Intracranial germ cell tumor is more common in Asian countries, including Japan, than in Western countries. The disease is characterized by juvenile onset with a mean age at diagnosis of 18 years. Most patients with intracranial germ cell tumors in the basal ganglia manifest paralytic symptoms, but few of these patients have been reported to have long-term progression of motor paralysis and rehabilitation interventions.A young male patient was diagnosed as having right basal ganglia germinoma and left hemiplegia at the age of 10 years. He received intervention and long-term follow-up for upper limb function. He underwent hybrid assistive neuromuscular dynamic stimulation therapy at the age of 14 years and modified constraint-induced movement therapy (modified CI therapy) at the age of 20 years. With such a gradual neurorehabilitation intervention, the Fugl-Meyer assessment score for the upper limb improved from 41 to 58 points, and the frequency of use of the paralyzed hand also improved. We hope that this report will provide guidance when considering treatment options for similar diseases in the future.

Spinal cord stimulation (SCS) has been reported to be effective for complex regional pain syndrome (CRPS). This is a case report of a patient with CRPS who was successfully treated with a combination of temporary SCS lead placement and physical therapy. A 19-year-old man presented with severe pain for a few months since receiving plaster cast fixation as treatment for an ankle sprain injury at the previous hospital. At his first visit to our pain center, he could not walk without crutches because of severe pain accompanied by symptoms such as allodynia, decreased skin temperature, redness, edema, muscle weakness, and changes in the appearance of the affected area. The symptoms met the diagnostic criteria for CRPS. Temporary SCS lead placement was performed to alleviate the pain and peripheral circulatory disorder, along with physiotherapy to improve the flexibility and restore the normal appearance of the affected limb. The interdisciplinary treatment effectively improved our patient's leg edema and walking ability, which consequently led to pain relief.

Spinal cord stimulation (SCS) has been reported to be effective for complex regional pain syndrome (CRPS). This is a case report of a patient with CRPS who was successfully treated with a combination of temporary SCS lead placement and physical therapy. A 19-year-old man presented with severe pain for a few months since receiving plaster cast fixation as treatment for an ankle sprain injury at the previous hospital. At his first visit to our pain center, he could not walk without crutches because of severe pain accompanied by symptoms such as allodynia, decreased skin temperature, redness, edema, muscle weakness, and changes in the appearance of the affected area. The symptoms met the diagnostic criteria for CRPS. Temporary SCS lead placement was performed to alleviate the pain and peripheral circulatory disorder, along with physiotherapy to improve the flexibility and restore the normal appearance of the affected limb. The interdisciplinary treatment effectively improved our patient's leg edema and walking ability, which consequently led to pain relief.

Intracranial germ cell tumor is more common in Asian countries, including Japan, than in Western countries. The disease is characterized by juvenile onset with a mean age at diagnosis of 18 years. Most patients with intracranial germ cell tumors in the basal ganglia manifest paralytic symptoms, but few of these patients have been reported to have long-term progression of motor paralysis and rehabilitation interventions.A young male patient was diagnosed as having right basal ganglia germinoma and left hemiplegia at the age of 10 years. He received intervention and long-term follow-up for upper limb function. He underwent hybrid assistive neuromuscular dynamic stimulation therapy at the age of 14 years and modified constraint-induced movement therapy (modified CI therapy) at the age of 20 years. With such a gradual neurorehabilitation intervention, the Fugl-Meyer assessment score for the upper limb improved from 41 to 58 points, and the frequency of use of the paralyzed hand also improved. We hope that this report will provide guidance when considering treatment options for similar diseases in the future.

Objective：This study aimed to identify the characteristics of daily rehabilitation in patients with spinocerebellar degeneration (SCD), including those with multiple system atrophy, with a focus on physical status and social background.Methods：We analyzed questionnaire responses from 914 patients in Japan and conducted inter-group comparisons of backgrounds and rehabilitation-related information by dividing patients into a rehabilitation group, a self-directed exercise group, and a non-rehabilitation group.Results：Among all subjects, the rehabilitation group accounted for 67.9％, the self-directed exercise group for 17.7％, and the non-rehabilitation group for 14.3％．In the rehabilitation group, the percentage receiving services increased with a decline in the level of independent living and increase in coverage by long-term care insurance. The frequency and duration of rehabilitation showed a maximum distribution of 2-3 sessions/week for 40 minutes per session in the rehabilitation group and 7 sessions/week for 20 minutes per session in the self-directed exercise group. The intent to continue in the rehabilitation group was significantly greater than in the self-directed exercise group (p＝0.018), although subjective changes with rehabilitation showed no difference between groups.Conclusion：The percentage of SCD patients who participated in rehabilitation programs including self-directed exercise was high. However, the subjective effect was not clear. We consider it necessary to develop an environment in which experts can provide rehabilitation to all SCD patients, irrespective of the disease stage.

Objective：This study aimed to identify the characteristics of daily rehabilitation in patients with spinocerebellar degeneration (SCD), including those with multiple system atrophy, with a focus on physical status and social background.Methods：We analyzed questionnaire responses from 914 patients in Japan and conducted inter-group comparisons of backgrounds and rehabilitation-related information by dividing patients into a rehabilitation group, a self-directed exercise group, and a non-rehabilitation group.Results：Among all subjects, the rehabilitation group accounted for 67.9％, the self-directed exercise group for 17.7％, and the non-rehabilitation group for 14.3％．In the rehabilitation group, the percentage receiving services increased with a decline in the level of independent living and increase in coverage by long-term care insurance. The frequency and duration of rehabilitation showed a maximum distribution of 2-3 sessions/week for 40 minutes per session in the rehabilitation group and 7 sessions/week for 20 minutes per session in the self-directed exercise group. The intent to continue in the rehabilitation group was significantly greater than in the self-directed exercise group (p＝0.018), although subjective changes with rehabilitation showed no difference between groups.Conclusion：The percentage of SCD patients who participated in rehabilitation programs including self-directed exercise was high. However, the subjective effect was not clear. We consider it necessary to develop an environment in which experts can provide rehabilitation to all SCD patients, irrespective of the disease stage.

Objective : The aim of this study was to assess the effects of using a motor point block with 5% phenol on spasticity and gait in patients with chronic hemiparesis. Methods : Participants were 13 patients with chronic hemiparesis after stroke, brain injury or brain tumor. We performed motor point block (MPB) with 5% phenol to the spastic muscles of the lower extremity that caused talipes varus or talipes equinus (i.e. gastrocnemius, soleus, and tibialis posterior). Before and after the MPB, we assessed modified Ashworth scale (MAS), brace wear scale (BWS) and goal attainment scale (GAS). Walking ability was measured using a 30-m walking timed test and 6-minute duration walking test. The step length, foot area during walking and body weight bearing ratio of the paretic side were measured with force plates. Results : We found significant changes in MAS of the plantar flexors (p=0.007), ankle inverters (p=0.006), walking speed (30-m walking time (p=0.046), 6-minute walking test p=0.016), foot area during the stance phase (p=0.006), and body weight bearing ratio of the paretic side (p=0.007)) and BWS (p=0.002). GAS also showed favorable appraisal of MPB by the participants. Conclusion : MPB with 5% phenol can reduce the spasticity and improve gait speed and stability.

Objective : The Mini-Balance Evaluation Systems Test (Mini-BESTest) is an assessment tool for dynamic balance dysfunction developed by simplifying the Balance Evaluation Systems Test (BESTest). The purpose of our study was to examine the validity of the Japanese version of the Mini-BESTest (J-Mini-BESTest) we translated. Methods : The J-Mini-BESTest was produced using a translation and back translation method referring to a guideline proposed by Guillemin et al. We tested 20 patients with balance dysfunction due to various diseases and 7 healthy persons with the J-Mini-BESTest, the Berg Balance Scale (BBS), the Falls Efficacy Scale-International (FES-I) and the Activities-specific Balance Confidence Scale (ABC Scale). We assessed the concurrent validity of the J-Mini-BESTest by comparing it with the other measures using the Spearman's correlation method. Results : The average assessment time when using the J-Mini-BESTest was 20.0 minutes. The J-Mini-BESTest was correlated with the BBS (r=0.82, p<0.01), FES-I (r=-0.72, p<0.01) and ABC Scale (r=0.80, p<0.01). The distribution of the BBS scores was more skewed compared to the J-Mini-BESTest (BBS skewness=-1.30 vs. J-Mini-BESTest skewness=-0.47) and the BBS also had a ceiling effect (9 participants had a perfect score in the BBS versus none in the J-Mini-BESTest). Conclusion : The J-Mini-BESTest was suggested as a clinically useful tool for detecting subtle dynamic balance deficits with good concurrent validity.