The specific effect of underwater exercise in a 61-year old woman with cerebellar ataxia induced by spinocerebellar degeneration was observed. She was treated through home visit rehabilitation. She was admitted to this hospital in 2004 and started underwater exercise. She received 40 minutes of physical therapy three times a week as well as 40 minutes of occupational therapy and 30 minutes of underwater exercise three times a week. After that training, her cerebellar ataxia was relieved, and she could walk indoors with good stability using a T cane. During 5 hospitalizations in 3.5 years, her cerebellar ataxia improved and her walking was stabilized.
Some differences in her rehabilitation during hospitalization compared to when she was at home was that occupational therapy was added and that the training frequency was increased five times by physical therapy and occupational therapy for one week in total, and that underwater exercise was added. In regards to the improvement of her dysfunction in terms of daily living, a trunk and an inferior limb were important factors. Therefore, we think that intervention through physical therapy and underwater exercise was significant. Also, the difference between her physical therapy during hospitalization and when at-home was three times a week during hospitalization and twice a week when at home. Therefore, we determined there was a large difference of her rehabilitation effected by the underwater exercise. There is a possibility the underwater exercise improved her intension tremor and dysmetria, stabilized her indoor walking, and extended the distance she walked outdoors.
Underwater exercise is a plural classical training method that is reasonably safe while at the same time providing rehabilitation for cerebellar ataxia, and this exercise is expected to provide addition due to the warm temperature of the water.
The authors propose that new rehabilitation using underwater exercise for cerebellar ataxia be considered.

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Objective
The purpose of this trial was to compare the cumulative and sustained effect of repeated acupuncture treatment and repeated local injection of anesthesia for localized low back pain.
Methods
A computer program was used to randomly allocate 26 patients with low back pain to either an acupuncture group (n=13) or a local injection group (n=13). Patients in both groups received treatment at the most painful points (from 2 to 5 points) once a week for a total of 4 weeks. For the acupuncture treatment, a 0.18mm diameter stainless steel needle was inserted to a depth of 10 to 20mm and then manual stimulation using the sparrow pecking method (1Hz) was given. For the local injection, injection needle (25G, 0.5mm in diameter) was inserted to a depth of 10 to 20mm before injection of the anesthetic (a mixture of local anesthetic and neurotropin). The visual analog scale (VAS: 100mm) was used to measure subjective pain intensity before and directly after the first treatment, before subsequent treatments, and at two and four weeks after completion of the treatment. The Roland-Morris Disability Questionnaire (RDQ) and Pain Disability Assessment Scale (PDAS) were also used to evaluate Quality of Life (QOL) of the subject at before the first treatment, at the time of completion of treatment, and at two and four weeks after the completion of treatment.
Results
There was a significant difference (p=0.0016) in changes in the VAS scores between two groups, with more favorable results in the acupuncture group than in the local injection group. Calculation of the degree of change from the initial scores indicated that acupuncture group showed significantly better results than those in the local injection group at directly after the first treatment (p=0.0348), and there was a significant cumulative effect (at the end of treatment: p=0.0076) and sustained effect (two weeks after treatment: p=0.0096, four weeks after treatment: p=0.0128). Similarly, RDQ and PDAS were also better in the acupuncture group compared to the local injection group.
Discussion
Both local injection and acupuncture reduced low back pain. The superior effect of acupuncture directly after treatment and its superior cumulative and sustained effect, indicate that it could be an effective treatment for low back pain. The reason for the disparity between the effects could be due to differences in the mechanisms of pain suppression.

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A case report
A 70-year-old male with small bowel adenocarcinoma involving retroperitoneal invasion had undergone chemotherapy after non-curative operation. However, this patient had to discontinue the first and second lines of chemotherapies within one month due to serious side effects of anti-cancer agents. Subsequently, the patient complained of severe low-back pain and there was evidence of local recurrence around the resected small intestine. Therefore, phototherapy was applied three times a week to relieve the low-back pain while the patient underwent the third line of chemotherapy. It was interesting to note that these combination therapies coincidentally ameliorated the various side effects caused by anti-cancer drugs. For one year during the third line of chemotherapy, the patient had to temporarily discontinue chemotherapy only two times when phototherapy was not available for one week due to consecutive national holidays in May and November. The quality of life of this patient was well maintained, and he only needed to be hospitalized for the last two months before he died.
Epidemiological studies have shown a high incidence of cancer in people less exposed to solar rays. The sunshine “vitamin” 1 alpha, 25-dihydroxy vitamin D₃ (1, 25(OH)₂D₃) is involved in these epidemiological studies based on the evidence that 1, 25(OH)₂D₃ is an antiproliferative agent that may inhibit proliferation of cancer cells in vitro and development in animals. To elucidate the synergetic effect of phototherapy in combination with chemotherapy, we assayed serum levels of 1, 25(OH)₂D₃ in this patient compared with those of end-stage cancer patients undergoing chemotherapy alone. Serum levels of 1, 25(OH)₂D₃ in this patient after receiving the combination therapies were higher than those in other cancer patients treated with chemotherapy alone.
Our results indicate that phototherapy may be a good complementary therapy with chemotherapy for cancer patients.

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Ginseng powder was dissolved in the warm water to develop bath salt that contained Ginseng powder (250mg: 1% Ginseng powder, 500mg: 2% Ginseng powder) and it made comparative study of the effects with the tap warm water for seven healthy adults (male 3, female 4, 20.7±0.8 years old). The Ginseng powder of 250mg and 500mg was made so that the bath salt of 25g may become 1% and 2%. The whole body immersion of 15 minutes was done to all subjects under the condition that 1% or 2% cannot be distinguished without tap water bathing.
As a result, the warm water with Ginseng powder increased in the changes of the deep thermometer in front of chest between immersion and after bathing, compared with the tap warm water. But there were not significant change of the surface skin temperature on the arm and the tissue blood flow on thigh skin.
Therefore, the warm water with Ginseng powder was suspected that the thermo effects and the retaining warmth were good compared with the tap warm water.
It seemed that it was possible to use it safely as bath salt for it did not change of the blood pressure, the heart rate, and abnormality of the skin without the case to whom the skin had temporarily flushed, was not additionally recognized.

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Objectives: The purpose of this study was to examine the beneficial effects of balneotherapy in patients with chronic heart failure (CHF).
Background: Some reports have shown that balneotherapy reduces systemic blood pressure in healthy volunteers. However, it is not clear whether balneotherapy improves the status of CHF. We hypothesized that hyperthermia using hot water would improve cardiac and peripheral endothelial function and clinical symptoms.
Methods: Twenty-six patients with chronic systolic heart failure classified as New York Heart Association (NYHA) functional status II or III were divided into two groups. In the balneotherapy group, patients were immersed in a hot spring at 40°C for 10min daily for two weeks; in the control group, patients took a daily shower. We measured plasma brain natriuretic peptide (BNP) and asymmetric dimethylarginine (ADMA). The left ventricular ejection fraction (LVEF) and cardiothoracic ratio (CTR) were evaluated by echocardiography and chest radiography, respectively. Brachial-ankle pulse-wave velocity (baPWV) was measured non-invasively using an automatic device.
Results: Clinical symptoms were improved after two weeks of hot spring therapy. Although heart rate and CTR did not change, clinical symptom and LVEF improved and mean blood pressure, BNP, ADMA and PWV significantly decreased.
Conclusions: Repeated immersion in a hot spring improves peripheral vascular endothelial function, thus leading to improvement of clinical activity and symptoms in patients with CHF.

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Our previous studies have shown that spa therapy can reduce subjective symptoms and improve ventilatory function in patients with chronic obstructive pulmonary disease (COPD). The aim of this study is to measure the effects of spa therapy on walking distance during the six-minute walk test in patients with COPD. Twenty-five COPD patients hospitalized for pulmonary rehabilitation at our hospital were included in this study. Twenty-two patients were male and 3 patients were female. Two patients had stage I, 9 patients had stage II, and 14 patients had stage III COPD, according to the Global Initiative for Chronic Obstructive Lung Disease. We offered complex spa therapy (swimming training in a hot spring pool, inhalation of iodine salt solution, and fango therapy) in all patients for 4 weeks. Ventilatory function, six-minute walk distance, oxygen saturation and Borg scale were measured. Vital capacity (VC) was significantly improved by spa therapy at 4 weeks (p<0.05). The values of forced vital capacity (FVC), forced expiratory volume in one second (FEV_1.0), forced expiratory flow after 75% of expired FVC (FEF₇₅), forced expiratory flow after 50% of expired FVC (FEF₅₀), forced expiratory flow after 25% of expired FVC (FEF₂₅), mean expiratory flow during the middle half of the FVC (FEF_25-75), residual volume (RV), functional residual capacity (FRC), peak expiratory flow (PEF) and diffusing capacity for carbon monoxide (DLco) showed a tendency to increase, however the increase in the 10 parameters was not significant. The values of six-minute walk distance before and after spa therapy were 288±106m and 323±114m, respectively (p<0.05). There was a significant decrease in values of maximum Borg Scale values (p<0.05). The values of minimum oxygen saturation and the values of oxygen saturation at rest slightly increased, but not significantly. The change of six-minute walk distance correlated with change of VC (r=0.545; p<0.05), with change of FVC (r=0.628; p<0.05), with change of FEV_1.0 (r=0.559; p<0.05), with change of FEF₅₀ (r=0.480; p<0.05), with change of minimum oxygen saturation (SpO₂) (r=0.554; p<0.05) and with change of SpO₂ at rest (r=0.445; p<0.05). We found that spa therapy induced improvements in ventilatory dysfunction and six-minute walk distance in patients with COPD. The results from this study reveal that spa therapy may improve disease control and exercise tolerance in patients with COPD.

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