Background : Constraint-induced movement therapy (CI therapy) is a rehabilitation treatment that effectively improves upper extremity function in patients with chronic hemiparesis after stroke. In Japan, no previous studies have shown the effects of CI therapy in a large size sample, and the Simple Test for Evaluating Hand Function (STEF), a standard assessment tool for upper extremity function, is rarely used to evaluate the effects of CI therapy. Little is known regarding the factors capable of predicting the outcome of CI therapy. The present study aimed to examine potential predictors of outcomes after CI therapy and the effects of CI therapy using STEF. Methods : This study included patients with hemiparesis in the chronic stage of stroke (≥180 days from onset). We compared upper extremity function before and after CI therapy intervention, which involved 5 hours per day for 10 consecutive weekdays of training. We assessed upper extremity function using the STEF, Wolf Motor Function Test-functional ability scale (WMFT-FAS) before and after intervention, and investigated potential predictors (age, gender, time since stroke, type of stroke, side of stroke, hand dominance, spasticity). Results : There were 107 subjects. Our comparison revealed that both STEF and WMFT-FAS scores improved significantly following intervention, from means of 31.3 to 42.7 points and 51.8 to 57.0 points, respectively. No significant predictors that influenced the functional outcome were identified. Conclusion : CI therapy is effective for improving upper extremity function. It is important not to exclude people from CI therapy based on any supposed predictors.

Rehabilitation using myoelectric prosthesis for trans-radial amputees has become wide spread and well established in several developed countries. However, the clinical use of myoelectric prostheses for trans-radial amputees has not yet spread in Japan. It is well known that once amputees become accustomed to using their prosthesis efficiently through adequate rehabilitation, that various activities which the amputees had given up so far will become possible through enhanced bimanual activities. Although myoelectric prostheses have proved to be useful, the majority of amputees have not been satisfied with their function. As an amputee becomes a better user, they request not only simple tasks but also complicated ones. As a consequence, the amputee comes to know the limits of their myoelectric prosthesis, thus expectations for superior prostheses will arise. The recent remarkable development of engineering technology has enabled the progress of prosthetic limb technology, leading to the production of far superior functional prostheses which meet the user's expectations. However, there is a paradox in developing such superior prostheses. The more advanced the prosthesis we produce, the higher the cost. To achieve this end, it is absolutely imperative to secure the cooperation of both clinicians and engineers. Furthermore, a rehabilitation strategy for patients with a higher level of amputation(trans-humeral amputation, shoulder disarticulation)remains unsolved. In this paper, we propose a “Hybrid Myoelectric Prosthesis”, which consists of a myoelectric hand as a terminal device and a body-powered active elbow joint, as a realistic solution for higher level amputees. In addition, we introduce Targeted Reinnervation (TR) as a future strategy for reference.

A Major earthquake and giant tsunami occurred on 3.11, which broadly affected the eastern Japan area along the Pacific Ocean. A large elderly population was confined to their place of refuge and faced a high risk of disuse syndrome due to immobility. Elderly survivors aged 65 and over who were markedly found in an inactive state due to immobilization were regarded as the “risk group” for inactive lifestyles, possibly leading to disuse syndromes. Intervention by means of rehabilitation assistance was required in approximately one third of these inactive survivors (“high risk group”), a rate which was significantly higher in the elderly over 65 years than in younger survivors. Establishment of a rehabilitation assistance system for use in the event of a mass disaster is one of the critical lessons learned following 3.11, which will contribute to serve as a prophylaxis against disuse syndromes arising from inactivate locomotive function. Legal reform of relief actions in mass disasters is highly required to also include physical therapists as official members.

As a scholarly research activity using “the Japanese Association of Rehabilitation Medicine rehabilitation patient database”, we performed an analysis with the objective of clarifying the actual conditions of DVT in stroke patients. The subjects consisted of 345 stroke patients with DVT data from the “December 2010 version" of the database. In 9 of the 345 cases (2.6%), DVT complications were observed. No significant relevance among NIHSS, mRS, or the FIM score was found at the time of admission to hospital. In addition, no association with the number of days from the onset of PT (which is believed to be a related factor) and the onset of DVT was observed. For the acute condition change rate, the DVT complication group was observed to have a significantly high rate. Moreover, for the home recovery rate, the DVT complication group was observed to have a significantly low rate. Therefore, using only the severity of the condition at the time of admission and the length of the period until the commencement of rehabilitation, it is difficult to predict the onset of DVT, and it was shown that there is a danger of DVT occurring in any stroke patient. Furthermore, the acute condition change rate when DVT occurs as a complication is high. As a result, it is therefore necessary to be vigilant in the prevention and early diagnosis of DVT.

The Japanese Association of Rehabilitation Medicine (JARM) is developing a Rehabilitation Patient Database (DB). The accumulated number of registered patients exceeded 10000 by March, 2011. The purposes of this article are to describe the process and procedures of secondary analysis and to consider potentials and limitations of the DB to promote the research activities of JARM members. JARM Members who submitted patient data or cooperate with JARM in the secondary analysis are regarded as eligible to use the combined data submitted by many hospitals. A suitable patient dataset should be derived from the DB including stroke, hip fracture, and spinal cord injury, and also patient data from the acute to recovery phase of rehabilitation. Additionally, before paper drafts can be submitted, a reviewing process is needed. The DB holds much potential, because the sample size is large and data were submitted from many hospitals. Since there are inherent limitations in all observational research, many issues such as endogeneities and confounders should be considered carefully to ensure high quality evidence is obtained with validity and reliability using the DB.

Objective : To examine the characteristics of rehabilitation in patients with cervical spinal cord injury, we statistically analyzed the factors that affected their home discharge. Methods : We examined 122 inpatients diagnosed with cervical spinal cord injury in our hospital from January 2001 to December 2010. We categorized the patients into a home discharge group and a non-home discharge group, and ruled out inpatients that underwent rehabilitation at other hospitals after discharge. We analyzed the following factors with regard to their influence on home discharge : sex, age, length of stay, surgery after injury, cervical vertebral fracture at injury, the grade on the Frankel grading system, Functional Independence Measure (FIM) scores, movement ability, pain severity, the number of comorbidities, complications, and the number of caregivers. Results : The factors that favored home discharge included : improvement of paralysis, improvement of FIM scores, high-FIM scores at both admission and discharge, and high potential for movement at discharge. The factors that hindered home discharge included : advanced patient age, long length of stay, pain severity, and urinary infection. Multivariate analyses showed that age, pain severity, and movement ability were the most relevant factors that influenced home discharge. Conclusion : Pain control as well as improvement of movement ability are important factors affecting home discharge in rehabilitation units.

A 43-year-old man was admitted to our hospital for rehabilitation of higher brain dysfunction caused by traumatic brain injury. He had undergone an emergency operation for acute epidural hematoma after a fall. He had impaired cognitive function with regard to memory, attention, and executive function. However, he also exhibited facial features such as frontal baldness and hatched face. Neurological examination showed mild distal muscle weakness in the extremities, gait disturbance, and grip and percussion myotonia. Needle electromyography showed myotonic discharges. Brain magnetic resonance imaging did not show any intra-axial abnormalities. Myotonic dystrophy (DM) was therefore diagnosed. Rehabilitation resulted in improved gait stability, but the patient's cognitive function did not improve. Severity of illness in DM patients varies from a floppy infant to a lack of awareness of the disease throughout one's lifetime. Therefore, DM patients might not be properly diagnosed because of the mildness of their clinical symptoms. It is important for non-neurologists to be aware of the possible occurrence of this disease.

Patients with Parkinson disease present with a variety of symptoms as well as the so-called 4 classic symptoms : tremor, muscle rigidity, akinesia, and postural instability. To treat this disease, the best combination of various antiparkinsonism drugs, deep brain stimulation, and rehabilitation should be determined and administered. Muscular training in rehabilitation for patients should place great importance on some especially vulnerable muscles including the truncal muscles, extensor muscles for hip and knee joints, and dorsiflexor muscles for ankle joints. Shifting the center of gravity and using rhythmic movements are important factors in getting the patient standing and walking. Training using visual and auditory cues and music is effective in Parkinson disease. Speech therapy using weighted noise is also available. In rehabilitation we have to pay attention to cognitive function and psychiatric symptoms in patients including depression, anhedonia, hallucination, delusion, dopamine dysregulation syndrome, and impulse control disorder. What priority should be set for rehabilitation differs according to the stages of disease. Utmost efforts must be made for patients in the advanced stage of Parkinson disease to prevent them from being bedridden, tube-fed, and demented. Medical staff must be creative in coming up with new ideas to assist such patients in sitting comfortably on chairs for long periods and in eating by mouth safely.

We compared food and water swallowing tests to investigate the reliability of the tests to exclude aspiration following acute stroke. Subjects were 155 patients with cerebral strokes aged between 20.98 years (66.6±12.9 years) and for whom videofluoroscopic examination of swallowing (VF) was performed for swallowing difficulty or suspected swallowing difficulty. Food tests (FTs) using jelly and rice porridge, and a modified water swallowing test (MWST) were evaluated during VF. The results showed fewer occurrences of choking, cough, wet voice and aspiration during the FTs than in the MWST. The sensitivity and specificity of the FTs for aspiration ranged from 80.0% to 83.3% and 25.5% to 41.3%, respectively. The MWST gave a sensitivity of 58.0% and a specificity of 72.4% for aspiration. There were more incidences of silent aspiration in the MWST than in the FTs. However, the validity of the FTs and their positive predictive value were lower than for the MWST. Choking and cough had a significant relation to aspiration in both tests. We recommend that we need to use each of these tests with an understanding of their characteristics and limitations in order to obtain correct findings in stroke patient swallowing assessments.