Parkinson's disease (PD) is the second most common neurodegenerative disorder after Alzheimer's disease, characterized by increasingly morbid motor dysfunction with advancing age. Recently, various antiparkinsonian agents and surgical intervention have been developed that, when used in combination, greatly promote sustained improvements in activities of daily living, leading to the establishment of a treatment algorithm. However, since all of these interventions are symptomatic therapies, it is difficult to resolve motor dysfunction completely. Recent evidence has revealed that exercise might enhance neuroplasticity and improve motor and cognitive behavioral impairment in PD. In this article, we reviewed recent therapeutic strategies for PD.

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In Japan, hip joint degenerative diseases are based on acetabular dysplasia and the treatment strategy has been focused primarily on how to maintain the hip joint function and how to achieve pain relief. We employed total hip arthroplasty (THA) to treat end-stage OA of the hip joint. There are many possible complications in THA including infection, dislocation and nerve palsy. Especially in patients with Crowe IV dislocation, THA should be accompanied by simultaneous subtrochanteric shortening osteotomy to prevent sciatic nerve palsy. There is concern that the small metal head and posterior approach without re-attachment of posterior soft tissue commonly used in THA may be susceptible to postoperative dislocation. To avoid this scenario, we developed a modified less invasive total hip arthroplasty surgical approach that uses the anterolateral approach of the modified Watson-Jones approach. By using this approach, the risk of postoperative dislocation can be greatly reduced due to the intact posterior stabilizing soft tissue of the hip joint. Recently, a new concept in hip pathology describing femoroacetabular impingement (FAI) including retroversion of the acetabulum was proposed by Professor Ganz in 2003. Patients with acetabular dysplasia were also assumed to have acetabular retroversion. In patients with acetabular dysplasia to prevent further pathology of the hip joint, we developed a reorientation rotational acetabular osteotomy using a navigation system to obtain accurate direction and alignment in the reorientated hip joint. Orthopedic surgeons and rehabilitation doctors need to understand each other well in their respective fields of pathology and treatment strategy to ensure the optimal treatment of motor diseases.

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Background and Purpose : Many cases of amnesia caused by thalamic hemorrhage involve anterior nucleus hemorrhage, dorsomedial nucleus hemorrhage, and intraventricular rupture. In the present study, intraventricular rupture was studied with a focus on cases with hematoma compression at the fornix. Methods : Of 116 patients with thalamic hemorrhage admitted to our hospital, 50 patients aged <70 years who had hemorrhage during their first stroke confined to the thalamus, internal capsule, and corona radiata, and who neither developed hydrocephalus nor showed dementia prior to onset were investigated. Thalamic hemorrhages were classified by CT findings and the extent of intraventricular rupture. Memory was studied by the FIM memory scores on admission and discharge. Results and Conclusion : Patients with dorsomedial nucleus hemorrhage showed no tendency toward amnesia and were equivalent to patients with posterolateral nucleus hemorrhage, which does not usually result in amnesia on its own. Of the 30 patients with posterolateral nucleus hemorrhage, a high degree of amnesia was observed in the 18 with intraventricular rupture. A high proportion of patients with dorsomedial nucleus hemorrhage experienced intraventricular rupture (5 of 6 patients). Equivalent degrees of amnesia were observed in patients with intraventricular rupture with dorsomedial nucleus hemorrhage and those with posterolateral nucleus hemorrhage. The present findings in conjunction with the fact that amnesia in thalamic hemorrhage involves episodic memory impairment suggest that amnesia in patients with dorsomedial or posterolateral nucleus hemorrhage or with intraventricular rupture does not stem from damage to the dorsomedial nucleus, which is part of the Yakovlev circuit involved in emotional memory. Instead, the primary cause appears to be the effects of intraventricular rupture on the Papez circuit surrounding the lateral ventricle and foramen of Monro.

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Background : The effects of rehabilitation on hemodialysis patients are unknown. We assessed the effects and investigated the association between rehabilitation treatment effects and all-cause mortality. Methods : This prospective cohort study included 120 patients on maintenance hemodialysis. ADL was assessed using the Functional Independence Measure (FIM) score (total points, 126), which comprises 13 motor items (total points, 91) and five cognitive items (total points, 35). A survival curve was constructed using the Kaplan-Meier analysis and stratified into an increase or no-increase of the FIM score. Multivariable logistic regression analysis was used to determine factors associated with the effects of rehabilitation. Discriminative sensitivity of FIM cognitive items for an increase in total FIM was estimated using the area under the receiver operating characteristic (AuROC) curve. Results : The average total FIM score increased from 64.2±3.6 to 75.8±3.0, and the increase in FIM motor and cognitive items was 11.0±1.3 and 0.5±0.6, respectively. The cumulative survival rate within 2.5 years was significantly higher in the FIM increase group than that in the FIM no-increase group. FIM cognitive items and anemia were significantly associated with rehabilitation effects, and AuROC showed that a cutoff of 34 points in cognitive FIM had moderate discriminative sensitivity for a total FIM increase (AuC, 0.719 ; p<0.0008). Conclusions : Rehabilitating hemodialysis patients improved their FIM score (particularly the motor items), and a higher FIM score resulted in a better prognosis. The effectiveness of rehabilitation depends on maintaining a perfect FIM cognitive score.

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Objective : We performed a systematic review to investigate improvements in body function and structure, activity, and health-related quality of life from exercise programs of >150 days' duration in patients with knee osteoarthritis (OA). Methods : We collected data on randomized controlled trials (RCTs) comparing the effects of exercise intervention with those of either nonintervention or psychoeducational intervention in patients with knee OA. Data were collected on pain, stiffness, muscle strength, range of motion, flexibility, maximal oxygen uptake, proprioception, time to climb a flight of stairs, disability as assessed by the Western Ontario and McMaster Universities Arthritis Index (WOMAC), walking distance (e.g., 6-min walking-distance test), walking time (e.g., time to walk arbitrary distances), walking velocity, and health-related quality of life assessed using the SF-36^® Health Survey (SF-36). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to determine the quality of the evidence. Results: Forty-one RCTs were identified. Outcomes that were significantly affected by exercise programs of >150 days were knee flexion muscle strength at a functional level, time to climb a flight of stairs and walking distance at activity level, and SF-36 General Health, Physical Functioning, Role-Physical, and Bodily Pain scales. The quality of evidence for these outcomes was moderate to high. Conclusion : In patients with knee OA, improvements in body function, activity, and health-related quality of life can be maintained with exercise programs of >150 days' duration, and these findings are supported by a moderate to high level of evidence.

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Based on my 40-years of experience as a physiatrist and health economist, I present several health economics and policy perspectives along with some basic knowledge requisite for rehabilitation professionals as follows : (1) There are two economic theories or schools concerning the role of health care in society. (2) It is crucial to correctly understand the concept of “ efficiency” ; efficiency in itself does not necessarily mean health care cost containment. (3) There are several basic methods to measure health efficiency ; the most practical one is cost-effectiveness analysis (CEA). (4) The cost of community-based long-term care is not necessarily cheaper than institutional care. (5) We must differentiate “long-term perspective” from “short-term perspective” when we evaluate the efficiency of health care and rehabilitation services.

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