This report presents the case of a patient treated with epiglottoplasty (Biller's laryngoplasty technique) for the pseudobulbar type of dysphagia associated with herpes simplex encephalitis (HSE). A 67-year-old man developed acute HSE with disturbance of consciousness and intractable aspiration. Oral intake was tried, but resulted in aspiration pneumonia and was therefore canceled at the patient's former institution. At 12 months following onset, the patient consulted our hospital and we judged that aspiration could not be controlled, and that surgical management would be needed. In order to both prevent aspiration and preserve phonation, epiglottoplasty was performed at 15 months following onset. Postoperatively, the patient was able to resume an unrestricted diet except for clear liquids. He also underwent voice rehabilitation with the support of his family and rehabilitation staff. These efforts finally enabled him to speak clearly. Epiglottoplasty is an effective treatment for intractable aspiration, but this procedure is not widely known to Japanese physiatrists. Careful patient screening and selection by the attending physiatrist is essential, as is providing adequate postoperative swallowing and voice rehabilitation.

We have tried to design a method to measure health degrees as one of ideas to grasp the activity of general population.
We should like to suggest to measure relative local endurance and to observe its index or their mutual index ratio measurement of their endurance in each item.
Exercise method was already reported in the report (1) .
Loading time by standing arm test (SAT) is 1 minute, knee test (KT) is 30 seconds, sit up test (ST) is 30 seconds for general population.
Extimate formulas on index are given as follows,
SAT=120-2Y/ (P₁+P₂) ×4×1.36×100=2206-37Y/P₁+P₂
KT=120-2X/ (P₁+P₂) ×4×1.22×100=2459-41X/P₁+P₂
_??_ST₃₀=120-3Z/ (P₁+P₂) ×4×1.20×100=2500-63Z/P₁+P₂
_??_ST₃₀=120-3Z/ (P₁+P₂) ×4×1.38×100=2174-63Z/P₁+P₂
X, Y and Z show frequency of impossible in each exercise.
The above index itself can be compared with index in another person, but for the individual SAT/KT and ST/KT show that balance of moving and in case need SAT+ KT and SAT+KT+ST can be compared as the whole body endurance.
After this, we are expected to investigate whether the health degree in each individual can be observated or not, by these methods.

The present aging rate in Japan of some 28% will continue to increase along with the advancing age of elderly persons. Therefore, the demand for care will also increase. Approximately 25% of the need for nursing-care defined by the Japanese long-term care insurance system is associated with disorders or deterioration of locomotive organs. Therefore, the prevention and treatment of diseases in the locomotor system and maintenance of motor function are important for extended healthy life span and to decrease the demand for long-term care. Based on this background, the Japanese Orthopaedic Association (JOA) proposed the concept of locomotive syndrome (LS) in 2007, which is defined as reduced mobility due to impaired locomotive organs. Changes in locomotion must be noticed early to ensure the timely implementation of appropriate checks and measures of locomotion can uncover risk of acquiring LS. The acquisition of an exercise habit, appropriate nutrition, being active and evaluating and treating locomotion-related diseases are important to delay or avoid LS. The JOA recommends locomotion training consisting of four exercises to prevent and improve LS. Countermeasures against LS should become a meaningful precedent not only for Japan, but for other countries with rapidly aging populations.
Aged ; Aging ; Asian Continental Ancestry Group ; Exercise ; Humans ; Insurance, Long-Term Care ; Japan ; Locomotion ; Long-Term Care

OBJECTIVES: To clarify the prevalence and characteristics of pain associated with sarcopenia and to verify the usefulness of evaluation of pain for sarcopenia. METHODS: In total, 759 community-dwelling people (aged 65–79 years) with or without sarcopenia and lower limb pain were classified into 4 groups (NSp, nonsarcopenia; NSpP, nonsarcopenia with pain; Sp, sarcopenia; and SpP, sarcopenia with pain). Body composition, motor function, history of fractures since age 50 years, and number of falls in the past 1 year were compared between the groups. RESULTS: Participant proportions by group were: NSp, 53.9%; NSpP, 42.8%; Sp, 1.3%; and SpP, 2.0%. Participants with lower limb pain showed low single leg standing, walking speed, and 2-step value scores and high 25-question Geriatric Locomotive Functional Scale (GLFS-25) score after adjusting for age, sex, body mass index, and presence of sarcopenia. The SpP group showed lower functional reach test and higher GLFS-25 scores than the Sp group. Regarding the history of fractures since 50 years of age and falls in past 1 year, a high retention rate of fracture was noted in the NSpP group. They also experienced significantly more falls in the past 1 year than those in the NSp group. The SpP group noted more falls and fractures although it was insignificant. CONCLUSIONS: The results indicate that participants with lower limb pain showed declining motor function and a high risk for falls and fractures. Sarcopenia could escalate this risk. Therefore, evaluating patients for both pain and sarcopenia may be useful for risk assessment and treatment.
Accidental Falls ; Aged ; Body Composition ; Body Mass Index ; Humans ; Leg ; Lower Extremity ; Prevalence ; Risk Assessment ; Sarcopenia ; Walking