Blackfoot disease is an endemic peripheral vascular disease due to long term consumption of high arsenic and fluorescent content water from artesian wells among the inhabitants of southwest coast of Taiwan which causes gangrenous change of the limbs, especially of the lower extremities. Eventually, the patients undergo amputation resulting in disability that need rehabilitation.
A rehabilitation program including free supply of prostheses was started by the end of 1971 by National Taiwan University Hospital under the support of regional government. From 1971 to 1986, a total of 323 amputees, 219 males and 104 females, with average age 59.66 years (6-87-year-old in range), has been supplied prostheses and rehabilitated. Among them, 1.83 cases deceased, 45.7% of cases has been followed for more than 5 years, and 20.4% more than 10 years. Nearly two thirds (210 cases) of the patients were unilateral below-knee (BK) amputees and 57 cases (17.7%) were bilateral BK. There were 38 cases (11.8%) of unilateral above-knee (AK) amputees and 4 cases of bilateral AK. Five patients have been amputated at below-elbow level, with one who underwent amputation of all limbs finally. The acceptance rate of prostheses were varied from 71.1% to 85.5% at different surveys.
Our experience in successful rehabilitation for the amputees from Blackfoot disease provides a good model for western-Pacific countries in the management of amputees in rural areas.

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In order to evaluate the cerebellar ataxia (Dysmetria, Decomposition) quantitatively in upper extremities, the pointing test (PT), the line drawing test (LDT) and the zig zag trace test (ZZTT) were made on patients with spino-cerebellar degeneration (SCD) and controls using a personal computer equipped with a digitizer.
As the results, the dysmetria (displacement errors from the targets) in PT and LDT significantly dicreased in patients with SCD compared to those in normal controls. The decomposition (area of displacement errors between the model wave pattern and the trace of patient) in ZZTT also significantly increased in the patients with SCD. The degree of such increase in the parameters of dysmetria and decomposition more augmented in the severe cases compared to those in the mild cases.
From these results, it was suggested that these tests were usefull as the methods which quantatively assess the degree of disturbances in the motor product (dysmetria) and the motor process (decomposition).

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The purpose of this paper is to make clear the effect of early treatment on children with cerebral palsy. 160 cerebral palsy children were divided into two groups, according to their birth days. We started early treatment to cerebral palsy regularly in 1977, so 74 patients (group I) were born from 1972 to 1976, and 86 patients (group II) were born from 1977 to 1982. The effect was determined by gross motor age (Gesell), age of starting to walk, and rates of gross motor development.
In spastic quadriplegia, the average of gross motor age was 2.4 months higher in group II than in group I. In spastic diplegia, the average age of starting to walk was earlier 6.4 months in group II than in group I. In spastic paraplegia, the average age of starting to walk was 8.9 months earlier in group II than in group I. And in athetoid quadriplegia, the average of gross motor age was 4.9 months higher in group II than in group I. The average of rates of gross motor development had a tendency to be heigher in group II than in group I, and it was the highest in the period of the first one year after biginning of physical therapy.

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The purpose of this investigation was to identify the cardiovascular response to lower body negative pressure (LBNP) in severely disabled people during prolonged recumbency. The disabled subjects were categorized in three groups according to the degree of their exposure to gravitational stress in daily living and their past history of posture and motor ability. One group (ST1), whose members were now supported in a sitting position regularly or occasionally during present daily living, were never able to sit or stand independently in the past. The another subjects in group (ST2) were able to sit or stand independently and were also supported in an orthostatic posture during daily living as now were ST1 group members. The third group (BR) was bedridden fully from birth and had no experience, ever, of orthostatic forces during daily living.
A marked decrease in the photoplethysmogram of the big toe during LBNP, which represented a reduction in peripheral blood flow and concomitant venous return, was observed in all the disabled groups compared with the response of normal subjects to the same procedure. A compensatory increase in heart rate was observed in the ST1 and ST2 groups but the BR group did not show this compensatory response. Mean blood pressure in the normal group remained unchanged while the disabled groups demonstrated a progressive decrease in mean blood pressure in the order BR>ST1>ST2 by reason of varying degree of their daily orthostatic stimulus.
It was concluded that cardiovascular regulation in the bedridden disabled was associated both with their present exposure to nomal gravitational forces during daily living as well as with regard to their past history of posture and motor ability.

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Fourteen patients with ataxic hemiparesis due to corebrovascular disorder were reported.
Clinical examination, CT and ADL evaluation was performed in all cases. CT lesions responsible for ataxic hemiparesis were mainly located in the thalamus, capsule interna, subcortex white matter, centroparietal cortex, and the upper basis pontis. Brainstem forms of ataxic hemiparesis may be separated from supratentorial forms by the presence of nystagmus. Certainly, all the patients were independent in most of activities in daily living (ADL) and they were able to do all self-care. However, eleven pationts felt some difficulties in using their both hands in spite of mild hemiparesis. These patients pointed out that they had problems in the actual life activities though no problems were noted in evaluation of ADL tasks. This finding suggested that we would need to make cosiderable approaches to each case.

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We studied the effect of essential hypertension on muscle function and its energy metabolism in spontaneously hypertensive rats (SHR) during exercise by phosphorus-31 Magnetic Resonance Spectroscopy (³¹P-MRS).
The initial tension on stimulation at 20 to 100Hz in SHR were significantly smaller than those in Wistar-Kyoto rats (WKY) (p<0.01). In other rats, both SHR and WKY performed intermittent tetanic contractions (ITC) at 67Hz for 20min. The initial tension in SHR was 259.0±9.7dynes, and that in WKY was 383.8±35.8dynes, which was significantly different (p<0.05). Later, tension did not produce significant difference between SHR and WKY. However, the tension% of the initial tension in SHR maintained greater values than that in WKY during exercise.
The energy metabolism both in SHR and WKY during ITC was evaluated by ³¹P-MRS. The energy level was estimated by the Phosphocreatine (PCr)/{Inorganic Phosphate (Pi)+Phosphomonoester (PME)} ratio, PCr/(Pi+PME). The intracellular pH was calculated by the chemical shift of Pi. PCr/(Pi+PME) in SHR maintained lower values during 8min of ITC than that in WKY with significance (p<0.05). In addition, the intracellular pH in SHR maintained lower values during 4min of ITC than that in WKY with significance (p<0.05).
The results suggest that the lower initial tension in SHR than in WKY may be due to a raised threshold intensity of excitation-contraction coupling and that the decreased energy level and the lower intracellular pH during ITC in SHR than in WKY may be attributed to decreased blood flow resulting from vascular rarefication of skeletal muscles of SHR.

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[in Japanese]

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[in Japanese]

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