Progress in rehabilitation medicine最新文献

Background: Streptococcal toxic shock syndrome (STSS) is a notifiable disease under Japan's Infectious Disease Control Law and has become a pandemic following COVID-19. STSS often leads to necrotizing fasciitis, with a mortality rate exceeding 30%. Even in surviving patients, limb amputations are common.

Case: A 39-year-old woman developed STSS. She underwent 18 surgeries and vacuum-assisted closure therapy, which resulted in ultra-short right transfemoral amputation. With a strong desire to walk again, she began fitting for a provisional prosthesis 3 months post-amputation. Given the preserved hip muscle strength, an ultra-short transfemoral prosthesis was selected over a hip disarticulation prosthesis. The key components included a plug-in quadrilateral socket, a belt used to suspend the transfemoral prosthesis, a hydraulic knee joint, and an energy-storing foot. She regained walking ability using crutches. To address pain and skin issues in the stump load-bearing area, compression and adhesion were improved using thick fabric spats. Muscle mass, including that of the paraspinal muscles, was maintained during follow-up evaluations using computed tomography, dual-energy X-ray absorptiometry, and bioelectrical impedance analysis. The phantom limb pain in the right leg diminished with medication and prosthetic training. Her quality-of-life scores measured using the 36-item Short Form Questionnaire and the Prosthesis Evaluation Questionnaire also showed improvement. She was discharged home 5 months post-amputation.

Discussion: This case highlights the importance of high motivation, multidisciplinary collaboration, preservation of the trunk muscle reserve from pre-illness exercise habits, and early trunk rehabilitation to achieve successful gait acquisition with a customized transfemoral prosthesis.

Objectives: This study investigated the impact of neuromuscular electrical stimulation (NMES) to the gluteus maximus in the bed flat position (F position) and 30-degree head elevation position (30 HE position) on sacral pressure.

Methods: Twenty volunteers consented to participate in this study. Sacral pressure was measured in the F position and at the 30 HE position with and without NMES in the supine positions. NMES was applied to the gluteus maximus (frequency, 50 Hz; pulse width, 300 μs) with sufficient stimulus intensity to induce muscle contraction. Sacral maximum pressure was determined as peak pressure index (PPI) by averaging the values from the central nine sensors of the maximum pressure zone. The effect of NMES on pressure gradient and the influence of sex difference were also explored.

Results: Sacral PPI was significantly lower after NMES implementation in both the F position and the 30 HE position when compared with conditions without NMES (P <0.001). The pressure gradient was also significantly decreased with NMES (P <0.001). Analysis of sex difference in subjects treated with NMES revealed a significantly greater effect on maximum sacral pressure in males than in females.

Conclusions: Application of NMES to the gluteus maximus helps to disperse sacral pressure in supine positions. NMES on the gluteus maximus can be a clinical means to manage interfacial pressure in supine positions.

Objectives: This study aimed to investigate the impact of shoulder dysfunction on concomitant neck disability in patients with shoulder disorders.

Methods: The participants were patients with subacromial impingement syndrome (SIS) and frozen shoulder (FS). Twenty patients with SIS and 21 with FS without cervical radiculopathy were enrolled. The participants were assessed for the 4-week prevalence of neck pain, Neck Disability Index (NDI), shoulder strength and range of motion, a short version of the Disabilities of the Arm, Shoulder, and Hand questionnaire (quick-DASH), and the Pain Catastrophizing Scale (PCS).

Results: The 4-week prevalence of neck pain was 12 out of 20 (60%) in patients with SIS and 13 out of 21 (62%) in patients with FS. The median NDIs were 13 and 12 for SIS and FS, respectively, with no statistically significant difference. About 41% (17/41) of the participants displayed an NDI greater than the cutoff value for disability in daily living. Although shoulder abduction strength correlated with the NDI in patients with SIS, the PCS score correlated with the NDI in patients with FS.

Conclusions: Concomitant neck disability is a critical concern for patients with shoulder disorders. The clinical factors related to concomitant neck disability differ between SIS and FS, with specific interventions recommended for each condition.

Background: We designed a telerehabilitation (TR) program for stroke patients based on reports from other countries and adapted the program for use by individual patients. Herein, we describe the clinical courses of three stroke survivors who used the TR program.

Cases: All three individuals were community-dwelling chronic stroke survivors. Patient 1 (P1) was a 50-year-old man who presented with severe paralysis of the right upper and lower extremities caused by left cerebral hemorrhage. Patient 2 (P2) was a 56-year-old woman who presented with severe paralysis of the left upper and lower extremities caused by right cerebral hemorrhage. Patient 3 (P3) was a 55-year-old man who presented with severe paralysis of the left upper and lower extremities caused by right cerebral hemorrhage. The TR program was conducted through a web conference system that allowed therapists and patients to interact with each other. The intervention consisted of 30-min sessions every 2 weeks for 6 months. The clinical courses and outcomes of the patients differed, but we identified positive changes in physical activity (number of steps) and participation (expansion of life-space) in addition to improvements in functional impairments (e.g., motor paralysis and balance order) in each patient. All three patients were highly satisfied with the TR program.

Discussion: The results observed in this case series suggest that TR programs are a viable intervention in Japan. TR programs can reduce barriers to continued rehabilitation after discharge and can encourage increased activity and participation.

Background: In patients vulnerable to skeletal-related events (SREs), a multidisciplinary approach is required to manage risk and determine the best treatment plan. We have used Bone Metastasis Cancer Boards (BMCBs) to deliver multidisciplinary treatments in our hospital since 2013. Here, we report a case in which we used BMCBs to coordinate multidisciplinary treatment for a pregnant patient with breast cancer and multiple bone metastases.

Case: A 41-year-old pregnant woman was admitted to our hospital because low back pain compromised her ability to stand. She was diagnosed with breast cancer-associated multiple bone metastases. Our unit was consulted for rehabilitation therapy, for which we formed a BMCB. The treatment was integrated and performed according to the recommendations of the BMCB. The patient underwent a cesarean section to initiate primary tumor treatment. After evaluating the risk of SREs, we provided her with rehabilitation therapy. Wearing a plastic molded thoracolumbosacral orthosis, she was able to walk with a pick-up walker. The patient continued outpatient chemotherapy and cared for her infant without experiencing any significant adverse events.

Discussion: In this case, we formed our BMCB to determine the treatment plan, which we used to support the patient's needs during childbirth and successfully improved her activities of daily living. BMCBs can contribute to preventing SREs and provide effective rehabilitation therapy for patients with bone metastases. We aspire to continually gather experience through our BMCBs and contribute to the establishment of evidence regarding the effectiveness of rehabilitation therapy for patients with bone metastases.

Objectives: Cancer cachexia has many effects on physical function and causes a decline in activities of daily living (ADL). Therefore, rehabilitation programs should be structured according to the degree of cancer cachexia. Currently, the evaluation of cancer cachexia is mainly based on body mass. However, there is no report on the use of the modified Glasgow Prognostic Score (mGPS) to evaluate the degree of cancer cachexia and survival prognosis in palliative cancer patients for whom rehabilitation has been prescribed. This study used mGPS to examine the prevalence of cancer cachexia in palliative cancer patients undergoing rehabilitation and the impacts of cancer cachexia, ADL, and complications on survival.

Methods: The participants included 135 palliative cancer patients who were admitted to the hospital and underwent rehabilitation between 2020 and 2022. Cancer cachexia classification by mGPS was conducted, and logistic regression analysis was used to examine factors affecting the survival of palliative cancer patients undergoing rehabilitation.

Results: The patients were grouped as follows: 6 (4.4%) normal, 13 (9.6%) undernourished, 12 (9.0%) pre-cachexia, and 104 (77.0%) refractory cachexia. Logistic regression analysis showed that the mGPS and BI affected survival.

Conclusions: In a cohort of palliative cancer patients undergoing rehabilitation, 86% had cachexia. mGPS and BI were associated with survival outcomes. Combination of mGPS classification with ADL assessment may provide meaningful prognostic information in these patients.

Objectives: This study used structural equation modeling (SEM) to elucidate the causal relationships between Functional Independence Measure (FIM) items and consciousness levels in patients with stroke and low consciousness levels 2 weeks after initiating occupational therapy (OT). This modeling sought to identify the factors influencing the number of days required to get out of bed.

Methods: SEM was used for multifactorial simultaneous analysis in a study of 22 patients with a Japan Coma Scale score of 20 after stroke. The Glasgow Coma Scale was used to evaluate patients' consciousness level; FIMs were used to evaluate activities of daily living in the ward. Influencing factors, including "bed/chair transfers" and "toilet transfers," were defined as "transfer functions," while factors involving "social interactions," "comprehension," "memory," "problem solving," and "expression" were defined as "cognitive decline."

Results: After 2 weeks, standardized coefficients showed that "transfer functions" and "cognitive decline" had effects of -0.33 and -0.25, respectively, on "early ambulation days." Further analysis revealed that improvements in "consciousness level" impacted "early ambulation days," with coefficients of -0.35 for "transfer functions" and 0.14 for "cognitive decline." Through the "consciousness level" observation variable, the coefficients of indirect effects were -0.27 for "transfer function" on "days to get out of bed," 0.38 for "cognitive decline," and -0.06 for "self-care" on "early ambulation days."

Conclusions: Improvement in transfer movements and cognitive decline influenced the number of days required to get out of bed without improving consciousness or affecting early ambulation.

Objectives: There is a lack of evidence regarding the association between whole-body exercise and independence in urination and defecation. This study aimed to evaluate the effect of chair-stand exercise on improving urination and defecation independence in post-stroke patients with sarcopenia.

Methods: A retrospective study was conducted on stroke patients admitted to a community rehabilitation hospital between 2015 and 2021. Patients diagnosed with sarcopenia who required assistance with bladder and bowel management were included. The primary outcomes were the Functional Independence Measure (FIM) scores for urination (FIM-Bladder) and defecation (FIM-Bowel) at discharge. Multiple regression analysis was used to examine the association between chair-stand exercise and the outcomes, adjusting for potential confounders.

Results: Of 586 patients, 187 patients (mean age 79.3 years, 44.9% male) were included in the urination analysis, and 180 patients (mean age 79.3 years, 44.4% male) were included in the defecation analysis. Multiple regression analysis showed that the number of chair-stand exercises was independently positively associated with FIM-Bladder at discharge (β=0.147, P=0.038) and FIM-Bladder gain (β=0.168, P=0.038). Similarly, the number of chair-stand exercises was independently positively associated with FIM-Bowel at discharge (β=0.149, P=0.049) and FIM-Bowel gain (β=0.166, P=0.049).

Conclusions: Chair-stand exercise was positively associated with improved urination and defecation independence in post-stroke patients with sarcopenia. Incorporating whole-body exercises, such as chair-stand exercise, in addition to conventional rehabilitation programs may help improve voiding independence, reduce incontinence, and enhance quality of life in these patients.

Background: Peripheral neuropathy is a common complication of diabetes, impacting many patients with type 1 or 2 diabetes. Acute-onset peripheral neuropathy after diabetic ketoacidosis (DKA) is rare yet serious, and reports on long-term functional outcomes and rehabilitation for this condition are limited. We present a case of bilateral foot drop caused by acute-onset peripheral neuropathy following DKA. The case was effectively managed through prompt and continuous intervention.

Case: A 21-year-old male university student with no notable medical history who was seeking employment presented with impaired consciousness. DKA associated with type 1 diabetes was diagnosed. As blood glucose and acidosis improved, he rapidly regained consciousness. On Day 3 post-onset, bilateral foot drop and lower leg sensory impairment emerged, with nerve conduction studies indicating lower extremity peripheral neuropathy on Day 8. Improvement during hospitalization was modest, so ankle-foot orthoses were prescribed on Day 10. He could walk independently with the orthoses on Day 12 and was discharged home on Day 15. Outpatient follow-up was continued to support the patient's efforts to gain employment. Needle electromyography in the tibialis anterior muscles bilaterally showed denervation at 2 months and polyphasic potentials at 8 months. In the 2 years post-onset, bilateral lower limb muscle strength progressively improved, and the patient successfully secured clerical employment.

Discussion: Successful rehabilitation for employment was achieved in the rare condition of acute-onset neuropathy after DKA through effective management based on early orthotic prescription, clinical and electrophysiological examinations, and continuous follow-up.

Background: : COVID-19 can cause respiratory symptoms, as well as various complications and sequelae. This report describes a patient with worsening neurological symptoms caused by a spinal cavernous hemangioma after infection with COVID-19. Cavernous hemangioma usually occurs in the upper part of the brain (70%-90%) and rarely occurs in the spinal cord (5%-7%). Approximately 65% of cases of intramedullary spinal cavernous hemangioma present with neurological symptoms, and more than half of these cases show a slow worsening of symptoms. This is a rare case of intramedullary spinal cavernous hemangioma with cysto-rectal involvement in which neurological symptoms rapidly worsened following COVID-19 infection.

Case: : A woman in her 30s was admitted to the hospital because of the sudden onset of muscle weakness in both lower limbs and cysto-rectal disturbances after COVID-19 infection. She was diagnosed with a hemorrhage from a spinal cord tumor and underwent emergency resection. The pathological diagnosis was a spinal cavernous hemangioma. At first, she had a spinal cord injury (third thoracic vertebrae; American Spinal Injury Association Impairment Scale, C; Frankel classification, B; with cysto-rectal impairment), but 2 months later, she started walking with knee-ankle-foot orthoses and parallel bars. After 3 months, she could move independently around the ward using a wheelchair. Upon discharge, the patient could walk with ankle-foot orthoses and Lofstrand crutches.

Discussion: : COVID-19 is associated with various extrapulmonary manifestations and may increase the risk of hemorrhage in cases of intramedullary spinal cavernous hemangioma.