Botulinum toxin has been successfully used to treat limb spasticity, but the optimal timing for initiating treatment remains unclear. Beneficial effects of early treatment have been suggested in previous studies. However, in Japan early treatment is difficult because of the drug’s cost. Here we report a case of severe limb spasticity that was treated in the subacute phase using botulinum toxin. The patient was a 50-year-old woman who had shoulder pain and equinus due to spasticity 3 months after stroke onset. Following botulinum toxin treatment of the pectoralis major and gastrocnemius muscles, her symptoms improved and she could walk with an orthosis and perform activities of daily living under supervision. In conclusion, botulinum toxin treatment can be considered when appropriate candidates have severe limb spasticity even in the subacute phase.

Objective: The efficacy of botulinum toxin type A (BoNT-A) injection on spasticity has usually been measured using the range of motion (ROM) of joints and Modified Ashworth Scale (MAS); however, they only evaluate muscle tone at rest. We objectively analyzed the gait of three patients with hemiplegia using three-dimensional motion analysis and ground reaction force (GRF) systems to evaluate muscle tone during gait.Materials and Methods: We measured passive ankle dorsiflexion ROM with knee extension and the MAS score for clinical evaluation, and gait speed, stride length, single-leg support phase during the gait cycle, joint angle, joint moment, and GRFs for kinematic evaluation before and one month after BoNT-A injection.Results: All patients showed an increase in ankle dorsiflexion ROM, improvement in MAS score, and increase in stride length. Case 1 showed an increase in gait speed, prolongation of the single-leg support phase, increase in hip extension angle and moment, and improvement in the vertical and anterior-posterior components of the GRFs. Case 2 showed an increase in gait speed, improvement in double knee action, increase in ankle plantar flexion moment, and improvement in propulsion in the progressive component of the GRFs. Case 3 exhibited a laterally directed force in the GRFs.Conclusion: We evaluated the effects of BoNT-A injections in three patients with hemiplegia using three-dimensional motion analysis and GRFs. The results of the gait analysis clarified the improvements and problems in hemiplegic gait and enabled objective explanations for patients.

　　In this study, to establish a system unique to our hospital, an awareness survey of physical therapists was conducted using a newly developed form to investigate the degree of anxiety about, and participation in supporting, pediatric patients with a developmental disorder, managing patients’ families, and interdisciplinary cooperative activities. The level of anxiety and the degree of participation were evaluated using a visual analog scale. The Mann-Whitney U test was used to compare cooperative activities with different professionals. The results showed that 20 (90.9%) of the physical therapists were anxious about supporting and handling pediatric patients with a developmental disorder and their families. No significant difference in the degree of anxiety was observed among different professionals, but the highest anxiety was observed when working in cooperation with physicians (Dr), followed by clinical psychotherapists (CP), nurses (Ns), medical social workers (MSW), occupational therapists (OT), and then speech therapists (ST). Physical therapists cooperated most frequently with Dr, followed by Ns, OT, MSW, ST, and then CP, with a significant difference between Dr and CP. The findings of this study, showing current awareness and challenges related to pediatric patients with a developmental disorder, provide information that is fundamental for the establishment of a system unique to our hospital.

  To assess the effect of pre-germinated brown rice on metabolism of glucose and lipids, blood parameters of glucose and lipids were measured before and after 3 months of intake of test rice, which was mixed with pre-germinated brown rice (PGBR) and white rice in a ratio of 1:1, in patients with diabetes mellitus type 2 (DM). Glycosylated hemoglobin A1c (HbA1c) was significantly decreased from 6.40±0.23% to 6.23±0.19 after 3 months of intake of PGBR. The fasting plasma glucose level was not changed by intake of PGBR, but serum insulin level and HOMA-IR were decreased slightly. As the decrease of LDL-cholesterol (LDL-c) and the increase of HDL-cholesterol (HDL-c) were slightly observed after 3 months of intake of PGBR, the LDL-c/HDL-c ratio was decreased significantly from 2.03±0.13 to 1.83±0.12. These changes were significantly larger in the high PGBR in take group than in the low PGBR in take group. These results suggested that the PGBR intake might have potentialities as one of therapeutic methods for diabetes mellitus type 2 and also be useful in the freatment of hypercholesterolemia.

Objective: The objective of this study is to investigate the outcome-determining factors of stroke patients treated in our hospital which is the largest hospital in Ibaraki Prefecture with more than 1,000 beds.Methods: Ninety two patients (62 with cerebral infarction and 30 with hemorrhage) who were hospitalized for stroke for the first time between January and June in 2004, and underwent rehabilitation. The patients were classified into two groups according to their outcomes: Group 1 patients who were directly discharged to home and Group 2 patients who were transferred to other hospitals or nursing homes. We investigated the severity of paresis, high cortical functional disorder as complication, functional outcome, and family background of these patients, and analyzed the outcome-determining factors.Result: Among the patients, 65.2% were directly discharged to home. Their paresis was not severe in most cases, and 70% of them could walk independently (with or without canes and devices). There were no significant differences in age or family size between the two groups. Fifteen patients did not choose to go home, even though they were physically able to do so. They all had higher brain dysfunction or difficulty in accepting their disability. For such patients, the shortage of caregivers was not necessarily considered as a factor in their decision not to go home.Conclusion: The severity of paresis and walking ability (locomotion) are the key factors in determining of whether the patients can be discharged to home or not.
Cerebrovascular accident ; Paresis ; Impaired health ; Hospitals ; agreement