Background : Both low-frequency repetitive transcranial magnetic stimulation (rTMS) and intensive occupational therapy (OT) have been recently reported to be clinically beneficial for post-stroke patients with upper limb hemiparesis. We have already reported that the function of the paralyzed upper limb in the post-stroke hemiplegic patients was improved after a 15-day hospitalization protocol, named NEURO-15. In this present study, we investigated whether two courses (2X) of NEURO-15 were superior to a single one in therapeutic efficacy. Methods: During NEURO-15, each patient was scheduled to receive 21 treatment sessions of 20-min low-frequency rTMS followed by 120-min intensive OT daily. Low-frequency pulses of 1 Hz were applied to the motor cortex of the nonlesional hemisphere. Fugl-Meyer Assessment (FMA), log performance time of the Wolf Motor Function Test (WMFT) and modified Ashworth Scale (MAS) were evaluated on the days of admission and discharge. The first NEURO-15 was given to 16 apoplectic hemiplegic patients whose Brunnstrom Recovery Stage in their fingers ranged from IV to V. After an average of 13.6 months, the second NEURO-15 was administered to all 16 patients. Results : The 2X protocol was completed by all patients without any adverse effects. After the first course of NEURO-15, all patients showed improvement in their paralyzed upper limb function ; improvements which remained until the second NEURO-15 course. The second NEURO-15 course yielded even further improvement in the paralyzed upper limb function. Conclusions : Our proposed combination treatment is a safe, feasible, and clinically useful neurorehabilitative intervention for post-stroke patients with upper limb hemiparesis when administered as both a single application or as a 2X protocol. The effectiveness of the 2X protocol or even more frequent application of NEURO-15 courses needs to be further explored.

The patient was a 37 year-old man. We diagnosed Loeys-Dietz syndrome based on his physical characteristics that were widely spaced eyes and brachycephaly etc. Since he developed De Bakey III b aortic dissection 3 months later, he needed surgical repair for saccular-shaped distal arch aortic aneurysm. We performed total aortic arch replacement for the aneurysm and valve-sparing aortic root reconstruction for dilatation of the Valsalva sinus. Furthermore we performed the frozen elephant trunk technique for residual aortic dissection at the same time. After 18 months from the operation, we were able to recognize by computed tomography that the false lumen of the aorta next to the stent graft was thrombosed and absorbed and finally disappeared. The stent graft treatment for patients with connective tissue disease might be an effective method and deserves more attention.

Purpose：The Assessment of readiness for mobility transition (ARMT) is a self-administered questionnaire that assesses individuals' emotional and attitudinal readiness when they need to change their means of mobility, such as driving due to old age. This study aimed to examine the linguistic validity of the Japanese version of the ARMT (ARMT-J).Methods：The translation was carried out for the “Basic Guidelines for Scale Translation.” Three occupational therapists in Japan conducted forward translation and adjustment, and a translation company conducted back translation. In addition, the original authors reviewed the back translation and the cognitive debriefing. The cognitive debriefing was conducted with five older people living in the community.Results：Disagreements were identified on five items in the forward translation and three in the review of back translation. In particular, item 11, “retirement community,” is not widely used in Japan and the Japanese translation differed among translators. A “retirement community” is defined as a residential area or building for the older people in other countries. The three occupational therapists who performed the translation discussed with the original author and changed the Japanese translation to “housing for the elderly.” In addition, a supplementary document was added to the translation, stating that it includes the meaning of “the need to change one's living area when one changes their means of transportation due to aging.Conclusion：In this study, we examined the linguistic validity of the ARMT-J and developed a Japanese translation that we believe is appropriate.

Purpose：The Assessment of readiness for mobility transition (ARMT) is a self-administered questionnaire that assesses individuals' emotional and attitudinal readiness when they need to change their means of mobility, such as driving due to old age. This study aimed to examine the linguistic validity of the Japanese version of the ARMT (ARMT-J).Methods：The translation was carried out for the “Basic Guidelines for Scale Translation.” Three occupational therapists in Japan conducted forward translation and adjustment, and a translation company conducted back translation. In addition, the original authors reviewed the back translation and the cognitive debriefing. The cognitive debriefing was conducted with five older people living in the community.Results：Disagreements were identified on five items in the forward translation and three in the review of back translation. In particular, item 11,“ retirement community,” is not widely used in Japan and the Japanese translation differed among translators. A “retirement community” is defined as a residential area or building for the older people in other countries. The three occupational therapists who performed the translation discussed with the original author and changed the Japanese translation to “housing for the elderly.” In addition, a supplementary document was added to the translation, stating that it includes the meaning of “the need to change one's living area when one changes their means of transportation due to aging.Conclusion：In this study, we examined the linguistic validity of the ARMT-J and developed a Japanese translation that we believe is appropriate.