1.Combining Robotic Therapy with Electrical Stimulation Therapy and Transfer Packages for Upper Limb Paresis in Cervical Spinal Cord Infarction:A Case Report
Ryota SATO ; Daisuke ITO ; Masayuki DOGAN ; Shota WATANABE ; Michiyuki KAWAKAMI ; Kunitsugu KONDO
The Japanese Journal of Rehabilitation Medicine 2024;():23039-
Objective:Studies on upper extremity functional interventions for patients with spinal cord infarction are limited, and the effectiveness of the interventions for upper limb paresis in such patients have not been elucidated. This case report describes evidence-based spinal cord injury interventions that improved upper extremity function in a patient with spinal cord infarction.Methods:A man in his 60s presented with mild right hemiplegia because of right anterior spinal artery infarction in the C5 medullary segment. Upon admission, the patient had an American Spinal Injury Association Impairment Scale of D, lacked cognitive impairment, and demonstrated independence indoors with ambulation. The intervention included a combination of robotic therapy and electrical stimulation, adherence-enhancing behavioral strategies (Transfer Package), and typical occupational therapy. We recorded the following upper extremity functional scores:①Active Range of Motion of the shoulder, ②Passive Range of Motion of the shoulder, ③Manual Muscle Test, ④Grip strength, ⑤Pinch strength, ⑥Action Research Arm Test, ⑦Simple Test for Evaluating Hand Function, and ⑧Motor Activity Log.Results:After intervention therapy for 39 days, upper extremity function and the degree and quality of arm use in daily activities improved.Conclusion:These results suggest that evidence-based interventions for spinal cord injury could improve upper extremity function and the degree and quality of arm use in daily activities in patients with cervical spinal cord infarcti.
2.Combining Robotic Therapy with Electrical Stimulation Therapy and Transfer Packages for Upper Limb Paresis in Cervical Spinal Cord Infarction:A Case Report
Ryota SATO ; Daisuke ITO ; Masayuki DOGAN ; Shota WATANABE ; Michiyuki KAWAKAMI ; Kunitsugu KONDO
The Japanese Journal of Rehabilitation Medicine 2024;61(4):311-316
Objective:Studies on upper extremity functional interventions for patients with spinal cord infarction are limited, and the effectiveness of the interventions for upper limb paresis in such patients have not been elucidated. This case report describes evidence-based spinal cord injury interventions that improved upper extremity function in a patient with spinal cord infarction.Methods:A man in his 60s presented with mild right hemiplegia because of right anterior spinal artery infarction in the C5 medullary segment. Upon admission, the patient had an American Spinal Injury Association Impairment Scale of D, lacked cognitive impairment, and demonstrated independence indoors with ambulation. The intervention included a combination of robotic therapy and electrical stimulation, adherence-enhancing behavioral strategies (Transfer Package), and typical occupational therapy. We recorded the following upper extremity functional scores:①Active Range of Motion of the shoulder, ②Passive Range of Motion of the shoulder, ③Manual Muscle Test, ④Grip strength, ⑤Pinch strength, ⑥Action Research Arm Test, ⑦Simple Test for Evaluating Hand Function, and ⑧Motor Activity Log.Results:After intervention therapy for 39 days, upper extremity function and the degree and quality of arm use in daily activities improved.Conclusion:These results suggest that evidence-based interventions for spinal cord injury could improve upper extremity function and the degree and quality of arm use in daily activities in patients with cervical spinal cord infarction.
4.Early Phase Functional Recovery after Spinal Intramedullary Tumor Resection Could Predict Ambulatory Capacity at 1 Year after Surgery
Tetsuya SUZUKI ; Osahiko TSUJI ; Masahiko ICHIKAWA ; Ryota ISHII ; Narihito NAGOSHI ; Michiyuki KAWAKAMI ; Kota WATANABE ; Morio MATSUMOTO ; Tetsuya TSUJI ; Toshiyuki FUJIWARA ; Masaya NAKAMURA
Asian Spine Journal 2023;17(2):355-364
Results:
In the early phase after surgery, 71% and 43% of the participants were nonindependent ambulators at 1W and 2W, respectively. Histopathology indicated that patients with solid tumors (ependymoma, astrocytoma, or lipoma) showed significantly lower indices at 1W and 2W than those with vascular tumors (hemangioblastoma or cavernous hemangioma). Regarding tumor location, thoracic cases exhibited poorer lower-limb function at 1W and 2W and poorer walking ability at 2W than cervical cases. According to the receiver operating characteristic (ROC) analysis, 2 WISCI II points at 2W had the highest sensitivity (100%) and specificity (92.2%) in predicting the level of walking independence at 1 year postoperatively (the area under the ROC curve was 0.99 (95% confidence interval, 0.93–1.00).
Conclusions
The higher the lower-limb function scores in the early phase, the better the improvement in walking ability is predicted 1 year after ISCT resection.
5.Survey on the Effectiveness of the “Let's Become a Physiatrist” Seminar
Fumihito KASAI ; Dai FUJIWARA ; Mari KAKITA ; Akira YOSHIDA ; Hidetsugu MATSUMOTO ; Michiyuki KAWAKAMI ; Takumi IKEDA ; Takashi HIRAOKA ; Fumihiro TAJIMA
The Japanese Journal of Rehabilitation Medicine 2023;60(3):248-252
Objective:Only 44 of the 82 university medical schools in Japan have rehabilitation medicine departments, although rehabilitation medicine is one of the 19 basic specialties recognized by the Japanese Medical Specialty Board, and many medical doctors are concerned regarding selecting rehabilitation medicine as a basic specialty without sufficient education in the field. The “Let's Become a Physiatrist” Seminar has been organized since 2017 to eliminate such concerns, and this study aimed to investigate how these results are manifested in the number of majors.Methods:We examined the number of past attendees and tracked how many of them became rehabilitation medicine majors.Results:The number of seminar attendees over a 5-year period was 589. The number of on-demand viewers in FY2020 and FY2021, which were held via the web, was 554. A total of 116 of the 471 physicians who began specialty training in rehabilitation medicine after the seminar was planned attended or web viewed the seminar accounting for 24.63%.This percentage has been increasing each year, with 36.81% of the majors who applied in 2022 attending the seminar, and the number of multiple attendees also increased. The number of majors has increased significantly doubling to 144 in 2022 compared with 74 in 2018.Conclusion:In many cases, the seminar helped the attendees learn more about physiatrists and develop their thoughts while attending multiple times. Thus, they started their majors. Five years have passed since we started planning this seminar, and we believe that the results are now coming to fruition.
6.Survey on the Effectiveness of the “Let's Become a Physiatrist” Seminar
Fumihito KASAI ; Dai FUJIWARA ; Mari KAKITA ; Akira YOSHIDA ; Hidetsugu MATSUMOTO ; Michiyuki KAWAKAMI ; Takumi IKEDA ; Takashi HIRAOKA ; Fumihiro TAJIMA
The Japanese Journal of Rehabilitation Medicine 2023;():22040-
Objective:Only 44 of the 82 university medical schools in Japan have rehabilitation medicine departments, although rehabilitation medicine is one of the 19 basic specialties recognized by the Japanese Medical Specialty Board, and many medical doctors are concerned regarding selecting rehabilitation medicine as a basic specialty without sufficient education in the field. The “Let's Become a Physiatrist” Seminar has been organized since 2017 to eliminate such concerns, and this study aimed to investigate how these results are manifested in the number of majors.Methods:We examined the number of past attendees and tracked how many of them became rehabilitation medicine majors.Results:The number of seminar attendees over a 5-year period was 589. The number of on-demand viewers in FY2020 and FY2021, which were held via the web, was 554. A total of 116 of the 471 physicians who began specialty training in rehabilitation medicine after the seminar was planned attended or web viewed the seminar accounting for 24.63%.This percentage has been increasing each year, with 36.81% of the majors who applied in 2022 attending the seminar, and the number of multiple attendees also increased. The number of majors has increased significantly doubling to 144 in 2022 compared with 74 in 2018.Conclusion:In many cases, the seminar helped the attendees learn more about physiatrists and develop their thoughts while attending multiple times. Thus, they started their majors. Five years have passed since we started planning this seminar, and we believe that the results are now coming to fruition.
7.The Impact of the COVID-19 Pandemic on Three Domains of Functioning of ICF in Participants with Spinocerebellar Degeneration and Multiple System Atrophy in Japan
Koshiro HARUYAMA ; Michiyuki KAWAKAMI ; Ichiro MIYAI ; Toshiyuki FUJIWARA
The Japanese Journal of Rehabilitation Medicine 2022;59(7):714-724
Objective:We aimed to determine the impact of the COVID-19 pandemic on the “body function”, “activity”, and “participation” domains of functioning as defined in the International Classification of Functioning (ICF) for individuals with spinocerebellar degeneration (SCD) and multiple system atrophy (MSA).Methods:A questionnaire survey was administered to 1,000 members of the SCD/MSA patient association in Japan between November and December 2020. Questions related to COVID-19 were extracted from the multipurpose data, and the degree of COVID-19-related effects on each life function was assessed using a 7-point scale. Results were stratified into two groups based on age, care needs based on long-term care insurance coverage, and limited opportunities for rehabilitation. The χ2 test was used to examine differences between pairs of groups regarding impacts on functioning.Results:Data from 460 participants with SCD and MSA were analyzed. Participation restriction was reported in 54% of participants with SCD and 46% of participants with MSA, and impairment and activity limitation in approximately 20% of participants with both conditions resulting from the COVID-19 pandemic. Participants with low care needs reported more impairment in SCD and more participation restriction in MSA. About 24% of subjects reported limited opportunities for rehabilitation. MSA participants with these limitations reported greater impairment.Conclusion:The COVID-19 pandemic has had a particular impact on the participation domain of functioning in participants with SCD and MSA. The domains of body function and participation were found to be affected in participants with low care needs or limited opportunities for rehabilitation.
9.The Impact of the COVID-19 Pandemic on Three Domains of Functioning of ICF in Participants with Spinocerebellar Degeneration and Multiple System Atrophy in Japan
Koshiro HARUYAMA ; Michiyuki KAWAKAMI ; Ichiro MIYAI ; Toshiyuki FUJIWARA
The Japanese Journal of Rehabilitation Medicine 2022;():21058-
Objective:We aimed to determine the impact of the COVID-19 pandemic on the “body function”, “activity”, and “participation” domains of functioning as defined in the International Classification of Functioning (ICF) for individuals with spinocerebellar degeneration (SCD) and multiple system atrophy (MSA).Methods:A questionnaire survey was administered to 1,000 members of the SCD/MSA patient association in Japan between November and December 2020. Questions related to COVID-19 were extracted from the multipurpose data, and the degree of COVID-19-related effects on each life function was assessed using a 7-point scale. Results were stratified into two groups based on age, care needs based on long-term care insurance coverage, and limited opportunities for rehabilitation. The χ2 test was used to examine differences between pairs of groups regarding impacts on functioning.Results:Data from 460 participants with SCD and MSA were analyzed. Participation restriction was reported in 54% of participants with SCD and 46% of participants with MSA, and impairment and activity limitation in approximately 20% of participants with both conditions resulting from the COVID-19 pandemic. Participants with low care needs reported more impairment in SCD and more participation restriction in MSA. About 24% of subjects reported limited opportunities for rehabilitation. MSA participants with these limitations reported greater impairment.Conclusion:The COVID-19 pandemic has had a particular impact on the participation domain of functioning in participants with SCD and MSA. The domains of body function and participation were found to be affected in participants with low care needs or limited opportunities for rehabilitation.
10.A Case Report of Stepwise Neurorehabilitation for Upper Limb Dysfunction after Juvenile-onset Brain Tumor Surgery:Increased Use of the Paralyzed Hand in Daily Life
Tadasuke SHIMOMURA ; Michiyuki KAWAKAMI ; Osamu OSHIMA ; Nanako HIJIKATA ; Takuya NAKAMURA ; Asako OKA ; Kohei OKUYAMA ; Meigen LIU
The Japanese Journal of Rehabilitation Medicine 2020;():19023-
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.


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