The Japanese Journal of Rehabilitation Medicine

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In patients with severe motor and intellectual disabilities, we investigated the principles of rehabilitation programs for the long term. According to the impairment and disability model of WHO (1980), the impairment level and its relationship to other clinical factors of 92 institutionalized patients were examined. Firstly, results showed that the teenage group revealed more severe impairment and suffered more frequently from pre-and perinatal disturbances (including prematurity) than other older age groups. These findings may reflect the recent noticeable advances in perinatal medicine. Secondly, deformity of the skeleton began in their 20s in some patients, and the significant correlations between each impairment component decreased in older groups. Thirdly, the multivariable analysis between sitting ability and impairment elements revealed that the level of motor and cognition abilities in a teenage group still reflect their individual developmental history during early life, but little in older groups. These evidences suggest that the fundamental factors that affect impairment levels may change their make-up by their 20s at latest.

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Long latency responses (LLR) were measured in stroke patients with spastic hemiplegia. Surface electromyograms of bilateral anterior tibial muscles (TA) were recorded after toe-up perturbation from 0 to 8 deg at a speed of 20 deg/sec. Five responses were averaged for perturbation of bilateral, hemiparetic, and non-paretic ankles, respectively. Latencies and amplitudes of LLR were compared to the Stroke Impairment Assessment Set. Latencies of LLR recorded from paretic TA in response to bilateral perturbation were closely correlated with motor and sensory items (r=-0.76, r=-0.91). Unilateral stimulation could not evoke LLR in patients with severe motor and/or sensory disturbance. The latencies of LLR from non-paretic side by paretic ankle perturbation were delayed in parallel with the degree of sensory disturbance (r=-0.74, r=-0.60). Since LLR from non-paretic side evoked by non-paretic perturbation were diminished, the bilateral projection and/or information processing responsible for LLR were hyposthesized. LLR may be useful to monitor motor and sensory recovery in stroke patients as an adjunct to routine clinical evaluation.

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