Various approaches to stroke rehabilitation, such as facilitation techniques including proprioceptive neuromuscural facilitation techniques (PNF), Brunnstrom's approach, and Bobath's approach, have been studied to improve the functional recovery of hemiplegia due to brain damage. However, there is some controversy surrounding these facilitation techniques with regard to their efficacy in stroke rehabilitation. Specifically, there is insufficient evidence that these techniques are superior to conventional exercise therapies.
Recent studies have shown that brain plasticity results in functional recovery in humans. Recovery depends on the plasticity of the synapse, and changes in the strength of a synapse are controlled by a basic mechanism:An increase in synaptic efficacy arises from the repeated stimulation of the postsynaptic cell by the presynaptic cell. The basic theory of repetitive facilitation exercises (RFE) using novel facilitation methods for the hemiplegic limb mainly aim to strengthen the neuronal circuits through the injured descending motor tracts by repetition of the movements that are to be recovered. The patient's intentions to move the hemiplegic limb are realized by using multiple sensory stimulations to target the neural circuits related to each movement. The effects of RFE on the functional recovery of hemiplegic limbs have been confirmed by scientific studies.
Combined therapy using vibratory or electrical stimulation might promote efficacy of RFEs for patients with hemiplegia.

Dry skin causes many skin disorders such as dry dermatitis. It requires a lot of time and medication to treat patients with skin disorder that cover a vast skin area. Although glycerin is a component of many skin care creams and cosmetics, there is no report regarding the effects of glycerin alone as a bathwater additive. We investigated the effects of bathing in warm water with added glycerin on skin conditions and the prevention of skin disorders in patients with severe motor and intellectual disabilities.
Two studies were conducted to analyze the effects of a glycerin+warm water bath (GWWB). In study 1, the skin conditions in a total of 18 subjects were compared between the glycerin group (G) and nonglycerin group (NG). In the G group, skin moisture, skin pH, and skin sebum were measured with a skin analyzer noninvasively at the forehead and precordial and lateral forearm after GWWB for approximately 6 months. Subjects in the 2 groups had bathed 2 times per week and were immersed in warm water at 40 to 41°C for 2 to 3min. In the G group, 250ml glycerin was added in a 14001 bathtub. In study 2, a total of 78 subjects were examined retrospectively; their medical records after GWWB for approximately 6 months were investigated to gain information regarding cutaneous diseases (number of diagnosis, drugs, areas affected with cutaneous diseases, and days of treatment) in order to compare the G and NG groups.
Skin moisture levels at forearm improved significantly (p<0.05) in the G group. The average skin moisture level in other areas was higher in the G group than in the NG group but without sig nificance. Skin sebum levels at the forehead improved significantly (p<0.05) in the G group. The number of diagnosis, drugs, and areas with cutaneous disease were significantly lower in the G group than in the NG group. Further, the average number of treatment days was lower in case of the G group than in case of the NG group but without significance.
The moisturizing effects are produced due to a thin film formed by glycerin after GWWB, especially in an area where there is friction between the skin and clothes. Skin sebum is also maintained due to glycerin-film formation.
It is possible that maintenance of skin moisture protects the skin from cutaneous diseases due to xerosis. In conclusion, these results indicate that GWWB maintains skin moisture and sebum and prevents skin disorders.

Bub-KAO tablet (50g) consisting of equimolar bicarbonate salt and succinate made it possible to use easily CO₂ bath at home. Since the obtained CO₂ concentration was not so high, we studied the circulatory effects of usual concentration of Bub-KAO bath in normal and hypertensive men.
Seven Bub-KAO tablets (KAO Co., Tokyo, Japan) were put into 350 l of 41°C simple hot spring bath (CO₂ conc. ≈300ppm). Eight normotensive subjects (32.2±4.2yrs) and 13 hypertensive patients (67.8±11.3yrs) took this artificial CO₂ bath for 10min. As a control, 12 normotensives (38.1±8.8yrs) and 12 hypertensives (51.0±8.2yrs) were immersed in 41°C simple hot spring bath for 10min. Hemodynamic functions and blood gas were followed before and after bathing for 30min in the supine position.
In normotensives, blood pressure (BP) was unchanged either by Bub-KAO or simple bath. The increase in heart rate (HR) and cardiac output (CO) and the decrease in total peripheral resistance (TPRi) after Bub-KAO bath were slightly but significantly greater than those of simple bath. In hypertensives, BP was significantly decrased after Bub-KAO bath (-17.2±6.4/-6.8±2.1mmHg) compared to simple bath. Although the increase in HR and CO (+0.55±0.22l/min) after Bub-KAO bath were not so remarkable, decrease in TPRi (-9.3±3.6 unit) was significantly greater than simple bath. Venous blood obtained 10min after Bub-KAO bath became fresh red showing a significant increase in pO₂ and pH (alkalosis) and significant decrease in pCO₂. In arterial blood, although pO₂ was unchanged, slight decrease in pCO₂ and increase in pH were also observed.
These results indicated that artificial CO₂ bath made by usual amounts of Bub-KAO tablets significantly reduced BP of the hypertensives due to vasodilating effect. Vasodilation by CO₂ bath was considered to be derived from the peripheral action of CO₂ as blood pCO₂ was rather reduced. As a basic mechanism of vasodilation by CO₂, we proposed the inhibitory effect on tissue enerqy metabolism of CO₂ as a product inhibtor of TCA cycle and subsequently, the onset of vascular autoregulation mechanism.

Effects of cold and warm water bathing of hemiplegic lower limb on its isokinetic muscle strength were studied in 12 chronic stroke patients (9 males and 3 females, 53.3±14.2 yo, Ueda's grading 8.5±1.6 Grade).
Measurements of the isokinetic muscle strength of the knee flexion/extension were repeated three times; 1) after sitting for 10min at room temperature (21-22°C) as a control, 2) after cold water bathing (18°C) of hemiplegic lower limb for 5min, 3) after warm water bathing (41°C, 700ppm artificial CO₂ bath) of hemiplegic lower limb for 10min. The measurements were performed, using Cybex 6000 (Cybex international Co) at velocities of 60, 120, 180 and 240°/sec. Artificial CO₂ bath was prepared by dissolving Kao Babu (Kao Co) in 41°C warm water.
Peak torque of the knee flexions at any velocity decreased significantly after cold water bathing and imcreased after warm water bathing. Change in the maximum power and total work were similar to that of the peak torque. The muscle strength of the knee extension were not changed by neither cold nor warm water bathing.
The correlation coefficient between Ueda's Grade and its isokinetic muscle strength ranged from 0.3 to 0.6 and significantly improved after warm water bathing at velocity of 120 (°/second) in flexion. Warm water bathing might make it easy to exert their muscle strength at 120°/sec in flexion corresponding to their severity of their hemiplegia.
Regarding to the influence of spasticity, patients with no ankle clonus or pseudoclonus showed a tendency to increase in muscle strength of flexion and extension after warm water bathing. In patients with evident clonus, a tendency to decrease on extension and increase on flexion was seen after warm water bathing.
Further studies on the effects of warm water bathing of partial and full immersion in the treatment for spasticity of hemiplegic limb would contribute to stroke rehabilitation.