The present study was performed on 172 complete paraplegics treated in our hospital. The physical conditions and ambulation activities of the 172 paraplegics were evaluated by mail questionnaire, and 53 of them were examined by us.
There are 31 (18.0%) paraplegics using crutches and leg braces of whom only 15 are actually walking as part of their daily activities. In our past follow-up study (1976), the percentage of walking group was 37.6%. Other paraplegics depend on wheel-chairs and cars for their ambulation activities. Regarding joint-contracture, decubitus, urinary trouble and edema of lower extremities, the walking group has showed to have less problems than the non-walking group.
With regards to these findings, we believe that the rehabilitation programs for paraplegia must be readjusted in accordance with the changes occurring in the life-style and the social activities of the rehabilitated paraplegics. But we have no effective solution for the above-mentioned problems which the non-walking group faces.
Our rehabilitation program for paraplegics is;
1) Up to the parallel-bar stage:-
Done According to conventional schedule.
2) Before the crutch gait stage:-
“To go on or not” is determined on patient's needs and his social background. If not, his rehabilitation program is based on wheel-chair activity.

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Exercise induced ST segment depression in ischemic heart disease has been accepted as a sign of myocardial ischemia. Although similar electrocardiographic ischemic changes are observed in some of the exercising patients with rheumatic valvular disease, its clinical importance has not been clearly identified.
The purpose of this study is to clarify the significance of exercise induced ST segment depression in patients with rheumatic valvular disease by means of multi-stage symptom-limiting exercise with upright ergometer, while monitoring hemodynamics, oxygen consumption and electrocardiogram.
The patients included in this study consisted of 27 males and females, all of whom had undergone various rheumatic valvular surgery. All patients were on digitalis compounds but none of them were on antiarrythmics nor β-blockers.
All patients were divided into two groups according to the degree of exercise induced ST segment changes; Group A: ST depression≥1mm, Group B: ST depression<1mm.
Results: i) Group A showed high mean pulmonary capillary wedge pressures at rest and they were further elevated with exercise. At the maximal exercise level, mean pulmonary capillary wedge pressures in group A were significantly higher than those in group B.
ii) Group A showed large stroke indices at rest but at the maximal exercise level they were smaller than those in group B.
iii) Different response to exercise was demonstrated on the left ventricular function curve, drawn from stroke indices and mean pulmonary capillary wedge pressures during exercise.
Group A moved to right side and shifted downward during exercise, while group B moved to right side and shifted upward.
Exercise induced ST segment depression in group A was probably indicating poor cardiac reserve capacity resulting from diminished augumentation of stroke volume with resultant compensatory increase in heart rate which caused shortening of diastole, and subsequently leading to the relative subendocardial ischemia due to diminished oxygen supply.
It was suggested that exercise induced ST segment depression (ST≥1mm) regardless of digitalis intake in post-operative rheumatic valvular patients should be considered as an manifestation of cardiac pump dysfunction and should be interpreted as over-loading when cardiac rehabilitation is carried out.

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Extensibility of the rectus femoris and the hamstring muscles in 1216 healthy people (595 males and 621 females) ranging from naonates to the 79 years old was measured and the results were statistically analysed.
Extensibility of the rectus femoris muscle from 7 years of age to 79 years of age in female was statistically higher than that in male. And extensibility of hamstring muscles from 3 years of age to 69 years of age in female was also higher than that in male.
There was no significant difference of both muscles' extensibility between the right and left. Neither was there any correlation in the extensibility between rectus femoris muscle and hamstring muscles.

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A field survey was performed on 147 homebound bedridden aged people in Shiroishi District (population: 211, 718), Sapporo, in 1976-1978.
There were 66 men and 81 women. Fifty-six % of them were above 75 years of age.
The highest cause of bedridden state was cerebrovascular accident (56%), which was followed by decrepitude (11%) and bone fractures (7%).
Fifty-five % of them were bedridden more than 3 years and 41% more than 5 years.
Over 50% of the bedridden aged were unable to perform such activities of daily living as bathing, walking, dressing and undressing. Twenty to 30% of them were incapable of sitting, feeding or turning in bed.
Mean size of household was 4.1 persons, ownership of one's own house 79%, and number of rooms 4.4. Corresponding figures for Sapporo were 3.5, 37%, 3.5, and for Japan 3.4, 59%, 4.1, respectively. Size of household, ownership of house, and number of rooms were the major factors influencing whether the family could afford to keep a bedridden person home without sending him to an institution or not.
The main care-givers were spouses (48%), son's wives (25%), and daughters (20%).
Fifty-five % of care-givers were over 60 years old and 76% of them over 50 years old.
The percentage of those receiving rehabilitation medecine services at rehabilitation hospitals or general hospitals was as low as 34%. Lack of proper rehabilitation institutes, inactiveness of patients themselves, financial problems were main reasons for not receiving rehabilitation services.
During the survey period, 39 of 147 died. The death rate was significantly higher in the age group above 80 years in 1976-1977, above 75 years in 1977-1978. Decrepitude was the highest cause of death. No positive correlation was observed between death rate and duration of bedridden state.

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