Effects of Botulinum Toxin Type A Injections Combined with Rehabilitation for Post-stroke Patients with Spastic Upper Limb Hemiparesis…Masahiro ABO, Toru TAKEKAWA 179

Ideal Outpatient Care for Higher Brain Dysfunction…Takashi HIRAOKA 183

Organization, Coordination and Reporting Are Required in Outpatient Service for Dysphagia…Junko FUJITANI 187

Points to Consider When Conducting Prosthetic-orthotic Therapy Outpatient Examinations…Toyoko ASAMI 191

Ambulatory Rehabilitation Clinic for Elderly Patients: Preserving Function…Setsu IIJIMA 196

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Rehabilitation in the Critical Care Centre…Shunsuke NAKAMURA 200

The Very Acute Phase Rehabilitation Approach for Patients in ICU and Immediately after Surgery…Takeshi NAKAMURA, Yusuke SASAKI, Ken KOUDA, Fumihiro TAJIMA 205

Pulmonary Rehabilitation in Intensive Care…Morihide ANDO 209

Patient-controlled Epidural Analgesia and Aggressive Postoperative Rehabilitation: An Attempt to Enhance Postoperative Recovery…Hiroshi ISHIMURA, Kohta YAMAUCHI, Hirofumi SHIMAZOE, Shinsuke MII 214

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Purpose : To study the effect of repetitive facilitation exercise combined with continuous low-frequency electrical stimulation on upper-extremity motor impairment or hand edema during the acute phase of cerebral infarction. Subjects : Thirty inpatients with both hemiplegia and hand swelling, who were admitted to a hospital from April 2011 to March 2012. Methods : In this randomized, controlled, observer-blinded trial, we randomized the subjects into two groups and provided treatment on a 2-week, 30 minutes/day schedule. Subjects in the intervention group received repetitive facilitation exercise concurrent with continuous low-frequency electrical stimulation, while subjects in the control group were provided passive range-of-motion (ROM) exercise. Upper Limb Fugl-Meyer Assessment (FMA), edema and passive ROM were evaluated at baseline and at two weeks. Results : At two weeks, the intervention group showed significant improvements on all measurements. However, the control group showed significant improvement only in their FMA. The intervention group had significantly greater improvements than the control group on all three measurements. Conclusion : Repetitive facilitation exercise concurrent with continuous low-frequency electrical stimulation therapy is effective not only for recovery from motor impairment but also for reducing swelling of the hand during the acute phase of cerebral infarction.

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Alien hand syndrome (AHS) is a rare neurologic disorder in which movements are performed without conscious will. Cognitive rehabilitation is usually first considered for treating AHS. However, we proposed different modalities for the treatment. This is the first case report showing therapeutic effects of the NEURO-15 program that consists of low-frequency repetitive transcranial magnetic stimulation and intensive occupational therapy on AHS symptoms and upper limb dysfunction caused by a stroke one year and three months before. A 68-year-old male developed right upper limb palsy secondary to cerebral infarction on the medial side of the left frontal lobe. On admission, he exhibited disturbed skilled motor behavior, compulsive grasping of the right upper limb, and dissociated behavior of the right hand independent from the left. The right hand interfered with the actions executed by the left hand. The left hand restricted the right hand in its actions by holding it. Six months after the onset, his Activities of Daily Living improved and he was discharged from hospital to home. However, his compulsive grasping of the right upper limb symptoms remained, and he underwent NEURO-15 one year and three months after the onset. His right upper limb function improved. Compulsive grasping of the right upper limb disappeared, and the contradictory action of the right upper limb was rarely seen. These results suggested that NEURO-15 influenced the neural network including the primary motor cortex and supplementary motor area.

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