論文

【目的】悪液質リスクの高い高齢進行がん患者に対して，初回化学療法導入時より栄養と運動を組み合わせたマルチモーダルな介入プログラムを開発した．本研究の目的は，その中の下肢筋力トレーニングの詳細と安全性および忍容性を報告することである．【方法】対象は，初回化学療法導入予定の70歳以上の進行非小細胞肺がんおよび進行膵がん患者30例とした．下肢筋力トレーニングは約8週間の在宅ベースプログラムとし，対象者別にトレーニング内容および負荷量を設定した．【結果】介入期間中の下肢筋力トレーニングの実施割合は91（69〜95）％であった．治療継続や日常生活に影響を及ぼすような有害事象発生はなく，介入前後で身体機能や活動量の有意な低下は認められなかった．【結論】悪液質リスクの高い高齢進行がん患者において，われわれが開発した下肢筋力トレーニングは高い実施割合を有し，身体機能や身体活動量の維持に寄与した可能性が示唆された．

【目的】悪液質リスクの高い高齢進行がん患者に対して、初回化学療法導入時より栄養と運動を組み合わせたマルチモーダルな介入プログラムを開発した。本研究の目的は、その中の下肢筋力トレーニングの詳細と安全性および忍容性を報告することである。【方法】対象は、初回化学療法導入予定の70歳以上の進行非小細胞肺がんおよび進行膵がん患者30例とした。下肢筋力トレーニングは約8週間の在宅ベースプログラムとし、対象者別にトレーニング内容および負荷量を設定した。【結果】介入期間中の下肢筋力トレーニングの実施割合は91(69〜95)%であった。治療継続や日常生活に影響を及ぼすような有害事象発生はなく、介入前後で身体機能や活動量の有意な低下は認められなかった。【結論】悪液質リスクの高い高齢進行がん患者において、われわれが開発した下肢筋力トレーニングは高い実施割合を有し、身体機能や身体活動量の維持に寄与した可能性が示唆された。(著者抄録)

癌患者に必要とされる支持・緩和療法は多岐にわたり，その一部については専門学会からのガイドラインも出版されているが，膵癌患者に特に重要と考えられる臨床的疑問については本ガイドラインにおいて指針を提示することが必要との議論がなされ，2016年版より精神心理的苦痛への対応方法，上腹部痛・背部痛に対する治療法，栄養療法，が取り上げられることとなった．2019年版ではさらに，膵癌術後患者に対する運動療法，アドバンス・ケア・プランニング，化学療法における末梢神経障害への対応方法，を新たなCQとして設定し，エビデンスの収集と推奨の提言を行った．また，悪液質を伴う膵癌患者における栄養支持療法，患者向け資材（パンフレット），コミュニケーション・スキル，心理的・社会的・経済的問題に対する支援，患者会，についてコラムで取り上げて情報提供を行うこととした．

進行がん患者がdistress:苦痛を抱える可能性は高いが、その適切な介入法は確立していない。著者らは肺がん患者の自宅復帰支援を多職種で行う機会を得た。その結果、対象者は自身の身体機能の低下や疼痛に影響を受けながらも、日常生活動作能力を向上させると共に、distressの症状を軽減させた。我々は、(1)正のフィードバックを行い対象者の自尊心を保持する、(2)対象者や家族のニーズを聴取し、目標に向け多職種で協働する、(3)外泊訓練を実施するなどの取り組みを行った。本介入は、心身に配慮した多職種でのリハビリテーションは、対象者の自宅復帰に至るまでの再適応の心理的過程である、心理的適応を促進させる可能性を示した。(著者抄録)

© The Author(s), 2019. Background: Somatosensory function has been frequently overlooked in clinics and research in the field of chronic stroke. The effects of neurorehabilitation interventions on sensory processing have still to be investigated using electrophysiological means. This study investigated the effect of hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy utilizing closed-loop electromyography-controlled neuromuscular electrical stimulation (NMES), on sensory changes and cortical plasticity among patients with chronic stroke. Methods: This study was a prespecified analysis of 23 participants involved in an ongoing large interventional study. Patients with severe upper limb hemiplegia dues to chronic stroke underwent 3 weeks of inpatient HANDS therapy, where daily treatment consisted of 8 h of NMES combined with wrist splinting, 90 min of comprehensive occupational therapy, and the practice of bimanual activities of daily living. Somatosensory evoked potentials (SEPs) and functional sensory assessments, including the Semmes–Weinstein monofilament test (SWMT) and thumb localizing test (TLT), were compared pre and post-treatment. Results: While no significant recovery of tactile sensation was observed, significant improvements in proprioception and motor function were induced. The number of cortical peaks significantly increased in the median nerve, but not in the tibial nerve. A total of 9 out of 11 participants who initially lacked certain peaks responded to treatment. Further analysis revealed a significant improvement in latency and amplitude of SEP peaks. Conclusions: Our results suggest that NMES-based neurorehabilitation induces certain plastic changes in the primary sensory cortex and in cortices associated with sensorimotor processing in people with chronic stroke sequelae, which may explain the observed improvements in proprioception.

© 2020, © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. Many studies have reported that physical exercise can improve the levels of function, quality of life (QoL), and fatigue in patients with hematologic malignancies. However, exercises should be prescribed with caution in patients with thrombocytopenia to prevent exercise-related bleeding. Some studies have suggested threshold platelet counts at which physical exercise can safely be performed. Herein, we review the current literature to determine the platelet count thresholds and types of physical exercise that may be prescribed to reduce the risk of exercise-related bleeding in those with hematological malignancies while undergoing chemotherapy.

Objective: The aim of the current study was to assess the risk factors for developing lymphedema following breast cancer treatment. Methods: The subjects of this study were 238 consecutive patients who underwent axillary lymph node dissection for breast cancer at Shikoku Cancer Center. The study variables were the occurrence of lymphedema, the body mass index, the follow-up period, the drain removal time, the level of lymph node dissection, the presence or absence of co-resident household members, radiation therapy, neoadjuvant chemotherapy, and adjuvant chemotherapy. Results: We observed lymphedema in 23.9% of patients after axillary lymph node dissection for breast cancer. Neoadjuvant chemotherapy and adjuvant chemotherapy using docetaxel and cyclophosphamide increased the risk of developing lymphedema (P <0.05). Conclusions: Those patients treated with neoadjuvant chemotherapy and adjuvant chemotherapy using docetaxel and cyclophosphamide should be observed closely after axillary lymph node dissection, and appropriate intervention should be considered from an early stage.

© 2020, Springer-Verlag GmbH Germany, part of Springer Nature. Objectives: Postoperative shoulder joint dysfunction has been observed at a certain rate after breast cancer surgery with axillary lymph node dissection. The purposes of this study were to verify the feasibility and effects of home-based exercise using a DVD and clarify the target of intensive intervention with physiotherapy by identifying the factors that cause postoperative shoulder dysfunction. Methods: The study comprised 237 female patients who underwent breast cancer surgery with axillary lymph node dissection, whose data were acquired until 3 months postoperatively. All patients were instructed to exercise at home using a DVD. Range of motion (ROM) of shoulder flexion and abduction and the disability of the arm, shoulder, and hand (DASH) score were measured before surgery, 1 week and 1, 2, and 3 months after surgery. As factors influencing the recovery of shoulder ROM at 3 months after surgery, the presence or absence of radiation and factors up to 1 month after surgery (age, body mass index, the relationship between operated side and dominant side of the hand, treatment modalities, and complications). Results: Shoulder ROM and DASH scores had gradually recovered from 1 week to 3 months postoperatively. As the results of the multivariate analysis, the factors that were associated with the recovery of ROM of shoulder flexion at 3 months were the side of surgery corresponding to the dominant hand (negative factor) and the presence of paresthesia at 1 week postoperatively (positive factor) (p < 0.05). Radiation therapy and the side of surgery corresponding to the dominant hand were negative factors for the recovery of shoulder abduction (p < 0.01). Regarding the feasibility of the home exercise, 214/229 (93.4%), 172/210 (81.9%), and 139/206 (67.5%) of patients performed exercise at least once a day at 1, 2, and 3 months after surgery, respectively. Conclusion: Our result indicated that the side of surgery corresponding to the dominant hand was the inhibiting factor for recovery for both shoulder flexion and abduction at 3 months after surgery. Home-based exercise with DVD was considered feasible. For the verification of this effectiveness, a randomized control study should be planned in the future.

© RSNA, 2020. Background: Detailed visualization of the lymphatic vessels would greatly assist in the diagnosis and monitoring of lymphatic diseases and aid in preoperative planning of lymphedema surgery and postoperative evaluation. Purpose: To evaluate the usefulness of photoacoustic imaging (PAI) for obtaining three-dimensional images of both lymphatic vessels and surrounding venules. Materials and Methods: In this prospective study, the authors recruited healthy participants from March 2018 to January 2019 and imaged lymphatic vessels in the lower limbs. Indocyanine green (5.0 mg/mL) was injected into the subcutaneous tissue of the first and fourth web spaces of the toes and below the lateral malleolus. After confirmation of the lymphatic flow with near-infrared fluorescence (NIRF) imaging as the reference standard, PAI was performed over a field of view of 270 3 180 mm. Subsequently, the number of enhancing lymphatic vessels was counted in both proximal and distal areas of the calf and compared between PAI and NIRF. Results: Images of the lower limbs were obtained with PAI and NIRF in 15 participants (three men, 12 women; average age, 42 years 6 12 [standard deviation]). All participants exhibited a linear pattern on NIRF images, which is generally considered a reflection of good lymphatic function. A greater number of lymphatic vessels were observed with PAI than with NIRF in both the distal (mean: 3.6 vessels 6 1.2 vs 2.0 vessels 6 1.1, respectively; P , .05) and proximal (mean: 6.5 vessels 6 2.6 vs 2.6 vessels 6 1.6; P , .05) regions of the calf. Conclusion: Compared with near-infrared fluorescence imaging, photoacoustic imaging provided a detailed, three-dimensional representation of the lymphatic vessels and facilitated an increased understanding of their relationship with the surrounding venules.

We developed a computerised test to evaluate unilateral spatial neglect (USN) using a touchscreen display, and estimated the spatial and temporal patterns of visual search in USN patients. The results between a viewer-centered USN patient and a stimulus-centered USN patient were compared. Two right-brain-damaged patients with USN, a patient without USN, and 16 healthy subjects performed a simple cancellation test, the circle test, a visuomotor search test, and a visual search test. According to the results of the circle test, one USN patient had stimulus-centered neglect and a one had viewer-centered neglect. The spatial and temporal patterns of these two USN patients were compared. The spatial and temporal patterns of cancellation were different in the stimulus-centered USN patient and the viewer-centered USN patient. The viewer-centered USN patient completed the simple cancellation task, but paused when transferring from the right side to the left side of the display. Unexpectedly, this patient did not exhibit rightward attention bias on the visuomotor and visual search tests, but the stimulus-centered USN patient did. The computer-based assessment system provided information on the dynamic visual search strategy of patients with USN. The spatial and temporal pattern of cancellation and visual search were different across the two patients with different subtypes of neglect.

Background and objective. Unilateral spatial neglect (USN) can interfere with rehabilitation processes and lead to poor functional outcome. The purpose of this study was to determine whether prism adaptation (PA) therapy improves USN and functional outcomes in stroke patients in the subacute stage. Methods. A multicenter, double-masked, randomized, controlled trial was conducted to evaluate the effects of a 2-week PA therapy on USN assessed with the Behavioral Inattention Test (BIT), the Catherine Bergego Scale (CBS), and activities of daily living (ADL) as evaluated with the Functional Independence Measure (FIM). A total of 38 USN patients with right-brain damage were divided into prism (n = 20) and control (n = 18) groups. Patients were divided into mild and severe USN groups according to BIT behavioral test (mild 55 and severe<55). The prism group performed repetitive pointing with prism glasses that induce rightward optical shift twice daily, 5 days per week, for 2 weeks, whereas the control group performed similar pointing training with neutral glasses. Results. The FIM improved significantly more in the prism group. In mild USN patients, there was significantly greater improvement of BIT and FIM in the prism group. Conclusions. PA therapy can significantly improve ADL in patients with subacute stroke. © 2011 American Society of Neurorehabilitation.

Objective: Patterned sensory electrical stimulation (PES) has been shown to induce plasticity in spinal reciprocal Ia inhibition of the calf muscles. To study the cortical modulation of spinal plasticity, we examined the effects of giving transcranial direct current stimulation (tDCS) to the motor cortex before PES. Methods: Seven healthy volunteers participated in this study. PES involved stimulating the left common peroneal nerve at the fibular head with a train of 10 pulses at 100. Hz every 1.5. s for 20. min using an intensity equal to the motor threshold of the tibialis anterior. tDCS was applied for 10. min before PES. For anodal stimulation, the electrode was placed over the motor cortex, and the cathodal electrode over the contralateral supraorbital area. For cathodal stimulation, the electrodes were reversed. Reciprocal inhibition was assessed using a soleus H reflex conditioning-test paradigm. Results: PES increased disynaptic reciprocal inhibition from the peroneal nerve to the soleus H reflex. When cathodal tDCS was applied before PES, PES no longer increased reciprocal inhibition. Conclusions: Applying tDCS before PES modulated the effects of PES on spinal reciprocal inhibition in a polarity specific manner. Significance: We suggest that the motor cortex may play a role in spinal plasticity. © 2011 International Federation of Clinical Neurophysiology.

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.