properties. The trajectory used for simulation was recorded from an able-bodied subject while walking with ankle-foot orthoses. A discrete mathematical model and dynamic programming were used to determine the optimal control. A cost function was selected as the sum of the squares of the tracking errors from the desired trajectories, and the weighted sum of the squares of agonist and antagonist activations of the muscle groups acting around the hip and knee joints. The aim of the simulation was to study plausible trajectories keeping in mind the limitations imposed by the spinal cord injury or stroke (e.g., spasticity, decreased range of movements in some joints, limited strength of paralyzed, externally activated muscles). If the muscles were capable of generating the movements required and the trajectory was achieved, then the simulation provided two kinds of information: 1) timing of the onset and offset of muscle activations with respect to the various gait events and 2) patterns of activation with respect to the maximum activation. These results are important for synthesizing a rule-based controller.