Significant bone mineral density (BMD) reduction occurs in stroke patients on the hemiplegic side compared with the unaffected side. We measured the bone mass of bilateral calcaneus in 41 patients with hemiplegia using ultrasound bone-densitimometer (LUNAR Co, Achilles) in order to elucidate the effects of duration of illness and gait pattern. The z-scores of bone mass were determined in both calcaneus. We also performed gait analysis in 28 patients using orthopedic measuring system (T & T medilogic Co, ORMES) and divided them into two groups (good gait and poor gait pattern group). Differences between the hemiplegic and unaffected sides were correlated well with the duration of illness and the Brunnstrom stage of the leg. There was statistically significant differrence between good and poor gait pattern groups in the z-scores of the hemiplegic side. We concluded that gait pattern could influence the degree of hemiosteopenia in hemiplegic patients.

View full abstract

Non-Hodgkin's lymphoma (NHL) was studied from the point of impediment and rehabilitation approach. Thirty-one patients diagnosed with NHL, who were referred to the Department of Rehabilitation Medicine at a university hospital. The patients could be classified into three types according to impediment: Twenty with disuse muscle atrophy, five with peripheral neuropathy, and six with spinal cord injury. The patients with disuse atrophy had been bed-ridden for three months before rehabilitation started, but at the end of the rehabilitation course, all of them could walk unaided inside the hospital. The patients with peripheral neuropathy showed foot drop and sensory disturbance because tumor cells invaded their peripheral nerves. Ankle-foot orthosis was very effective for this group and enabled the patients in this group to walk unassisted inside the hospital. The patients with paraplegia showed muscle clonus and atrophy in their legs because tumor cells had invaded the vertebral bodies. Following rehabilitation, all these patients could walk in their ward with the aid of a walker. We conclude that NHL can be classified into 3 types according to the type of impediment and requires a rehabilitation approach based on the classification.

View full abstract

We investigated the effect of spinal orthosis (so-called “Rucksack type orthosis”) for 15 kyphotic patients with osteoporotic thoraco-lumbar vertebral fracture. Eighty-three per cent patients improved the posture and 45 per cent improved their back pain. It also significantly improved the disability of ADL especially the work in flexion posture. The thickness of the orthosis was as thin as 10mm, so it could be not visible wearing the clothes on it. Therefore, “Rucksack type orthosis” is thought to be effective for the posture and disability of ADL for kyphotic patients with osteoporotic thoracolumbar vertebral fracture.

View full abstract

Functional imaging of the brain is of great value in investigating the mechanisms of motor control and reorganization of motor function after brain damage. Functional magnetic resonance imaging (fMRI) is one of the newer imaging techniques developed. The image contrast of fMRI is generated mainly by regional changes in levels of deoxy-hemoglobin associated with activated neural function. In contrast to positron emission tomography (PET), fMRI allows the study of single subjects without radiation risk and produces images with higher spatial resolution. Moreover, it can be conducted repeatedly. Brain activation observed in studies using fMRI and other techniques such as PET and single photon emission computed tomography depends on various attributes of motor tasks including the rate of performance; the body parts involved; the muscle force exerted; the amplitude during the motor tasks; the method for pacing (externally cued or self-paced) or starting the motions; and the complexity of the task. All of these attributes must be considered to reliably evaluate the results of functional imaging. Although SMC (sensorimotor cortex) activation is generally lateralized, some functional imaging studies showed the activation in ipsilateral SMC with movement of a unilateral hand. This was most pronounced in left hand motion of right-handers and depended on the task complexity. In contrast to the ipsilateral cortical activation, investigators have not yet reached a consensus on the asymmetry in contralateral SMC activation between right- and left-hand motions. The underlying mechanisms of the recovery of motor function following stroke are poorly understood. Some studies with fMRI have investigated the functional reorganization and showed that paretic hand movement produced extended activation in the ipsilateral sensorimotor cortex. This result indicated that the preexisting uncrossed motor pathway might be one of the important components of motor recovery after stroke. Other cortical areas such as the inferior parietal lobe and secondary motor areas have also been suggested to be involved in motor recovery. One study demonstrated that the peri-infarct area played a role in the reorganization of the cortical motor map.

View full abstract

In a previous review about the traumatic brain injury TBI rehabilitation presented in this journal in 1990, I pointed out the strong trends of development in this area in the U. S. A. In this review I again look into the current status of TBI rehabilitation in the U. S. A. and compare it with the status of Japan. The U. S. A. senate passed the public law called the Traumatic Brain Injury Act in 1996, which ensured the governmental funds of 8.5 million dollars a year available for TBI rehabilitation activities. The seventeen major rehabilitation facilities in the U. S. A. are assuming the role as the traumatic brain injury model systems TBIMS which provide the models of TBI rehabilitation and do research, education and technology transfer. The brain injury association of the U. S. A. BIAUSA, a very powerful organization of the patients and families, has established a network between 800 supporting organizations and has branches in 43 states. The Archives of Physical Medicine and Rehabilitation has published special issues on TBI rehabilitation in 1994 and 1997. It appears that the managed care environment in the U. S. A. has become a strong motive for the TBI specialists to publish articles to claim the efficacy of various types of TBI rehabilitation programs by many kinds of outcome studies. In Japan there are very scarce incidence studies and not such availability of the various kinds of TBI programs. The Japanese media have just started to broadcast about the lack of programs and insufficiencies of the governmental policies in TBI rehabilitation.

View full abstract