はじめに：回復期リハビリテーション病棟において歩行能力の評価は重要な課題である．しかし，従来の歩行能力評価尺度には，歩行困難である重症例の座位・立位能力や，歩行修正自立例での歩行補助具の違いを評価することには限界がある．そこでわれわれは，これらの限界を補う目的で，新たに歩行レベル評価尺度Walking LEVEL Scale（WaLS）を開発し，その信頼性と妥当性について検証することを本研究の目的とした．

方法：2022年11月17日～2023年5月6日の期間内に袋井市立聖隷袋井市民病院回復期リハビリテーション病棟に入院した患者を対象に，作成したWaLSを用いて評価した．統計解析は，検者内信頼性と検者間信頼性を明らかにするために重みづけκ係数を用いた．併存的妥当性はWaLSとFunctional Independence Measure（FIM）歩行項目と，WaLSとFunctional Ambulation Categories（FAC）の関連についてスピアマンの順位相関係数を用いた．有意水準は5％とした．

結果：分析対象者は脳血管42名，整形（骨折）47名，整形（非骨折）7名，廃用4名の計100名．検者内信頼性および検者間信頼性は，それぞれ重みづけκ係数0.989，0.951で有意であった．併存的妥当性は，スピアマンの順位相関係数でWaLSとFIM歩行項目は0.916，WaLSとFACは0.919であり，ともに有意な相関を認めた．

結論：回復期リハビリテーション病棟入院患者の歩行レベル評価において，WaLSは高い信頼性と妥当性を有することが示された．

Objective：Studies on upper extremity functional interventions for patients with spinal cord infarction are limited, and the effectiveness of the interventions for upper limb paresis in such patients have not been elucidated. This case report describes evidence-based spinal cord injury interventions that improved upper extremity function in a patient with spinal cord infarction.

Methods：A man in his 60s presented with mild right hemiplegia because of right anterior spinal artery infarction in the C5 medullary segment. Upon admission, the patient had an American Spinal Injury Association Impairment Scale of D, lacked cognitive impairment, and demonstrated independence indoors with ambulation. The intervention included a combination of robotic therapy and electrical stimulation, adherence-enhancing behavioral strategies (Transfer Package), and typical occupational therapy. We recorded the following upper extremity functional scores：①Active Range of Motion of the shoulder, ②Passive Range of Motion of the shoulder, ③Manual Muscle Test, ④Grip strength, ⑤Pinch strength, ⑥Action Research Arm Test, ⑦Simple Test for Evaluating Hand Function, and ⑧Motor Activity Log.

Results：After intervention therapy for 39 days, upper extremity function and the degree and quality of arm use in daily activities improved.

Conclusion：These results suggest that evidence-based interventions for spinal cord injury could improve upper extremity function and the degree and quality of arm use in daily activities in patients with cervical spinal cord infarcti.

Osmotic demyelination syndrome is a pathological condition that leads to electrolyte imbalances and rapid correction, resulting in pseudobulbar palsy, quadriplegia, and altered consciousness. Approximately 33-55％ of affected patients experience residual functional impairment. Herein, we describe a case of a patient with osmotic demyelination syndrome who developed locked-in syndrome during the disease course, underwent rehabilitation treatment, and achieved complete remission without sequelae.

The patient was a 47-year-old man who was admitted to hospital A owing to weakness in the lower extremities and dysarthria. He had severe hyponatremia and received sodium correction. However, on hospital day 9, dysarthria redeveloped and involuntary finger movements were noted. Osmotic demyelination syndrome was suspected based on the findings of magnetic resonance imaging of the head and clinical course, leading to his transfer to hospital B. Steroid pulse and rehabilitation therapies were initiated at hospital B. By the 19th day of symptom onset, his limb and facial muscle paralysis progressed, leading to locked-in syndrome. Thereafter, the patient was transferred to hospital C, where he received physiotherapy, occupational therapy, and eating training, markedly improving his physical functions. He was discharged from hospital C, 4 months after the symptom onset, with limited range of motion of the fingers and weakness of the extremities and continued to receive outpatient rehabilitation treatment. His symptoms improved further, and 1 year after the onset of symptoms, he returned to work without any sequelae.

A 31-year-old woman infected with severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) at 33-weeks pregnant was subject to cesarean delivery due to a worsening respiratory condition. On the fourth day of illness, the patient was placed on a ventilator, with extracorporeal membrane oxygenation (ECMO) treatment initiated on the ninth day. Passive range of motion (ROM) training started on the day 33 of illness. She was weaned off ECMO on day 55 of illness and taken off of the ventilator on day 8. The tracheostomy tube was replaced with a speech cannula on day 87 of illness, at which time the patient began to complain of pain during passive ROM training. Plain X-ray photography and computed tomography (CT) showed ossification around the bilateral shoulder and hip joints, as well as on medial thighs, accompanied by an alkaline phosphatase (ALP) value of 942 U/L. She was subsequently diagnosed with heterotopic ossification, after which passive ROM training was changed to protective ROM training, in addition to treatment with indomethacin farnesyl and etidronate disodium. The patient was transferred to our hospital on day 122 of illness for the purpose of continuing rehabilitation. On day 155 of illness, ossification decreased on the medial thighs, according to CT. She was able to walk independently indoors and was discharged home on day 181 of illness. This case demonstrates the importance of checking the ALP levels and palpating the periarticular area in patients infected with SARS‑CoV‑2 before initiating passive ROM training, as well as being aware of any pain experienced during training. In the case of any abnormalities, assessing the ossification around the joints of extremities by imaging examination is a priority.

Congenital myotonic dystrophy is the most severe form of inherited myotonic dystrophy, presenting with generalized muscle weakness, breathing problems, and feeding difficulties. We report a patient with congenital myotonic dystrophy who began rehabilitation early in the neonatal intensive care unit. The mother had myotonic dystrophy and experienced no complications during pregnancy. The patient was born at a gestational age of 38 weeks and 1 day, weighing 2712 g, with an Apgar score of 1/4, and was diagnosed with congenital myotonic dystrophy. Marked generalized hypotonia and respiratory compromise were observed from birth, and the patient was orally intubated and managed with a ventilator. Rehabilitation to promote sensory-motor development was started 13 days after birth. Initially, generalized muscle hypotonia and prominent limitation of joint range of motion were observed. Therefore, joint range of motion exercises, positioning, and rehabilitation of the sensory-motor system were conducted first, while monitoring circulatory and respiratory status. After weaning from the ventilator, feeding evaluation was started on the 123rd day of life. In collaboration with physicians and nurses, feeding volume was increased stepwise to safely introduce oral feeding. The infant gradually became capable of oral intake and was discharged from the hospital on the 160th day of life. In this report, we demonstrated that rehabilitation intervention for infants with congenital myotonic dystrophy from the time of admission to the neonatal intensive care unit contributed to improved motor development, initiation of oral feeding, and smooth discharge.

Introduction：Intracranial hemorrhage after severe coronavirus disease 2019 (COVID-19) is associated with increased mortality and unfavorable patient outcomes.

Case：A man in his 60s with independent activities of daily living (ADL) was diagnosed with COVID-19, and placed on a ventilator on Day (D)-3 and VV-ECMO on D-5. On D-23, an emergency craniotomy was performed for a left acute subdural hematoma. The patient was weaned from VV-ECMO on D-27. On D-33, sitting was initiated. On D-36, the patient was weaned from the ventilator and began exercise therapy. The Glasgow coma score (GCS) was E2V1TM4. Basic movement as assessed by the Functional Status Score for ICU (FSS-ICU) and Barthel Index (BI), was 3 and 0 points, respectively. On D-40, wheelchair use commenced. He began standing with a long leg orthosis on D-50, and began walking on D-53.

On D-67, the patient transferred to a convalescent hospital. His GCS was E4V4M6. Generalized cognitive decline and motor paralysis were noted. The right upper limb, hand, and lower limb were assessed as Brunnstrom recovery stage IV, V, and V, respectively. The patient's grip strength was 11.9 kg [right] and 18.3 kg [left]. His knee extensor strength was 0.13 kgf/kg [right] and 0.19 kgf/kg [left]. The FSS-ICU, walking speed, and BI were 21 points, 0.17 m/sec, and 40 points, respectively. The patient was discharged on D-240.

Discussion：The Early Mobilization and Rehabilitation Expert Consensus reports that early mobilization and active exercise can improve ADL at discharge. Our patient was weaned from VV-ECMO as soon as possible and practiced standing and walking with a long leg orthosis, resulting in a better outcome.

Anti-signal recognition particle myositis (ASRPM) is a steroid-resistant disease that develops in approximately 5-8％ of patients with dermatomyositis, polymyositis, or other types of myositis. It restricts the patient's activities of daily life (ADLs), mainly owing to muscle weakness of the trunk and proximal lower extremities. We report a case of ASRPM treated at a Kaifukuki rehabilitation ward (KRW；a type of inpatient rehabilitation ward in Japan). A female ASRPM patient in her eighties underwent treatment at the KRW twice, with an interval of 18 months between treatments. During each hospital stay, concentrative and graded exercise therapy was performed under continuous administration of steroid and tacrolimus hydrate. The severity of ASRPM was evaluated using periodic measurement of creatinine kinase (CK) levels. After each KRW treatment, the patient gained the ability to walk and perform instrumental ADLs to live alone. The details of exercise therapy for ASRPM and the management of ASRPM and steroid-induced osteoporosis and its complications (for e.g., lumbar compression fracture) are also discussed.

目的：慣性センサ式モーションキャプチャシステムは測定方法が簡易的なため臨床に導入しやすいが，現状では歩行動作の正常と異常を判別し，評価・診断へ導く運動学的な標準値が十分に整っていないことが課題である．本研究の目的は，男女別・年代別の歩行動作における時空間変数および下肢関節可動域（ROM）の標準値を得ることである．

方法：被験者は健常者177名で，性別（男女）と年代（若年，中年，高齢）で6つの群に分けられた．被験者が快適と感じる速さの歩行（自由歩行）とできる限りの速さの歩行（速歩）を慣性センサ式モーションキャプチャシステムで計測した．歩行標準値として8つの時空間変数と14カ所の下肢ROMを算出した．各変数について測定値分布を確認するとともに性と年齢の影響を分散分析で調べた．

結果：全132変数（22変数×2性別×3年代）のうち自由歩行では123変数，速歩では112変数が正規分布とみなすことができた．歩行速度への年齢の主効果は速歩で認められたが自由歩行では認めなかった．中年群と高齢群では歩行の速度維持においてケイデンスへの依存が大きかった．高齢群は若年群と比べて足関節と股関節ROMが小さく，その違いは自由歩行よりも速歩において顕著であった．股関節ROMには性差があり，男性は内・外旋が大きく，女性は屈曲・伸展が大きかった．

結論：自由歩行および速歩の歩行標準値は，男女別の若年者，中年者および高齢者の歩行評価における変数として使用できる．

We report a case of intractable complex regional pain syndrome (CRPS). The pain improved with regional anesthesia and physical therapy.

A 24-year-old man with hemophilia A, developed throbbing pain from his left foot to the ankle, with no identifiable cause. No organic abnormalities were observed. He diagnosed with CRPS at the pain clinic and admitted to the hospital 10 months after symptom onset for physical therapy with regional anesthesia under clotting factor replacement therapy. Spinal anesthesia was administered on the first and second day of hospitalization, and plantar load stimulation and ankle stretching were performed in the operating room. Subsequently, sciatic nerve blocks and continuous epidural blocks were given, and plantar contact training, ankle joint ROM training, and parallel bar walking training were conducted with cognitive behavioral therapy. Sciatic nerve blocks were continued after discharge. Ninety-five days after onset, the patient was re-admitted for physical therapy, and ROM exercises, partial weight bearing, and gait training together with sciatic nerve blocks and cognitive-behavioral therapy. On discharge following re-admission, the pain improved. The patient walked using one crutch. One year later, the pain further improved, and the patient walked independently.

The combination of regional anesthesia, physical therapy, and cognitive behavioral therapy created a virtuous cycle of pain relief, improved physical functions, and prevented withdrawal from catastrophizing, ultimately leading to overall improvement.

目的：本研究の目的は，決定木分析を用いて回復期リハビリテーション病棟における大腿骨近位部骨折患者の転帰先に必要な条件を明らかにし，在宅復帰のモデルを提示することである．

対象：2018年1月～2022年6月に当院回復期リハビリテーション病棟から退院した患者181名とした．

方法：転帰先によって自宅群と施設群に分類し，基本属性，入院時FIM，入院時MMSEについて対応のないt検定，χ²検定およびMann-Whitney U検定を用いて2群間で比較後，決定木分析を実施した．

結果：決定木分析による解析の結果，入院時FIMの問題解決とトイレ動作からなる決定木が得られ，入院時FIMの問題解決が4点以下の場合には自宅退院が困難となる（自宅復帰率9.7～28.6％）などのルールが得られた．

結語：大腿腿骨近位部骨折患者の在宅復帰を検討する場合は，入院時FIMの問題解決とトイレ動作を組み合わせて判断することが重要であることが示された．