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.

    A 76-year-old woman with dementia with Lewy bodies (DLB) was transferred to our Recovery Rehabilitation Unit because of systemic muscle weakness due to disuse. She had been bed-ridden for about 6 months because of treatment for deep venous thrombosis and urinary tract infection. Weakness and features of parkinsonism were severe and she could barely turn over in bed. On admission, she needed considerable assistance to sit up and have meals. Her Unified Parkinson's Disease Rating Scale (UPDRS) score was 129 and Functional In de pendence Measure (FIM) score was 27 at the first evaluation. The doctor organized the dose of the drugs for DLB, and physical rehabilitation therapists performed repeated arm stretching exercises using Red Cord, raising the body, and standing exercises. Recreational activities such as ball-throwing games and singing songs gradually made her feel positive. She returned home on day 84 after admission. On discharge, she could stand and transfer to a wheelchair by slight assistance. The final evaluation showed that her UPDRS and FIM scores were 105 and 43, respectively. The outcome in this case suggests that adequate interventions in recovery rehabilitation units can improve ADL in patients with advanced neurodegenerative disease.

There is no evidence for effects of gait training in spinocerebellar degeneration (SCD) of SCD severity level IV. Here we report the effect of gait training in a 42-year-old man diagnosed with SCD severity level IV. At the beginning of physical therapy (day X), his Scale for Assessment and Rating of Ataxia (SARA) score was 20 and his Berg Balance Scale (BBS) score was 27. The patient required two people to assist him in walking because of his high risk of falling due to ataxia, which caused the lower limbs to step out in unexpected directions. His Functional Ambulation Categories (FAC) score was 0. Regular standing and balance function exercises failed to improve his condition, and he was switched to physical therapy focusing on gait training using a walker with a saddle (OG Giken Safety Walker GB-500), which improved his SARA score to 15 and BBS score to 35 at day X+24. He became able to walk with the assistance of one person, and with the use of handrails, his 10 m walking speed was 12 s and his continuous walking distance was 60 m. His FAC score also improved to 2, and he was transferred to another hospital to continue his rehabilitation. Even in this patient with SCD severity level IV, intensive gait training using a walker with saddle resulted in improved walking ability.

A 60-year-old woman with Parkinson disease (PD) treated by Levodopa / carbidopa intestinal gel (LCIG) began physical therapy (PT). Before inducing LCIG therapy, she had six hours off time a day, and she have not walked outside for six years due to the fear of off time freezing. Scores for depression and anxiety on the Hospital Anxiety and Depression Scale (HADS) were 14 and 11, respectively. Symptoms of depression and anxiety as well as impaired endurance and balance were confirmed. While maintaining LCIG treatment, physical therapy (PT) was started with a focus on tasks to improve endurance and balance. Activity goals were decided with the patient. She stopped experiencing episodes of off time four months after PT was introduced and her HADS scores for depression and anxiety decreased to 6 and 3, respectively. She achieved the activity goals she had set, and outings became part of her daily routine. When introducing PT alongside LCIG treatment, patients and therapists should decide the activity goals together and work on activities that address the problems identified by the pre-PT assessment.

Few reports have described assessment methods or exercise interventions in detail for patients isolated with COVID-19. Here, we report our experience of providing physical therapy to these patients based on motor assessment with consideration of infection control. This study involved 4 patients with COVID-19 who needed physical therapy due to a fall or frailty during isolation. The assessment method used was intended to minimize physical contact, to be easily performed, and to reflect muscle strength and balance. Based on the assessment, we created exercise programs and provided exercise intervention to the patients in cooperation with nurses. One patient was discharged early; the other 3 patients showed improved motor function and activities of daily living as a result of the intervention in the acute ward. However, they needed ongoing rehabilitation in the rehabilitation ward. No physical therapists showed signs of COVID-19 infection. Performing motor assessments and providing exercise intervention to these patients isolated with COVID-19 contributed to motor improvement and enabled us to promptly determine whether they needed ongoing rehabilitation.

The Trail Making Test (TMT) is a widely used measure of attention impairment. The time needed to complete the TMT (TMT score) is longer with greater impairment of attention in patients with brain diseases. TMT score becomes large in a proportion of patients with minor ischemic stroke. The Japanese version of the TMT- (TMT-J) was published in 2019. The purpose of this study was to clarify serial changes in TMT-J scores in patients with minor ischemic stroke. We retrospectively reviewed the TMT-J scores in those patients who completed the test both 8-14 days and 29-35 days after stroke onset. On initial evaluation, 1 of 21 patients could not complete TMT-J Part A. TMT-J Part A scores had a mean of 67 s and were abnormally large in 45% of the 20 patients who completed this part. Two of these 20 patients could not complete TMT-J Part B. TMT-J Part B scores had a mean of 135 s and were abnormally large in 61% of the 18 patients who completed this part. On second evaluation, scores on Part A and Part B improved in 76% and 73% of patients, respectively. This study demonstrated that abnormal TMT-J scores 8-14 days after onset of minor ischemic stroke improved over time in most patients.