Comprehensive Rehabilitation : Significance and Current Perspectives…Masahiro KOHZUKI 199

Role of the Physiatrist in Comprehensive Cardiac Rehabilitation…Shigeru MAKITA 205

Role of the Physiatrist in Comprehensive Respiratory Disease Rehabilitation…Fumihito KASAI, Masazumi MIZUMA 209

Role of the Physiatrist in Comprehensive Rehabilitation for High Risk Metabolic Syndrome Patients…Osamu ITO 214

Role of the Physiatrist in Comprehensive Muscolo-skeletal Rehabilitation…Kenji ISHIDA, Yasunori NAGANO, Toshikazu TANI, Katsuhito KIYASU, Hiroshi YAMAMOTO 219

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After April 2006, the Japanese Ministry of Health and Labor raised the permitted training time from 6 to 9 units (1 unit of training time corresponds to 20 minutes of exercise with a therapist) for patients in a kaifukuki (convalescent) rehabilitation ward. We examined the effect of the increased rehabilitative training time on patients using feeding tubes in a kaifukuki rehabilitation ward after an initial cerebrovascular disorder, with a particular focus on improving swallowing disorders. Our study was comprised of post-stroke patients with feeding tubes who underwent rehabilitation from April 2001 to March 2006 (N=14, 6-unit group) and from April 2006 to March 2009 (N=16, 9-unit group). All patients went to the ward within two months after suffering a stroke. There was no significant difference in the Functional Independence Measure(FIM) efficiency or length of hospital stay between the two groups. Feeding tube removal was more common in the 9-unit group compared to the 6-unit group (81.3% vs. 35.7%, p<0.05), and the 9-unit group also had more training time per day. Logistic regression analysis showed that the increased training time per day spent with a speech therapist contributed to improving swallowing disorders (p<0.01).

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The purpose of this study was to estimate the effect of our post-acute comprehensive intensive inpatient treatment (Program A) on persons with acquired brain injury in the hospital. Program A, designed for work or school, consists of daily six hours sessions for three months, personal and group sessions, and family support. It was designed to build cognitive and behavioral skills through a transdisciplinary approach and 17 patients with acquired brain injury were enrolled in the program. Seventeen program non-participants were selected as our control. Cognitive functions were measured with FIM, WAIS-III, RBMT, and TMT before and after the program. Significant cognitive improvements (especially attention) and increased societal participation were obtained for the Program A participants compared with non-participants. Considering that Program A improved both the cognitive function and level of social participation in program participants, we suggest that it is valuable to perform intensive treatment programs in an inpatient condition for acquired brain injury patients.

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The effectiveness of rehabilitation in patients with HTLV-1associated myelopathy (HAM) was evaluated. The HAM patient is characterized by chronic progressive spastic paraplegia with dysuria and muscular weakness of the lower trunk, as well as the pelvic and hip muscles. However, the muscular strength of the lower limbs and feet is relatively well maintained. The 12 subjects enrolled in this study included 2 men and 10 women. Their average age was 53.2 years, their average duration of disease was 20.5 years, and they were involved in training for an average of 41 days. The rehabilitation program involved muscular strength training of the lower trunk, pelvic, and hip muscles. After all patients completed the rehabilitation program, a significant improvement was seen in the truncal flexors, the truncal extensors, and the truncal rotators in the lower trunk. As for the hip muscles, a significant improvement was seen in the iliopsoas, the gluteus maximus, and the gluteus medius. The improvement was evaluated using Osame's Motor Disability Score (OMDS), the Functional Independence Measure (FIM) and the Barthel Index. The patients' improvements in motor function and ADL suggest that rehabilitation was effective.

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