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.

 The purpose of this study was to clarify the change in symptoms, behavior, and feeling with acupuncture and the relationship between the changes and physical activity level in middle-aged and elderly people with musculoskeletal pain.
 The Subjects were 55 (26 males and 29 females, aged 65.0±12.2 years) middle-aged and elderly people with musculoskeletal pain who have been treated with acupuncture. We investigated the change in their symptoms, behavior, and feeling (symptoms, frequency of other treatments, exercise, frequency of going out and taking trips, general feeling, confidence in physical fitness, and coping with the prospects for the symptoms) with acupuncture using an unsigned self-administered question naire. In addition, the health-related quality-of-life was evaluated with SF-8 and the physical activity level was assessed with the Short Version of the International Physical Activity Questionnaire.
 The subjects mostly recognized that their symptoms, behavior, and feeling had a tendency to improve or remain unchanged with acupuncture. Evaluation of the relationship between the changes with acupuncture and walking physical activity showed that the subjects who felt their frequency of exercise or of going out or taking trips tended to increase with acupuncture treatment showed a significantly higher physical activity level than those who stated there was no change or a decreasing tendency (p<0.05). Similarly, the subjects whose assessment for the general feeling or coping with the prospects for symptoms was a tendency to irnprove with acupuncture showed a significantly higher physical activity level than those whose assessment was no change or deleterious change (p<0.05).
 These results indicate that acupuncture might have a positive affect on their symptoms, behavior, and feeling, and also provide opportunities to increase walking physical activity in middle-aged and elderly people with skeletai and muscular disorders.

The definition of Pain, “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (International Association for the Study of Pain : IASP, 1994), which is often used to explain its subjectivity. It is necessary to evaluate the pain objectively for diagnosis and effectiveness of therapy.
As an evaluation method of chronic pain, Visual Analog Scale (VAS) and Numerical Rating Scale (NRS) are used. Recent years, face visual analog scale and Current Perception Threshold (CPT) testing are also used commonly. Drug challenge test draws attention as it combines an evaluation method and an effective therapy. Meanwhile as a therapy of chronic pain, the reports of epiduroscopy and phototherapy are increasing. The epiduroscopy is an endoscopic operation for patients with the chronic low back pain. In Japan the therapy is performed increasingly for patients with the low back pain of spinal canal stenosis, failed back syndrome and lumbar disc herniation. Regarding the phototherapy, the reports which show the effectiveness of linear polarized infrared raytherapy and xenon phototherapy are mainly observed. Though the nerve block is still the dominant therapy in pain clinics, acupuncture therapy and phototherapy are prospected to increase their demands in future.

The largest percentage of patients receiving acupuncture treatment in Japan are those with chronic aches. Aches are major factors of QOL, and the pain-killing effect of acupuncture treatment has a large clinical significance. In the study, therefore, we expressed the QOL of the patients who received acupuncture treatment as scores using SF-36 and then examined the effect of acupuncture treatment on improving the QOL. Each score of SF-36 was rated from 0 to 100, where higher points represent better states of health.
The study was conducted on 60 patients who received acupuncture treatment in our facility from Oct. 2002 to Jan. 2003.
All scores before the start of treatment were low, and all score fell below the national standard value. Physical functions (PF), bodily pain (BP), and generally view of healthiness (GH) of the physical component summary (PCS) and vitality (VT) of mental component summary (MCS) showed particularly low scores relative to other scores. Comparison of scores before the start of treatment with those 1 month after the treatment revealed that BP among the eight sub-scales was improved significantly (p<0.05). In conclusion, these results suggest that receiving acupuncture treatment can contribute to improving a patient's QOL.

Electro-nerve stimulation is an Electro Acupuncture (EA) method that is clinically applied to treat periphral neuropathy. We examined the effects of electro-nerve stimulation on the Sensory Nerve Conduction Velocity (SCV). The changes in SCV caused by applying electro-nerve stimulation to the peripheral nerves were measured.
Al-Hz EAT was applied for 10min to the right upper arms of healthy adult volunteers (n=12). The SCV in the median nerve and the skin temperature of the forearm were measured before and after the application. The SCV and skin temperature were found to exhibit asignificant decrease after the electricity was turned on. Therefore, we concluded that EAT caused the decrease in skin temperature of the forearm and, as a result, lowered the SCV in the median nerve.