Specific features of poststroke patients with generalized convulsive seizures in medical rehabilitation were studied. 48 poststroke patients with generalized convulsive seizures were compared with 478 poststroke patients who were the whole discharged from this hospital in 1981.
1) Attained levels of ADL in the convulsive patients after medical rehabilitation were significantly lower than that in the control group.
2) In the convulsive patients, 96% of right hemiplegic patients were combined with aphasia, and 70% of left hemiplegic patients were combined with agnosia and or apraxia.
3) Convulsive patients were significantly more frequently noted in the group under 60 than in the group over 59.
4) Size of lesions in the brain examined by CT-scan were significantly larger in the convulsive group than in the control group.
5) Ventricular dilatations in the brain were more frequently noted in the convulsive group than in the control group, but there was no difference on brain atrophy (peripheral type).
6) Cortical-subcortical lesions were more frequently noted in the convulsive group than in the control group. Lesions in MCA were noted in 95% of cerebral infarction in the convulsive group.
7) In the convulsive patients, specific epileptic wave of EEG were noted very rarely.

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The analysis of the course of motor impairment in 67 cases of Fukuyama type congenital muscular dystrophy (FCMD) revealed the following;
1) The validity of the origin 8 (1-8) motor functional level (Ueda, 1975) was confirmed, provided a level 0 (zero: No head control) should be supplemented;
2) FCMD cases could be divided into three groups according to the rate of motor progress and the peak motor level; (a): ambulant, (b): intermediate, and (c) poor motor development groups;
3) The higher the peak motor functional level, the higher is the age to attain the peak;
4) There is a conspicuous superiority in female cases in motor development, especially gait, suggesting a strong sex difference in phenotypes of this hereditary (autosomatic recessive) conditions;
5) Predictive schemes for the peak motor function level, which were tried upon in the previous paper, were partially altered and improved.

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We investigated a problem frequently encountered among patients with cervical spinal cord injury, disturbance of physical condition after defecation. First, we distributed a questionnaire to 17 patients in our hospitals who had cervical spinal cord injuries. Of these 17 patients, 14 reported experiences of feeling loss of strength, listlessness, or dizziness after defecation. Some of them also complained of sweating, chills, or headache during defecation. Blood pressure, heart rate, and fingertip plethysmography were measured during defecation in three patients randomly selected from those who had complained of disturbance in physical condition after defecation. Blood pressure rose while plethysmographic values decreased in these three patients, suggesting excessively high sympathetic tone during defecation followed by a dropoff in autonomic function after defecation.
Using a tilt table, we observed blood pressre, heart rate, and fingertip plethysmography in ten of the 14 subjects who had complained of disturbances in physical condition. Most of the subjects, when raised from recumbency, tended to show decrease in blood pressure and increase in heart rate, but correlation between these two variables was higher on days in which no defecation occurred than on days in which defecation did occur. Fingertip plethysmographic measurements were lower on days of defecation than on days of no defecation (p<0.02) regardless of whether the position during measurement was upright or supine.
These facts suggest impairment of circulatory function after defecation in patients with cervical spinal cord injuries. We believe one reason for this may be abnormal bias of the parasympathetic nervous system to assume dominance in autonomic function.

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The purpose of this study was to reveal rehabilitation need for patients with rheumatoid arthritis (RA)
The subjects were 202 RA patients who had rehabilitation service on an outpatient basis at Central Rehabilitation Service, University of Tokyo Hospital. A questionnaire was sent to them, and 173 (female: 157, male 16) patients answered (85.7%).
The results suggested the following
1) Although patients had received medical treatment, they had few opportunity of receiving RA patient education of impairment, disability and handicap before they came to the rehabilitation service.
2) Approach to the level of “disability” and “handicap” are principal approach in RA rehabilitation program.
3) Aggravation of “impairment” does not necessarily lead to the recognition of that fact by the patients.
4) Rehabilitation service is not rarely discontinued due to the changs in condition of RA and complications, so that there is necessity for total rehabilitation education in the early phase.

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It is well known that many physical factors such as age, severity of hemiplegia and muscle strength of unaffected extremities, have a great influence on physical improvement in stroke patients.
But little research has been done about the psychological influence on rehabilitation in stroke patients. In this study, we will try to clarify the influence of psychological condition on physical improvement in stroke patients. 143 stroke patients (73 men, 70 women, 61±12yr.), without ambulation on admission, were twice evaluated for physical ability, psychological condition and cognition; firstly at the time of admission and again after the completion of the stroke rehabilitation program.
Physical activity was evaluated by scoring the ability of the lower extremities to accomplish ruled movements and action. Psychological evaluation was done by means of the Cornell Medical Index (CMI) and the Manifest Anxiety Scale (MAS). Cognition was evaluated by copying a picture and cancellation. Patients were divided into several subgroups based on psychological condition and cognition, and their physical improvements during the period until discharge were compared.
1) Patients who scored over 30 points in the lower limb activity test showed similar physical improvement irrespective of psychological condition and cognitive ability.
2) Results aquired from patients who scored below 30 points in the lower limb activity test are described below.
i) Patients with abnormal psychological condition (CMI III, IV·MAS I, II) showed less improvement in lower limb activity and significantly worse restoration of ambulation than patients with borderline (CMI III, IV·MAS III, IV, V or CMI I, II·MAS I, II) and normal psychological condition (CMI I, II·MAS III, IV, V). No difference in physical improvement and restoration of ambulation were found between the borderline psychological group and the normal group.
Patients with a high CMI physical score (more than 31) showed significantly less improvement in lower limb activity and restoration of ambulation than patients with low (less than 20) or middle scores (from 21 to 30). Patients with a high CMI psychological score (more than 16) showed significantly less improvement in lower limb activity and restoration of ambulation than patients with low (less than 7) or middle scores (from 8 to 15).
ii) As regards the influence of psychological condition and cognition, the best improvement in lower limb activity and restoration of ambulation was observed in patients with both normal psychological condition and normal cognition. The worst improvement was observed in patients with both abnomal psychological condition and abnormal cognition.
3) Typically patients who could not achieve ambulation by discharge showed low physical activity, agnosia, and abnormal psychological condition on admission.
The results of this study indicate that psychological condition on admission could have a strong influence on physical improvement in stroke patients' rehabilitation. In order to make a more appropriate and more effective program of treatment, we wish to stress the necessity of paving attention to the psychological condition of patients as well as their physical complications.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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