Background and purpose: Information on the recurrence or progression of the stroke in early phase is scant. To perform the early stroke rehabilitation safely, we have to know the risk-factor of the recurrence or progression. The purpose of this study is to examine the factors associated with recurrence or progression of the stroke. We investigated, at first, the relation between recurrence or progression and the severity of stroke on admission (Part 1).
Subjects: We selected 384 consecutive stroke patients, including TIA and RIND, who were admitted to a community hospital within 7 days after the onset and were discharged between 1985 and 1986. The average age was 69.7 years.
Results: 1) Among 384 patients, 6 patients had recurrence and 91 patients had progression of the stroke within 2 weeks after the admission. 2) The severity of recurrence or progression varied from death in 38 patients to minimal impairment in 24 patients which disappeared within 3 weeks. 3) Within the initial 3 days, 89.8% of recurrence or progression occurred. Only 6.7% of recurrence or progression occurred between 8 to 14 days after the admission. 4) There was definite association between the severity of impairment on admission and rate of recurrence or progression. i. e. a very low rate, only 3.3% in patients without disturbance of consciousness (Japan Coma Scale: Level 0), to 20.5% in patients whose consciousness level was senseless (Level 1), 42.9% in somnolent conscious patients (Level 2), and a much higher rate, 63.0% in comatose patients (Level 3); and in 190 patients whose consciousness was Level 1, 7.3% in hemiparetic patients whose Brunnstrom stage was 5 or 6, to 44.1% in hemiplegic patients whose Brunnstrom stage was lower than 4.
Conclusion: These results indicate that recurrence or progression are most likely to occur in an early phase and according to the severity of the stroke on admission.

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It is very common to see severely handicapped men having chronic respiratory failure due to recurrent aspiration pneumonia. To prevent missdeglutition, separation procedures of an airway from foods passage were employed.
The results and the effectiveness, in terms of prevention of aspiration and complications, of various types of surgical procedures (simple tracheostomy, vocal cord plication procedures, total laryngectomy, tracheoesophageal diversion) were compared.
Simple tracheostomy was performed on 15 patients. This procedure is very common and easy to perform, however, many complications such as tracheal erosion and granulation were not negligible.
And the results of the procedure were not satisfactory for preventing aspiration. Additional surgical procedure such as vocal cord plication was needed for 4 patients.
Vocal cord plication procedure (Montgomery WW, 1975) was performed on 4 patients. Although a pin-hole on the plicated glottis was seen after the operation in 3 patients, aspiration was satisfactorily minimized.
On 2 patients, total laryngectomy was chosen. This procedure provides complete protection of airway, however, total removal of larynx pressed heavy mental stress upon patients and their families, because of the lack of possibility of functional reconstruction in the future. Therefore, this procedure should be avoided.
Tracheoesophageal diversion (Lindeman RC, 1975), which keeps larynx aside from airway, was tried on 4 patients. This procedure was slightly complicated yet, it was the most applicable with respect to realization of oral feeding, prevention of aspiration pneumonia, improvement of respiratory function and nutrition. The tracheoesophageal diversion completely freed patients from aspiration with minimal complication.
In addition to that, the procedure keeps patients and their families having hope for functional reconstruction of larynx in the future, although the possibility of the restoration depends upon the patient's neurological condition. After this operation, patients become animated and active in the life.

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The clinical benefit of physical training was evaluated in 23 patients (19 valvular heart disease and 4 coronary heart disease) after cardiac surgery. Physical training program was consisted of 3 minutes' warm-up, 6 minutes' stimulus with an intensity of 60-80% of maximal oxygen uptake in initial exercise test and 3 minutes' cool-down. This training was performed in the ward under the supervision of a physician twice a day and continued for 3-5 weeks.
Maximal VO₂ uptake was increased from 20.3 to 23.5ml/min/kg (by 16%) in patients with valvular heart disease and increased from 20.3 to 22.0ml/min/kg (by 12%) in patients with coronary heart disease after training. Although the extreme muscular power was lower in patients with valvular heart disease than a control group, after training the power was increased by 21% in valvular heart disease and by 13% in coronary heart disease. In 4 patients with valvular heart disease who served as a control group undergoing without physical training, no spontaneous improvement in exercise capacity was observed.
These observations therefore indicated that physical training after cardiac surgery is beneficial in improving both the cardiac function and the power of the skeletal muscle.

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