Injecting botulinum toxin type A (BTX-A) into spastic muscles is a recent alternative for treating conditions such as stroke, spinal cord injury, and cerebral palsy. BTX-A injection blocks acetylcholine release at the neuromuscular junction (NMJ) in the muscles. Therefore, BTX-A must be injected near the NMJ. In this paper, the anatomical, histochemical, and electrophysiological studies to determine the location of NMJs in the extremities are reviewed. Further, methylene blue vital staining as a method to identify the intramuscular nerve fibers and NMJs in the muscle and propose a so-called “mid portion of muscle fibers” along with the NMJ map of the upper and lower limbs are discussed.

At the end of 2012, Prof S Yamanaka received the Nobel Prize for his work on induced pluripotent stem cells. Now iPS cell therapy, his contribution to regenerative medicine, will shine a light on many disabled persons. The dream of curing patients with upper motor neuron diseases, such as spinal cord injury (SCI), Parkinson disease, strokes etc will finally come true. Dr Krusen, the father of Rehabilitation Medicine or Physical Medicine & Rehabilitation, defined this specialty as consisting of two categories : one being the Phys Med, a branch of medicine using physical agents such as heat, water, electricity, mechanical agents, therapeutic exercises and recent sophisticated physical modalities in diagnosing and treating neuro-musculo-skeletal diseases. The other being Rehab, which denotes “enabling the patient to return to his/her previous social setting.” In the past, the Department of Rehabilitation Medicine at Keio University used to collaborate with the Department of Physiology to adapt embryonic stem cell therapy for treating SCI, Parkinson diseases etc along with physical modalities. Going forward, research in “iPS cell therapy or regenerative medicine” should be the primary concern of PM&R specialists as it is the first step on our way to the next generation in the specialty of Physical Medicine and Rehabilitation or Rehabilitation Medicine.

incorrect: Received December 28, 2013
correct: Received December 28, 2012

Regenerative medicine, which aims to restore, replace or regenerate cells and tissues using novel approaches such as iPS therapy, is currently a big issue in the field of rehabilitation medicine. Neurological recovery has been proved using marmoset monkeys with spinal cord lesions and Hematoxylin-Eosin and Luxol fast blue staining were adopted to identify the increased number of neurons at the spinal cord level. In regenerative medicine, pathophysiological findings demonstrating the recovery of motor units can provide direct evidence of neuromuscular function. In the field of rehabilitation medicine, the final common pathway, e.g. intramuscular nerve fibers and neuromuscular junctions, will be the target used to identify the recovery of motor function. Present physiatric modalities such as electrical or magnetic stimulations and therapeutic exercises will serve as the strategic applications used in neuromuscular regeneration treatments. The methylene blue vital staining method is a classical technique that when combined with the recently developed functional fluorescent protein staining along with transgenic procedures and confocal endomicroscopy examinations will illuminate our investigations into the degree of regenerative success obtained. These neuromuscular pathologies at the spinal cord level as well as the lower motor neuron level will allow us to more clearly determine the efficacy of various physical modalities used in rehabilitation medicine. The regenerative medicine era will require rehab efforts not only for treating spinal cord lesions but also for treating brain damaged patients in the future.

Polio epidemics in the USA during the 1940s and 1950s were among the most feared diseases of the 20th century. Sister Elizabeth Kenny and President Franklin Roosevelt both made key contributions to modern rehabilitation medicine, leading to the promotion of global progress made by the International Society of Physical and Rehabilitation Medicine a half century later. Dr. Miland Knapp at the University of Minnesota was also considered a pioneer in modern rehabilitation medicine, as he supported the Kenny treatment method for acute polio patients. The Kenny method was subsequently widely adopted in the USA.

No abstract available.
Fires* ; Relaxation*