Language：Japanese   Publisher：Frontiers in Neurology  

Introduction: Whereas repetitive facilitative exercise (RFE) affects primarily recovery of motor impairment after stroke, task-oriented training (TOT) focuses on facilitating daily use of the affected upper extremity. However, feasibility of combined RFE and TOT has not been reported. We originated “task-oriented RFE,” as a new combination therapy for patients with hemiplegic upper extremity after subacute stroke, to examine its feasibility in convalescent rehabilitation wards. Methods: This is a before-and-after pilot study. Eight patients with hemiplegic upper extremity after subacute stroke received the task-oriented RFE program for 6 weeks at 80 min per day (20–60 min of TOT applied after 60–20 min of RFE under continuous neuromuscular electrical stimulation) in a convalescent rehabilitation ward. In the current program, we introduced the Aid for Decision-making in Occupation Choice (ADOC) iPad application as a goal-setting method for determining tasks. Feasibility was assessed with adherence to the protocol, adverse events in response to the intervention, and preliminary efficacy. Motor functions, amount of use and quality of movement in the hemiparetic upper extremity, and satisfaction of the patients were evaluated with Fugl-Meyer Assessment (FMA), the Action Research Arm Test (ARAT), the motor activity log (MAL) for the amount of use (AOU) and quality of movement (QOM) of the paralyzed hand, and ADOC. Results: All participants accomplished the program, which was implemented as originally planned; neither nonattendance nor an adverse event occurred during the study. Favorable outcomes were obtained with all measures; mean changes in FMA, ARAT in the dominant hand, MAL-AOU, and MAL-QOM were greater than minimal clinically important differences. Mean changes in ADOC were greater than the minimal detectable change. Discussion: The task-oriented RFE program was safe, well-tolerated, beneficial, and feasible within 80 min a day of occupational therapy, which means also within the procedural constraints of the Japanese health insurance system during the convalescent phase. Future studies are warranted to examine whether combined RFE and TOT enhances the efficacies of each program alone.

DOI： 10.3389/fneur.2024.1356732

Scopus

PubMed

Language：English   Publisher：The Japanese Association of Rehabilitation Medicine  

<p><b>Background: </b>Carnitine is a vital human nutrient. Although there are many reports on carnitine deficiency, most studies have been conducted on children, patients with severe mental and physical disabilities, epileptic patients, patients with liver cirrhosis, and dialysis patients. To the best of our knowledge, there are no reports on carnitine administration for disorders of consciousness after stroke. We report two such cases in which carnitine administration improved disorders of consciousness.</p><p><b>Cases: </b>Case 1 was a woman in her sixties who was admitted to our rehabilitation center 4 months after the onset of subarachnoid hemorrhage. After admission, her disorders of consciousness worsened even though she was actively undergoing rehabilitation. Suspecting carnitine deficiency, we administered 1500 mg/day of L-carnitine, which resulted in improvement of her disorders of consciousness and disappearance of symptoms such as convulsions. Case 2 was a man in his thirties who was admitted to our rehabilitation center 5 months after the onset of cerebral hemorrhage. During active rehabilitation, he suffered worsening disorders of consciousness, convulsions, and cramps. We found carnitine deficiency with a blood carnitine concentration of 21 mg/dL, so we administered 1500 mg/day of L-carnitine; symptoms of disorders of consciousness and convulsions then improved.</p><p><b>Discussion: </b>It is possible that carnitine deficiency has been overlooked in some patients in rehabilitation wards, and measurement of ammonia might facilitate its detection. Because carnitine deficiency can interfere with active rehabilitation, nutritional management with attention to carnitine deficiency could be important during rehabilitation.</p>

DOI： 10.2490/prm.20230019

PubMed

CiNii Research

Publisher：医歯薬出版(株)  

DOI： 10.32118/j02606.2022227464

CiNii Research

Language：Japanese   Publisher：医歯薬出版(株)  

目的◆本学リハビリテーション科初期研修後に他科の専攻医となった医師は、どのような動機で初期研修にて当科を選択したか、そして現在の診療の現場で当科研修がもたらす意義について検討する。対象◆2018年度および2019年度に初期臨床研修で当科を研修した他科専攻医。方法◆Googleフォームを用いた匿名のアンケート調査を実施した。結果◆対象者17名のうち、14名からアンケートの回答を得た。研修で学んだことは「リハビリテーション診断」に関する項目が多かった一方で、「リハビリテーション治療」に関する項目は「もっと学びたい」と答えた割合が高かった。また、「社会福祉制度の利用(リハビリテーションマネジメント)」は専攻医らが現在の診療現場で直面している問題であった。結語◆当科研修を経て、患者の障害に目を向け、退院後の生活にまで関心が向くようになっていることが初期研修における当科選択の意義と考えられる。今後、対象者を増やすとともに複数施設での検討が望まれる。(著者抄録)

Language：Japanese  

Language：Japanese  

Language：Japanese