We analyzed the ADL structure for stroke patients at admission and discharge based on the Functional Independence Measure (FIM).
The subjects were 190 stroke patients who had been admitted to Keio University Hospital and its eight affiliated hospitals in 1993 within 4 months of the occurrence of stroke. The “Independence of the FIM items” (percentage of the patients scoring 6 and 7 of all patients at each item) was calculated from the FIM scores at admission and discharge. The scores were also converted to the interval scale by use of the Rasch analysis program, and the item score distribution by each total score was calculated.
The difficulty pattern for motor FIM items shows almost no differences between admission and discharge between patients with left and right hemisphere lesions, and for age. Bladder management, bowel management and eating were the easiest items, whereas stairs and tub/shower transfer were the most difficult. Concerning cognitive FIM items, expression was easiest for patients with right hemisphere lesions and most difficult for those with left hemisphere lesions. Dementia (Mini Mental State<10) affected the difficulty patterns of motor and cognitive FIM items. The motor FIM items were divided into five groups according to total score. 50>represent the completely assisted group (dependence on a helper for all items or for all items except eating), 50≤represent the incompletely assisted group (independence for eating, grooming, bladder management and bowel management, but dependence on a helper for the other items)<70, 70≤represent the independent group for “self-care-associated items” (dependence on a helper for bathing, tub/shower transfer and walk or wheel chair, but independence for the other items)<80, 80≤represent the independent indoor walking group (independence for all items except stairs)<85, and 85≤represent the independent outdoor walking group (independence for all items). Because the cognitive items do not have the unidimensionality, they fit the Rasch model poorly. We must be careful when using cognitive FIM data converted by Rasch analysis.

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Short-latency Somatosensory Evoked Potentials (SSEPs) were elicited by median nerve stimulation in 44 patients, (33 men and 11 women, with mean age 56.7±9.2 years, with putaminal hemorrhage confirmed by CT). The amplitudes of N20 were discussed in their relationship to function predicts and sites of lesion.
Based on the amplitude ratio of N20 of the affected side to the unaffected side, the patients were devided into three groups; 1) absence of N20 (23 cases), 2) decrease of the amplitude ratio (14 cases), 3) normal ratio (7 cases). In the absence group, no patients recovered to the level of useful hand after rehabilitation. The amplitude ratio was correlated with sensory disturbance of both superficial and deep sensation.
According to the CT classification of putaminal hemorrhage, the patients were devided into five types; type I (localized in the outside of internal capsule, 3 cases), type II (extended to the anterior limb, 2 cases), type III (extended to the posterior limb, 11 cases), type IV (extended to the anterior and posterior limb, 14 cases) and type V (extended to the thalamus or subthalamus, 14 cases). In type I and type II, all patients showed normal amplitude ratio of N20. In type III, type IV, and type V, only 2 patients showed normal amplitude ratio of N20.

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The Key issues of the social recovery of the traumatic brain injured (TBI) are not only physical disorders but intellectual disorders. We assessed intellectual disabilities of severe 15 TBI persons with the revised Wechsler Adult Intelligence Scale (WAIS-R) and the revised Wechsler Memory Scale (WMS-R). In order to assess the significance of intellectual abilities on daily living, we adopted the memory and problem solving subscales of the Functional Independence Measure (FIM).
The results are as follows.
1. The mean scores and standard deviations of the verbal IQ (VIQ), performance IQ (PIQ) and full scale IQ (TIQ) were 87.2±20.39, 65.0±15.83 and 75.7±17.27 respectively. There was a characteristic finding that the PIQ was lower than VIQ in scores.
2. The scores were also lower in the revised Wechsler Memory Scale index in all subjects.
3. The memory and problem solving subscales of the FIM were significantly correlated with the PIQ scores, but not with VIQ or TIQ scores. It is likely that the traumatic brain injured with 80 or more of PIQ score become independent in daily living situations even at the onset of severe brain injury with rather prolonged coma.

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Using a three dimensional knee motion analyzer (CA4000), we investigated anterior knee laxity in one hundred normal adults, in which sixty were males and forty were females. Anterior laxity was measured using the difference between active knee motion and passive motion in tibial translation movement.
At 0 degrees of knee flexion, the anterior laxity was greater in females, however at 40 and 60 degrees, laxity was greater in males. As for the right-left difference, laxity in the left knee was always greater than that in the right knee among both males and females. Therefore, one should remember the basic differences in examining the laxity of the knee joint for accurate use of this instrument.

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We report a 19-year-old man suffering from acute poliomyelitis induced by the attenuated strain of type 3 polio virus. As he had severe muscular weakness in the right lower limb and slight weakness in the left lower limb, we prescribed the following rehabilitation program: active assistive or manual resistive exercises for his right lower limb, resistive exercises for his left lower limb, and gait training with a knee-ankle-foot orthosis. As only two or less than two cases of acute poliomyelitis a year have been reported in Japan, we are following up this patient from the standpoint of preventing post-polio syndrome.

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Progressive supranuclear palsy (PSP) is a relatively rare disorder manifesting Parkinsonism. This report describes the neurologic presentation, rehabilitation management and outcome of treatment of two patients with PSP.
Our cases showed typical symptoms with supranuclear opthalalmoplegia, pseudobulbar palsy, axial dystonia in extension and subcortical dementia. For maintaining the activities of daily living, range of motion exercise of neck, balancing of trunk and education for feeding activities were specially important.
Finally family education for supporting the patients was required because of tendency of frequent falls and subcortical dementia.

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[in Japanese]

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