Objective : To investigate how rehabilitation outcomes improved after the rehabilitation plan was changed. Subjects : 54 patients that were admitted to a kaifukuki rehabilitation ward in a regional hospital from January 2007 to June 2007 and 679 patients that admitted from January 2008 to June 2011. Methods : We changed the rehabilitation plan as follows to improve rehabilitation outcomes. Physiatrists estimated the rehabilitation goal and the length of hospital stay (LOS) at the first examination. All patients had intensive rehabilitation with standing up exercises and ADL training toward the goal. LOS, Functional Independence Measure (FIM) gain, FIM efficiency and the percentage of patients discharged home during 6 months before the change were compared with those during the same period after the change. In stroke patients, hip fracture patients and deconditioned patients, the same comparison was performed. Results : In the 4 years after the change was initiated, LOS was reduced significantly from 96.5 days to 29.2 days (p<0.001). The change of FIM gain was not significant, but FIM efficiency increased significantly from 0.22 to 0.91 (p<0.001). The percentage of patients discharged home also increased significantly from 85.2% to 99.1% (p<0.001). Also in stroke patients and hip fracture patients, LOS was reduced and FIM efficiency was increased significantly. The sample of deconditioned patients was small, but their LOS was reduced significantly. Conclusion : The changed rehabilitation plan reduced LOS, increased FIM efficiency and enabled most patients to discharge home.

Introduction: Intracranial tumors cause various neurological symptoms and neuropathic pain, which are often refractory to opioids. In some of these cases, the combination of Kampo medicines can be effective. Case: The case was a 44-year-old patient who underwent surgery for a suspected papilloma. After resection, pathological examination revealed squamous cell carcinoma, positive for margins, and then, the left intraorbital metastasis was observed. Due to the intracranial invasion of the tumor, he had pain in the second and third branches of the trigeminal nerve in the left face and paresthesia in the second branch of the trigeminal nerve bilaterally (Numerical Rating Scale: NRS 10/10). Hydromorphone was introduced, and the pain was relieved, but the paresthesia remained (NRS 8/10). Both paresthesia and pain worsened during the course of chemotherapy, but MRI showed no tumor progression, thus, the cause of symptom aggravation was diagnosed edema of the tissue around the tumor. Therefore, Goreisan was started, and both paresthesia and pain were relieved. Discussion: Goreisan has been shown to be effective in cerebral edema due to its water-regulating effect by inhibiting aquaporin. In the present case, the reduction of edema in peritumoral tissues by Goreisan may have contributed to the symptomatic relief.