The processes required to cook the food is complicated, and demands great care since the food needs to be prepared in a way that allows a bolus to be formed for easier swallowing. We served an average of 46 people per a day, which is 11% of all diet food served in our hospital. Our mission is to constantly develop and upgrade recipes to our patients' needs by implementing enzyme and vacuum cooking. We have been carrying out these techniques for the past six years and it allows for successful bolus formation of food to answer to the degree of each patient's eating and swallowing disability. Even with all of these modifications to the food, it still looks delicious and unprocessed. Our team organized Conference of Recipes Which are Modified to be Easy to Swallow for share information and progress on the modifications of foods.

We devised a therapeutic approach to facilitate the use of the paretic upper extremity (UE) in daily life by combining integrated volitional control electrical stimulation (IVES) with a wrist splint, the hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy. IVES can change its stimulation intensity in direct proportion to the changes in voluntary generated EMG amplitude recorded with surface electrodes placed on the target muscle. The stimulation was applied to the paretic finger extensors. Using this assistive stimulation combined with a splint, patients with moderate to severe hemiparesis, who cannot extend their paretic fingers voluntarily, could extend their fingers at their will. Patients wore a wrist–hand splint and carried a portable IVES in an arm–holder for 8 hours during the daytime. The system was active for 8 hours, patients were instructed to use their paretic hand as much as possible. HANDS therapy was conducted for 3 weeks. The patients were also instructed to practice bi–manual activities in their daily lives. To examine the effects of the HANDS system, a randomized controlled trial conducted with stroke patients. Furthermore, we studied changes in selected markers of brain and spinal plasticity induced by HANDS therapy. The paretic upper extremity motor function improved after 3 weeks HANDS therapy. Neurophysiologically, the intervention induced restoration of presynaptic and long loop inhibitory connections. Paired pulse TMS study indicated plastic change in the affected hemisphere. Functional improvement of upper extremity motor function and spasticity induced with HANDS therapy are based on the disinhibition of affected hemisphere and modulation of reciprocal inhibition. The HANDS therapy may offer a promising option for the management of the paretic UE in patients with stroke.

Repetitive transcranial magnetic stimulation (rTMS) has the potentials to change brain excitability, inducing plasticity. In recent years, the use of rTMS has been increased for basic research and clinical applications, such as post–stroke complicatons, including hemiparesis, aphasia or unilateral spatial neglect.

rTMS is classified into inhibitory low–frequency (≦1Hz) and facilitatory high–frequency rTMS (≧5Hz), totally named as conventional rTMS (c–rTMS), in which stimulation pattern is regular. In contrast, patterned rTMS (p–rTMS) has irregularly modified stimulation pattern. The after–effect of rTMS, lasting beyond stimulation time, depends on the number, intensity and frequency of stimulation pulses, contributing to clinical efficacy of rTMS. Lastly, p–rTMS is used much often than c–rTMS, because the after–effect of the former is more than the latter in duration and magnitude of the effect. The author and collegue use theta burst stimulation (TBS) (Huang et al, 2005) among various p–rTMS. TBS is classified into inhibitory continuous TBS (cTBS) and facilitatory intermittent TBS (iTBS). In this report, in addition to c–rTMS, the efficacies of cTBS are described for unilateral spatial neglect (USN) or non–fluent aphasia, stimulating over posterior parietal cortex or Brodmann area 45 (BA45) on unaffected hemisphere, respectively. Also, in recent, we have reported the effect for post–stroke ataxia of hybrid therapy of iTBS over the motor cortex on affected hemisphere combined with integrated volitional control electrical stimulation (IVES).

rTMS (in particular, TBS) is expected a promising useful therapy for rehabilitation.

Transcranial direct current stimulation (tDCS) is a method of altering cortical excitability using low intensity direct current for improving motor and neuopsychological disturbances in neuromuscular diseases including stroke. For treatment of hemiplegic arm, tDCS delivers constant direct current (1–2mA) during 10–20min thorough a pair of sponge electrodes which placed on the scalp overlying a target motor cortex region of the brain and the contralateral supraorbital region. The stimulation parameter is determined by the polarity of the electrodes, current intensity and duration. Although tDCS is less in resolution of both time and space than the transcranial magnetic stimulation (TMS), tDCS is safer than TMS. Combination therapy using tDCS with other rehabilitation methods have developed. The combination therapies using tDCS with robotic arm training are effective for improving the motor functions of the hemiplegic arms of chronic stroke.

Two major contributing factors of human falls are the gravity and the longevity. Wilds et al. (1981) revealed that older adults who experienced falls had extremely lower mortality than those who did not fall. Falls can be interpreted as the consequences of weakened physical function or bad health condition, as well as a risk factor of health in older adults.

The number of deaths due to falls is now higher than that from traffic accidents. The number of deaths due to falls was 7,766 per year, while the number of traffic deaths was 6,060 per year in 2013, decreased from more than 15,000 per year in the past. Deaths due to falls are the consequences of fall–related : 1) fractures of proximal femur impairing physical function and requiring long–term care ; 2) head trauma ; 3) disuse syndrome ; or 4) worsened chronic diseases or complications.

Falls are considered as a yellow light (warning signal) of life. Prevention of falls can reduce fractures, head injuries, and related need for long–term care and deaths. Falls prevention is considered as an important element for achieving healthy life expectancy and reducing physical, mental, and economic burdens of individuals and society. In other words, prevention of falls in individuals can contribute to the prevention of falls in society (i.e., collapse of social systems). Through the prism of “falls”, we can deeply understand physical function, diseases, and disorders of older adults. From the standpoint of “falls prevention”, we can check and reconsider the current health care systems including the environment of our community. These considerations may lead to the development of new software/hardware.

It is strongly desired that a new academic field of “Falls Prevention Sciences” will be established through the practical and academic multidisciplinary efforts.

Falling is more frequent in patients with neurological diseases than in older persons residing in the community. Patients with neurological diseases have many factors that contribute to falls, such as palsy, postural instability, and cognitive impairment.

To prevent falls in patients with neurological diseases, multifactorial fall risk assessment should be considered. Interventions include modification of the environment, withdrawal of potential drugs causing a fall, and exercise. It is important that patients and care givers actively participate in fall prevention. Team approach is indispensable for fall prevention in neurological patients. Multifactorial and multicomponent interventions with multidisciplinary staff should be considered.

Incidence of dementia and the proportion of hospitalized elderly individuals with dementia have been increasing as the population ages. Elderly individuals with dementia are more prone to falls as their psychological and bodily functioning is affected by neurological impairments associated with dementia. Nurses can prevent such falls by identifying high–risk situations. Thus, it is necessary to identify risks associated with the main behavioral and psychological symptoms of dementia (BPSD). Furthermore, elderly individuals with dementia tend to have extreme responses to BPSD and often fall because they have to perform activities of daily living without assistance. It is important that nurses consider elderly individuals' perspective when providing care. Therefore, a multi–faceted intervention that requires the active involvement of an interdisciplinary team comprising nurses, caregivers, physiotherapists, occupational therapists, and physicians may effectively prevent falls among elderly individuals with dementia.

Falls are the most frequently encountered risk phenomenon in rehabilitation.

Falls result from various factors. Diseases effecting the nervous system, cerebral vascular accidents, and Parkinson's disease are all known to be the catalysts of these occurrences.

We are aware that many incidents of falls occur during occupational, speech–language–auditory, and physical therapy according to the Guideline for Safety Management and Promotion in Rehabilitation Medicine.

Various exercises are performed for to prevent falls. As they are related to the patient's center of gravity, muscle strength, flexibility, and balance are of the utmost importance regarding fall prevention. Basic knowledge about various internal and external factors in relation to the selection of walking aids and environmental improvement as appraised by the physical therapist is also of utmost importance. Collective efforts by a hospital's medical safety control department and risk management are absolutely essential. The balance of one patient who has neurological intractable disease, and progressive supranuclear palsy (PSP), was improved when undergoing specialized therapeutic exercises. It is necessary to accurately report a cerebral vascular patient's acute and recovery rates to all concerned personnel.

Teaching how to help a patient stand after having fallen down is also of vital importance. This for both hospitalized and discharged patients. Communication between all the therapeutic modalities is absolutely necessary in regard to total patient care.

In 2014, donepezil was approved for treatment of dementia with Lewy bodies (DLB) in Japan, and became the world's first licensed medicine for DLB. Because of severe cholinergic dysfunction in DLB, cholinesterase inhibitors (ChEIs) have been thought to be highly effective, and several clinical trials have demonstrated favorable potential of ChEls such as rivastigmine and donepezil for DLB. Most of the trials, however, were open–labeled, and no ChEI had been approved for DLB.

Thus, clinical development of donepezil for DLB was initiated in 2007. As there was no precedent, many challenges were faced during the development. In this article, the history of development was described in light of the challenges.

Considering the globalization of new drug development, the current situation of multi–regional clinical trial is addressed. Recent review example of neurological drug is also introduced. In addition, recent challenges of PMDA to promote development of neurological drug/medical devices and expectation for academia are discussed.

Pharmaceuticals and Medical Devices Agency (PMDA) has been working to establish a framework for pharmacoepidemiological (PEpi) drug safety evaluation in MIHARI Project (Medical Information for Risk Assessment Initiative) since FY 2009. In this project, PEpi studies utilizing electronic medical records (EMRs) database such as claim, DPC and Hospital Information System have been conducted for quantitative risk evaluation of a drug. Recently, a new initiative to establish large–scale HIS database called as Medical Information Database Network (MID–NET) has been started. In this way, a marked progress on drug safety evaluation based on EMRs has been made recently and further progress on this area will be needed for promoting a proper use of drugs based on scientific evidences.

進行期のParkinson病患者の療養状況を調べる目的で過去4年間に当大学病院を受診していたHoehn&Yahrの臨床重症度分類Stage4とStage5の患者113名を対象に症状，加療や通院の状況，療養の内容や社会制度の利用状況を後ろ向きに調査を行った．進行期の重症Parkinson病患者では移動が極めて困難であるために通院が困難となるが，当院では訪問診療と並行した診療体制が整備されていないことや，介護認定の取得がHoehn&Yahrの臨床重症度分類Stage4の患者では70.0%，同分類Stage5の患者では88.2%であったことに比し身体障害者手帳を有している患者の割合は臨床重症度分類Stage4の患者では38.4%，Stage5の患者では66.7%と少なく，社会資源の利用状況実態を把握する必要性があると考えられた．外科治療後の患者の割合が高く，術後管理の必要性も兼ねて高度専門病院である大学病院に通院している可能性が考えられた．進行期のParkinson病患者の療養環境を整えるために今後も療養上の問題点を明らかにする必要があると考えられた．