Tottori University Hospital Fall-Prevention Team…Mari OSAKI, Hideki YAMASHITA, Mika YAMAWAKI, Satoko NAKASHITA, Hiroshi HAGINO 254

Preventing Falls and Fractures in Kochi Medical School Hospital's General Ward…Kenji ISHIDA, Yasunori NAGANO, Toshikazu TANI 258

Preventing Patient Falls in Convalescent Rehabilitation Wards : Concurrent Action on Activity Improvement and Prevention of Serious Accidents with an Approach from the Perspective of Clinical Ethics…Susumu WATANABE, Katsuhiko SANNOMIYA, Masaaki FUJITA, Tooru SHIBATA, Hiromichi UMETSU, Mariko SUGIMOTO, Yoshiko ITAKURA, Kouhei OKADA, Shinya KUBO, Makoto ISHIKAWA 262

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For rehabilitation of patients with aphasia, the accurate diagnosis of aphasia and its type is very important. The types of aphasia are classified on the basis of the impairment pattern found in speech fluency, comprehension, and repetition. The aphasia types provide medical staffs with clues for how to best communicate with patients with aphasia. Physiatrists should grasp the language signs and symptoms of those patients and organize suitable rehabilitation. Standard medical practices in treatment of aphasia and recent methods to boost language recovery are also reviewed.

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Objective : The aim of this study was to assess the effects of using a motor point block with 5% phenol on spasticity and gait in patients with chronic hemiparesis. Methods : Participants were 13 patients with chronic hemiparesis after stroke, brain injury or brain tumor. We performed motor point block (MPB) with 5% phenol to the spastic muscles of the lower extremity that caused talipes varus or talipes equinus (i.e. gastrocnemius, soleus, and tibialis posterior). Before and after the MPB, we assessed modified Ashworth scale (MAS), brace wear scale (BWS) and goal attainment scale (GAS). Walking ability was measured using a 30-m walking timed test and 6-minute duration walking test. The step length, foot area during walking and body weight bearing ratio of the paretic side were measured with force plates. Results : We found significant changes in MAS of the plantar flexors (p=0.007), ankle inverters (p=0.006), walking speed (30-m walking time (p=0.046), 6-minute walking test p=0.016), foot area during the stance phase (p=0.006), and body weight bearing ratio of the paretic side (p=0.007)) and BWS (p=0.002). GAS also showed favorable appraisal of MPB by the participants. Conclusion : MPB with 5% phenol can reduce the spasticity and improve gait speed and stability.

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The purpose of this study was to assess the effects of different daily lengths of physical training on postoperative walking ability and functional performance among elderly inpatients following hip fracture. Fifty-eight eligible elderly patients (mean age 81 years, SD 8) undergoing inpatient rehabilitation after fall-related hip fracture were randomized to receive either 2 units (40 minutes in 29 patients) or 6 units (120 minutes in 29 patients) of daily physical training postoperatively. There were no significant differences in patients' age, preoperative walking ability, type of femoral neck fracture and preoperative QOL functional score (FIM, BI and EQ-5D). All patients commenced the same postoperative rehabilitation program immediately after surgery consisting of bed-side sitting, wheelchair mobilization and progressive muscle strengthening exercises on the second day, followed by weight-bearing exercises and walking between the second and the 14th day. All patients walked with a stick or a rollator at the time of discharge from the hospital after 4 weeks of inhospital rehabilitation. There was no significant difference in the BI, FIM and EQ-5D scores and walking ability between the two groups during 12 weeks postoperatively, however, medical expenses in the 2 units group were decreased by US$ 2,000. Postoperative rehabilitation of elderly patients with femoral neck fracture aims to return the patients to pre-injury conditions as early as possible. This can be achieved with the help of a 2 unit (40 minutes) a day training program.

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Generally, conservative treatment is performed at the initial stage of Osgood-Schlatter disease (OSD) to decrease pain. When this conservative treatment is no longer effective, surgery will be performed to decrease OSD pain by removing a tibial tuberosity avulsed bone and a synovial capsule. We reported a time-series change of pain before and after the OSD surgery on a wrestling athlete. The present subject was a 20-year-old male wrestler (height 183 cm ; weight 90 kg), who received OSD surgery on the left knee. Numerical rating scale (NRS) was used to determine pain before and after the OSD surgery. NRS was measured by three positions : resting position (RP), sitting with knee extending position (SKEP), squat with knee flexing 90° position (SK 90 P) and pressure pain (PP). Immediately after the OSD surgery, NRS at the RP, SKEP, SK 90 P, and PP decreased from NRS 3 to NRS 0, NRS 5 to NRS 1, NRS 8 to NRS 6, and NRS 8 to NRS 1, respectively. Three weeks after the OSD surgery, pain at the SKEP and PP decreased to NRS 0. Eight and eleven weeks after the OSD surgery, pain at the SK 90 P decreased to NRS 2 and NRS 1, respectively. The present case study suggests that OSD surgery may progressively decrease pain. Further studies are needed to clarify the effect of OSD surgery on pain.

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Skeletal dysplasias are developmental disorders of chondro-osseous tissue, and include 456 disorders according to "Nosology and Classification of Genetic Skeletal Disorders : 2010 Revision". Research on the rehabilitation for patients with skeletal dysplasias is scarce, but many patients experience various kinds of disabilities throughout their lives. Achondroplasia is a representative disorder manifesting short stature. In childhood, muscle hypotonia leads to delayed motor development. Individuals with achondroplasia may need support for their ADL, mainly ambulation. Though discussion exists as to whether short stature itself is a disability, growth hormone treatment and limb lengthening surgery are performed in some patients and patients undergoing the latter require postoperative physiotherapy. Leg deformities associated with knee joint laxity are refractory to brace treatment and treated with tibial osteotomies to prevent progression to osteoarthritis in some patients. In adulthood, spinal canal stenosis is a matter of great concern. Kyphosis at the thoracolumbar junction is a risk factor for early development of clinical symptoms, and must be prevented with posture management and spinal orthoses, if necessary, from childhood on. Osteogenesis imperfecta is a representative disorder manifesting bone fragility. Bone fragility constitutes a vicious cycle with fractures, fixation and reduced weight bearing as their treatment. A multidisciplinary approach to break this vicious cycle is mandatory, including orthoses and/or surgery to treat fragility/deformity of long bones and spinal deformities, medication for bone fragility, and rehabilitation to prevent fractures and improve ambulatory status. In rehabilitation planning, it is important to set an appropriate goal in ambulation.

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