Graduate School of Medical and Dental Sciences
Dept. of Rehabilitation and Physical Medicine
[Japanese Page is here]
Welcome to Kagoshima University Graduate School of Medical and Dental Sciences Dept. of Rehabilitation and Physical Medicine web site. We hope that you will find the information you need regarding clinical practices and academic endeavors, especially the latest facilitation method for stroke rehabilitation.
We hope you take the time to explore our site.
Kazumi KAWAHIRA, MD, PhD
Professor of Dept. of Rehabilitation and Physical Medicine, and the Director of Kirishima Rehabilitation Center
Facilitation Method for Stroke Rehabilitation
The KAWAHIRA Method is a newly designed, and the latest facilitation technique to elicit movements of hemiplegic limbs isolated from synergy, including movement of each isolated finger using stretch reflex and skin-muscle reflex. Each applied exercise pattern was performed 100 times a day with the assistance of a therapist.
The hypothesized mechanism of the KAWAHIRA Method is shown in Fig. 1, 2. Neurons activated by the stretch reflex are timed to discharge when neuronal excitation of the patient's intention comes from the prefrontal cortex. Repetition of these voluntary movements of hemiplegic limbs is indispensable for functional recovery because only these repetitions can strengthen neural circuits to accomplish voluntary movement.
Although various facilitation techniques, including PNF, Brunnstrom's approach, and Bobath's approach, have failed to show their efficacy in the motor functional recovery of hemiplegia, clinical studies using the KAWAHIRA Method have progressed to demonstrate its efficacy in stroke rehabilitation. Its efficacy is shown in Fig 3-13.
With the spread of the KAWAHIRA Method, patients with hemiplegia will get better recovery of motor function of hemiplegic limbs. I hope this new facilitation method contribute to stroke rehabilitation in the world.
You can see a video of the KAWAHIRA Method at our Home page (http://reha.xsrv.jp/index-e.html) or (http://www.kufm.kagoshima-u.ac.jp/~rehabil/index-j.html).
Professor. Kazumi KAWAHIRA
Dept. of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
3930-7, Makizono-cho, Kagoshima 899-6603, Japan
Figure 1: Hypothesized mechanism of the KAWAHIRA Method for the hand
Figure 2: Facilitation to extend the isolated finger
This method facilitates voluntary movement of the isolated finger and repeated elicited identical movements.
Figure 3: Enhanced muscle activities during extension of the finger facilitated by the KAWAHIRA Method
EMG was recorded from the extensor digitorum muscle using silver surface electrodes during repetition of the index finger extension.
Figure 4: Functional improvement in hemiplegic upper limb and hand after repetition of facilitation exercise (RFE)
During the 2-week RFE session, the motor function of the hemiplegic upper limb and hand significantly improved in contrast to small improvement during the 2-week Occupational therapy session
Figure 5: Subtests of motions in Ueda's Grade of upper limb classified into 0 to 12 grades.
Eight of 11 subtests of motions are shown. Ueda's Grade was designed to evaluate the isolation of synergy using eight subtests of motions of uper limb. Ueda's grade allowed classified isolation of synergy of hemiplegia into small divisions.
Figure 6: Subtests of motions in Ueda's Grade of hand classified into 0 to 12 grades.
Ueda's Grade was designed to classify the isolation of synergy using eight subtests of hand motions into small divisions.
Figure 7: Facilitation of flexion of the shoulder and modified PNF pattern, using tapping and rubbing on the target muscle.
New facilitation exercises that were designed to elicit movements isolated from synergy including movement of each isolated finger using stretch reflex and skin-muscle reflex, which were induced by tapping or rubbing on the muscles or quick passive stretch of the muscle. Furthermore,this method enable a PNF pattern using many stimulations to the proximal part of the limb, in addition to manipulation of the distal part of the limb.
Figure 8: Repetition of facilitation exercise on hemiplegic lower limb and functional evaluation
Figure 9: Functional improvement in hemiplegic lower limb after repetition of facilitation exercise (RFE)
The motor function of the hemiplegic lower limb significantly improved during the 2-week RFE sessions and the first 2-week conventional physical therapy session, in contrast to small improvement during the second 2-week conventional physical therapy session
Figure 10: Functional improvement in hemiplegic lower limb after repetition of facilitation exercise (RFE)
The muscle strength of the hemiplegic lower limb significantly improved during the 2-week RFE sessions and the first 2-week conventional physical therapy session, in contrast to small improvement during the second 2-week conventional physical therapy session
Figure 11: New facilitation exercise using the vestibulo-ocular reflex for ophthalmoplegia
Theory and manipulation of Facilitation exercise using the VOR
The therapist's hand is covering the eye that is not being treated (starting position). After instructing the patient to look at the therapist's face as long as possible, the therapist quickly turns the patient's head to the direction opposite of the ophthalmoplegic direction to facilitate eye movement toward the ophthalmoplegic direction by the VOR.
Figure 12: New functional vibratory stimulation using small vibrators
The small vibrators were stabilized on the anterior tibial muscle and gluteus medius muscle by a bandage. Gait speed was greater during stimulation than without. The new device of functional vibratory stimulation is useful for treatment of patients with stroke.
Figure 13: Text book of the KAWAHIRA Method
Although the book is written by Japanese, many pictures help non-Japanese persons to understand manipulation in Kawahira Method.