Purpose
 Forearm bathing is considered beneficial for the hands of patients with spastic hemiplegia, but the effect has not been investigated comprehensively. This study investigated the effectiveness of forearm bathing for patients with hemiplegic hands.
Subjects and Methods
 In total, nine hemiplegic patients participated in the study (mean±standard deviation age=56.9±16.6 years; mean±standard deviation period from onset=21.1±21.2 months). Participants sat in a relaxed position on a chair, and dipped the affected forearms into 40°C warm water for 15 mins. The Simple Test for Evaluating Hand Function (STEF) score was evaluated before and after forearm bathing as an indicator of hemiplegic hand function. The Modified Ashworth Scale (MAS) score for the biceps brachii muscle, and both the resistance power of elbow extension and the F/M ratio (F-wave amplitudes/ M wave amplitudes) for the abductor pollicis brevis muscle, were evaluated as indicators of hemiplegic hand spasticity. The device used to measure the resistance power of elbow extension comprised a motor, cuffs to fix the hemiplegic arm and forearm in place, and a control system. The axis of rotation of the device was positioned over the axis of rotation of the elbow joint. The device induced passive elbow flexion and extension movements at an angular velocity of 60°/sec or 90°/sec.
Results
 After forearm bathing, the STEF score increased significantly (p<0.05) from 42.9±28.0 to 47.8±28.4 (n=9), the resistance power of elbow extension at 90°/min decreased significantly (p<0.01) from 4.0±1.8 N to 3.0±1.9 N, and the MAS score and F/M ratio were unchanged (n=6).
Conclusions
 Forearm bathing appeared to improve function and decrease spasticity in hemiplegic hands. This treatment might facilitate hand rehabilitation.

Objective: Exercise baths are generally considered to be one of the most appropriate and advantageous rehabilitative therapies, yet their effects have not been comprehensively investigated. The aim of this study is to assess the efficacy of exercise baths on quality of life (QOL).
Methods: The 49 subjects consisted of 20 patients with brain disease, 21 patients with orthopaedic disease, and 8 patients with other diseases (i.e., 7 life-style related diseases and one heat burn). In the present study, all patients were first treated by conventional rehabilitation comprising physical therapy and occupational therapy for 4.2±1.4 weeks. Exercise baths were then added to the rehabilitation program for a further 4.4±1.2 weeks. The subjects were immersed in water at 38°C for 30-60min, twice a week. QOL was evaluated by alterations in the MOS Short-Form 36-item Health Survey (SF-36). We defined the period from admission to exercise bath start as Treatment I, and the period from exercise bath start to discharge (exercise bath finish) as Treatment II. On admission, before and after exercise bath, QOL was evaluated using the SF-36 scores.
Results: We found that the increase of all eight subscales of the SF-36 was smaller in Treatment I period than in Treatment II period. Increases in SF-36 scores were observed in all patients, in all eight domains. Specifically, after exercise baths, increased scores of Physical functioning (PF), Role physical (RP), General health (GH), Vitality (VT), Role emotional (RE) and Mental health (MH) subscales of the SF-36 were observed in the patients with brain disease. Further, after exercise baths, increased scores of PF, RP, Bodily pain (BP), GH, VT, RE and MH subscales of the SF-36 were observed in the patients with orthopedic disease.
Conclusions: It was concluded that exercise baths are an effective non-pharmacological treatment that might facilitate rehabilitation programs.

A self-reporting questionnaire was designed and sent to our Jichi Medical School graduates each year since 1980, in order to investigate clinical competence. The format was designed based on several major reports concerning postgraduate clinical training in primary medical care. We found that more than 70% of Jichi Medical School graduates trained in the multi-specialty rotation style in general hospitals that were certified by the Ministry of Health and Welfare. Our results also suggested that these graduates obtained a relatively high level of clinical competence in performing physical examinations, basic laboratory testing, clinical procedures, and various treatments.

A self-reporting questionnaire was designed and sent to our Jichi Medical School graduates each year since 1980, in order to investigate clinical competences attained in certain technical items. The responses from graduates of classes 1984 through 1987 were analysed, and the questionnaire was found to be highly reliable and moderately valid. The coefficient variable was 0.942, and the relevant variable was 0.934 using the half-split method. The content was clear, because items in the questionnaire were selected from published official reports. In the construction validity, 4 meaningful groups of items were found by factor-analysis. Yearly analysis using such a questionnaire may clarify some of the problems experienced by trainees and training hospitals, and would encourage the trainees to undergo a process of selfevaluation.

Objectives: Recently, it has been reported that the effects of artificial high concentration carbon-dioxide (CO2) on core temperature, cutaneous blood flow, thermal sensation. However, the effect of artificial high concentration CO2 water foot baths for spasticity, lower extremity motor function and walking ability was not identified. The purpose of this study was to investigate whether the newly artificial high concentration CO2 water foot bath inhibits spasticity and improves lower extremity motor function and gait speed in spastic paraplegia patient. Case Presentation: The patient was a 37 years old man with spastic paraplegia of human immunodeficiency virus encephalopathy, without signs of cognitive impairment. The patient was able to walk without assistance using a T-cane or an ankle-foot orthosis. He had no medical condition that limited footbath usage (such as uncontrolled cardiopulmonary disease, severe joint disability and severe sensory disturbance), severe aphasia that made it impossible to follow verbal instructions, and cognitive dysfunction that interfered with outcome assessments. Informed consent was obtained from him according to the ethical guidelines of the hospital, after he fully understood the purpose and methodology of the study. This work was carried out with permission from the Ethical Committee of Kagoshima University. Methods: This case study was before and after intervention trial. Six outcome instruments were used at baseline and after the artificial high concentration CO2 water foot bath: the modified Ashworth scale (MAS) score for the gastrocnemius muscles as a measure of spasticity, ankle clonus, muscle stiffness at triceps muscle of calf, deep body and surface skin temperature as a monitor for physical condition, the active range of motion as an assessment tool for motor function, and the 10-m walk test as a measure of walking ability. Lower-extremity movement acceleration was also measured using an accelerometer. The subject rested in a chair for 10 min and the above-noted physiological reactions during the last 5 min of the resting period were recorded as baseline values. Next, the subject received a 20-min foot bath in water at 38 °C, with a 10-min recovery period. The artificial high concentration CO2 water foot bath improved the acceleration of the spastic lower extremities and this improvement in acceleration lasted for 10 min after the footbath usage. Results: The subject experienced no discomfort before, during or after the intervention, and all assessments were completed safely. The deep body temperature and skin temperature increased immediately after and 10 minutes after the artificial high concentration CO2 water foot baths. The MAS score, ankle clonus and the muscle stiffness for the triceps muscle of calf were decreased. The active range of motion for ankle dorsiflexion and gait speed improved after the 20-min intervention. Conclusion: These findings suggest that artificial high concentration CO2 water foot bath is an effective method for controlling spasticity, and improves motor function and walking ability in spastic paraplegia patients.

Objectives: To preliminarily assess the effects of a single warm-water bath (WWB) on the quality of sleep, we measured sleep pattern after WWB in healthy volunteers. The primary objective of the present before-after study was to evaluate whether a single 10-minute WWB at 41°C could modulate sleep pattern in a single group of healthy subjects. In this pilot study, we also assessed the difference in general fatigue and subjects’ satisfaction responses to WWB under two conditions: WWB using tap water (WWB with tap water) and WWB using a bath additive that included inorganic salts and artificial carbon-dioxide (CO2) (WWB with ISCO2). Methods: Eleven healthy volunteers aged 20 to 48 years (29.8±8.9 years, mean ± SD) participated in this study. Inclusion criteria were as follows: age 20-50 years; free of cardiovascular disease; not taking medications or supplements. In this within-subject, two-way crossover study, all subjects underwent WWB with tap water or WWB with ISCO2 in random order for two consecutive nights. Objective sleep measures from sleep sensor mat (sleep-scan) and subjective subjects’ reports were collected. This study was approved by the Ethics Committee of Kagoshima University Hospital and written informed consent was obtained from all of the subjects. Results: None of the subjects experienced discomfort before, during or after the study period. The objective sleep measures and subjects’ reports were completed safely in all subjects. WWB with ISCO2 bathing produced significant improvement in objective and subjective sleep latency compared with WWB with tap water bathing (P<0.05). Sleep-scan-determined wake time after sleep onset (WASO), sleep efficiency, and number of awakenings (NA), and patient-reported measures of WASO, NA, sleep quality, sleep depth, and daytime functioning significantly improved following WWB with ISCO2 bathing versus WWB with tap water bathing (P<0.05). WWB with ISCO2 bathing also increased deep sleep time and sleep score (P<0.01 for both comparisons), but did not alter REM or slow-wave sleep. Conclusion: In conclusion, in our group of healthy volunteers, a single warm-water bath was shown to have the potential to modulate the quality of sleep. These findings demonstrate that WWB with ISCO2 bathing might be effective in improving some domains of sleep quality of healthy volunteers, and the subjects showed acceptance towards the intervention. Strengths and limitations of the present study as well as suggestions for further studies were considered. Further evaluations with larger and longer-term randomized double-blind placebo-controlled trials based on the present study are needed.

The aims of this study are 1. to evaluate the usability of workshop to introduce and manage distress screening effectively and efficiently and to use it for cancer patients and their family and 2. to consider the appropriate subject of workshop. All of the participants answered the questionnaire on the site (n=51). Their knowledge about screening practice, various screening tools and how to use screening tools and data from screening tool were significantly improved after the workshop. The workshop was highly regarded by participants. Thirty-eight of fifty-one patients responded to web questionnaire three months later (Response rate: 75%). More than thirty percent of participants put into practice what they learned in the workshop. The workshop decreased factors to interfere screening practice three months later. Knowledge about how to use screening tools was negatively correlated to number of cancer patients at hospital where participants worked and number of their hospital beds. And factor to interfere screening practice was negatively correlated to how long participants were involved in palliative care team. This study indicated the usability of workshop to spread screening triage program regarding cancer patients’ distress. The workshop may be appropriate for medical staffs who have relatively much experience of palliative care team and who have difficulty in screening practice at designated cancer hospitals where number of cancer patients is relatively large.

 The effects of bathing in a solution of artificial bath additive including inorganic salts and carbon dioxide (CO2-bathing: 41°C, 10 minutes; the concentration of carbon dioxide was 160-180 ppm, and that of inorganic salts was about 64 ppm) on the cardiovascular system, body flexibility, muscle stiffness and the subjective feeling of bathing were compared with those of no bathing and plain water bathing in the healthy subjects.  The deep body temperature and skin blood flow increased after bathing, and the increases after CO2-bathing were significantly greater than those after plain water bathing. Body flexibility after CO2-bathing was similar to that of no bathing and plain water bathing.  Stiffness of the trapezius muscle was decreased at both 15 min and 30 min after CO2-bathing and plain water bathing, with no change in no bathing. The changes at 15 min after CO2-bathing and plain water bathing were statistically significant. Stiffness in the latissimus dorsi muscle decreased at both 15 min and 30 min after CO2-bathing and plain water bathing, with no change in no bathing. However, only these changes at 15 min and 30 min after CO2-bathing were statistically significant.  A large decrease in the stiffness of the trapezius muscle by its isometric contraction was observed during both CO2-bathing and plain water bathing, and the decrease after CO2-bathing was greater than that after plain water bathing. These changes did not reach statistical significance.  Improvements in subjective feeling of bathing were observed after both plain water bathing and CO2-bathing. Improvements after CO2-bathing in stiffness of muscle, ease of movements and mental relaxation were statistically greater than those after plain water bathing.  Compared with plain water bathing, CO2-bathing showed additional effects on muscle stiffness and subjective feeling of bathing. Further research is needed to confirm the effectiveness of the CO2-bathing alone and combined with isometric movements on muscle stiffness.

Objectives: The purpose of this study was to investigate whether the whole body vibration (WBV) inhibits spasticity and improves motor function and walking ability in the hemiplegic legs of post-stroke patients. Patients and Methods: This before-and-after intervention trial examined 13 post-stroke patients (11 male and 2 female; mean age, 54.3 ± 13.0 years; range, 24-72 years). The Brunnstrom Recovery Stage of the hemiplegic lower limb was stage 3 in three patients, stage 4 in 7, stage 5 in three. The modified Ashworth scale (MAS) score for the gastrocnemius muscles was 1 in one case, 1+ in 6 cases and 2 in six cases. All patients had increased muscle tonus of the affected lower limb (MAS score ≥1), and were able to walk without assistance using a T-cane or an ankle-foot orthosis. Exclusion criteria were any medical condition preventing vibratory stimulation (such as uncontrolled cardiopulmonary disease, severe joint disability and severe sensory disturbance), severe aphasia that made it impossible to follow verbal instructions, and dementia that interfered with outcome assessments. Each subjects sat on the chair with hip joint angles to approximately 90° of flexion, and with knee joint angles to 0° of extension. WBV was applied at 30 Hz (4-8 mm amplitude) for 5 min on hamstrings, gastrocnemius and soleus muscles (Figure 1). The parameters measured before and after the intervention were the MAS, the F-wave parameters as a measure of motor-neuron excitability, the active and passive range of motion (A-ROM, P-ROM) as a measure of motor function, and the 10-m walk test as a measure of walking ability. Results: None of the subjects experienced discomfort before, during or after the intervention and all assessments were completed safely in all subjects. The MAS and F-wave parameters were significantly decreased (p < 0.05), the A-ROM and P-ROM for ankle dorsiflexion increased (p < 0.01), and the P-ROM for straight leg raising increased (p < 0.01), and walking speed improved (p < 0.01) after the 5-min intervention. Conclusion: These findings suggest that WBV is an effective method for controlling spasticity, and improves motor function and walking ability in post-stroke patients.