Background : Constraint-induced movement therapy (CI therapy) is a rehabilitation treatment that effectively improves upper extremity function in patients with chronic hemiparesis after stroke. In Japan, no previous studies have shown the effects of CI therapy in a large size sample, and the Simple Test for Evaluating Hand Function (STEF), a standard assessment tool for upper extremity function, is rarely used to evaluate the effects of CI therapy. Little is known regarding the factors capable of predicting the outcome of CI therapy. The present study aimed to examine potential predictors of outcomes after CI therapy and the effects of CI therapy using STEF. Methods : This study included patients with hemiparesis in the chronic stage of stroke (≥180 days from onset). We compared upper extremity function before and after CI therapy intervention, which involved 5 hours per day for 10 consecutive weekdays of training. We assessed upper extremity function using the STEF, Wolf Motor Function Test-functional ability scale (WMFT-FAS) before and after intervention, and investigated potential predictors (age, gender, time since stroke, type of stroke, side of stroke, hand dominance, spasticity). Results : There were 107 subjects. Our comparison revealed that both STEF and WMFT-FAS scores improved significantly following intervention, from means of 31.3 to 42.7 points and 51.8 to 57.0 points, respectively. No significant predictors that influenced the functional outcome were identified. Conclusion : CI therapy is effective for improving upper extremity function. It is important not to exclude people from CI therapy based on any supposed predictors.

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Rehabilitation using myoelectric prosthesis for trans-radial amputees has become wide spread and well established in several developed countries. However, the clinical use of myoelectric prostheses for trans-radial amputees has not yet spread in Japan. It is well known that once amputees become accustomed to using their prosthesis efficiently through adequate rehabilitation, that various activities which the amputees had given up so far will become possible through enhanced bimanual activities. Although myoelectric prostheses have proved to be useful, the majority of amputees have not been satisfied with their function. As an amputee becomes a better user, they request not only simple tasks but also complicated ones. As a consequence, the amputee comes to know the limits of their myoelectric prosthesis, thus expectations for superior prostheses will arise. The recent remarkable development of engineering technology has enabled the progress of prosthetic limb technology, leading to the production of far superior functional prostheses which meet the user's expectations. However, there is a paradox in developing such superior prostheses. The more advanced the prosthesis we produce, the higher the cost. To achieve this end, it is absolutely imperative to secure the cooperation of both clinicians and engineers. Furthermore, a rehabilitation strategy for patients with a higher level of amputation(trans-humeral amputation, shoulder disarticulation)remains unsolved. In this paper, we propose a “Hybrid Myoelectric Prosthesis”, which consists of a myoelectric hand as a terminal device and a body-powered active elbow joint, as a realistic solution for higher level amputees. In addition, we introduce Targeted Reinnervation (TR) as a future strategy for reference.

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A Major earthquake and giant tsunami occurred on 3.11, which broadly affected the eastern Japan area along the Pacific Ocean. A large elderly population was confined to their place of refuge and faced a high risk of disuse syndrome due to immobility. Elderly survivors aged 65 and over who were markedly found in an inactive state due to immobilization were regarded as the “risk group” for inactive lifestyles, possibly leading to disuse syndromes. Intervention by means of rehabilitation assistance was required in approximately one third of these inactive survivors (“high risk group”), a rate which was significantly higher in the elderly over 65 years than in younger survivors. Establishment of a rehabilitation assistance system for use in the event of a mass disaster is one of the critical lessons learned following 3.11, which will contribute to serve as a prophylaxis against disuse syndromes arising from inactivate locomotive function. Legal reform of relief actions in mass disasters is highly required to also include physical therapists as official members.

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