At the end of 2012, Prof S Yamanaka received the Nobel Prize for his work on induced pluripotent stem cells. Now iPS cell therapy, his contribution to regenerative medicine, will shine a light on many disabled persons. The dream of curing patients with upper motor neuron diseases, such as spinal cord injury (SCI), Parkinson disease, strokes etc will finally come true. Dr Krusen, the father of Rehabilitation Medicine or Physical Medicine & Rehabilitation, defined this specialty as consisting of two categories : one being the Phys Med, a branch of medicine using physical agents such as heat, water, electricity, mechanical agents, therapeutic exercises and recent sophisticated physical modalities in diagnosing and treating neuro-musculo-skeletal diseases. The other being Rehab, which denotes “enabling the patient to return to his/her previous social setting.” In the past, the Department of Rehabilitation Medicine at Keio University used to collaborate with the Department of Physiology to adapt embryonic stem cell therapy for treating SCI, Parkinson diseases etc along with physical modalities. Going forward, research in “iPS cell therapy or regenerative medicine” should be the primary concern of PM&R specialists as it is the first step on our way to the next generation in the specialty of Physical Medicine and Rehabilitation or Rehabilitation Medicine.

View full abstract

Robotic Devices for Rehabilitative Training…Kenji HACHISUKA 343

Functional Electrical Stimulation…Yoichi SHIMADA, Toshiki MATSUNAGA, Kana SASAKI, Daisuke KUDOH, Yoshihiko OKUDERA, Nobusuke SHIBATA, Ken SASAKI 348

Gait Training using Functional Electrical Stimulation in Chronic Stroke Patients with Hemiplegia : A Report of Two Cases…Mitsuhiro OCHI, Noriaki KATO, Futoshi WADA, Kenji HACHISUKA 353

Training Combined with Engineering Devices for the Upper-extremities in Stroke Patients : The Role of the Therapist…Takashi TAKEBAYASHI, Keisuke HANADA, Kazuhisa DOMEN 357

View full abstract

Cardiovascular and Body Fluid Adaptation during Prolonged Bed Rest in Early Acute Phase Rehabilitation…Shigeru MAKITA 362

View full abstract

Objective : An adequate risk stratification protocol is important in cardiac rehabilitation. However, defining this is difficult in patients with myocardial infarction in the early recovery phase, because the maximal exercise testing for determining the stratification cannot be performed in this phase. The purpose of this study was to investigate the usefulness of the risk stratification protocol of the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) based on an index without cardiopulmonary exercise testing. Methods :We investigated 164 patients with ST-elevation myocardial infarction who completed the acute rehabilitation program after percutaneous coronary intervention. Patients were classified into low, moderate, and high-risk groups by the risk stratification,and then we calculated their Thrombolysis in Myocardial Infarction risk score for STEMI (TIMI RS), Global Registry of Acute Coronary Events risk model (GRACE RS), Primary Angioplasty in Myocardial Infarction risk score (PAMI RS), and Zwolle risk score for STEMI (Zwolle RS) which are the major comprehensive risk scores designed for predicting short-term outcome after acute coronary syndromes. We compared the risk scores among the three groups, and we investigated major adverse cardiac events (MACE) during supervised exercise in the early recovery phase. Results : As a result, we found a statistically significant difference between the low-risk group and the high-risk group in all risk scores. In addition, there were no MACE during supervised exercise in this period. Conclusion : This study suggests that, by using the AACVPR risk stratification protocol based on an index without cardiopulmonary exercise testing, it is possible to roughly classify the risk in this phase, and that it is useful for defining safe exercise regimes in patients with ST-elevation myocardial infarction in the early recovery phase.

View full abstract

Purpose : We verified electromyogram activity during hip flexion under different pelvic rotation positions, investigated the effects of pelvic rotational position and defined the difference between males and females. Subjects : 15 healthy adults (5 male, 10 female) with a mean age of 28.8 years participated in this study. Method : We recorded surface electromyograms of the tensor fasciae latae muscle (TFL), rectus femoris muscle (RF), biceps femoris muscle (BF), semitendinosus muscle (ST), and the bilateral internal oblique muscle (OI) during flexion of the hip joint in a supine position with three different pelvis rotation conditions. Results : Males showed no significant differences at all muscle activity levels. Meanwhile, TFL muscle activities were significantly higher for females in other side rotation of the pelvis than in the pelvis neutral position (p<0.05). Moreover, opposite side of OI muscle was activated significantly highly in both side rotation position (p<0.05). Conclusion : Generally, the transverse diameter of the pelvis in females is longer than that in males. When the lower extremity is elevated in the pelvis rotation positions, the moment of force on the pelvis is thought to be higher in females. Therefore, the stabilizing muscles of the pelvis, like the OI, need to be activated isometrically in females.

View full abstract

A 47-year-old male with a left middle cerebral artery embolism due to a left atrial myxoma was admitted to our hospital for severe right hemiparesis (Brunnstrom Recovery Stage I in all parts) and total aphasia. On day 29, the tumor was extracted but he developed complete AV block as a complication after surgery. Rehabilitation was delayed for a long time and the severe hemiparesis remained unchanged. He required assistance even when taking a sitting position on the bed, but muscle tonus appeared on the right lower limb. Beginning on day 59, before pacemaker implantation, we applied high-frequency repetitive transcranial magnetic stimulation to his bilateral lower limb motor areas for 5 consecutive days. As a result, paresis in the right lower limb improved to Brunnstrom Recovery Stage III and he could walk between parallel bars. On day 67, a pacemaker was implanted. On day 88, he could walk independently with a cane on discharge from our hospital, although the upper limb and hand paresis remained severe. Although there has been no report on the use of transcranial magnetic stimulation on the lower limb motor area except in the chronic stage, our experience suggests that this type of intervention can be effective in the recovery stage as well. Since transcranial magnetic stimulation is not feasible after pacemaker implantation, careful assessment is necessary for determining the precise indication for this treatment.

View full abstract

incorrect: Received December 28, 2013
correct: Received December 28, 2012

View full abstract