The aim of this study is to validate the effect of a nutrition support team's (NST) interventions in convalescent stroke rehabilitation using the Functional Independence Measure (FIM). Three hundred and four patients were retrospectively divided into an NST-nourishment group, an NST-losing-weight group and a non-NST group. We then compared the FIM gain, the FIM efficiency and the change of body mass index during admission among these three groups. The FIM gain was 17.3±15.9 in the NST-nourishment group and 16.7±12.5 in the non-NST group and there was no significant difference. The FIM efficiency in the NST-nourishment group (0.20±0.19) was significantly lower than the one in the non-NST group (0.27±0.19). Patients with an FIM of 53 or less showed no significant difference in FIM gain and FIM efficiency between the two groups. Since those patients who received NST intervention would tend to have a poor prognosis in general, we assumed that our “no difference” results indicated the effectiveness of the NST intervention. There was no evident relationship between FIM gains and changes in the body mass index.

View full abstract

Subdural hematoma or effusion is a common complication in ventriculoperitoneal shunts. However, the incidence of subdural hematoma in shunted patients requiring a surgical procedure has been decreasing recently, since it can be treated with a newly developed pressure-programmable valve system. We treated two shunted patients with subdural hematomas caused by simple falls during gait training. The management was complicated, involving multiple surgical procedures. Case 1 : A 65-year-old woman, who had undergone ventriculoperitoneal shunting for normal pressure hydrocephalus after removal of a meningioma, suffered mild head trauma due to a fall during gait training and developed consciousness disturbance after 2 hours. Computed tomography revealed an acute subdural hematoma with marked midline shift. Emergency craniotomy and hematoma evacuation were performed. Case 2 : A 61-year-old man, who had previously undergone ventriculoperitoneal shunting for normal pressure hydrocephalus after subarachnoid hemorrhage, fell to the floor during gait training. Computed tomography demonstrated a thin subdural hematoma, thus the pressure-programmable valve was adjusted to a higher pressure. However, the hematoma continued to enlarge and his level of consciousness deteriorated. Consequently, shunt ligation and irrigation of the chronic subdural hematoma were performed 6 days after the head trauma. Brain atrophy and a lowering of the intracranial pressure, which are both shunt-related complications, may have contributed to these patient's subdural hematomas forming after such relatively minor head traumas. In conclusion, rehabilitation physicians treating shunted patients must be aware of the possibility of a catastrophic intracranial hemorrhage following minor head trauma and of the various treatment-related difficulties arising in such a scenario including exacerbation of hydrocephalus, meningitis, and rebleeding.

View full abstract

The Actual Situations and Measures of Sexual Dysfunctions in Spinal Cord injured Persons ; The Questionary Survey of their Sexual Functions and Measures for their Erectile and Ejaculatory Dysfunctions…Atsushi SENGOKU, Akihiro YANAGIUCHI 141

Approaches to the Fertility Problems in Male Spinal Cord Injury Patients…Hitoshi MOMOSE, Kaoru YAMADA 148

Return to School or Job of Cervical Cord Injured Patients in Young Generation (10 to 29 years Old)…Takayoshi UETA 150

Health Promotion in the Workplace…Futoshi WADA 152

View full abstract

The Present Status of the Patients with Visceral Impairment and the Rehabilitation Evidence…Masahiro KOHZUKI 157

The Practice of Cardiac Rehabilitation…Shigeru MAKITA 163

The Rehabilitation Program and the Effects for Patients with Chronic Renal Failure…Masayuki KANAZAWA 169

Effects of Rehabilitation for Outpatients under Hemodialysis…Mitsuo TAKEI 173

Pulmonary Rehabilitation for Respiratory Disease…Hitoshi KAGAYA 178

View full abstract