Various evaluation methods for spinal cord injury have been reported. However, the best evaluation method for predicting the prognosis remains controversial. We investigated patients with spinal cord injury using our original evaluation methods between 1990 and 1998. In this study we used two methods for evaluation; one is modified Frankel classification for evaluating the transverse lesion, and the other is the evaluation of the level of lesion of the spinal cord. We studied patients who had been admitted to our center within 7 days of their acute spinal cord injury. The total number of the patients was 294, and they were re-evaluated 6 months after their admission. Our modified Frankel classification showed, 5 of 149 patients (3%) with grade A at admission improved to grades D or E after 6 months. The patients who improved from grades B1, B2, and B3 to higher than grade D were one of 5 patients (20%), 7 of 22 patients (32%), and 8 of 10 patients (80%). The grade B3 group significantly improved more than the grade B1 and B2 groups. Additionally, the patients who improved from grades C1 and C2 to higher than grade D were 20 of 33 patients (61%) and 33 of 34 patients (97%). The grade C2 group significantly improved more than the grade C1 group. Our modified Frankel classification was useful to predict the neurological improvement in acute spinal cord injured patients 6 months after their accident.

View full abstract

Patients who receive hydrotherapy often have some thrombotic risk factors. To study the relationship between immersion and the possibility of thrombotic disease, effects of 20-min 40°C and 10-min 42°C immersions on platelets and on the blood coagulation and fibrinolytic systems were examined in ten healthy male subjects. The mean value of tissue plasminogen activator antigen (tPA) was increased and that of plasminogen activator inhibitor-I antigen (PAI-I) was decreased by 20-min 40°C immersion. The mean values of hematocrit, tPA and PAI-I were increased by 10-min 42°C immersion. However, these changes were not significant. In addition, neither of the immersion methods showed any significant effect on platelets. These findings suggest that hydrotherapy at 40-42°C has no beneficial effect on platelets or the blood coagulation and fibrinolytic systems.

View full abstract

We compared the performance of a concentric active electrode with conventional disc electrodes and examined its potential for clinical application. After both types of electrodes were placed on the flexor muscles of the forearm, the median or ulnar nerve was stimulated. The amplitudes of compound muscle action potential (CMAP) and electromyography (EMG) detected by the concentric active electrode were significantly lower than those detected by the disc electrodes, but no difference was found in the latency and phase between two types. Further, the reproducibility of the concentric active electrode was confirmed to be equal to that of the disc electrodes. The results showed that the concentric active electrode detects CMAP and EMG from more precise muscle desired, whereas the conventional disc electrode picks up widespread muscles adjoining the target musle. These findings suggest that the active electrode may be clinically useful for electrophysiological evaluation.

View full abstract

Fatal pulmonary embolism is a well known complication of various disorders, including orthopedic surgical cases. We present two cases of pulmonary embolism occurring in the perioperative periods. Case 1: A 66-year-old woman suffering from intraduralextramedullary tumor at the level of Th 9 complained of gait disturbance. On the sixth day after tumor resection, cardiopulmonary arrest occurred immediately after muscle manual test of lower limb. She expired despite resuscitation. Pulmonary embolism was suggested. Case 2: A 80-year-old woman suffered from right hip fracture. Six days after admission, she experienced dyspnea and chest pain during muscle strengthening exercise of upper limb. Pulmonary embolism was diagnosed based on defective images in the right upper lobes on urgent pulmonary blood flow scintigram. Her clinical status improved with urgent anticoagulation therapy (with heparin). Special attention should be paid to prophylaxis of pulmonary embolism in patients in the perioperative periods. Intermittent pneumatic compression and therapeutic exercises offers advantages over pharmacological prophylaxis against venous thromboembolism-namely, safety, absence of bleeding complications, and efficacy in reducing calf thrombosis. Early rehabilitation should be recommended by means of thromboprophylaxis.

View full abstract

Although cancer has been the leading cause of death in Japan since 1981, advances in early cancer detection combined with aggressive multimodal treatments such as surgical procedures, chemotherapy, and radiotherapy dramatically changed life expectancy of cancer patients. This situation is forcing medical professionals to consider quality of life issues of cancer patients. Because cancer patients often develop functional deficits not only by the cancer itself but also by its treatment and immobility, they need rehabilitation approaches to regain premorbid functional status. Cancer rehabilitation is defined as a comprehensive, multidisciplinary approach to help patients to obtain maximum physical, social, psychological, and vocational functioning within the limits imposed by the cancer and its treatment. The goals of cancer rehabilitation depends on what adaptation may be necessary for the patient to meet physical and personal needs, that is preventive, restorative, supportive, and palliative needs. In addition to direct cancer infiltration and compression to neuro-motor organs, its neuromuscular remote effects and metastatic brain and bone lesions cause various physical dysfunction. Surgical treatment, side effect of chemotherapy and radiotherapy, pain and immobility also affect patient's cognitive, psychological, physical, and nutritional conditions. Physical impairments and disabilities of the cancer patient are so complex that physiatrists should evaluate patient's dysfunction appropriately and set rehabilitation goals realistically. It is required for physiatrists who manage cancer rehabilitation to resolve medical problems, to make strong doctor-patient relationship, and to communicate with other physicians and rehabilitation specialists. Although there are many articles domestically and internationally that cancer rehabilitation is effective for patients to improve functional abilities and quality of life, very few controlled studies are available yet, which makes cancer rehabilitation still controversial and skeptical. Evidence based outcome research as well as cost-effectiveness analyses regarding cancer rehabilitation should be done in the future.

View full abstract