The 9.0-magnitude under sea megathrust earthquake and the subsequent extremely destructive tsunami waves on March 11 2011 brought an extensive and severe disaster to the Tohoku and Kanto areas. This natural disaster has been markedly complicated by a series of nuclear power plant failures, leading to radioactive contamination, power shortages and ungrounded rumors. Faced with this most difficult crisis, the JARM set up an earthquake disaster headquarters, and has so far taken the following actions, with an emphasis on supporting its members in the disaster stricken areas, preventing immobilization syndromes and providing necessary rehabilitation services for the frail elderly and persons with disabilities, in collaboration with other specialists organizations, local and central governments : 1) Activities in the disaster zone including support of the physiatrists there, dispatch of JARM members, medical caravans for isolated home-dwelling persons with disabilities, and relief activities as a part of multidisciplinary specialists teams ; 2) Organizing a nation-wide system for transferring persons needing rehabilitation and care services ; 3) Activities in the non-disaster areas for victims relocated from the disaster zone ; 4) Information support services to collect and provide useful information ; 5) Proposals to the government for enlightenment of the importance of rehabilitation disaster relief and for relaxation of regulations for eligibility for rehabilitation and care services. The scope of the disaster is too extensive, both in magnitude and geographical area, and too complex. The situation on the ground and the needs of affected persons are constantly changing. Therefore, well-coordinated, creative, and long-term efforts will be needed, and the JARM is determined to be actively involved in the reconstruction process.

Depression is a common complication of stroke. Reported prevalence ranges from 23 to 40% of patients with stroke. The range is very wide, because there are methodological differences between the different studies (e.g. diagnostic criteria, type of rating scales used, timing of evaluation and wide range of patient selection). Poststroke depression (PSD) has a negative impact on functional recovery, activities of daily living (ADL), and quality of life, and can impede the process of rehabilitation. Furthermore, PSD leads to increased morbidity and mortality. It is therefore important to identify and treat depression in its early stages. In this paper, we reviewed the diagnosis and treatment of PSD. Many studies used diagnostic tools that are routinely employed for the diagnosis of major depression and other depressive disorders. Diagnosis is hindered by problems related with self-reporting in patients with cognitive and communicative deficits following stroke, and is confounded by the fact that many of the somatic symptoms of depression can also arise directly from stroke itself. There is therefore a concern about the validity of regular diagnostic tools in assessing poststroke patients. Different approaches and diagnostic criteria used to assess neuropsychiatric disorders in different studies make it difficult to compare their results and to interpret neuropsychiatric phenomena. The effects of treatment of poststroke depression have been examined and confirmed in several trials with tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRI). There is currently no evidence that exercise, whose effectiveness has been demonstrated in major depression, may reduce depression in stroke patients. This is an area to be further explored in rehabilitation settings.

The aim of this study is to investigate the relationship between wheelchair type and impairments among patients with Duchenne muscular dystrophy (DMD). Participants were 52 patients with DMD who used wheelchairs for daily locomotion. We assessed muscle strength, spinal deformity, sitting balance, respiratory function and ADL among 4 groups using different types of wheelchairs (manual wheelchair, manual wheelchair attached with powered component, powered wheelchair, and assist type wheelchair). Spinal deformity was related with wheelchair type. Muscle strength, peak flow and FIM motor score were significantly different among the four groups. The duration of daily use of ventilators was significantly different between the powered wheelchair users and the completely dependent group.

Objective : Little is known about the energy demands of stroke patients in the rehabilitation phase, information essential to both appropriate clinical and nutritional management. The aims of this study were to determine the resting energy expenditure (REE) of stroke patients in the rehabilitation phase, and to evaluate whether REE estimation using the Harris-Benedict equation (HBE) requires the addition of a “stress factor” to capture possible additional REE imposed by stroke. Method : We measured REE with a portable calorimeter, MetavinTR, and compared it with basal energy expenditure (BEE) calculated with HBE in 76 stroke patients admitted to a rehabilitation ward. We then analyzed its relationship with sex, stroke type, paretic side, severity of paralysis, the Functional Independence Measure (FIM) score and dysphagia. Results : Mean REE and REE/BEE (%) were 1231.3±245.7 kcal/day and 104.3±16.4%. A comparison showed no significant difference. Sex, stroke type, paretic side, severity of paralysis, FIM and dysphagia were not significantly related with REE/BEE (%). Conclusion : The REE of stroke patients was not significantly different from that predicted with HBE. This information would be useful in planning appropriate nutritional management.

Objective : The aim of this study was to assess the effects of using a motor point block with 5% phenol on spasticity and gait in patients with chronic hemiparesis. Methods : Participants were 13 patients with chronic hemiparesis after stroke, brain injury or brain tumor. We performed motor point block (MPB) with 5% phenol to the spastic muscles of the lower extremity that caused talipes varus or talipes equinus (i.e. gastrocnemius, soleus, and tibialis posterior). Before and after the MPB, we assessed modified Ashworth scale (MAS), brace wear scale (BWS) and goal attainment scale (GAS). Walking ability was measured using a 30-m walking timed test and 6-minute duration walking test. The step length, foot area during walking and body weight bearing ratio of the paretic side were measured with force plates. Results : We found significant changes in MAS of the plantar flexors (p=0.007), ankle inverters (p=0.006), walking speed (30-m walking time (p=0.046), 6-minute walking test p=0.016), foot area during the stance phase (p=0.006), and body weight bearing ratio of the paretic side (p=0.007)) and BWS (p=0.002). GAS also showed favorable appraisal of MPB by the participants. Conclusion : MPB with 5% phenol can reduce the spasticity and improve gait speed and stability.