We report on 32 children with Down's syndrome whom we have given early habilitation. We classify them into three groups, according to the age of the child at the time habilitation began: group A (less than 6 months), group B (6 to less than 12 months), and group C (12 months to less than 2 years).
Group A achieved a higher developmental index than groups B or C. Group A developed significantly further socially than group C. Within group A, children for whom both parents had received habilitative instruction within the first three months had the most prominent results.
In the motor area, emphasis in the early habilitation of children with Down's syndrome was laid on maintaining antigravity postures. In the mental area, emphasis was stressed on developing the ability to concentrate. Guidance for habilitation in the home environment via various behaviors of everyday life was found to be important for enhancing mental function.
Postural tone in children with Down's syndrome was dominated more by flexor muscles than by extensors, and such children more readily adopted shuffling (scooting seated) than crawling as a means of locomotion. Seven children who had been shuffling for a long time began walking at a mean of 31.4 months. Fifteen others who had not shuffled or had shuffled only a little before changing to crawling began to walk at a mean of 23.8 months, clearly sooner than the other seven. All three children who had never shuffled were found to be in group A.
Early habilitation was effective for both motor and mental function in children with Down's syndrome. The sooner habilitation started, the greater was the effectiveness.

View full abstract

A boy, born in 1973, was seen at the age of 10 days because of bilateral amelia of the lower extremity. He was born at term with uncomplicated delivery and a birth weight of 2950g after severe emesis during early stage of gestation. His siblings were normal and the family history revealed neither similar affection nor evidence of consanguinity.
Training for sitting was started at the age of 6 months with a bucket stabilizer constructed of plastic laminate material which was mounted on a board platform. In order to improve sitting balance and trunk strength, the top of the bucket was lowered and the platform was exchanged to rocking type. He was fitted at the age of 2 years and 1 month with CAPP (Child Amputee Prosthetic Project, UCLA) type lower-limb prosthesis and could ambulate without help of crutches at the age of 2 years and 8 months. The prosthesis had Canadian hip joints and is designed to ambulate using swivel type movements. Body rotary movements increased step length. The footplates were replaced with SACH feet at the age of 2 years 9 months and single-axis knee joints with the ring rock were added for convenience of sitting at the age of 5 years and 8 months. He could walk more than 10m on a level floor without crutches at the age of 6 years and 6 months. The ring rock knee joints were replaced with LAPOC (Labor Accident Prosthetic and Orthotic Center) type knee joints at the age of 8 years and 11 months.
Walking analysis was performed using motion-picture camera, motion analyzer and foot prints when he weared the prosthesis consisted of Canadian hip joints at the age of 8 years. The camera was run at 16 frames/sec.
The results of analysis were as follows:
Cadence, 101st eps/min; speed, 0.6Km/hr; walking cycle, 19/16sec; right single supporting period, 7/16sec; left single supporting period, 2/16sec; double supporting period, 10/16sec; stride width, 15cm; step length, 10cm; pelvic rotation angle, 45°.

View full abstract

We used plethysmography to study blood flow in the upper and lower limbs of hemiplegic patients. Measurements were taken, after the subject quietly rested supine for 30 minutes, from the middle finger of each hand and from the great toe of each foot. Five measurements at each locus were averaged to obtain the values used for analysis. A “paretic blood flow value” was calculated by dividing the volume pulse-wave amplitude of the paretic side by the sum of the amplitudes for both sides and expressing this ratio as a percentage. We had the following results:
1) For most patients whose strokes had occurred within a year, blood flow was greater in the paretic upper limb than in the nonparetic upper limb.
2) For most patients whose strokes had occurred more than a year before, blood flow was lower in the paretic upper limb than in the nonparetic upper limb.
3) The number of months after the stroke correlated significantly with upper limb blood flow, but not with lower limb blood flow.
4) No correlation was seen between blood flow in the limbs and Brunnstrom stages.
5) Blood flow in the limbs was not correlated to age.
6) Blood flow in the lower limb failed to correlate with ability to walk.

View full abstract

The purpose of the present paper is introduce the design of a new force plate and its features in clinical application. Because most force plates hitherto used for gait study have been small, measurement has been laborious and tedious, and the accumulation of clinical data difficult. We developed a large force plate and a gait measuring system to aid in the evaluation of pathological gait. With this device, gait information can be obtained consistently, rapidly, and easily. Our evaluation has confirmed that this device is useful for clinical application and research. Summary of details:
(1) The measurement area of the force is 4m by 80cm. This permits continuous walking of more than five steps at a time, so the walking pattern is not disturbed and the number of trials is reduced. The device is designed so that all floor reaction forces can be measured separately for foot.
(2) The device consists of strain gages, a box-type steel platform, and inner suspended support parts. The precision of the device is on the order of 1 percent or better. The natural frequency of the system is 88Hz in the vertical, 56Hz in the sagittal, and 48Hz in the lateral direction.
(3) With a small computer having only 48 kilobytes of memory, the measurement and data processing are automated and the system can successfully sample a large amount of data in real time. Several kinematic measuring systems and electromyography can thus also be used simultaneously with the large force plate. The period for measurement is up to one minute, only one or two persons are necessary to operate the system, and fatigue of the patient is reduced.
(4) Compared to a small force plate, the variability of data from our large force plate is small. With a small force plate, the normal subject's floor reaction-force envelopes, especially for deceleration forces, are poorly reproducible. Also, the stance phase in hemiplegic gait shows a tendency to lengthen as a result of using a small force plate.
(5) We have used our system to evaluate gait after surgical procedures on CVA patients with pes equinovarus. We were able to detect increases in acceleration forces.

View full abstract

[in Japanese]

View full abstract