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Predictive Factors for Good Functional Recovery and the Effect of Constraint-induced Movement Therapy on Motor Function : An Assessment of Upper Extremity Function using STEF in a Large Sample

Masashi HOSOMI ; Kenji SHIMADA ; Kenji MATSUMOTO ; Takashi TAKEBAYASHI ; Kohei MARUMOTO ; Kazuhisa DOMEN

The Japanese Journal of Rehabilitation Medicine.2012;49(1):23-30. doi:10.2490/jjrmc.49.23

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.

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Myoelectric Prostheses : Current Status and Problems to be Solved, a Rehabilitation Strategy for Higher Level Amputation Patients, and the Future Outlook

Takaaki CHIN

The Japanese Journal of Rehabilitation Medicine.2012;49(1):31-36. doi:10.2490/jjrmc.49.31

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.

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Rehabilitation Support in the Kesen-NumaEarthquake and Tsunami Disaster Area

Michiaki TAKAGI

The Japanese Journal of Rehabilitation Medicine.2012;49(1):37-45. doi:10.2490/jjrmc.49.37

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.

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Deep Venous Thrombosis in Stroke Patients : An Analysis of the Rehabilitation Patient Database of the Japanese Association of Rehabilitation Medicine

Yuichiro SOGAWA

The Japanese Journal of Rehabilitation Medicine.2012;49(3):137-141. doi:10.2490/jjrmc.49.137

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.

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Secondary Analysis of the Rehabilitation Patient Database : Process, Potentials and Limitations

Katsunori KONDO

The Japanese Journal of Rehabilitation Medicine.2012;49(3):142-148. doi:10.2490/jjrmc.49.142

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.

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The Subtraction Approach for Safety Management and 5S Activities in a Hospital Setting

Makoto YANO

The Japanese Journal of Rehabilitation Medicine.2012;49(4):191-193. doi:10.2490/jjrmc.49.191

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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.

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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.

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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.

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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.

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