In our acute medical center, the medical rehabilitation for acute traumatic brain injured patients consisits of 3 programs; 1) a basic program to prevent deconditioning, 2) an advanced program to promote recovery of paresis and other associated injuries, 3) a program for cognitive and behavioral disorder during the acute phase. To evaluate the effect of these rehabilitation program and acute medical care, the Glasgow outcome scale (GOS) and ADL level was investigated retrospectively in 48 patients from January 1992 to June 1995. The mean age was 37 years at the time of injury. They referred to the department of rehabilitation medicine on average 13 days (±9 days) post injury. The mean length of acute hospitalization was 36 days (±28 days). The duration of coma was longer than 1 week in 35% of patients. Twenty-one patients had cognitive and behavioral disorders, 18 had spastic paralysis and 13 had fractures of extremities. Because many of the cognitive and behavioral disordered patients were in a hypoaroused and confused state, bedside physical therapy and/or occupational therapy was initiated to stimulate them using habitual gross motor and self care activities. In addition, we reinforced their orientation by adapting the environment around their bedside. At the time of discharge, 2 patients met GOS criteria for a ‘good’ outcome, 33 for ‘severe disability’ and 9 for ‘persistent vegetative state.’ Fifteen patients could walk without any assistance, but only 7 were independent in self care activities. After discharge, only 16 patients could continuously received medical rehabilitative services controlled by the physiatrists. At the time of follow-up by mail, to which 25 patients (mean periods from injury: 25±13 months) answered, 13 patients had returned to job or school. The length of coma significantly correlated to the outcome at discharge from the acute medical center, but not at 2 years post injury. GOS at discharge did not have a significant correlation with the late outcome. Therefore, we concluded that the overall functional prognosis of brain injured patients cannnot be accurately predicted during the early phase of recovery, within 1 month post injury. In conclusion, we recommend that all patients with severe brain injury should provided medical rehabilitative services for an adequate period of time post injury. We must make every effort to develop comprehensive rehabilitation system for brain injured patients from the acute medical phase to the chronic social phase.

View full abstract

We examined P300 in patients with dementia, dysarthria and aphasia and compared the P300 latency between these groups and age-matched controls. Non-verbal and verbal auditory stimuli as well as visual stimuli were employed for experimental paradigms. In dysarthria, P300 was recorded in almost all the patients but there was no significant difference in latency between verbal and non-verbal stimuli. In Broca's aphasia, auditory verbal P300 was not elicited and visual verbal P300 latency was longer than visual non-verbal. In demented group, P300 was not elicited in 11 out of 19 subjects in auditory and visual verbal stimuli as well as in non-verbal stimuli. In totally aphasic patients, non-verbal P300 could be recorded both in responce to auditory and visual stimuli, while verbal P300 could not be recorded at all. Verbal P300 was especially disturbed in aphasia group (total aphasia, Broca's aphasia). These findings support the future application of P300 to the discrimination between dysarthria and Broca's aphasia and between total aphasia and dementia.

View full abstract

The motions of step ascending and descending of six below-knee (transtibial) amputees and six healthy adults were evaluated by using two force plates and 2-dimensional motion analyzer. The subjects ascended and descended the steps with 10, 20 and 30cm in height by leading with the prosthetic limb. The angle of trunk inclination, the angle of knee and hip joint and the floor reaction forces of each subject were analyzed. The results were as follow, 1) in ascending, as the step became higher, the flexion angle of hip joint and anterior inclination of trunk of the amputees were larger than those of healthy adults, 2) in ascending, as the step became higher, the vertical force of the prosthetic limb was smaller and the vertical force of non-amputated limb was larger, comparing with that of the healthy limb, 3) in descending, the flexion angle of hip joint was larger and the anterior inclination of trunk of the amputees was a little larger than those of healthy adults. These results indicated that below knee amputees could ascend and descend the step by the compensation of the non-amputated limb covering to the dysfunction of prosthetic limb.

View full abstract

A new electric powet assist unit for wheelchairs (JW-II; YAMAHA MOTOR Co., LTD.) has become available. With this unit, a little muscle power is needed to drive the handrim. The usefulness of this unit was clinically evaluated for four patients with Duchenne muscular dystrophy (DMD). None of the patients were ambulatory, and their upper limb muscular power was gravity eliminated. Although they had decreased muscle power, all four patients were able to drive their wheelchairs. Neither roll down nor pile up accidents occurred. The maximum heart rate during driving increased approximately 33% on average above that at rest. In addition, the patients felt that they could drive their wheelchairs by themselves without electrical power assist, unlike ordinary electric wheelchairs. This new unit appears to be safe and useful for DMD patients in expanding their ADL.

View full abstract