Spina bifida is a disease that requires cross-disciplinary treatment for each life stage from the neonatal period to adulthood. Various rehabilitation therapies are required depending on the life stage of patients. In this study, we aimed to clarify the current status of rehabilitation services at children's hospitals in order to improve quality of rehabilitation care for children with spina bifida. We performed a survey targeted at the Japanese Association of Children's Hospitals and Related Institutions. The framework of the cross-disciplinary co-operation of medical treatments for spina bifida existed in 67% of children's hospitals surveyed. In most of these hospitals, the departments of rehabilitation medicine participated in these frameworks. In the medical treatment for children with spina bifida, acute phase rehabilitation after orthopaedic surgery was adequately provided in children's hospitals. However, convalescent and community-based phase rehabilitation therapies, and the co-operation with education institutions or habilitation/rehabilitation facilities for children were determined to be inadequate. Regarding general paediatric rehabilitation, convalescent and community-based phase rehabilitation therapies were mainly provided outside children's hospitals：habilitation/rehabilitation facilities for children mainly provided convalescent and community-based phase rehabilitation therapies and were considered to be the desirable setting for such therapies. To improve paediatric rehabilitation, including the rehabilitation for children with spina bifida, several factors need to be considered. These include the construction of appropriate frameworks for medical services (such as personnel training and the recruitment of rehabilitation doctors, therapists, and related staff), and co-operation with regional education institutions or habilitation/rehabilitation facilities for children.

Children's hospitals and related institutions, along with habilitation/rehabilitation facilities for children with disabilities, practice pediatric rehabilitation medicine. However, the status of rehabilitation medical services at children's hospitals has not been examined. To help improve pediatric rehabilitation medicine, we aimed to clarify it with this study. We performed a nationwide survey targeting the Japanese Association of Children's Hospitals and Related Institutions. The median numbers of full-time rehabilitation doctors, board-certified rehabilitation doctors, and board-certified instructors per institution were one, zero, and zero, respectively. The median numbers of full-time physical therapists, occupational therapists, speech-language-hearing therapists, and clinical psychologists were nine, five, three, and two, respectively. Demand for increasing the number of rehabilitation staff members was high across all specialties. Only about half the institutions surveyed were certified as training facilities by the Japanese Association of Rehabilitation Medicine. Some institutions did not meet the health insurance system's higher-level criteria for rehabilitation facilities. The construction of an appropriate medical service framework and an increase in hospital services, including staff assignment, will be needed to improve pediatric rehabilitation and to expand research and education in this field.

Children's hospitals and related institutions, along with habilitation/rehabilitation facilities for children with disabilities, practice pediatric rehabilitation medicine. However, the status of rehabilitation medical services at children's hospitals has not been examined. To help improve pediatric rehabilitation medicine, we aimed to clarify it with this study. We performed a nationwide survey targeting the Japanese Association of Children's Hospitals and Related Institutions. The median numbers of full-time rehabilitation doctors, board-certified rehabilitation doctors, and board-certified instructors per institution were one, zero, and zero, respectively. The median numbers of full-time physical therapists, occupational therapists, speech-language-hearing therapists, and clinical psychologists were nine, five, three, and two, respectively. Demand for increasing the number of rehabilitation staff members was high across all specialties. Only about half the institutions surveyed were certified as training facilities by the Japanese Association of Rehabilitation Medicine. Some institutions did not meet the health insurance system's higher-level criteria for rehabilitation facilities. The construction of an appropriate medical service framework and an increase in hospital services, including staff assignment, will be needed to improve pediatric rehabilitation and to expand research and education in this field.

The incidence of cerebral infarction due to Takayasu's arteritis is relatively low, and there are few reports on rehabilitation for this condition. We report the case of a patient with Takayasu's arteritis, repeated expansion of cerebral infarction, and subclavian steal syndrome who required careful observation at the start of ambulation. A 17-year-old male was diagnosed with Takayasu's arteritis complicated by subclavian steal syndrome eleven months ago. He was admitted for the treatment of cerebral infarction in the right side of the middle cerebral artery. One day after admission, the area of the infarction expanded. Next day, after he started ambulation (16 days after admission), the area of the infarction further expanded despite ongoing medical treatments, including corticosteroid and immunosuppressant administration. Cerebral blood flow scintigraphy showed stenosis of right middle cerebral, right internal carotid, right common carotid, brachiocephalic, left subclavian, and left vertebral arteries.These arterial stenosis progressed in the two weeks following admission. Thereafter, he complained of dimmed vision more frequently when he raised his body to an upright position. The rehabilitation schedule had to be carefully adjusted according to his symptoms. Two and a half months later, angiographic examination showed development of adequate collateral circulation from the bilateral intercostal arteries to both vertebral arteries. After we confirmed the collateral circulation, we allowed him to use a wheelchair. The confirmation of collateral circulation by image analysis is important in order to decide the time to start ambulation in patients with Takayasu's arteritis (early phase) along with repeated cerebral ischemia.

The incidence of cerebral infarction due to Takayasu's arteritis is relatively low, and there are few reports on rehabilitation for this condition. We report the case of a patient with Takayasu's arteritis, repeated expansion of cerebral infarction, and subclavian steal syndrome who required careful observation at the start of ambulation. A 17-year-old male was diagnosed with Takayasu's arteritis complicated by subclavian steal syndrome eleven months ago. He was admitted for the treatment of cerebral infarction in the right side of the middle cerebral artery. One day after admission, the area of the infarction expanded. Next day, after he started ambulation (16 days after admission), the area of the infarction further expanded despite ongoing medical treatments, including corticosteroid and immunosuppressant administration. Cerebral blood flow scintigraphy showed stenosis of right middle cerebral, right internal carotid, right common carotid, brachiocephalic, left subclavian, and left vertebral arteries.These arterial stenosis progressed in the two weeks following admission. Thereafter, he complained of dimmed vision more frequently when he raised his body to an upright position. The rehabilitation schedule had to be carefully adjusted according to his symptoms. Two and a half months later, angiographic examination showed development of adequate collateral circulation from the bilateral intercostal arteries to both vertebral arteries. After we confirmed the collateral circulation, we allowed him to use a wheelchair. The confirmation of collateral circulation by image analysis is important in order to decide the time to start ambulation in patients with Takayasu's arteritis (early phase) along with repeated cerebral ischemia.

For lower limb amputees, good prosthetic fittings are important for wearing prostheses while ensuring gait stability, without skin breakdown. Poor prosthetic fittings tend to occur in the early stage after amputation because of significant changes in residual limb volume. We measured the extent of change in residual limb volume in three below-the-knee amputees by using computed tomography. The measurements were performed before and after inpatient rehabilitation for the first prosthesis. The measurement showed a remarkable change in residual limb volume in a highly active amputee without complications. In contrast, the change in residual limb volume was small in two less active below-the-knee amputees with serious complications, such as heart and renal failures. Generally, to maintain good prosthetic fittings, the first prostheses should be made during inpatient rehabilitation to facilitate maturation of the residual limbs. For the less active below-knee amputees, the prostheses could be made in the outpatient settings because the volume fluctuations of their residual limbs are small and the functional requirements for their daily living are modest.