&' "J. Hot Spring Sci.# 0*# ,/+ῌ,/3 ",*+*

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Applications of Balneotherapy for Rehabilitation
Kazumi KAWAHIRA+, Shuji MATSUMOTO+ and Megumi SHIMODOZONO+

Abstract
Balneotherapy (or spa therapy) for patients with disabilities is one of the oldest formsof rehabilitative therapy. In order to examine the e#ectiveness of balneotherapy forpatients with disabilities, our rehabilitation methods in combination with balneotherapy
were reviewed. We observed beneﬁcial e#ects of balneotherapy on controlling the spasticity of hemiparetic limb, in accomplishing repepetive facilitation exercise, and on thequality of life in patients with stroke and orthopedic disease. Rehabilitative treatment inassociation with both neuro-rehabilitation and traditional spa therapy will develop andcontribute to welfares of the people.
Key words : Spa, Rehabilitation, Spasticity, Stroke῍ῌ&'()*+,-./012# &'314(&5.-46 " 7/-8.9:01$+ ;<=# >?@7AB=2>?@7CD8EFGHI# F JKLM1NOKP4Q# R
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Health Survey "SF--0 .-4Q\][6$ n7¥¤K¦§# =¡-(7m¨.fg[6$ &'.-46({|x3# ©77ª«Z¬­2®¯1$°±² : &'# # rs# RST+   233ῌ00*-  ! -3-*ῌ1. + Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Takachiho -3-*ῌ1, Makizono-cho, Kagoshima 233ῌ
00*-, Japan.

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663CNON !!|}~xy@abcadefgh)8X ]uC"., 673 eo PNF,ῌ  ¡ho¢£e¤)* ¥¦§¨©#CPª««S8¬ !­®C¯3°¬ ±²8 ,**3  N³´µ¶´h ,**33 ·¸Fªt5 ¹$+)abcadefghº34:t» +¼½)t :EFtFig. + Hypothesized mechanism of a newly designed facilitation exercise for the hemiplegic
upper limb and ﬁngers.
Neurons or neural circuits in the motor cortex or descending motor tracts related to thepatient’s intention of movement do not discharge because of an insu$cient excitation levelin response to excitation from the prefrontal/premotor cortex. Premotor neurons that are
disconnected due to apraxia or injury to descending motor tracts due to hemiparesis will
respond to excitation and realize the patient’s intended movements when these neuralcircuits have been excited su$ciently by facilitation techniques.
Thick arrow and thin arrow indicate manipulation for stretch reﬂex and light touch tomaintain a-g linkage, respectively.

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Fig. , Improvements in isolation from synergy of the hemiplegic upper limb and hand, and the ability ofmanipulating objects during ,-week sessions of RFE or CR in all patients
Data for the BRS of the hemiplegic upper limb and hand, and the STEF of the upper limb in the ﬁrst
and second ,-week sessions of RFE or CR among all ,- patients were combined. Data are shownas the median (and quartiles). Pre denotes the beginning of the indicated session. Post denotes theend of the indicated session. * p*.*/, ** p*.*+. Abbreviations : BRS, Brunnstrom stage ; STEF,
Simple Test for Evaluating Hand Function.

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STEF score was increased signiﬁcantly (p*.*/) after forearm bathing (n3). Resistance powerof elbow extension (3*/sec) was decreased signiﬁcantly (p*.*+) after forearm bathing (n0).
STEF : Simple Test for Evaluating Hand Function being designed to evaluate the speed of manipulation of objects using one upper limb including ﬁngers.

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Healthy controls () and post-stroke patients (). Signiﬁcant di#erences : healthycontrols vs post-stroke patients. * P*.*+, ** P*.*/.

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strength for both knee extension and ﬂexion, but the cold water leg bathing (+2, /min) did not show these changes. The di#erences in knee ﬂexion between the warm
water leg bath and the cold water leg bath are statistically signiﬁcant.

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Fig. 0 Changes in SF--0 scores on admission, and before and after exercise bath in all patients
The subjects were treated by conventional rehabilitation including PT, OT, and ST for a month,followed by exercise bath (-2 for -* min, twice a week) in addition to conventional rehabilitation for a month. QOL was evaluated by SF--0. Improvements in SF--0 scores were observed
after both conventional rehabilitation and exercise bath. Those scores after exercise bath weresigniﬁcantly better than those after conventional rehabilitation.
PF : Physical functioning, RP : Role physical, BP : Bodily pain, GH : General health, VT ; Vitality,SF ; Social functioning, RE ; Role emotional, MH ; Mental health.

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uvwx40tyz{|}ῌ~ /gh Jpn. J. Rehabil. Med., .1, -+/ῌ-+3.
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Kawahira, K., Shimodozono, M., Etho, S., Kamada, K., Noma, T. and Tanaka, N. (,*+*) : E#ects
of intensive repetition of a new facilitation technique on motor functional recovery of thehemiplegic upper limb and hand. Brain Injury, ,., +,*,ῌ++,+-.
Kawahira, K., Shimodozono, M., Ogata, A. and Tanaka, N. (,**.) : Addition of intensive repetition of facilitation exercise to multidisciplinary rehabilitation promotes motor functional
recovery of the hemiplegic lower limb. J. Rehabilitation Medicine, -0, +/3ῌ+0..

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Matsumoto, S., Kakahira, K., Etoh, S., Keda, S. and Tanaka N. (,**0) : Short-term e#ects ofthermotherapy for spasticity on tibial nerve F-waves in post-stroke patients. Int. J. Biometeorol., /*, ,.-ῌ,/*.
Matsumoto, S., Shimodozono, M., Etoh, S., Shimozono, Y., Tanaka, N., Kawahira, K. (,*+*) :Beneﬁcial e#ects of footbaths in controlling spasticity after stroke. Int. J. Biometeorol., /.,.0/ῌ1-.

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Noma, T., Matsumoto, S., Etoh, S., Shimodozono, M. and Kawahira, K. (,**3) : Antispastic
e#ects of the direct application of vibratory stimuli to the spastic muscles of hemiplegic
limbs in post-stroke patients. Brain Injury, ,-, 0,-ῌ0-+.

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