The efficacy of therapeutic swimming was studied in 29 patients with chronic lumbago.
The patients' lumbago was alleviated and they showed improvement in the results of spinal function testing mainly involving abdominal and dorsal muscle strength within 3 months after initiation of therapy. Their obesity also marked decreased. Functional analysis by superficial electromyography revealed that the action potential asymmetry of their paravertebral muscles present before therapy had disappeared after therapy, indicating an improvement in the contracture of their paravertebral muscles.
The results suggest that therapeutic swimming under appropriate supervision is very effective in the treatment of chronic lumbago.

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Natural recovery of aphasia was investigated in thirty stroke patients (11 cerebral hemorrhage, 14 cerebral infarction, 5 subarachnoid hemorrhage) who had never been taken speech therapy. The SLTA was applied to all the subjects at the first month and three months interval from the onset. At the same time, the severity of their comprehension, oral speech and writing was evaluated with SLTA three dimensional scale. Comprehension score showed some improvements for first 3 months in amnestic type, in other types it improved after 6 months. Oral speech score was showed some improvements in amnestic type for 3 months, and in expressive and receptive type it showed some improvements after 6 months. Oral speech score showed no improvement in expressive-receptive type. Writing score showed some improvements in all types except for expressive-receptive type. Expressive-receptive type showed no improvement.
These results suggest that severe aphasia can not improve without speech therapy.

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When evaluating the level of impairment of stroke patients, we cannot clarify their problems only by the assessment of motor function. We used the Fugl-Meyer physical performance scale to make a comprehensive assessment of physical function in stroke patients, including ROM, pain, balance, sensory and motor function. We examined 40 stroke patients with hemiplegia (24 cerebral infarction, 12 intracranial hemorrhage, 4 subarachnoid hemorrhage), right side; 18, left side; 22, who had all been rehabilitated for more than three months and had achieved their rehabilitation goals. There were 30 males and 10 females, with an average age of 61.7 years. In 10 patients, two examiner evaluated their physical function at the same time to assess inter-examiner variation.
Using the Fugl-Meyer physical performance scale, we could evaluate patient impairment effectively, and detect the problems in the rehabilitation easily. Such problems were reflected not only in the total score of the test but also by the scoring pattern. Looking at chart, we could understand the patients' problems quite easily.
In the Fugl-Meyer physical performance scale, the method of scoring is so simple that the inter-examiner correlation was high (rs=1.0, p<0.01), and we could finish the evaluation quite rapidly, making it useful for daily clinical practice.
The total score of the Fugl-Meyer physical performance scale correlated well with the Barthel index (rs=0.827, p<0.01). This means that we could predict the patients' disabilities, besides understanding their impairments and rehabilitation problems using Fugl-Meyer physical performance scale.

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Nineteen patients with spinocerebellar degeneration were studied on the effect of various kinds of loadings in an attempt to reduce ataxic gait. Weights of either 250g or 500g around the each ankle and also of 1kg anteriorly or posteriorly placed around the waist as well as elastic bands around the ankles and the waist were employed. The sway of the center of gravity was measured while the patient was standing upright on a Gravicorder (Anima, Japan) with eyes fixed at 3m ahead for 20 to 60 seconds. The sway area was recorded before and after each testing and the rate of improvement was used for evaluation. Clinical signs were scored according to the severity of gait disturbance, maintenance of standing posture and hyperreflexia. Midline sagittal magnetic resonance imagings of the brain obtained by 0.5 tesla equipments were assessed using an image analyzer (PIAS, Japan), and the area ratio of the vermis and/or the pons to the posterior fossa was used as an index. The following results were obtained;
1) Weights loading both at the ankles and the waist were effective for reducing the sway of the center of gravity, and the rate of improvement by above two methods were significantly correlated. The patients who received the benefits were turned out to have hyperreflexia (p<0.01) and greater atrophy of the pons with the preservation of the vermis (p<0.05).
2) Elastic band loading showed variable effects regardless of the place of loading and the finding of magnetic resonance imagings.

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In the field of rehabilitation, attention has again recently been drawn to disuse atrophy (DA). However, there were only a few visual or noninvasive methods for the evaluation of DA.
We have already reported that ultrasound muscle imaging is able to observe muscle-contraction in realtime and dynamically, and that increases in muscle echo reflect DA.
In this study, we evaluated DA in the anterior tibial muscle (ATM) in both of the hemiplegic and unaffected sides (HS and US) in 61 cases of hemiplegia due to cerebrovascular disease using this method. We then divided the changes in the echogenicity of the ATMs into 6 grades (echo grade: EG), and measured the maximum depth at rest (MDR) and calculated variation ratio (VA, maximum depth of maximal contraction/MDR).
The relationships between the age, the rehabilitation grade as determined by ourselves, the period from onset, the muscle strength evaluated by manual muscle testing (MMT) and EG, the MDR, and the VA were examined.
An increase in muscle echo was observed in all cases on the HS and in 86% on the US. The mean values for MDR and VA on the HS were lower than those on the US, and the degree of EG on the HS was higher than on the US.
There were correlations between aging and MDR, and between the degree of RG and the degree of EG, MDR, and VR on the both sides, and between results of MMT on the US and the degree of EG, MDR, and VR on the both sides, and between results of MMT on the HS and the degree of EG, MDR, and VR on the HS.
DA existed not only in the HS but also frequently in the US. Aged patients and those with a low RG tended to develop DA.
Ultrasound muscle imaging is very useful in detecting and evaluating DA.

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[in Japanese]

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