When subacute elderly patients are transferred from an acute hospital to a rehabilitation facility, the likelihood is that the environmental change will decrease the patients' ability to perform the basic activities of daily living (ADLs). In this study, we assessed the effects of the ambient changes on ADLs by the use of the Barthel Index, the reliability as well as validity of which is rated high for assessing the patient's fundamental ability. Our subjects consisted of the patients with hemiplegia who had undergone medical treatment of stroke and those who had been operated on for femoral neck fracture (FNF) in Toride Kyodo General Hospital. They were transferred to the convalescent rehabilitation ward (CRW) of Aida Memorial Rehabilitation Hospital, affiliated with our hospital. We compared the BI scores given to the patients by physical, occupational and speech therapists, when discharged from our hospital, and those scores given by nurses within one week after the patients moved to the CRW. Differences between BI scores given at Toride Hospital and those at the rehabilitation hospital averaged -5.9±16.0 points for stroke patients and -7.3±14.1 points for FNF patients. Spearman's rank correlation coefficient of BI scores in the acute hospital and in the CRW for stroke patients was 0.91 (p<0.001) and 0.69 (p<0.001) for FNF. There was no significant difference in changes in BI scores between stroke and FNF. However, there was a tendency for the patients' functional ability in daily living to be assessed lower in the FNF patients than in the stroke patients. This was probably because the former were older than the latter on the average. The average age of the FNF patients was 81.4 years and that of the stroke patients was 68.5 years.

  For a female patient with lower back pain and stress urinary incontinence, a trunk stability exercise program was initiated. When the conventional exercise to contract pelvic floor muscles was done, the patient held her breath and tried hard to adduct and extend the hip joint. She could draw in the navel by activating transversus abdominis muscle in a relaxing position during sling exercise therapy. At the initial stage of the trunk stability exercise, the intra-abdominal pressure was adjusted by the contraction of transversus abdominis muscle and pelvic floor muscles, and by the movement of the diaphragma as had been expected. Also in the initial stage ofsling exercise therapy, the unloaded body weight attached with elastic cords supported the pelvis so that she can lift her body with the shape of the lumber region maintained correctly.According to the progressive ladder principle in the sling exercise, elastic cords support gradually reduced, hip joint movement was added, and the sling on the leg changed distally. Thus, the patient suffering from stress urinary incontinence could be managed successfully by the trunk stability treatment with sling exercise therapy.

  The patient was a female in her 60's with Parkinson's disease. She had lateral trunk flexion, which was suspected to be caused by drug-induced dystonia with Pramipexole. Even one month after withdrawal of the drug, the condition didn't improve. Therefore, physical therapy was initiated. Chief complaints were pain of the left trapezius and erector spine, and inability to walk for a long time. Dystonia of oblique muscles caused lateral trunk flexion. Lateral trunk flexion caused the secondary pain of left trapezius and erector spine for compensation. Physical therapy using a sling was carried out to practice relaxation of the right oblique muscles and contraction of the right erector spine without conpensation of the left side. Standing position and gait training were done shoe height on the right side. After 7 months, pain of the left trapezius and erector spine dissapeared during rest and housework. Gait duration increased to over 1 hour. QOL (SF-36) was improved on all of 8 scores.

Aspergillus pseudoaneurysm of the ascending aorta is rare in patients who have undergone coronary artery bypass graft surgery (CABG), and there are few cases reports of patients with AIDS, or after transplantation. A 76-year-old man underwent CABG due to unstable angina in 2002 ; in 2005 and 2006, he suffered 3 episodes of pseudoaneurysm formation in the ascending aorta. The aneurysm was resected and the defect was repaired with a Dacron patch twice. Finally, aortic root replacement with the modified Bentall technique was performed, but pathological examination of the wall of the pseudoaneurysm showed Aspergillus. On day 13, the Aspergillus infection developed into septicemia, and he died.

Aspergillus pseudoaneurysm of the ascending aorta is rare in patients who have undergone coronary artery bypass graft surgery (CABG), and there are few cases reports of patients with AIDS, or after transplantation. A 76-year-old man underwent CABG due to unstable angina in 2002 ; in 2005 and 2006, he suffered 3 episodes of pseudoaneurysm formation in the ascending aorta. The aneurysm was resected and the defect was repaired with a Dacron patch twice. Finally, aortic root replacement with the modified Bentall technique was performed, but pathological examination of the wall of the pseudoaneurysm showed Aspergillus. On day 13, the Aspergillus infection developed into septicemia, and he died.

  When subacute elderly patients are transferred from an acute hospital to a rehabilitation facility, the likelihood is that the environmental change will decrease the patients' ability to perform the basic activities of daily living (ADLs). In this study, we assessed the effects of the ambient changes on ADLs by the use of the Barthel Index, the reliability as well as validity of which is rated high for assessing the patient's fundamental ability. Our subjects consisted of the patients with hemiplegia who had undergone medical treatment of stroke and those who had been operated on for femoral neck fracture (FNF) in Toride Kyodo General Hospital. They were transferred to the convalescent rehabilitation ward (CRW) of Aida Memorial Rehabilitation Hospital, affiliated with our hospital. We compared the BI scores given to the patients by physical, occupational and speech therapists, when discharged from our hospital, and those scores given by nurses within one week after the patients moved to the CRW. Differences between BI scores given at Toride Hospital and those at the rehabilitation hospital averaged -5.9±16.0 points for stroke patients and -7.3±14.1 pointsfor FNF patients. Spearman's rank correlation coefficient of BI scores in the acute hospital and in the CRW for stroke patients was 0.91 (p<0.001) and 0.69 (p<0.001) for FNF. There was no significant difference in changes in BI scores between stroke and FNF. However, there was a tendency for the patients' functional ability in daily living to be assessed lower in the FNF patients than in the stroke patients. This was probably because the former were older than the latter on the average. The average age of the FNF patients was 81.4 years and that of the stroke patients was 68.5 years.

Purpose: To create flow charts of eating and swallowing that make it easy to identify the cases requiring professional treatment including dysphagia rehabilitation during oral intake.Subjects: 28 patients (mean age: 78.7±11.3 years) with dysphagia who underwent videofluorography (hereinafter “VF”).Methods: We conducted various tests such as Repetitive Salvia Swallowing Test (RSST), Modified Water Swallowing Test (MWST) and Food Test (FT), and studied relationships between VF findings and Fujishima's grade of eating and swallowing capability.Results: After the examination of th results of RSST (sensitivity: 0.83, specificity: 0.22), MWST (sensitivity: 0.56, specificity: 0.72), FT (sensitivity: 0.33, specificity: 0.75), VF and grade of eating and swallowing capability of Fujishima, the use of MWST and FT was appropriate. However, four cases in which the results of MWST and FT were over the cut-off value had misswallowed water and food. We created the flowcharts considering that all of those 4 cases are also the cases that suffered from the consequences of cerebral strokes.