Hybrid Assistive Neuromuscular Dynamic Stimulation (HANDS) therapy is one of the neurorehabilitation therapeutic approaches that facilitates the use of the paretic upper extremity (UE) in daily life by combining closed-loop electromyography- (EMG-) controlled neuromuscular electrical stimulation (NMES) with a wrist-hand splint. This closed-loop EMG-controlled NMES can change its stimulation intensity in direct proportion to the changes in voluntary generated EMG amplitudes recorded with surface electrodes placed on the target muscle. The stimulation was applied to the paretic finger extensors. Patients wore a wrist-hand splint and carried a portable stimulator in an arm holder for 8 hours during the daytime. The system was active for 8 hours, and 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 bimanual activities in their daily lives. Paretic upper extremity motor function improved after 3 weeks of HANDS therapy. Functional improvement of upper extremity motor function and spasticity with HANDS therapy is based on the disinhibition of the affected hemisphere and modulation of reciprocal inhibition. HANDS therapy may offer a promising option for the management of the paretic UE in patients with stroke.

Measuring PMP parameters with a second lumbrical-interosseous study may be useful for diagnosing CTS.

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Cervical necrotizing fasciitis, commonly of pharyngeal, tonsillar, or odontogenic origins, is a rare polymicrobial infection. Reports show that in 40-45% of cases, cervical necrotizing fasciitis spreads rapidly to the mediastinum, often becoming fatal.1) Prompt diagnosis and treatment of descending necrotizing mediastinitis (DNM), e.g., securing the airway, administering antibiotics, performing drainage, and providing intensive care for sepsis, can contribute to improved survival. Complications include a compromised airway, jugular vein thrombosis, suppurative jugular thrombophlebitis (Lemierre's syndrome), carotid artery erosion and rupture, septic shock, empyema, and a bronchocavitary fistula.2) Dysphagia can persist after DNM treatment. Such dysphagia is thought to be caused by movement disorder of the hypopharyngeal muscle and hyoid/thyroid cartilage that develops as a result of fibrosis and scarring caused by the inflammatory changes in the fascial space.3,4) However, the mechanism remains a matter of speculation. There are very few reports on rehabilitation for this condition,5) probably