Objective: Shoulder pain, which is common in hemiplegic stroke patients, decreases quality of life and interferes with rehabilitation. Although many local injection therapies have been reported for shoulder pain in hemiplegic stroke patients, that to the coracohumeral ligament has not been reported. In a stroke paraplegic patient with shoulder pain, we evaluated the effect of local steroid injection therapy on pain, sleep and range of movement.Methods: Among stroke hemiplegia patients with shoulder pain admitted to our rehabilitation department, 14 shoulders with inadequate pain control by joint range of motion training, anatomical restoration, and analgesic medication were included in this study. Local steroid injections were performed on the coracohumeral ligament under ultrasound guidance. The evaluation items were pain during movement, nocturnal pain, sleep disturbance, and changes in shoulder joint range of motion (flexion, abduction, and external rotation in the pronated position). The Athens Insomnia Scale score was used to assess sleep disturbance. Each item was evaluated before injection, 2 weeks after injection, and 4 weeks after injection.Results: Pain during movement 4 weeks after injection, nocturnal pain and Athens Insomnia Scale score 2 and 4 weeks after injection improved significantly. The range of motion of the shoulder joint was also significantly improved in flexion 2 weeks after injection and in external rotation after 4 weeks of injection.Conclusion: Local steroid injections into the coracohumeral ligament may be one treatment option to reduce shoulder pain in stroke hemiplegic patients, as it significantly reduced pain during movement and nighttime pain and sleep disturbances.

Objective: Shoulder pain, which is common in hemiplegic stroke patients, decreases quality of life and interferes with rehabilitation. Although many local injection therapies have been reported for shoulder pain in hemiplegic stroke patients, that to the coracohumeral ligament has not been reported. In a stroke paraplegic patient with shoulder pain, we evaluated the effect of local steroid injection therapy on pain, sleep and range of movement.Methods: Among stroke hemiplegia patients with shoulder pain admitted to our rehabilitation department, 14 shoulders with inadequate pain control by joint range of motion training, anatomical restoration, and analgesic medication were included in this study. Local steroid injections were performed on the coracohumeral ligament under ultrasound guidance. The evaluation items were pain during movement, nocturnal pain, sleep disturbance, and changes in shoulder joint range of motion (flexion, abduction, and external rotation in the pronated position). The Athens Insomnia Scale score was used to assess sleep disturbance. Each item was evaluated before injection, 2 weeks after injection, and 4 weeks after injection.Results: Pain during movement 4 weeks after injection, nocturnal pain and Athens Insomnia Scale score 2 and 4 weeks after injection improved significantly. The range of motion of the shoulder joint was also significantly improved in flexion 2 weeks after injection and in external rotation after 4 weeks of injection.Conclusion: Local steroid injections into the coracohumeral ligament may be one treatment option to reduce shoulder pain in stroke hemiplegic patients, as it significantly reduced pain during movement and nighttime pain and sleep disturbances.

Introduction: We investigated a protocol to support the treatment of constipation that was developed in collaboration with physicians and the effectiveness of Protocol Based Pharmacotherapy Management (PBPM) performed by pharmacists in improving constipation.Methiod: Patients with constipation who underwent PBPM between August 2020 and May 2021 were included in this study. The results of the Constipation Scoring System (CSS) and the Bristol Stool Form Scale (BSFS) assessments by pharmacists on the first day of intervention and at discharge were collected retrospectively to evaluate the efficacy of PBPM. Wilcoxon's signed rank test was used for statistical analysis, and the threshold value for rejecting the null hypothesis was p < 0.05.Results: Of the 23 eligible patients, three were excluded according to the criteria, and 20 patients were included. Median CSS improved significantly from 11.5 points [8.25-16.75] at the first intervention to 5.5 points [2.75-10.25] at discharge. The median BSFS improved significantly from Type 2 [2-3] to Type 3.5 [3-4]. Conclusion: PBPM by pharmacists to support the treatment of constipation resulted in improvement of constipation.

Dysphagia is a syndrome associated with many diseases and is emerging as a big problem in the Japanese aged society. It is important to observe the symptoms and realize the causes of dysphagia. Swallowing disorders are often caused by organic etiology such as tumors and traumas, but many patients suffer from functional disorders after stroke and neuromuscular diseases. Nasogastric tube placement and medications can also iatrogenically cause swallowing problems. When making a diagnosis, it is important to understand the mechanisms and signs of pseudobulbar palsy and bulbar palsy. Whereas bulbar palsy occurs following a lesion in the brain stem swallowing center, pseudobulbar palsy relates to bilateral corticobulbar tract damage. Interestingly, some clinicians report that dysphagia can be caused by unilateral cortical lesions including lesions in the insular cortex. To detect dysphagia, questionnaires and screening tests are helpful, as are water swallow tests, RSST, cervical auscultation and so on, but clinical observation of the swallowing session is most valuable. Videofluoroscopic and videoendoscopic examinations are required for precise diagnosis and further management. To know the gap between the capability function and performance state of swallowing, it is good to establish treatment goals. It is also important to know if the disease is progressive or not. For patients with progressive disease such as ALS, compensatory management should be a priority. We use functional training including muscle strengthening and swallowing technique for non progressive disorders. Medical treatments using ACE inhibitors and so on are options which might be effective to prevent aspiration pneumonia, and also, surgical treatments such as cricopharyngeal myotomy and laryngeal suspension are indispensable in treating patients with severe dysphagia.