Current Status and Issues of Return to Work in Amputees and Patients with Spinal Cord Injury and Stroke from the Viewpoint of Medical Rehabilitation…Hirotaka TANAKA 11

Assessment of Social Participation for Persons with Disabilities <Original>…Kimika MASUDA 16

Occupational Medicine Viewpoint on Return to Work for the Physically Challenged…Satoru SAEKI 21

Supported Independence for Persons with Disabilities…Katsuyuki UBUKATA 25

The Concept of Vocational Rehabilitation and a Practical Supporting Model <Original>…Nobuo MATSUI 31

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We performed a 15 day protocol of low-frequency repetitive transcranial magnetic stimulation (rTMS) combined with intensive occupational therapy in hemiplegic upper limbs in poststroke and investigated the effect of cerebral blood flow using single photon emission computed tomography (SPECT). Seventeen chronic stroke patients were studied with SPECT at rest before and 4 weeks after undergoing the 15 day protocol. Before and after the treatment, Fugl-Meyer Assessment (FMA) score and Wolf Motor Function Test (WMFT) -Log performance time showed a significant improvement. The specific areas with a significant increase in perfusion in the affected hemisphere were the insula (BA 13), the precentral gyrus (BA 44) and the cerebellum. In the nonaffected hemisphere, perfusion was significantly increased in the lingual gyrus and cerebellum. On the other hand, perfusion was significantly decreased in the middle frontal gyrus (BA 6), precentral gyrus (BA 4) and postcentral gyrus (BA 3) in the nonaffected hemisphere. It was suggested that low-frequency rTMS combined with intensive occupational therapy effects the cerebral blood flow and contributes to improving upper limb hemiplegia after stroke.

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Skeletal muscles are overstretched following limb lengthening procedures. Muscles can adapt to this lengthening by adding new sarcomeres in series. Recent developments in limb lengthening provide adult patients more opportunities to undergo limb lengthening procedures. The purpose of this study was to clarify the difference in muscle adaptation between adult and young groups using a rabbit model of limb lengthening. Five mature (10-43 month old) and 6 immature (3-4 month old) white rabbits underwent tibial osteotomy. After a 1-week lag phase, tibial lengthening was applied at a rate of 1.4 mm/day for 2 weeks. Animals were euthanized after the completion of lengthening. Both hindlimbs were immersed in buffered formalin with the ankle and knee at a right angle. Muscle belly length, muscle fiber bundle length and sarcomere length were measured, and sarcomere number and internal tendon length were calculated in five representative muscles around the lengthened segment. Muscle belly length increased in all the lengthened muscles compared with the corresponding contralateral muscles regardless the group. Aponeurosis length increased significantly in one muscle for the adult group and three muscles for the young group. Sarcomere length tended to be longer or was significantly longer in the lengthened muscles. Serial sarcomere number significantly increased in 3 lengthened muscles in the adult group with a more conspicuous increase in the amount, while this occurred in 2 muscles in the young group with only a tiny increase. The predominant processes of skeletal muscle adaptation to the limb lengthening are sarcomere number addition in muscle fibers for the adult group and elongation of internal tendon for the young group.

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As Japan has become a super-aging society a new focus has been placed on locomotive syndrome (Locomo), musculoskeletal ambulation disorder symptom complex (MADS), frailty and sarcopenia. Locomo is a condition whereby long-term care or support is needed or may be needed in the future due to weakness of the locomotive organs. MADS is a condition presenting with unstable balance or walking difficulty, which leads to a high risk of the patient falling down or giving up excursions outside the home. In a broad sense, MADS patients also belong in the Locomo category. The prevention and treatment of Locomo and MADS are very important, because these conditions typically result in deterioration of the exercise function and loss of mental and physical health. The aim of Locomotive syndrome exercises is to reduce pain, and to restore and improve joint function. We need to take a comprehensive approach to Locomotive syndrome, including lifestyle modification, muscle exercise, stretching and therapeutic exercise. Two basic, simple and commonly used exercises are single-leg standing and squats exercises.

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