Recently the importance of prevention in rehabilitation is reemphasized, especially that of industrial and traffic accidents. Of the injuries due to traffic accidents, the brachial plexus injury is one of the serious problems as it deprives vocational ability from young workers severely. The number of patients is growing with the increase of the big motor cycles. Of 294 patients seen at the Hospital of Tokyo University between 1958 and 1972, the information of 135 patients on their status could be obtained. Of 135 patients, there were 78 cases of the whole plexus type, 48 cases of the upper plexus type and 9 cases of the lower plexus type. Ninety-one patients were under the age of thirty years. Thirty-four patients of the upper plexus type returned to previous work and some of them took the lighter and easier work. Only 6 of them received vocational training, and 4 of them failed in employment due to maladjustment and misplacement. The traumatic brachial plexus injuries tend to occur most frequently in the socially and educationally disadvantaged people. This fact makes their work adjustment difficult.
Baclofen was given to 115 spastic patients whose disorders were secondary to the spinal cord lesion in 57 cases, to the cerebral vascular accident in 18 cases and to the infantile cerebral palsy in 40 cases respectively. Fifteen to thirty mg per day of Baclofen was given for more than two weeks on an average before the evaluation of its effects. Treatment results were evaluated according to the following items: subjective assessment of tightness of muscle, discomfort or pain. objective assessment about alteration in neurological findings, gain or loss in ADL, side effects. Considerable relief of spasticity was noticed both in spinal and cerebral cases and more gain in ADL was also observed particularly in C. P. cases. No serious side effects were encountered. From this study Baclofen was found useful as an adjunct to rehabilitation of the spastics.
Cryotherapy as well as heattherapy has been long applied clinically. However, either cryo- or heattherapy has been taken up only empirically. In order to revaluate the effects of cryotherapy and heattherapy, we carried out cryomassage at the knee-joints suffering from rheumatoid arthritis in sixteen cases, comparing with other cryotherapies and heattherapies. The results were reported as follows. 1. Analgesic effect, anti-spastic effect, improvement of stiffness, improvement of muscle strength, and improvement of walking time were best by cryomassage in heattherapies and cryotherapies. 2. The reactive hyperaemia was most remarkable in the cryomassage, and 55 minutes after cryomassage the skin temperature showed higher values than those by the hot pack, and lasted for 4 hours. 3. Compared with heattherapy, our cryomassage is easy to apply. It can be applied in short time, has an immediate effect, keeps the effect long time, thus it is considered to be a very excellent physical therapy.
The positional change of the wrist during activities using fingers is not precisely known. The lack of the control of the wrist could be one of the reasons why the quadriplegic patients are not actually using flexor hinge splints as expected. Minor attention to the role of the wrist in training the hemiplegic hands could make the affected hands less functional than potentially capable of. The purpose of this study is to provide some fundamental data regarding the functional adjustment of the wrist in the normal hand. 52 subjects volunteered. In Series I, discs of 5 different sizes, cylinderes of 3 different sizes, a pin and a card were transferred, rotated or turned on or between the various height. In Series II, 15 selected objects for the daily use were picked up, used and relocated. With use of the electrogoniometer developed for this study, the upper and lower terminal values (UTV, LTV) in extension-flexion plane of the wrist and the range of these two (U-L range) were measured for each task for each subject. The individual variation in each task demonstrated the normal distribution with the range of 40-50 degrees usually. Objects of ordinary sizes were transferred on the desk, with the wrist in slight to moderate extension, demonstrating less than 10 degrees of U-L range. Thin, very small, very large or heavy objects located on the desk inclined the wrist position to flexion. Location of objects on higher horizontal plane or handling on the wall increased extension, usually without exceeding 65 degrees of extension. Consequently, the transfer task between planes of different height or different direction increased U-L range. Rotatory or turning task increased U-L range too, lowering LTV. Any tasks in Series II demonstrated the higher amount of U-L range than simple transfer tasks on the desk in Series I. The amount of U-L ranges in use of selected objects for the daily use frequently exceeded the ones in single rotatory tasks or single transfer tasks between different planes, indicating the high frequency of the combination of these two factors in daily hand activities. The position of the wrist in the process of picking up selected objects for the daily use were quite similar to those of rotatory tasks in Series I. In use of some tools, the position of the wrist was limited to only extension. However, many of selected objects for the daily use required the wide change of the wrist position including both flexion and extension. This was particularly so in objects handled on the surface of the body, such as a comb or toilet paper. For instance, in use of a pencil, the variation range demonstrated by 95% of subjects was [Ext. 15°-45°] in LTV, and [Ext. 30°-55°] in UTV, although in use of toilet paper, [Flex. 60°-25°] in LTV, and [Ext. 20°-60°] in UTV. In order that the position should not be deviated more than 3 standard deviations' from the mean, the minimal dynamic range of the wrist was estimated to be Flex. 15° to Ext. 35° (Flex. 25° to Ext. 40° in order to be within 2 standard deviations) allowing the associated finger movements.