We examined abilities in activities of daily living as well as functional prognosis in 18 traumatic quadriplegic persons who had ossification of the posterior longitudinal ligament in the cervical region due to injury without fracture.
Among the activities of daily living investigated, those related to eating readily improved, but little progress was seen in other functional activities. The improvements in eating were seen in 14 of the persons, and 11 of them ultimately became independent in eating.
Six persons eventually became able to walk without support. All of them had begun supported walking within two months of injury, and with one exception they were able to progress to walking unsupported within four months of training.
Another eight persons had developed no locomotor abilities for at least six months, and training on a daily basis had little benefit for them. They could perform hardly any activities of daily living without the help of other people, and manifested little potential for improvement in functional activities.
Certain tendencies could be seen in those persons displaying improvement in activities of daily living: effective mobility, skill and strength in the hands, and a high level of voluntary control in the upper limbs.
Various factors interfering with the rehabilitation process could be identified. These could be classified into three principal categories: physical factors, mental factors, and age-related factors. Among the quadriplegic persons whom we encountered in this study, most of them had age-related problems in addition to physical and mental difficulties often associated with quadriplegia but not with age. Some of these age-related factors included osteoporosis, degenerative arthritis, decline in physical fitness, depression, and dementia. We believe that such factors appreciably impeded progress in activities of daily living.

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We examined 16 patients with thoracolumbar spinal injuries who underwent anterior decompression and fusion by surgical use of an aterior two-rod plate. The subjects were 15 men and one woman. Follow-up ranged from five to 21 months, with an average of 11.4 months. The injuries included ten burst fractures (T12:1, L1:5, L2:1, L3:1, and L4:2) and six dislocation fractures (T11-12:2, T12-L1:2, and L1-2:2). All the burst-fracture cases were neurologically incomplete, but five out of six dislocation-fracture cases showed complete neurological deficit below the spinal lesion.
First we examined the local stability of the operated level and total mobility of the lumbar spine, using lateral bending and flexion-extension x-ray films. Scoliosis averaged 6.3 degrees prior to surgery. Although scoliosis improved to 2.6 degrees immediately after surgery, by follow-up it was back to 6.3 degrees. Average preoperative kyphosis of 23 degrees was reduced to 12.2 degrees immediately after surgery, but reverted to 17.9 degrees by follow-up. Dislocation-fracture cases lost more ground postoperatively and had greater deformities tan did the burst-fracture cases. Total mobility of the lumbar spine was evaluated according to two angles: (a) on the A-P view, the angle between the axis of L1 and a line connecting both iliac crests, and (b) on the lateral view, the angle between the axes of L1 and L5. We confirmed good mobility of the lumbar spine for every case, in both A-P and lateral views.
Finally, in order to investigate postoperative progress in activities of daily living (ADL), we took serial assessments of the Barthel Index. Cases receiving the two-rod plate for burst fractures showed prompter recovery of ADL than cases of incomplete lesions treated by Luque instrumentation. The cases of dislocation fracture treated by two-rod surgery showed recovery curves resembling the recovery patterns of patients with complete lesions treated by Luque instrumentation. In our series, conservatively treated groups showed the slowest recovery of the Barthel Index, irrespective of completeness versus incompleteness of the lesion.

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Directly stimulated muscle conduction studies were conducted in 80 normal, 8 myopathic, 11 neuropathic and 15 hemiplegic subjects.
Two monopolar Teflon-coated needle electrodes with tips exposed 4mm were placed in the distal end of the brachial biceps muscles as the stimulating electrodes. A recording monopolar needle electrode was then placed 4cm proximal to the stimulation electrode along the same muscle with the surface reference electrode. After the maximal evoked response was detected using the supramaximal stimulation of 0.2msec square wave pulse, the latency, peak latency, amplitude and duration were measured. The maximum muscle fiber conduction velosity (CVmax) and peak muscle fiber conduction velocity (CVpeak) were calculated dividing the distance by each latency.
The results showed that the age and sex in healthy subjects related to the muscle fiber conductivities. The amplitudes of the evoked responses increased as the age advanced. Also male subjects indicated faster CVmax and CVpeak and larger amplitudes compared with female subjects. Healthy subjects did not show the difference in conductivity between right and left arm and between the first and second examination.
The patients of polymyositis showed decreased amplitudes and long durations compared to normal age-matched subjects. The neuropathic patients with branchial plexus neuropathy, revealed remarkable changes in muscle conductivities. They showed the decreased CVmax and CVpeak, accompanied with smaller amplitude and prolonged duration. As for the hemiplegic patients, there existed only slightly delayed CVpeak and small amplitude.
Directly stimulated muscle conduction study might be useful for diagnosing and evaluating muscles themselves, without interference from neuronal transmission.

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A group of 19 children with spastic diplegia (CP), a group of 9 spina bifida with hydrocephalus (SB) and 9 controls were studied. In all the groups the children's ages ranged from 6 to 15 years. They were individualy assessed on a detailed battery of tests which included the Japanese Wechsler Intelligence Scale for Children Revised, the Taken-Tanaka Binet, the Frostig test of Visual Perception and the Bender Gestalt test. There were little difference between CP and SB on Binet IQ but both were lower than controls (p<0.01). Both of them had frequently higher scores of verbal IQ than performance IQ, and also had lower scores of perceptual quotient on Frostig test than controls (CP p<0.001; SB p<0.01). 72 percentages of both them were beyond +1SD Koppitz standard scale on Bender Gestalt test.
We came to the conclusion that brain damaged children with spina bifida with hydrocephalus and spastic diplegia had much problems on the cognitive-perceptual-motor disorders.

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Thirty cases of thalamic hemorrhage were investigated to predict the outcome for walking ability from initial information. Initial information included common factors affecting the outcome, such as age, whether the lesion was on the right or left, CT classification, hematoma volume, and the consciousness level at the time of admission. Although the relationship with each factor and the outcome have been discussed separately so far, they should be examined synthetically. Therefore the author used a multivariate analysis, the first method of quantification, and calculated the category weight (CW) of each items. Then their clinical properties were considered.
The prediction equation was as follows.
Y=⁴Σ_i=1a_ix_i+²Σ_j=1b_jx_j+⁵Σ_k=1c_kx_k+³Σ_l=1d_lx_l+⁴Σ_m=1e_mx_m
Y: prediction value
CW: a-age, b-rt. or lt. of lesion, c-CT classification, d-hematoma volume, e-cons. level
By comparing the prediction value of the outcome with the actual one, a comparatively accurate prognosis of thalamic hemorrhage could be forecast from the intial information.

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[in Japanese]

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[in Japanese]

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