Journal Detail Information

1

Cite

Share

Acute Cardiac Failure during Rehabilitative Intervention for Disuse Syndrome following Chest Trauma : A Case with Traumatic Aortic Regurgitation

Masaki HYODO ; Minoru TOYOKURA ; Akira ISHIDA

The Japanese Journal of Rehabilitation Medicine.2007;44(1):36-39. doi:10.2490/jjrmc.44.36

The patient was a 70-year-old man. He was injured in a motorcycle accident and was brought to the hospital suffering from pulmonary contusions, multiple rib fractures, and a dislocation fracture of the left hip joint. Mechanical ventilation and tracheostomy were performed because of decreased oxygenation. As dysphagia and gait disturbance persisted even after his respiratory condition improved, the patient was transferred to our institution for rehabilitation 63 days after the injury. Rehabilitative intervention for the patient's physical impairments progressed smoothly, and the patient regained independence in activities of daily living. However, 1 week before his scheduled date of discharge, the patient suffered from sudden heart failure at 168 days after the initial injury. Traumatic aortic regurgitation was diagnosed based on the following findings : aortic regurgitation rapidly exacerbated after heart failure, no medical history of heart disease, and no other cause for aortic regurgitation. Surgical treatment with aortic valve replacement was performed. Postoperative recovery was favorable, and the patient was discharged to his home after regaining independence in activities of daily living. Traumatic aortic regurgitation is rare, and patients with this disease often suffer heart failure from a few days to several years after injury. This condition needs to be kept in mind during the rehabilitation process following chest trauma.

2

Cite

Share

Three Cases of Cerebral Venous Thrombosis with Rehabilitation

Fuminobu SUGAI ; Futoshi AOIKE ; Kazuo ABE

The Japanese Journal of Rehabilitation Medicine.2007;44(1):40-45. doi:10.2490/jjrmc.44.40

Cerebral venous thrombosis(CVT)is a rare cerebrovascular disorder. However, many reports have suggested that the prognosis of CVT is better than arterial ischemic infarction accompanied with cytotoxic edema. In this report, we present three cases of CVT to explain the possible effectiveness of using a rehabilitation approach. Case 1 was a 51-year-old female oculist with amnestic aphasia and mild right hemiparesis. MRI revealed a massive edematous lesion in the left basal ganglia and thalamus, due to thrombus in the vein of Galen. Speech therapy to facilitate word recall showed remarkable benefit, sufficient enough for her to return to work. Case 2 was a 68-year-old male tax accountant with fluent aphasia. MRI showed multiple contrast-enhanced lesions in his left temporal lobe, due to a lack of venous flow in the left transverse sinus. Speech therapy was also effective enough for him to return to work at 35 days after onset. Case 3 was a 57-year-old male pilot. He suddenly presented severe generalized convulsions controlled by venous anesthetic under mechanical ventilation, due to CVT in the superior sagittal sinus with bilateral frontal hemorrhagic infarction. After extubation, he was transferred to our hospital at 38 days after the disease onset, presenting frontal lobe dysfunction, including apathy, emotional incontinence, and grasp reflexes. During 43 hospitalization days, physical and occupational therapy resulted in drastic improvement in this patient's Barthel index score, from 0 to 50. In conclusion, an early rehabilitation approach should be recommended for CVT, since a better prognosis can be anticipated than in arterial ischemic infarction, regardless of the severity of original brain damage.

3

Cite

Share

Team Rehabilitation for Spinal Cord-Injured Patients with Mental Disorders

Yuko URAKAMI

The Japanese Journal of Rehabilitation Medicine.2007;44(2):97-106. doi:10.2490/jjrmc.44.97

The purpose of this study was to evaluate the effectiveness of therapeutic intervention via liaison-psychiatry by a psychiatrist to the team rehabilitation for spinal cord-injured patients with mental disorders. Out of 652 spinal cord-injured patients who underwent rehabilitation during post-acute stages in our hospital from April 2000 to March 2006, 82 patients aged from 19 to 65 with mental disorders according to the diagnostic criteria of DSM-IV-TR were selected. In order to assess the effectiveness of this comprehensive team approach, the outcomes of these 82 patients were compared with the outcomes of 82 control patients without mental disorders. As a result, there were no significant differences of the acquired BI (Barthel Index), FIM (Functional Independence Measure), and abilities of transfer between the two groups. In addition, 35 out of 82 patients went back to their home. These results demonstrate the effectiveness of liaison psychiatry in conducting the comprehensive team rehabilitation for spinal cord-injured patients with mental disorders.

4

Cite

Share

Rehabilitation of a Cerebral Infarction Patient with Antiphospholipid Syndrome

Yuuichirou SOGAWA ; Yutaka SATO ; Yuri KUDO ; Takashi TAKEMAE ; Akiko MIYAIRI ; Yuki IZUMI

The Japanese Journal of Rehabilitation Medicine.2007;44(2):107-111. doi:10.2490/jjrmc.44.107

We experienced a difficult case which had multiple impairments caused by antiphospholipid syndrome. This disease is a thrombophilic disorder in which venous or arterial thrombosis, or both, may occur in patients with antiphospholipid antibodies (e.g. anticardiolipin antibody, lupus anticoagulant). This disease is well demonstrated as a cause of ischemic stroke in young adults. But the optimal treatment of these patients is unclear, and their prognosis is not good. Antiphospholipid syndrome causes recurrent multiple ischemic strokes, induces severe impairments and the disturbance of various higher brain functions, and shows resistance against rehabilitation. To address these difficulties we should, as rehabilitation experts, conduct chronic disease-management with the cooperation of the neurologists, and devise a rehabilitation approach that takes into consideration the nature and severity of this disease. In other words, a diversified approach, which is characteristic to rehabilitation, is no less important than medical remedies in treating antiphospholipid syndrome patients.

5

Cite

Share

A Successfully Treated Ruptured Aneurysm in a Patient over 90 Years of Age using early Rehabilitation and a One-way Ball Valve for Ventricular Drainage

Kenji MORI ; Naoki KODAMA ; Kenji FUJII ; Koichi MIYAKOSHI ; Shigeo IAI

The Japanese Journal of Rehabilitation Medicine.2007;44(3):171-176. doi:10.2490/jjrmc.44.171

We report a case of a ruptured aneurysm in a patient in her 90's who was treated by coil embolization and returned to her independent life after discharge. A 95-year-old woman with a diagnosis of subarachnoid hemorrhage (SAH) of Hunt & Kosnik Grade II was treated by coil embolization, ventricular drainage, and a ventriculo-peritoneal shunt. The ventricular drainage was assembled as a closed system using a newly developed one-way ball valve to regulate the cerebrospinal fluid (CSF) outflow. With this system the patient was able to assume any posture and perform any movement she wished. The patient was freed from the physical constraint involved in conventional ventricular drainage. Early rehabilitation during the ventricular drainage would be useful to prevent pneumonia and muscle atrophy.

6

Cite

Share

Poststroke Depression—Diagnosis and Treatment—

Maiko OSADA ; Kaori MURAOKA ; Meigen LIU

The Japanese Journal of Rehabilitation Medicine.2007;44(3):177-188. doi:10.2490/jjrmc.44.177

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.

7

Cite

Share

Reliability and Validity of the Spinal Cord Independence Measure

Makiko KUROKAWA ; Hiroyuki TOIKAWA ; Kanjiro SUZUKI ; Ken UCHIKAWA ; Naofumi TANAKA ; Meigen LIU

The Japanese Journal of Rehabilitation Medicine.2007;44(4):230-236. doi:10.2490/jjrmc.44.230

Objective : To evaluate the reliability and the validity of the Japanese version of the Spinal Cord Independence Measure (SCIM) in patients with cervical spinal cord injury. Design : Cross-sectional, observational study. Setting : Rehabilitation ward for spinal cord injury in Japan. Patients and Methods : 26 inpatients with traumatic and non-traumatic cervical spinal cord injury, with an average age of 60.3, were included to examine the internal consistency of the subscales (subscores in each domain) and the whole scale, and to determine concurrent validity of the SCIM and the Functional Independence Measure (FIM) motor subscores. To examine interrater reliability, 12 of these patients were assessed by 2 physiatrists independently and intraclass correlation coefficients (ICC) for total scores and weighted kappas for individual item scores were calculated. Results : The ICC for total SCIM score was 0.99, and the weighted kappas for individual item scores showed moderate to strong agreement (kappa=0.54-1.00). The Cronbach's alpha coefficients for domain subscores and total score were above 0.71, demonstrating appropriate internal consistency of the SCIM. The total SCIM scores significantly correlated with the FIM motor subscores (Spearman's rho=0.95), however, there were some variations with the SCIM scores in patients who were rated as 6 (modified independence) with the FIM in such items as bladder management and indoor mobility. Conclusion : The results supported the internal consistency, interrater reliability and concurrent validity of the SCIM in patients with cervical spinal cord injury. The SCIM may be a potential measure to evaluate certain functional aspects that cannot be assessed by the FIM alone.

8

Cite

Share

Stroke Patients in the Convalescent Rehabilitation Ward of an Acute Stroke Center : A Regional Inter-hospital Referral Model Compared with an Intra-hospital Referral Model

Hironao KITAGAWA ; Masazumi MIZUMA ; Akane YAMASHITA ; Yoshiaki YAMAMOTO

The Japanese Journal of Rehabilitation Medicine.2007;44(4):237-241. doi:10.2490/jjrmc.44.237

The purpose of this study is to investigate stroke patients in a convalescent rehabilitation ward of an acute stroke center. We collected data on 314 stroke patients discharged from the convalescent rehabilitation ward between January 2004 and December 2005. In total, 108 patients were classified as our regional inter-hospital referral model group. Alternately, 206 patients were classified as our intra-hospital referral model group. The regional inter-hospital referral model group took a longer time for transferring and discharging as compared with the intra-hospital referral model group. There was a significant difference in the days between onset of stroke and transfer, and the days between onset of stroke and discharge returned home. In conclusion, we should have a better opinion of the intra-hospital referral model in order to improve the quality of rehabilitation medicine.

9

Cite

Share

Successful nCPAP (nasal Continuous Positive Airway Pressure) Treatment for a Disuse Syndrome Patient with SAS (Sleep Apnea Syndrome)

Yuji WADA ; Tomoyoshi OTSUKA ; Kazuto AKABOSHI

The Japanese Journal of Rehabilitation Medicine.2007;44(5):276-279. doi:10.2490/jjrmc.44.276

The patient, a 72-year-old man, was admitted for disuse syndrome after left lower thigh cellulites, who originally developed left hemiparesis at age 60. At the time of admission, he was alert, his Body Mass Index was 18.5 and his FIM (Functional Independence Measure) score was 49. We thought this was a case of post stroke disuse syndrome manifesting after long-term bedridden inactivity. He underwent a hospital rehabilitation program; however, he gained only poor functional recovery after one month. He complained about nighttime snoring and awakening from sleep. So he was evaluated with a portable device for SAS (Sleep Apnea Syndrome). His ESS (Epworth Sleepiness Scale) was 21, his Apnea-Hypnea Index was 58.2 and his lowest SpO₂ level was 75%. With a diagnosis of severe SAS, he was treated with nighttime nCPAP (nasal Continuous Positive Airway Pressure). After treatment, his lowest SpO₂ level rose to 90%, and the patient's excessive daytime sleepiness (ESS=15) and ADL (FIM=85) improved. When patients exhibit poor recovery after training, the possibility of SAS should be taken into consideration and they should be tested accordingly.

10

Cite

Share

Stroke Rehabilitation for Nothnagel Syndrome : A Case Report

Kazunari TANAKA ; Tomoharu SATO ; Jun YAMAGUCHI

The Japanese Journal of Rehabilitation Medicine.2007;44(5):280-285. doi:10.2490/jjrmc.44.280

We report a case of Nothnagel syndrome with inattention. A 69-year-old laborer was admitted to our hospital for rehabilitation therapy complaining of gait disturbance a month after the onset of brainstem infarction. He had right oculomotor palsy, ataxia on the left side and upward movement limitation of the left eye. Magnetic resonance imaging demonstrated high signal intensity in the right tegmentum of the midbrain and the medial aspect of the right thalamus on T2-weighted and diffusion weighted images. This lesion involving nuclei in the medial aspect of the right thalamus, which is considered to be closely related with the reticular activating system, might explain his inattention. And it is suggested that the low blood flow in the right basal ganglia and parietal lobe revealed by his SPECT scan, could be related with that as well. We administered rehabilitation programs for his ataxia and inattention. Because diplopia is thought to be difficult to improve, we did not attempt to treat the patient's eye movement limitation. Three months after our intervention, he was able to walk without support. However, his inattention remained. Patients with brainstem infarction are apt to have plural impairments concurrently. In such cases, it is necessary to assess the treatment priority for each impairment adequately. Evidence based guidelines for the assessment of treatment priority would aid in this endeavor and the development of such guidelines is therefore expected.

DISPLAY OPTIONS

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share