Objective : We developed a new 4 degree of freedom robot capable of mirror-image movement of the upper limbs, including shoulders, elbows, forearms, and wrists. The objective of the present study is to assess the acceptability and clinical results of robot training. Methods : Eighteen subacute, first-ever stroke patients were randomly assigned to a robot-aided therapy group (n=9) and to a control group (n=9). The robot-aided group received additional robot-aided bilateral arm exercises, whereas the control group received bilateral repetitive arm exercises. Both exercises were conducted in the form of 20-minute sessions, for a total of 16-30 sessions, 41-104 days. Both groups also received conventional physical therapy. Motor functions were assessed using the Fugl-Meyer Upper Extremity Motor Performance Test of impairment (FM) (0-66), modified Ashworth scale sum (0-12), manual muscle strength test sum (0-35), and grip strength. Patients were also assessed using the Barthel Index (BI). Questionnaires were used to assess the patients' subjective impressions of their training sessions under the following categories : enjoyment (1-10), difficulties (1-10), and willingness for continuous training (0-2). Results : No side effects were noted. The robot-aided group showed significant improvement on FM and grip strength (p<0.05). The control group showed significant improvement on manual muscle strength test sum (p<0.05). Both groups showed significant improvement on BI (p<0.05). The robot-aided group had larger improvement in the finger movement portion of FM after treatment (p<0.05), and reported more enjoyment (p<0.05) and demonstrated greater motivation (p<0.05) than the control group. Conclusion : Use of the new 4 degree of freedom robot resulted in a larger improvement in the finger movement portion of FM and greater motivation for repetitive training of affected upper limbs in subacute, first-ever stroke patients.

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Objective : Little is known about the energy demands of stroke patients in the rehabilitation phase, information essential to both appropriate clinical and nutritional management. The aims of this study were to determine the resting energy expenditure (REE) of stroke patients in the rehabilitation phase, and to evaluate whether REE estimation using the Harris-Benedict equation (HBE) requires the addition of a “stress factor” to capture possible additional REE imposed by stroke. Method : We measured REE with a portable calorimeter, MetavinTR, and compared it with basal energy expenditure (BEE) calculated with HBE in 76 stroke patients admitted to a rehabilitation ward. We then analyzed its relationship with sex, stroke type, paretic side, severity of paralysis, the Functional Independence Measure (FIM) score and dysphagia. Results : Mean REE and REE/BEE (%) were 1231.3±245.7 kcal/day and 104.3±16.4%. A comparison showed no significant difference. Sex, stroke type, paretic side, severity of paralysis, FIM and dysphagia were not significantly related with REE/BEE (%). Conclusion : The REE of stroke patients was not significantly different from that predicted with HBE. This information would be useful in planning appropriate nutritional management.

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Paragraphia due to cerebellar cognitive affective syndrome (CCAS) has not been reported previously. This report presents a patient with cerebellar hemorrhage, showing cognitive dysfunctions including paragraphia. A 74-year-old right-handed man was hospitalized with sudden dizziness. CT demonstrated a small hemorrhage in the right cerebellar dentate nucleus. He also exhibited gait disturbance due to mild truncal ataxia and became aware of errors while writing his dairy. Neuropsychological assessments showed phonological paragraphia with Kana characters and semantic paragraphia with Kanji characters, as well as mild auditory comprehension and verbal memory disorders. Although MRI did not detect any abnormality in the cerebral hemispheres, SPECT demonstrated decreased cerebral blood flow in the left angular gyrus, frontal lobe and parieto-occipital lobe, predominantly on the left side. On neuropsychological assessment 3 months after stroke, the patient's paragraphia and auditory comprehension disorder had subsided, but his verbal memory disturbance remained. The clinical features in this case differed from those of CCAS cases previously reported. In particular, the lesion considered responsible for the cognitive dysfunctions in this case involved the right dentate nucleus, which is supplied by the superior cerebellar artery, but not the posterior inferior cerebellar artery, and especially the presence of dis-orders in writing ability, such as paragraphia. The possible mechanism of paragraphia in this case might be a reduction of cerebral blood flow in the angular gyrus due to a crossed cerebello-cerebral diaschisis. However, this case suggests that the right dentate nucleus contributes to the neuropsychological mechanism of writing.

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The 9.0-magnitude under sea megathrust earthquake and the subsequent extremely destructive tsunami waves on March 11 2011 brought an extensive and severe disaster to the Tohoku and Kanto areas. This natural disaster has been markedly complicated by a series of nuclear power plant failures, leading to radioactive contamination, power shortages and ungrounded rumors. Faced with this most difficult crisis, the JARM set up an earthquake disaster headquarters, and has so far taken the following actions, with an emphasis on supporting its members in the disaster stricken areas, preventing immobilization syndromes and providing necessary rehabilitation services for the frail elderly and persons with disabilities, in collaboration with other specialists organizations, local and central governments : 1) Activities in the disaster zone including support of the physiatrists there, dispatch of JARM members, medical caravans for isolated home-dwelling persons with disabilities, and relief activities as a part of multidisciplinary specialists teams ; 2) Organizing a nation-wide system for transferring persons needing rehabilitation and care services ; 3) Activities in the non-disaster areas for victims relocated from the disaster zone ; 4) Information support services to collect and provide useful information ; 5) Proposals to the government for enlightenment of the importance of rehabilitation disaster relief and for relaxation of regulations for eligibility for rehabilitation and care services. The scope of the disaster is too extensive, both in magnitude and geographical area, and too complex. The situation on the ground and the needs of affected persons are constantly changing. Therefore, well-coordinated, creative, and long-term efforts will be needed, and the JARM is determined to be actively involved in the reconstruction process.

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