Objectives:To evaluate the effect of a self-controlled vocal exercise in elderly people with glottal closure insufficiency.Design:Parallel-arm, individual randomized controlled trial.Methods:Patients who visited one of 10 medical centers under the National Hospital Organization group in Japan for the first time, aged 60 years or older, complaining of aspiration or hoarseness, and endoscopically confirmed to have glottal closure insufficiency owing to vocal cord atrophy, were enrolled in this study. They were randomly assigned to an intervention or a control group. The patients of the intervention group were given guidance and a DVD about a self-controlled vocal exercise. The maximum phonation time which is a measure of glottal closure was evaluated, and the number of patients who developed pneumonia during the six months was compared between the two groups.Results:Of the 543 patients enrolled in this trial, 259 were allocated into the intervention group and 284 into the control; 60 of the intervention group and 75 of the control were not able to continue the trial. A total of 199 patients (age 73.9 ±7.25 years) in the intervention group and 209 (73.3 ±6.68 years) in the control completed the six-month trial. Intervention of the self-controlled vocal exercise extended the maximum phonation time significantly (p < 0.001). There were two hospitalizations for pneumonia in the intervention group and 18 in the control group, representing a significant difference (p < 0.001).Conclusion:The self-controlled vocal exercise allowed patients to achieve vocal cord adduction and improve glottal closure insufficiency, which reduced the rate of hospitalization for pneumonia significantly.Clinical Trial.gov Identifier-UMIN000015567

The results suggest that a high BSI (≥1.0) is an independent predictor of poor ADL in patients with NSCLC, while showing no correlation with the overall survival.

Left hand apraxia is known as a unique symptom of callosal apraxia, but lower limb symptoms are rarely mentioned. We report a patient who experienced left ideomotor apraxia affecting both the upper and lower limbs after a stroke in the territory of the right anterior cerebral artery. His spontaneous gait was normal, but he was unable to move his left leg intentionally either by verbal command or by imitation. His leg symptoms gradually improved over time. We evaluated the change in cerebral blood flow in this patient using single-photon emission computed tomography. The results showed an increase in blood flow in the posterior corpus callosum; therefore, we suggested that the callosal pathway might contribute to left leg as well as left hand volitional movement.

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Dysphagia due to the varicella zoster virus (VZV) infection has the type of the main constituent Hunt syndrome and dysphagia of the main constituent a facial paralysis. The difference is considered to be the thing due to the ganglionic site which a virus reactivated. We report a case of the rehabilitation for dysphagia due to the VZV viral infection. Keywords: Rehabilitation; Varicella zoster virus; Dysphagia Case ReportA 76-year-old-female patient came to a nearby hospital with a sore throat and hoarseness in August, 2016. In acknowledgement of laryngeal edema, she was admitted to other hospital and did tracheotomy. There was the remaining, but the remaining was able to be eliminated by adding deglutition in the videofluorography at admission.VZV IgG rose by a blood test, and VZV virus neuropathy with dysphagia was diagnosed. She was admitted to the hospital for rehabilitation 65 days later. The Barthel index (BI) was 80 point and she had diabetes, hypertension, a gastric ulcer, but the control was good. The soft palate and lingual were normal. Left vocal cord paralysis was detected in swallowing videoendoscopy (VE) at admission, and the left vocal cord was fixed in a cadaveric position (Figure 1). Also, a larynx had remaining swallowing videofluorography (VF), but the remaining removal was possible in additional deglutition and compensation movement (Figure 2).There was a larynx invasion and a diet was paste foods and ate in 60 degrees reclining position, cervical rotation rank. The rehabilitation program trained her for dysphagia directly and conducted muscular strength reinforcement for muscle weakness. The diet was ingested by tube feeding two weeks before she was admitted, and she continued a paste meal after admission. There was not the aspiration in 90 degrees She removed a cannula 109 days after the onset, and became calm and finally became able to almost take in general diet with nothing. The ADL became independent, and the FIM became 126 points and became the home discharge 131 days after the onset. In VE at discharge, pharyngeal paralysis was improved and there was not the velopharyngeal insufficiency (Figures 3 and 4). Figure 4: There was the remaining, but the larynx movement was improved in the videofluorography at discharge. International Journal of PhysicalMedicine & Rehabilitation Nagai et al., Int J Phys Med Rehabil 2017, 5:In VF at discharge, a larynx had the remaining, but the movement was improved. Because a little larynx invasion was found when we consumed water, we taught it to drink by small quantity. DiscussionThe cause of the mixed laryngeal nerve paralysis is vascular and is neoplastic, and there is postoperative infectivity. The reports of the viral mixed laryngeal nerve paralysis increased [1][2][3][4][5][6][7].The diagnosis is confirmed by demonstration of VZV-DNA or VZV-antibodies in the CSF [8,9]. If there is unilateral herpes zoster infection of the larynx, insilateral LCN may be affected [10]. Our case had a diagnosis in VZV antibody in the CSF similarly.As for the tr...