Two cases of upper limb spasticity were treated with Muscle afferent block (MAB). The potential of this mode of treatment as an alternative to botulinum toxin A (BTX-A) was evaluated, and the effectiveness of the MAB in each case was determined. The MAB was an intramuscular injection containing 0.5% lidocaine and pure ethanol at a ratio of 10 : 1 (v/v). The target muscles of the two patients, both suffering from a chronic hemiplegia after a stroke, were injected with MAB once every 3 days, and a total of 10 injections were administered. The severity of spasticity was evaluated according to the Modified Ashworth Scale Score and the passive range of motion at the affected joint. The spasticity in the injected muscle was immediately alleviated, and the patient experienced relief with regard to the problems caused by the severe spasticity. The effect of the MAB treatment persisted for approximately 2 months. The simple technical procedure involved in the MAB treatment and its immediate effects are illustrated in this case report. We concluded that MAB may be a useful alternative to BTX-A, or a neuromuscular block, for the management of upper limb spasticity.

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We experienced a case of a 66-year-old man who had lumbar plexus paralysis caused by a retroperitoneal hemorrhage complicated by anticoagulation treatment administered for f cerebral infarction. He was hospitalized for cerebral infarction with right hemiplegia and aphasia, and underwent anticoagulation treatment. After a few days, both the hemiplegia and the aphasia were improved by the treatment. However, disturbance of consciousness and serious anemia developed suddenly, and his condition was diagnosed as retroperitoneal hemorrhage. It was treated conservatively, and the disturbance of consciousness was improved one month later, but then, he noticed motor paralysis of the right lower extremity. Objectively, muscles of the iliopsoas, quadriceps femoris, and hip adductors showed serious paralysis, and this was diagnosed as lumbar plexus paralysis by physical examination and electromyography. For the neuroparalysis, rehabilitation such as therapeutic electrical stimulation and biofeedback, were administered, but the paralysis still remained six months later. A knee brace and a T cane were necessary for him to walk. As a complication of anticoagulation treatment, retroperitoneal hemorrhage is known, but there are a few reports about coincidence with hemiplegia. It is necessary to consider this complication from the early phase such as bedside rehabilitation because an early diagnosis can lead to the developmental prevention of serious dysfunction.

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It has been generally considered that physical fitness is represented by exercise performance under aerobic conditions. However, we are often required to exert highly powerful movements momentarily or within a few seconds in daily life. Therefore, when we evaluate physical fitness, it appears important to evaluate physical fitness not only under aerobic conditions, but also under anaerobic conditions, with the latter being represented by maximal muscle power. In the daily living of people with physical disabilities, whether or not they can achieve a specific activity (for example, standing up, getting up from the floor and sitting down, etc.) is considered to depend on their performance under anaerobic conditions rather than under aerobic conditions. The Wingate anaerobic test (WAnT) has been developed as one of the most precise tests to evaluate anaerobic exercise performance. The WAnT, established at the Wingate Institute in Israel in 1970s, is a test incorporating bicycle riding with a maximal effort for 30 seconds. An ergometer with equipment to load an examinee with a constant resistance from a suspended weight is used in this test. The WAnT is measured as the changes in mechanical power that are yielded by multiplying the resistance produced from a suspended weight by the rotation speed of pedaling during a period of 30 seconds. The WAnT has not been usually applied so far to disabled people due to some technical problems. However, we have been improving the test to overcome those problems so that we can adopt the WAnT in the field of rehabilitation. We expect that this modified WAnT would contribute to a comprehensive evaluation of physical fitness in people with disabilities.

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Perioperative Rehabilitation Foreseeing Patient's QOL…Teruyuki KOYAMA 839

Pulmonary Rehabilitation for Preventing Complications after Thoracic and Upper Abdominal Surgery…Tetsuya TSUJI 844

Perioperative Lung Physical Therapy and its System…Toshimitsu SUGA, Akira OKII 852

Pulmonary Rehabilitation in Acute Care…Shin-ichi TAKAHASHI 859

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[in Japanese]

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