The Japanese Journal of Rehabilitation Medicine
Online ISSN : 1880-778X
Print ISSN : 0034-351X
ISSN-L : 0034-351X
Volume 40, Issue 9
Displaying 1-7 of 7 articles from this issue
  • 2003 Volume 40 Issue 9 Pages 563-586
    Published: September 18, 2003
    Released on J-STAGE: October 28, 2009
    JOURNAL FREE ACCESS
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  • Tomitaro AKIYAMA
    2003 Volume 40 Issue 9 Pages 587-592
    Published: September 18, 2003
    Released on J-STAGE: October 28, 2009
    JOURNAL FREE ACCESS
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  • Yoshio TOKUDA, Toshiro KISA, Tomoko NAGATA, Masayuki IGO
    2003 Volume 40 Issue 9 Pages 593-599
    Published: September 18, 2003
    Released on J-STAGE: October 28, 2009
    JOURNAL FREE ACCESS
    This study was designed to determine the clinical significance of the gag reflex in evaluating swallowing disorders. The degree of gag reflex was classified into four groups: “positive”, “slightly decreased”, “decreased”, and “absent”, and the relation between the gag reflex degree and aspiration or penetration into the larynx detected by videofluorography (VF) was investigated. Among the 67 patients studied by VF for swallowing disorders the “absent” group plus the “decreased” group accounted for 79%. The degree of the gag reflex was affected by hemiparesis, dementia, and bilateral or multiple lesions. The findings of VF were affected by bilateral hemiparesis, gag reflex degree, and the water-drinking test profile. Choking during the water-drinking test was highly sensitive (91%) in screening for aspiration, and aspiration was observed in 73% of the subjects who choked and whose gag reflex was absent. Among the subjects who did not choke during the test, no aspiration or penetration into the larynx was observed in the “positive”, “slightly decreased”, or “decreased” groups, whereas aspiration or penetration into the larynx accounted for 60% of those in the “absent” group. The results suggested that it might be possible to some degree to predict the risk of aspiration based on a combination of bedside evaluation of the degree of gag reflex and the presence of choking during the water-drinking test.
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  • Junichi USHIBA, Yoshihisa MASAKADO, Yoko KOMUNE, Yutaka TOMITA
    2003 Volume 40 Issue 9 Pages 600-609
    Published: September 18, 2003
    Released on J-STAGE: October 28, 2009
    JOURNAL FREE ACCESS
    Neural projections from the extensor carpi radialis longus (ECRL) muscle to the ipsilateral biceps brachii (BB) motoneurons were studied in 10 healthy human subjects using a post-stimulus time histogram, in which a conditioning stimulus was triggered by the BB motor-unit discharge. Out of 100 BB motor units, electrical stimulation to the ECRL nerve using intramuscular needle electrodes induced inhibition in 15 units (15%) and facilitation in 10 units (10%). Both inhibition and facilitation were also evoked at intensities well below the motor threshold. As a reference for latency, a monosynaptic Ia facilitation was also induced in the BB in each subject by stimulating the median nerve trunk using surface electrodes at the distal end of the medial intermuscular septum of the arm. Compared to this latency, the evoked modulations by ECRL nerve stimulation were regarded as projections of mono- or di-synaptic connections.
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  • Yuko URAKAMI, Yasoichi NAKAJIMA
    2003 Volume 40 Issue 9 Pages 610-616
    Published: September 18, 2003
    Released on J-STAGE: October 28, 2009
    JOURNAL FREE ACCESS
    A concussion describes the brief loss of consciousness after head injury, but if this loss of consciousness lasts longer than 6 hours, it is presumed that there was brain tissue injury, and the term “Diffuse Axonal Injury (DAI)” is used. CAT scan evidence of DAI is provided by punctuate hemorrhage, with little edema. A MRI may show some signs of DAI even when a CT scan does not. An EEG is not as useful as an emergency examination, but it aids in prognosis. Areas of focal damage to the cortex may show evidence of abnormal activity (slowing and spike activity) for weeks or months after the injury. We evaluated 15 patients (6 months after brain injury) who are in post acute rehabilitation in our center to examine how EEG can provide us with clinical information in the chronic phase after brain injury. Six patients with normal EEG findings were in a coma for significantly less time after injury and had a higher alpha frequency than the nine patients who showed EEG abnormalities (p<0.01). Three patients who showed severe higher brain dysfunction showed EEG abnormalities, such as focal slow waves. Some patients who showed normal EEG findings had higher brain dysfunction, so we must be careful in clinical situations, since the EEG may look normal. We showed the clinical significance of EEG exanimation 6 months or longer after brain injury in patients with DAI; and that EEGs can provide important information during post acute rehabilitation.
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  • Kenichiro MAKINO, Nami YOSHIMOTO, Hutoshi WADA, Kenji HACHISUKA
    2003 Volume 40 Issue 9 Pages 617-620
    Published: September 18, 2003
    Released on J-STAGE: October 28, 2009
    JOURNAL FREE ACCESS
    Background: Although hemiplegic patients often use an ordinary wheelchair (OW), by propelling the hand rim with the unaffected hand and pushing the ground backward using the unaffected leg, it is a hard task for them over any great distance. If patients could drive a leg-pedaled wheelchair (LW) using both legs, it would be less hard on them. Aims: This study was performed to determine whether or not hemiplegic patients can pedal the LW, and whether pedaling the LW is easier and faster than using an ordinary wheelchair. Methods: The subjects were 5 poststroke hemiplegic patients whose severity of lower extremity paralysis was III or IV on Brunnstrom's Motor Recovery Stage. The subjects practiced propelling a standard wheelchair for the OW trials and pedaling an EZchair® for the LW trials. After the subjects became skilled in driving both wheelchairs, they were asked to propel the OW and to pedal the LW on a slalom course to evaluate controllability, and on a rectangular course to evaluate wheelchair speed. Physiological cost index (PCI) was obtained for evaluation of driving efficiency. Results: All subjects could pedal the LW without any trouble. The wheelchair speed of the LW on both courses was faster than the OW. The PCI when pedaling the LW on the rectangular course was lower than when propelling the OW. However, the LW was less controllable in braking. Conclusion: Although the LW used still requires some minor modifications, we believe that a LW is suitable for hemiplegic patients who want to travel a long distance in their wheelchairs.
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  • 2003 Volume 40 Issue 9 Pages 621-628
    Published: September 18, 2003
    Released on J-STAGE: October 28, 2009
    JOURNAL FREE ACCESS
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