論文

BACKGROUND: Blood pressure (BP) dysregulation is frequently observed in patients after surgical management of brainstem lesions; however, there has been no standard rehabilitation. Considering the conflicting risks for hypoperfusion and disuse syndrome in these patients, a safe and effective rehabilitative strategy is warranted. OBSERVATIONS: A 50-year-old man who had undergone craniotomy for resection of a recurrent dorsal medullary epidermoid cyst developed persistent orthostatic hypotension. It was resistant to physical exercise, pharmacological therapy, abdominal binders, and compression stockings; therefore, it inhibited postoperative rehabilitation. Although the responsible lesion was not clearly visible on the postoperative image, accompanying symptoms, including segmental sensory impairment, implied an improvement in BP control. Although there was a trade-off between the risk of developing disuse syndrome and a delay in functional recovery, the authors decided to continue a conservative rehabilitation strategy rather than increasing the workload. The patient's BP control was gradually restored by the seventh postoperative week, and the authors proceeded with basic activity training. LESSONS: A conservative prognostic prediction-based rehabilitation strategy was applied in this case. The precise evaluation of the accompanying neurological symptoms was helpful in deciding the treatment regimen. The conflicting risks for hypoperfusion and disuse syndrome in such cases must be considered.

Each stage of stoke requires different approach in treatment. In the acute phase, treatment is centered on the "disease" itself according to the critical path specific to the disease. In the convalescent phase, treatment is centered on the "impairments" through rehabilitation programs to treat functional impairments such as motor paralysis and aphasia as well as disability in walking and activities of daily living (ADL). In the chronic phase, the focus is on the "life quality," and patients receive disease management mainly from primary care physicians to prevent the recurrence of stroke and to control comorbidities, while taking advantages of social welfare services and undergoing rehabilitation management that aims at preventing the deterioration of walking ability and ADL. Since the approach to stroke patients shifts from "disease" to "impairment" and then to "life quality" according to the disease stage, therefore, it is necessary to formulate a system that facilitate appropriate treatment and care across disease stages with mutual understanding and consent among involved parties. Such system will entail close collaborative relationships among the various care facilities to share awareness, information, assessment procedures, etc., and should provide rational explanations to patients and their families who transfer from one facility to another. In this regard, a community liaison path can serve as a tool to smoothly connect various facilities designed for particular stages of disease. This paper describes the concept of a community liaison path for stroke from a perspective of rehabilitation medicine.

This article describes data related to the research study entitled "The neural correlate of gait improvement by rhythmic sound stimulation in adults with Parkinson's disease - A functional magnetic resonance imaging study" [1]. We evaluated gait performance using the 10-meter walk test (10MWT) in adults with Parkinson's disease (PD) and age-matched healthy controls (HC). Gait speed (GS) and step length (SL) were calculated from the results of the 10MWT. We also evaluated neural activities in regions that were significantly activated by gait imagery in adults with PD using functional magnetic resonance imaging (fMRI). The correlation among GS, SL, and activation of blood oxygenation level-dependent (BOLD) signals by gait imagery in adults with PD. Both GS and SL were smaller in adults with PD than in HCs. The left parietal operculum (PO), left supplementary motor area (SMA), and right cerebellum were activated by gait imagery in adults with PD. No significant correlation was found in any pair of gait performance and neural activation of such regions. This data set could be reused for studies to investigate the relationship between gait performance and neural activities in adults with PD.

Stem cell-based regenerative therapy has opened an avenue for functional recovery of patients with spinal cord injury (SCI). Regenerative rehabilitation is attracting wide attention owing to its synergistic effects, feasibility, non-invasiveness, and diverse and systemic properties. In this review article, we summarize the features of rehabilitation, describe the mechanism of combinatorial treatment, and discuss regenerative rehabilitation in the context of SCI. Although conventional rehabilitative methods have commonly been implemented alone, especially in studies of acute-to-subacute SCI, the combinatorial effects of intensive and advanced methods, including various neurorehabilitative approaches, have also been reported. Separating the concept of combined rehabilitation from regenerative rehabilitation, we suggest that the main roles of regenerative rehabilitation can be categorized as conditioning/reconditioning, functional training, and physical exercise, all of which are indispensable for enhancing functional recovery achieved using stem cell therapies.

BACKGROUND: Arm-lifting movements (shoulder flexion) are essential for upper extremity rehabilitation after a stroke. Abnormal flexor synergy (elbow flexion) is frequently observed during shoulder flexion, impeding functional improvement. However, no quantitative method exists for assessing abnormal flexor synergy. This study investigated the validity and responsiveness of a newly developed index to quantitatively evaluate abnormal flexor synergy. METHODS: Participants included 103 patients (mean age: 58.0 ± 10.1 years; 64 men, 39 women) with stroke. Using three-dimensional coordinate data during shoulder flexion obtained from a depth sensor camera, we calculated the abnormal flexor synergy based on our developed index. The abnormal flexor synergy index decreases with increasing flexion of the elbow joint during shoulder flexion (the maximum value is 100% without abnormal flexor synergy). The validity of the abnormal flexor synergy index was assessed by analyzing the correlation between the index and both the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) four-category scores and the Modified Ashworth Scale (MAS) scores for elbow, wrist, and finger flexors, using Pearson's and Spearman's correlation coefficients. Responsiveness was studied in 17 inpatients (mean age: 59.5 ± 8.1 years; 7 men, 10 women) who underwent proximal upper extremity intervention for approximately 3 weeks, evaluating change from admission to discharge using the standardized response mean (SRM). RESULTS: Significant correlations were observed between the abnormal flexor synergy index and FMA-UE scores: A (r = 0.625, p < 0.001), B (r = 0.433, p < 0.001), C (r = 0.418, p < 0.001), and D (r = 0.411, p < 0.001), as well as MAS scores for elbow flexors (r = -0.283, p = 0.004) and proximal interphalangeal flexors (r = -0.201, p = 0.042). The highest responsiveness was observed in the FMA-UE A score (SRM = 0.81), followed by the abnormal flexor synergy index (SRM = 0.79). CONCLUSIONS: The newly developed index for assessing abnormal flexor synergy demonstrated superior validity and high responsiveness. These results suggest the potential for using this index to evaluate upper extremity function in patients with stroke.

PURPOSE: The purpose of this study was to investigate the differences in muscle strength, muscle mass, balance function, and quality of life (QOL) among middle-aged breast cancer survivors (BCSs) and older BCSs. METHODS: The study included 53 middle-aged (<65 years old) BCSs and 49 older (≥65 years old) BCSs. Muscle strength was evaluated via handgrip and knee extensor strength, and muscle mass was assessed using a body composition test. Balance function was assessed using the Timed Up and Go test and the body sway test. QOL was assessed using the Medical Outcome Study 36-item Short-Form Health Survey. RESULTS: The older BCSs had significantly lower right grip strength, right knee extension strength, and muscle mass (P < .05) than the middle-aged BCSs. In addition, the body sway test showed that older BCSs had a significant increase in the length of center of pressure compared to middle-aged BCSs (P < .05). Older BCSs showed significantly lower physical functioning subscales in QOL compared to middle-aged BCSs (P < .05). The associations among muscle strength, muscle mass and QOL were more significantly observed in the older BCSs (P < .05). Furthermore, a significant correlation between QOL and balance function was observed in the older BCSs, but not in the middle-aged BCSs (P < .05). CONCLUSION: There may be associations among muscle strength, muscle mass, balance and QOL in older BCSs, but not in middle-aged BCSs. We believe that the findings of this study will be relevant in the context of planning rehabilitation for older BCSs.

There is no choice other than rehabilitation as a practical medical treatment to restore impairments or improve activities after acute treatment in people with spinal cord injury (SCI); however, the effect is unremarkable. Therefore, researchers have been seeking effective pharmacological treatments. These will, hopefully, exert a greater effect when combined with rehabilitation. However, no review has specifically summarized the combinatorial effects of rehabilitation with various medical agents. In the current review, which included 43 articles, we summarized the combinatorial effects according to the properties of the medical agents, namely neuromodulation, neurotrophic factors, counteraction to inhibitory factors, and others. The recovery processes promoted by rehabilitation include the regeneration of tracts, neuroprotection, scar tissue reorganization, plasticity of spinal circuits, microenvironmental change in the spinal cord, and enforcement of the musculoskeletal system, which are additive, complementary, or even synergistic with medication in many cases. However, there are some cases that lack interaction or even demonstrate competition between medication and rehabilitation. A large fraction of the combinatorial mechanisms remains to be elucidated, and very few studies have investigated complex combinations of these agents or targeted chronically injured spinal cords.