Title: Physical Therapy Approach for Walking of a Patient with Involuntary Movement (Symptomatic Dystonia)

Author・・・・・Katsuhiro Ito,RPT
Organization・・Yamanashi Hot Spring Hospital
406-0004 Japan
Key words・・・involuntary movement, symptomatic dystonia, postural control

We treated a patient who had external head injury that caused him left side hemiplegia. It is difficult for him to touch the ground with the sole of his foot when he walks, because of dystonic inversion.  As for autonomous walking, essentially, to touch the center of his heel at heel contact activates vestibular system and it autonomously brings antigravity extensor activity toward mid stance.And they say that it is important for the function of CPGs, for autonomic rhythmical walking, to extend flexors of hip joint and planter flexors in the latter stance phase. The patient was hindered antigravity extensor activity of trunk and pelvis muscles by walking pattern that he consciously touched his sole, we thought that increase of dystonic strength caused decline of walking ability.Then we treated the patient for the purpose of improvement of autonomous postural control around pelvis, trunk and cooperation with input from the sole, and we obtained some improvement and opinions. Involuntary movement is often caught as a disorder of motor output, but poor alignment, such as rotation of trunk, inversion of ankle joint, it makes information from B.O.S poor or incorrect. Especially, as for treatment of symptomatic dystonia with CVA, we think that a therapist shouldn't be tied to preventing appearance of involuntary movement; we should stimulate ability of normal postural control that keeps up with changes of information of B.O.S, So we should try to treat for more autonomous practical function.

Title: Treatment for the upper-extremity with ataxia

Author・・・・・ Kazuhiro Nagashima ,OTR
Organization・・Matsue Red Cross Hospital
Address・・・・ 200 Hahakoromo-Cho, Matsue city, Shimane, 690-8506 Japan
Key words・・・ ataxia, pons , functions of upper extremity

I report a case of cerebellar ataxia due to cerebral thrombosis of pons in a 76-year-old man. Favorable results were obtained by the treatments based on Bobath concept. On May 18, 2002, It became difficult for him to speak and to move his right upper extremity. MRI revealed an infarct focus in the left ventral to the dorsal pons. Problems : The movement of the upper extremity was restricted because of hypertonia in the shoulder girdle and the upper extremity. He moved his upper extremity in flexor pattern,so he couldn`t move his fingers independently. He could not use the affected hand for various activities of daily life. He was unable to reach for an article and manipulate an instrument. Treatments : I started his treatments 5 days after the onset. The treatments given 2 month after were as follows: In side lying position, I reduced hypertonia of his trunk muscles and improved the mobility. Then, I facilitated his trunk righting reaction with weight transfer at the all fours position. Also, his balanced reaction was facilitated by placing the upper trunk at a sitting position. Moreover, a postural set of trunk for activities of extremities was established as placing the upper extremity. Then treatments were applied to the selective movement of the elbow, forearm and wrist joint. He needed time between the facilitated movement and verbal command. Because I wanted him to have images of movement. I thought that he needed time to organize a lot of information through his cerebellum. Visual stimuli were used to let him recognize the purpose of the action so he could move easily. In addition, tactile stimuli were also added to make appropriate sensory inputs through facilitation of selective movements. Results : His ataxia was improved and satisfactory results were obtained in various objective functional tests.

Title: Approach for the Patient of Spinocerebellar Degeneration with Disturbance in Breathing, Phonation, Articulation, and Swallowing

Author・・・・・ Naoko Nagahisa ,ST
Organization・・Hokuto Hospital
Address・・・・ 7-5, Kisen, Inada-Cho, Obihiro-City, Hokkaido, 080-0833 Japan
Key words・・・ spinocerebellar degeneration, cerebellar ataxia , involuntary movement (tremor)

Spinocerebellar degeneration has various types. In patients with hereditary spinocerebellar atrophy (SCA), cerebellar ataxic symptoms are strong in special. This time, I report the treatments given to a SCA patient and evaluated the treatments. The patient was able to walk by himself and his daily life was on his own. However, he had slight disorders in breathing,phonation, articulation and swallowing. The maximum phonation time was only 2 sec and his voice was tremor. His speaking rhythm was also disordered, the degree of clearness for his speaking was low. When he moved his oral organs, tremor often appeared. Problems: his posture was unstable. Muscle tone was increased and rigid in the whole body to compensate the lowering of muscle tone in the proximal region.The trunk became unstable as a decrease in the base of support (BOS), resulting that the movements of oral organs were inhibited and involuntary movements were increased. Thus, he became so difficult to make functional movements. Purpose:I wanted to stabilize his trunk and improve his ataxic symptoms and involuntary movement. So he could use his oral organs more easily. Treatments: His lumbar back region was difficult to move, treatment was made to change it mobile by increasing the stability of the proximal region. Since the center of gravity was deviated to the left, the therapist attempted to put it on central , resulting his posture was made symmetrical. Then I moved his trunk , head and cervical together with his breathing and phonation. Next I stabilized his oral organ by holding his lower jaw with my hands (key point)and induced skillful movements. I facilitated his oral organ to move quickly. Conclusion :The first treatments for the patient with spinocerebellar atrophy were to stabilize the trunk. Thus, movements of the trunk, head and cervical region, lower jaw and oral organs were enhanced resulting that various functions, such as breathing, phonation, articulation and swallowing were markedly improved.

Title :Life is extended by controlling involuntary movements

Author・・・・・ Yukie Sakano , RPT
Organization・・Minami-Osaka Ryouikuen Hospital for children
Address・・・ 5-11-21, Yamasaka Higashi-Sumiyoshi-Ku Osaka, 546-0035
Key Words・・ subjectivity, compensation/fixation , expanding of activities of daily life

This report outlines the course of a male patient with athetoid cerebral palsy associated with involuntary movement from birth to age 25. Although his muscle tonus has been influenced by his emotional condition, the course shows his daily life was improved through the control of involuntary movement. He received outpatient treatment till age 2 years and 2 months and he entered a handicapped children center till the age of 6. During he went to school , he was under outpatient treatment except for 3 short term periods and a 2 year period when he was in the hospital. After graduation from school, he was also under treatment as an outpatient, indicating that he had been receiving careful and prolonged treatments. At infant age, he often fell into a state of frustration because his intermittent spasm wouldn't allow him to move just as he wanted. Now he drives an electric wheel chair as a result he is more independent. He became able to enjoy sports and now he is a member of a wheel soccer team. A significant turning point appeared in his clinical courses when he was in the 6th year of primary school. Before this time, he was receiving treatment passively, but he took the initiative for his treatment after that. Thus, it became possible to successfully utilize the therapeutic effects in his daily life. He became able to utilize compensatory fixation not so as to induce adverse effects according to the advice from a therapist. Thus, the degree of freedom in his life has been markedly increasing by a control of involuntary movement through the therapist's advice without adverse effects. We hope to continue long term treatments aiming to support and improve all aspects of his life.

Title: How can we support the adult patient with athetoid cerebral palsy

Author・・・・・ Ryuuhei Hikoda, RPT
Organization・・ Minami Osaka Ryouikuen Hospital for Children
Address・・・・ 5-11-21, Yamasaka Higashi-Sumiyoshi-Ku Osaka, 546-0035
Keywords・・・ athetoid cerebral palsy, adult patient , pain

I reported a case of athetoid cerebral palsy. Treatments for lumbago and coxodynia were conducted. The patient was a 50-year old married male. He has cervical vertebral disease, Spondylolysis of lumbar vertebrae, Internal derangement of left knee joint and Scoliosis. He can perform his daily activities independently. He recognized body image and he could also recognize and inform the status of pain when it became necessary. Methods : Physical therapy for his lumbago was recorded video and the therapy was evaluated based on that video. Each course of the therapy lasted 40 min. I thought that his lumbago would have been effected by muscular fatigue due to the over-working of his lumbar muscles that contracted to maintain posture and to move. So, a therapeutic program was designed and started to improve his lumbago. Physical therapy progressed based on his feeling of resistance that appeared in the lower extremity and the trunk during combined movement as an indicator. The degree of his pain was rated with a score of 0 (no pain) to 10 by the patient, himself. Results : The pain score was reduced from 8 to 5 after the physical therapy. Discussion : I thought his pain would have been caused by some troubles in his muscles, because his pain was reduced after the recovery of selective movement and improvements of mobility for trunk and the flexibility of muscle of spine. The therapy was continued for one year. The patient told me that his pain score had been 10 before the therapy, but now the score was reduced to 2 when he was in wheel chair. For reduction of the pain, it is important to keep muscular flexibility first. Then he reproduced movement through recognition of feeling of resistance to movement. Moreover, I thought it was necessary for a patient to have an experience of reconstructing process of movement.