著者

Nobuyuki Sasaki Masato Yamatoku Tomoya Tsuchida Hiroyuki Sato Keiichiro Yamaguchi

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.8, pp.20230004, 2023 (Released:2023-02-28)

参考文献数

32

被引用文献数

3

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Objectives: There is no established treatment for chronic fatigue and various cognitive dysfunctions (brain fog) caused by long coronavirus disease 2019 (COVID-19). We aimed to clarify the effectiveness of repetitive transcranial magnetic stimulation (rTMS) for treating these symptoms.Methods: High-frequency rTMS was applied to occipital and frontal lobes in 12 patients with chronic fatigue and cognitive dysfunction 3 months after severe acute respiratory syndrome coronavirus 2 infection. Before and after ten sessions of rTMS, Brief Fatigue Inventory (BFI), Apathy Scale (AS), and Wechsler Adult Intelligence Scale-fourth edition (WAIS4) were determined and N-isopropyl-p-[123I]iodoamphetamine single photon emission computed tomography (SPECT) was performed.Results: Twelve subjects completed ten sessions of rTMS without adverse events. The mean age of the subjects was 44.3 ± 10.7 years, and the mean duration of illness was 202.4 ± 114.5 days. BFI, which was 5.7 ± 2.3 before the intervention, decreased significantly to 1.9 ± 1.8 after the intervention. The AS was significantly decreased after the intervention from 19.2 ± 8.7 to 10.3 ± 7.2. All WAIS4 sub-items were significantly improved after rTMS intervention, and the full-scale intelligence quotient increased from 94.6 ± 10.9 to 104.4 ± 13.0. Hypoperfusion in the bilateral occipital and frontal lobes observed on SPECT improved in extent and severity after ten sessions of rTMS.Conclusions: Although we are still in the early stages of exploring the effects of rTMS, the procedure has the potential for use as a new non-invasive treatment for the symptoms of long COVID.

著者

Takaaki Ikeda Upul Cooray Toshifumi Yodoshi Makoto Kaneko Ken Osaka Masayasu Murakami

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.8, pp.20230033, 2023 (Released:2023-09-27)

参考文献数

41

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Objectives : There has been no analysis of the effects of in-hospital rehabilitation on adult patients with Down’s Syndrome (DS) after hospitalization for community-acquired pneumonia (CAP). Medical claims data retrospectively collected nationwide were used to examine outcomes at discharge.Methods : Hospitalization data were obtained from 440 Japanese hospitals for DS patients with CAP that were discharged between 1 June 2009 and 31 January 2022 (n=2897). After the exclusion of 2478 patients, mainly on the basis of age or type of admission, the records of 419 patients were extracted. The following were used as outcomes: (1) 30-day readmission, (2) 45-day readmission, (3) discharge Barthel Index (BI), (4) BI score gain, and (5) length of hospital stay. The targeted minimum loss-based estimator was used to examine effects of the average daily times of rehabilitation on outcomes at discharge.Results : Most patients had no in-hospital rehabilitation (73.5%). Provided that the average daily time of rehabilitation therapy was at least 20 min, BI scores were lower at discharge (coefficient, −15.91; 95% confidence interval, −30.07 to −1.75) and BI gain was lower (coefficient, −12.56; 95% confidence interval, −25.60 to 0.47) when compared with the use of no rehabilitation therapy.Conclusions : In-hospital rehabilitation medicine in DS patients with CAP provided by a therapist was not associated with improved activities of daily living at discharge. Future studies are warranted to develop systematic, efficient, and comprehensive rehabilitation medicine for DS patients suffering from CAP.

著者

Yuki Yoshimatsu Kazunori Tobino Saori Nishizawa Kohei Yoshimine Yoshitaka Oku

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.7, pp.20220007, 2022 (Released:2022-02-17)

参考文献数

19

被引用文献数

2

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Objectives: Swallowing function is affected in patients with chronic obstructive pulmonary disease (COPD), putting them at risk of exacerbation of COPD. We previously reported the effectiveness of the repetitive saliva swallowing test (RSST) in screening for patients at risk of COPD exacerbation. However, evidence on how to improve swallowing function in this population is extremely limited. Interferential current transcutaneous electrical sensory stimulation (IFC-TESS) stimulates the larynx and pharynx, thereby improving their sensory function. IFC-TESS is an emerging tool to enhance airway protection and increase swallowing frequency; however, its safety and efficacy in patients with COPD is unknown. Therefore, we performed a preliminary prospective study focusing on stable COPD patients.Methods: Patients with stable COPD who were hospitalized for yearly evaluation were recruited. Patients were included if their RSST was 5 or less. Nurses carried out IFC-TESS twice daily for 10 days. Swallow screening results were compared before and after the 10-day intervention.Results: Ten patients were included in the study. The IFC-TESS intervention was performed safely. Patients and nurses reported no discomfort or concerns regarding the intervention. The EAT-10 and RSST scores improved significantly after the intervention, and tongue pressure also tended to improve.Conclusions: IFC-TESS may be a promising intervention to improve swallowing in patients with COPD who are easily fatigued and struggle to perform swallowing exercises.

著者

Yoshiyuki Yoshikawa Terutaka Hiramatsu Masaharu Sugimoto Mikiko Uemura Yuki Mori Ryoko Ichibori

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.7, pp.20220045, 2022 (Released:2022-09-07)

参考文献数

37

被引用文献数

2

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Objectives: This double-blind crossover-controlled trial aimed to verify the effect of electrical stimulation therapy on pressure injuries with undermining.Methods : In this trial, we compared the healing rates between a sham period and a treatment period using monophasic pulsed microcurrent therapy. The participants were randomly assigned to the sham or treatment group and received stimulation for 2 weeks. All the participants, physical therapists, and researchers were blinded to the allocation. For the main analysis, data on the effect of the intervention on changes in weekly healing and contraction rates of the wound areas, including undermining, were analyzed based on a two-period crossover study design. The intervention effect was estimated by examining the mean treatment difference for each period using Wilcoxon’s signed-rank test.Results : The reduction of the entire wound area, including the undermining area, resulted in significantly higher healing and contraction rates in the treatment group (overall wound area reduction rate: contraction rate, P=0.008; period healing rate, P=0.002).Conclusions : Electrical stimulation therapy for pressure injuries, using conditions based on the findings of an in vivo culture study, was effective in reducing the wound area.

著者

Yoshihiro Yoshimura Takahiro Bise Fumihiko Nagano Sayuri Shimazu Ai Shiraishi Makio Yamaga Hiroaki Koga

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.3, pp.20180011, 2018 (Released:2018-05-18)

参考文献数

53

被引用文献数

1 43

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Objective: The aim of our study was to investigate how systemic inflammation relates to sarcopenia and its impact on functional outcomes in the recovery stages of stroke. Methods: A retrospective cohort study was performed in consecutive patients admitted to convalescent rehabilitation wards following stroke. Patients with acute or chronic high-grade inflammatory diseases were excluded. Systemic inflammation was evaluated using the modified Glasgow Prognostic Score (mGPS). Sarcopenia was defined as a loss of skeletal muscle mass and decreased muscle strength, with the cut-off values set by the Asian Working Group for Sarcopenia. The primary outcome was the motor domain of the Functional Independence Measure (FIM-motor). Univariate and multivariate analyses were used to determine whether mGPS was associated with sarcopenia and FIM-motor at discharge. Results: The study included 204 patients (mean age 74.1 years, 109 men). mGPS scores of 0, 1, and 2 were assigned to 149 (73.0%), 40 (19.6%), and 13 (6.4%) patients, respectively. Sarcopenia was diagnosed in 81 (39.7%) patients and was independently associated with stroke history (odds ratio [OR] 1.890, P=0.027), premorbid modified Rankin scale (OR 1.520, P=0.040), body mass index (OR 0.858, P=0.022), and mGPS score (OR 1.380, P=0.021). Furthermore, the mGPS score was independently associated with sarcopenia (OR 1.380, P=0.021) and FIM-motor at discharge (β=−0.131, P=0.031). Conclusion: Systemic inflammation is closely associated with sarcopenia and poor functional outcomes in the recovery stage of stroke. Early detection of systemic inflammation and sarcopenia can help promote both adequate exercise and nutritional support to restore muscle mass and improve post-stroke functional recovery.

著者

Yoshihiro Yoshimura Ayaka Matsumoto Ryo Momosaki

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.7, pp.20220025, 2022 (Released:2022-05-14)

参考文献数

133

被引用文献数

25

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Pharmacotherapy is important in older patients undergoing rehabilitation because such patients, especially those with frailty and physical disabilities, are susceptible to drug-related functional impairment. Drug-related problems include polypharmacy, potentially inappropriate medications (PIMs), and potential prescription omissions. These problems are associated with adverse drug events such as dysphagia, depression, drowsiness, falls and fractures, incontinence, decreased appetite, and Parkinson’s syndrome, leading to impaired improvement in activities of daily living (ADL), quality of life (QOL), and nutritional status. Moreover, the anticholinergic burden is associated with impaired physical and cognitive functions. Therefore, pharmacist-centered multidisciplinary pharmacotherapy should be performed to maximize rehabilitation outcomes. Pharmacotherapy includes a review of all medications, the assessment of drug-related problems, goal setting, correction of polypharmacy and PIMs, monitoring of drug prescriptions, and reassessment of drug-related problems. The goal of pharmacotherapy in rehabilitation medicine is to optimize drug prescribing and to maximize the improvement of ADL and QOL as patient outcomes. The role of pharmacists during rehabilitation is to treat patients as part of multidisciplinary teams and as key members of nutritional support teams. In this review, we aim to highlight existing evidence regarding pharmacotherapy in older adults, including drug-related functional impairment and the association between pharmacotherapy and functional, cognitive, and nutritional outcomes among patients undergoing rehabilitation. In addition, we highlight the important role of pharmacists in maximizing improvements in rehabilitation outcomes and minimizing drug-related adverse effects.

著者

Shinichi Watanabe Yasunari Morita Shuichi Suzuki Kaito Kochi Mika Ohno Keibun Liu Yuki Iida

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.6, pp.20210054, 2021 (Released:2021-12-29)

参考文献数

36

被引用文献数

7

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Objectives: The aim of this study was to investigate the association between the Rehabilitation Activity Time score (RATs)—a score based on the level and duration of rehabilitation activities—of ventilated patients in the intensive care unit (ICU) and activities of daily living (ADL) dependence at discharge.Methods: This retrospective, single-center study evaluated patients aged >18 years who underwent mechanical ventilation in the ICU for at least 48 h. The patients were categorized into the low- and high-dose rehabilitation groups based on the median RATs. The primary outcome was the rate of ADL dependence at discharge, defined as a Barthel index of <70. The association between low or high doses of rehabilitation and the primary outcome was assessed using multiple logistic regression analysis adjusted by baseline factors.Results: The rate of ADL dependence at discharge was significantly lower in the high-dose rehabilitation group (low dose 81% vs. high dose 22%, P<0.001). Multivariate analysis showed a significantly lower ADL dependence at discharge among those who received high-dose rehabilitation (P<0.001). Increased RATs during the entire ICU admission period and during ICU admission after meeting the criteria for physiological stability was significantly associated with lower ADL dependence at discharge (P<0.001). Moreover, a higher RATs from low-level activity before meeting the criteria for physiological stability also showed a significant association with lower ADL dependence at discharge (P=0.047).Conclusions: ADL dependence was significantly lower among those who underwent high-dose rehabilitation. The RATs was consistently associated with ADL dependence at discharge.

著者

Masahiro Iwakura Masahiko Wakasa Kazuki Okura Atsuyoshi Kawagoshi Keiyu Sugawara Hitomi Takahashi Takanobu Shioya

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.6, pp.20210008, 2021 (Released:2021-02-06)

参考文献数

29

被引用文献数

2

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Objectives: We aimed to identify the quadriceps muscle strength (QMS) thresholds below which exercise capacity is compromised in men with chronic obstructive pulmonary disease (COPD).Methods: We measured the quadriceps isometric maximum voluntary contraction (QMVC) and calculated the QMVC values normalized to weight (QMVC-BW), height squared (QMVC-H2), and body mass index (QMVC-BMI) in 113 patients with COPD. The functional exercise capacity was evaluated using the 6-minute walk distance (6MWD), and 6MWD <350 m was defined as functional exercise intolerance. Thresholds were determined for QMVC and its normalized values to achieve high specificity (>0.90) with maximal sensitivity. P-values <0.01 were considered statistically significant.Results: Data from 99 male patients (age, 74 ± 6 years; percentages of predicted forced expiratory volume in 1-s, 56.9 ± 26.4%) were analyzed; 3 women and 11 participants with the missing data were excluded. Multivariate logistic regression models identified significant associations of QMVC and QMVC-H2 with 6MWD, after adjustment for age and dyspnea. C-statistics showed that the area under the curves of all QMVC parameters were comparable. The thresholds of QMVC and QMVC-H2 for predicting compromised exercise capacity were 26.2 kg and 9.6 kg/m2, respectively.Conclusions: QMS thresholds in men with COPD could help clinicians evaluate whether QMS is insufficient to achieve 6MWD ≥350 m and thereby identify patients who should be specifically targeted for muscle strengthening training during their pulmonary rehabilitation program.

著者

Tomoko Sakai Chisato Hoshino Masanobu Hirao Reiko Yamaguchi Rui Nakahara Atsushi Okawa

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.6, pp.20210013, 2021 (Released:2021-03-04)

参考文献数

18

被引用文献数

10

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Objectives: The aim of the study was to describe the characteristics and efficiency of rehabilitation for patients diagnosed with moderate-to-severe coronavirus disease (COVID-19).Methods: We retrospectively assessed the medical records of patients with COVID-19 who underwent rehabilitation for early mobilization and to maintain activities of daily living at our hospital between April 21 and August 20, 2020. The following patient data were evaluated: age, sex, diseases, and the total number of sessions completed by patients with severe COVID-19 in the intensive care unit (ICU) and by patients with moderate disease in the general COVID-19 wards. The number of daily sessions performed by physiotherapists was also evaluated.Results: Of 161 patients with COVID-19 admitted during the study period, 95 underwent rehabilitation (78 in the general COVID-19 wards and 17 in the ICU). These 95 COVID-19 patients completed 1035 rehabilitation sessions in total (882 in the general ward and 153 in the ICU). Polymerase chain reaction test results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were positive for 79 patients on the initiation of rehabilitation. Moreover, 86 sessions were supervised remotely, thereby reducing the duration of the medical staff’s stay in the SARS-CoV-2 isolation area. Patients with COVID-19 in the ICU received significantly more daily physiotherapy sessions than general ward patients (P<0.001). Each physiotherapist performed, on average, 4.6 sessions daily, with 4.3 daily sessions being performed wearing personal protective equipment (PPE).Conclusions: COVID-19 rehabilitation required more efforts as wearing PPE was necessary for most cases although tried with remote rehabilitation in some cases. Overall, a longer rehabilitation period was needed for ICU patients.

著者

Yumi Yamada Hiroshi Shamoto Keisuke Maeda Hidetaka Wakabayashi

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.3, pp.20180019, 2018 (Released:2018-11-20)

参考文献数

18

被引用文献数

7

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Background: Sarcopenic dysphagia is caused by decreased muscle mass and muscle weakness in the swallowing muscles that occurs because of sarcopenia. The key to treating sarcopenic dysphagia is combined therapy with rehabilitation and aggressive nutrition management. However, to our knowledge, no studies based in a home medical care setting have yet been published. Case: A 72-year-old man with Parkinson’s disease developed sarcopenia and possible sarcopenic dysphagia during hospitalization for drug adjustment. At discharge, the patient’s body weight was 39.0 kg (−33.8%/4 months, body mass index: 15.3 kg/m2), the Barthel Index was 45, Functional Oral Intake Scale was level 4, and Dysphagia Severity Scale was 4. Sarcopenia was confirmed by a calf circumference of 23.8 cm, a handgrip strength of 22 kg, and a gait speed of 0.5 m/s. The patient was diagnosed with sarcopenic dysphagia, according to the consensus diagnostic criteria for sarcopenic dysphagia. After the patient was discharged, he underwent a combination of dysphagia rehabilitation, daily activity training, and aggressive nutrition management, which started from 1200 kcal/day and reached a maximum of 2800 kcal/day. Four months after discharge, the patient’s swallowing function returned to normal (Functional Oral Intake Scale: 7, Dysphagia Severity Scale: 6) and his weight increased by 31% (body mass index: 20.1 kg/m2). Increases in muscle mass (calf circumference: 32 cm), muscle strength (handgrip strength: 34 kg), physical function (gait speed: 1 m/s), and activities of daily living (Barthel Index: 90) indicated recovery from sarcopenia. Discussion: Sarcopenic dysphagia may be a complication of Parkinson’s disease, and home-based combined therapy with rehabilitation and aggressive nutrition management may be effective for treating this condition.

著者

Tatsuya Yamaoka Yuta Takagi Ryota Shimomura Yuki Murata Katsumi Shimotake Akihiro Itoh Tatsuya Mima Satoko Koganemaru

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.8, pp.20230018, 2023 (Released:2023-06-22)

参考文献数

24

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Background: Transcutaneous electrical sensory nerve stimulation (TESS) is used to enhance the recovery of sensorimotor function in post-stroke hemiparesis. However, TESS efficacy for post-stroke gait disturbance remains unknown. We hypothesized that TESS on the area innervated by the tibial nerve, targeting the superficial plantar sensation, combined with gait training would improve gait function in patients with gait disturbance caused by severe superficial sensory disturbance after stroke.Case: A 42-year-old man was referred to the convalescent rehabilitation hospital 4 months after a left pontine hemorrhage. He showed severe superficial sensory disturbance without motor paresis in the right lower leg and planta pedis. Gait training with TESS on the tibial nerve innervated area was performed, targeting plantar sensation according to an N-of-1 study design of a single-case ABCAB that included two 10-min sessions of gait training without TESS (phase A), two gait training sessions with TESS targeting the right plantar sensation (phase B), and one session with TESS targeting the upper leg sensation as control (phase C). The patient showed increased gait distance and stride length, improved superficial sensation on the right planta pedis, and improved balance after phase B, but not after phases A and C.Discussion: Gait training with TESS on the tibial nerve innervated area improved gait ability, superficial plantar sensation on the targeted side, and balance function in a post-stroke patient with sensory disturbance. Gait training with TESS may be effective for gait dysfunction caused by sensory disturbance in patients with central nervous system disorders.

著者

二木 立

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

リハビリテーション医学 (ISSN:0034351X)

巻号頁・発行日

vol.19, no.4, pp.201-223, 1982-07-18 (Released:2009-10-28)

参考文献数

53

被引用文献数

41 18

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脳卒中患者のリハビリテーション後の最終自立度が,(1)患者の年齢,(2)各時期の自立度,(3)臨床的諸因子の組み合わせにより,早期にどの程度予測可能かを検討した.対象は発症後第30病日以内に入院した脳卒中患者406人で,平均年齢は67.0歳である.自立度は,屋外歩行,屋内歩行,ベッド上生活自立,全介助の4段階に分類し,臨床的諸因子としては,運動障害の他に,意識障害,痴呆,夜間せん妄等12因子を選んだ.これら諸因子を組み合わせて作製した予測基準により,入院時自立歩行不能患者のうち,7割は入院時に,8割は入院後2週時に,9割は同1月時に,最終自立度が予測可能であった.

著者

Mitsunobu Watanabe Junji Maeda

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.7, pp.20220063, 2022 (Released:2022-12-14)

参考文献数

37

被引用文献数

2

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Objectives: Hip fracture in the elderly involves two cases of invasive damage to the body within a short period of time: the fracture itself and subsequent surgery. This situation affects physical strength and presents a major challenge during convalescent rehabilitation. This study aimed to evaluate the effects of hochuekkito, a traditional Japanese herbal medicine, on physical activity, appetite, motivation, and quality of life (QOL) during inpatient rehabilitation treatment after hip surgery.Methods: Thirty-eight patients with hip fracture who underwent postoperative convalescent rehabilitation were randomly assigned to either the hochuekkito group (n=20, daily hochuekkito administration from day 3 after surgery until discharge from hospital) or the control group (n=18). Physical activity was measured with a small tri-axial accelerometer worn by the patients; appetite was evaluated based on daily dietary calorie consumption; motivation was measured using the vitality index score; and QOL was measured using the European QOL 5-Dimensions 5-Levels questionnaire and its associated EQ-visual analog scale (EQ-VAS). All patients were assessed at day 3 (baseline) and 2, 4, 6, 8, and 10 weeks after surgery and at the time of discharge from hospital.Results: The results for the hochuekkito group were significantly higher than the control group for walking exercise at 10 weeks, vigorous activity time at 8 weeks, dietary calorie consumption at 10 weeks and at discharge, and EQ-VAS score at 6 weeks.Conclusions: In elderly hip fracture patients, a course of hochuekkito administration starting soon after surgery significantly improved QOL, physical activity, and appetite at 6 weeks after surgery.

著者

井上 幸一 長谷川 武志 荏原 包臣 桑原 敏樹 藤田 良範 新谷 博一

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

リハビリテーション医学 (ISSN:0034351X)

巻号頁・発行日

vol.25, no.2, pp.93-104, 1988-03-18 (Released:2009-10-28)

参考文献数

20

被引用文献数

1

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心筋梗塞回復期の男性患者54名に入浴の負荷試験を日常と同じ体を洗う動作を加えて行い,同時に40℃と42℃とを比較し,入浴の安全性と適温について検討した.PRP (pressure rate product)は温浴直後と洗う動作で増大し,心電図変化はST偏位が温浴と洗う動作で,期外収縮が温浴直後に多く出現し,1回心拍出量を表すPEP/ETは温浴で低下し,これらの変化は40℃より42℃で大きかった.臨床経過や検査成績を軽症と重症に分け比較すると,急性期Peelの予後指数10以上の例,リハの心合併症出現例,運動負荷試験の成績不良例,筆者らのHolter DCGの分類3以上の例など重症な例では,入浴時に心電図変化の出現が多く注意を要した.一方,軽症例では変化が少なく安全と考えられた.

著者

Ryozo Tanaka Hiroaki Fushiki Reiko Tsunoda Tomohiko Kamo Takumi Kato Hirofumi Ogihara Masato Azami Kaoru Honaga Toshiyuki Fujiwara

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.8, pp.20230002, 2023 (Released:2023-01-14)

参考文献数

35

被引用文献数

2

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Objectives: This study investigated the effects of a supervised home-based vestibular rehabilitation program using a booklet on gait function and dizziness in patients with chronic peripheral vestibular hypofunction.Methods: This was a non-blinded, randomized, controlled trial. Patients (n=42) with chronic peripheral vestibular hypofunction were randomly divided into the vestibular rehabilitation group (VR group; n=20) or the control group (n=22). Patients in the VR group received a supervised home-based vestibular rehabilitation program using a booklet in addition to physician care for 4 weeks. The physical therapist checked the home program when the VR group visited the outpatient clinic once a week. Patients in the control group received physician care only during the trial period. The primary outcome was functional gait assessment (FGA). The secondary outcomes were the dynamic gait index (DGI) and the dizziness handicap inventory (DHI).Results: Two-way repeated measures analysis of variance showed a significant interaction for FGA, DGI, DHI total, and DHI emotional scores (P<0.05) with the VR group improving more than the control group. No significant interactions were found for DHI physical and DHI functional scores (P≥0.05).Conclusions: The home-based vestibular rehabilitation program in this study was effective in improving gait function and dizziness in patients with chronic peripheral vestibular hypofunction. Regular supervision may have improved adherence to home exercise and contributed to the effectiveness of vestibular rehabilitation.

著者

Aki Tabata Hiroki Yabe Yuya Mitake Tomohiro Shirai Marina Yoshida Rie Kurosu Ken Kawamura

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.7, pp.20220040, 2022 (Released:2022-08-10)

参考文献数

31

被引用文献数

1

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Background: Exercise therapy for patients with pediatric nephrotic syndrome is necessary to improve physical function to maintain the patient’s activities of daily life and school life while managing the risk of relapse; however, few studies have examined exercise therapy in the acute phase of the syndrome. This case study aimed to evaluate the efficacy and safety of exercise therapy in a patient with acute pediatric nephrotic syndrome being treated with steroids.Case: The patient was a 10-year-old boy diagnosed with primary nephrotic syndrome. Prednisolone (50 mg) was started on the 3rd day of hospitalization. Exercise therapy (moderate-intensity, 40 min, five times a week) was started on the 15th day. The urine protein/creatinine ratio from the 15th day (at the start of rehabilitation) to discharge decreased from 1.1  to 0.4, with no recurrence of nephrotic syndrome. At the initial, middle, and final evaluations, respectively, the grip strength was 10.1, 8.9, and 8.3 kg; the knee extension strength was 0.38, 0.46, and 0.45 kgf/kg; the sit-up test results were 18, 18, and 15 times; the side-step test results were 34, 36, and 31 times; the sit-and-reach test results were 22.9, 24.5, and 23.8 cm; and the 6-min walk test results were 420, 490, and 520 m. Leg muscle strength and exercise tolerance improved, but upper limb strength, trunk muscle strength, and agility decreased.Discussion: Moderate-intensity exercises may be effective and safe for pediatric patients with nephrotic syndrome in the acute phase. Exercise therapy may be beneficial to improve physical function and prevent decline during hospitalization in pediatric nephrotic syndrome patients.

著者

Minori Kurosaki Masahiko Tosaka Yoko Ibe Hironori Arii Junichi Tomono Masayuki Tazawa Tatsuya Shimizu Masanori Aihara Yuhei Yoshimoto Naoki Wada

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.7, pp.20220039, 2022 (Released:2022-08-04)

参考文献数

27

被引用文献数

1

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Objectives: Stroke patients with hemiplegia can sometimes achieve independent life at home or in light care facilities after rehabilitation. This study examined the outcomes of rehabilitation in stroke patients with severe hemiplegia.Methods: This study included 50 patients with Brunnstrom recovery stage I–II hemiplegia at the start of rehabilitation for stroke. Good outcome after rehabilitation was defined as independent life with functional independence measure (FIM) score of 100 or greater. Predictors for post-rehabilitation functional recovery were statistically analyzed.Results: FIM scores of 100 or greater in 12 of 50 patients (24%) allowed independent life after stroke rehabilitation. According to univariate analysis, factors associated with a FIM score of 100 or greater and good prognosis after rehabilitation were younger age (<70 years), paralysis caused by intracerebral hematoma (ICH), no cortical lesions, short time from admission to comprehensive inpatient rehabilitation (CIR) for stroke (within 1 month), and good status at the start of early rehabilitation and CIR. Eleven of the 12 patients with good prognosis (FIM ≥100) had ICH and a basal ganglia lesion with no cortical damage. Analysis of the location of lesions suggested that many patients with basal ganglia ICH lesions and little cortical involvement have good prognoses.Conclusions: Stroke patients with severe hemiplegia showed a slightly different distribution of lesions between ICH and cerebral ischemia. Cortical involvement may be a prognostic factor for outcome after rehabilitation in stroke patients with severe hemiplegia. More aggressive rehabilitation interventions may be important for patients with severe hemiplegia, especially without cortical involvement.

著者

Mayumi Matsuda Kuroda Nobuaki Iwasaki Kenichi Yoshikawa Ryoko Takeuchi Yuki Mataki Tomohiro Nakayama Junko Nakayama Haruka Ohguro Kayo Tokeji Hirotaka Mutsuzaki

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.7, pp.20220050, 2022 (Released:2022-09-15)

参考文献数

29

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Background: Constraint-induced movement therapy (CIMT) improves the motor function of paralyzed upper limbs of adults after stroke. However, in patients with severe spastic cerebral palsy (CP), the use of CIMT is not warranted. Our aim was to investigate the feasibility and effectiveness of repetitive voluntary-assisted upper limb training (VAUT) for three patients with severe CP using a combination of robotics [Hybrid Assistive Limb (HAL)] and functional electrical stimulation [Integrated Volitional Control Electrical Stimulation (IVES)].Case: Three patients with CP were enrolled. Patients 1, 2, and 3 were 8-, 19-, and 18-year-old males, respectively. Patient 1 had spastic hemiplegia, while patients 2 and 3 had spastic quadriplegia. VAUT using single-joint HAL was performed for 1 or 2 sessions/month for 50 min/session over an 8-month period for 9–13 sessions in total. One patient’s voluntary hand movement was insufficient, affecting his upper limb exercise performance; therefore, IVES was required in addition to HAL. Outcome measures included motor function of the upper limbs and use of paralyzed hands, which were measured before and after intervention. No adverse events were observed during VAUT. After intervention, the Action Research Arm Test scores showed improvements in all three patients. The Children’s Hand-use Experience Questionnaire showed improvements in two patients.Discussion: The use of VAUT, together with new systems such as HAL and IVES, for severe CP is safe and may be effective. Our study suggested that upper limb function can be improved for patients with severe CP.

著者

Yoichi Sato Noriaki Iino

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.7, pp.20220057, 2022 (Released:2022-11-12)

参考文献数

21

被引用文献数

3

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Objectives: Physical activity is an important prognostic factor in managing hemodialysis patients. During winter, physical activity decreases, which necessitates interventions to maintain physical function. This study investigated whether snow removal is an effective physical activity to maintain physical function in hemodialysis patients.Methods: This retrospective cohort study examined 32 patients (aged 68.9 ± 14.2 years, 21 men) who underwent hemodialysis at Uonuma Kikan Hospital from March 2021 to March 2022. The patients were divided into snow-remover and non-snow-remover groups. The primary outcome was the Short Physical Performance Battery (SPPB). Secondary outcomes were grip strength, skeletal muscle index, and physical activity level. Differences in outcomes between the groups were investigated at 1 year of follow-up.Results: The snow-remover group had significantly high SPPB score, grip strength (men), skeletal muscle index (men), and physical activity at baseline. The decline in SPPB after 1 year was significantly smaller in the snow-remover group than in the non-snow-remover group. The level of physical activity in the non-snow-remover group decreased over time.Conclusions: Snow removal contributed to the maintenance of physical function in hemodialysis patients after 1 year. However, snow removal is not recommended for all hemodialysis patients, and further studies should identify other safe winter activities to maintain physical function.

著者

Yoshihiro Yoshimura Ai Shiraishi Yuri Tsuji Ryo Momosaki

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.7, pp.20220019, 2022 (Released:2022-04-12)

参考文献数

15

被引用文献数

19