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.

We performed a 15 day protocol of low-frequency repetitive transcranial magnetic stimulation (rTMS) combined with intensive occupational therapy in hemiplegic upper limbs in poststroke and investigated the effect of cerebral blood flow using single photon emission computed tomography (SPECT). Seventeen chronic stroke patients were studied with SPECT at rest before and 4 weeks after undergoing the 15 day protocol. Before and after the treatment, Fugl-Meyer Assessment (FMA) score and Wolf Motor Function Test (WMFT) -Log performance time showed a significant improvement. The specific areas with a significant increase in perfusion in the affected hemisphere were the insula (BA 13), the precentral gyrus (BA 44) and the cerebellum. In the nonaffected hemisphere, perfusion was significantly increased in the lingual gyrus and cerebellum. On the other hand, perfusion was significantly decreased in the middle frontal gyrus (BA 6), precentral gyrus (BA 4) and postcentral gyrus (BA 3) in the nonaffected hemisphere. It was suggested that low-frequency rTMS combined with intensive occupational therapy effects the cerebral blood flow and contributes to improving upper limb hemiplegia after stroke.

Objective：This study investigated the relationship between posture and voluntary cough strength in healthy people.Methods：The participants were 50 normal adults. We measured cough peak flow (CPF), chest circumferences at maximal inspiratory level and maximal expiratory level, blood pressure, and pulse rate in the supine position, prone position, and prone position with a pillow under the abdomen. The difference between chest circumferences at maximal inspiratory and maximal expiratory levels was calculated and defined as the thoracic expansion difference.Results：CPF and chest circumferences at maximal inspiratory level and maximal expiratory level were significantly higher in the prone position with a pillow under the abdomen than in the supine position. There were no differences in thoracic expansion difference and blood pressure among all the positions. Pulse rate was significantly lower in the supine position compared with the other positions.Conclusion：We concluded that voluntary cough strength would increase in the prone position with a pillow under the abdomen.

Objective：This study investigated the relationship between posture and voluntary cough strength in healthy people.Methods：The participants were 50 normal adults. We measured cough peak flow (CPF), chest circumferences at maximal inspiratory level and maximal expiratory level, blood pressure, and pulse rate in the supine position, prone position, and prone position with a pillow under the abdomen. The difference between chest circumferences at maximal inspiratory and maximal expiratory levels was calculated and defined as the thoracic expansion difference.Results：CPF and chest circumferences at maximal inspiratory level and maximal expiratory level were significantly higher in the prone position with a pillow under the abdomen than in the supine position. There were no differences in thoracic expansion difference and blood pressure among all the positions. Pulse rate was significantly lower in the supine position compared with the other positions.Conclusion：We concluded that voluntary cough strength would increase in the prone position with a pillow under the abdomen.