We investigated relation of disability and independency in housework. Objects are 84 women who worked as housekeepers before the onset of stroke. The items of house works which are investigated are cooking, cleaning, washing, and shopping. The results are as follows: 16 women do all items, and 22 women do no items, and 46 women do partial items. According to the statistic evaluation, ability of ambulance and severity of upper extremity function most influence on the ability of house work. And higher cortical dysfunction without severe dementia make a minor influence on the ability. The patients who act as housekeepers have a normal intellectual ability, ability of outdoor walking, and mild damage of upper extremity function. Many women are given assistance by other home members, and many assistance are given if women's ability is lower.

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The present study determined the incidence of dysthymia in chronic cervical spinal cord injury (CSCI) and examined the relationships between dysthymia and chronic pains, personality traits (low IQ and B type), and prolonged administration of drugs. Persons with CSCI admitted for ADL and vocational training in the Ito National Training Center for the disabled were requested to participate in this study. The total sample (n=63) included 59 men and four women. The mean age of the subjects was 29.9±9.3 years; mean time since injury was 6.4±2.7 years, and level of injury ranged from C5 to C7. Diagnosis of dysthymia was made according to DSM-III-R criteria. By definition, dysthymia was a chronic disturbance of mood involving depressed mood for two years or more, therefore subjects were then seen yearly throughout their stay in the Training Center for more than two years. The investigation also involved the administration of the Self-rating Depression Scale, the Pain Rating Scale, the Yatabe-Guilford Personality Inventory, the Wechsler Adult Intelligence Scale. Medication records were reviewd. Of our 63 subjects, 21 (33.3%) met the criteria for dysthymia: A further 27 (42.9%) had persistent or transient periods of lowered mood, while 15 (23.8%) showed normal mood for at least two years. The prolonged administration of drugs, such as muscle relaxants, hypnotics, and ataractics, occurred in 47.6% of those with dysthymia, as compared with 13.3% in those with normal mood (χ²=4.629, p<0.05). Mean IQ in those with dysthymia was significantly lower as compared with those with normal mood (t=2.097, p<0.05). No significant difference in chronic pains or B type was seen in both groups, simply because there may be few subjects with chronic pains or B type in this study.

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Hepatopulmonary syndrome (HPS) is a rare but severe complication for patients with liver disease. So far, there are no reports as to rehabilitation approaches for patients with HPS. We report a case of HPS patient and introduce the approaches of rehabilitation to them. The patient is a 17-year-old woman with HPS who had portal hypertension after Kasai's operation for congenital biliary atresia and had living related orthotopic liver transplantation (LT). After LT, her allograft functioned well but she continued to have hypoxemia and orthodeoxia. She was referred to us for rehabilitation to disuse atrophy, contracture of hip and shoulder joints, left common peroneal nerve palsy and rehabilitation to respiratory dysfunction. By the time of 103 days after LT, her orthodeoxia was improved by supine exercise and ADL training and her disuse atrophy was markedly improved by exercise and ADL training. Special consideration as to rehabilitation was needed for this patient. Patients with orthodeoxia secondary to HPS respond poorly to oxygen therapy, and their recovery from hypoxemia is slow after LT. We recommend supine exercise for rehabilitation intervention early after LT surgery because hypoxemia probably caused by unevenness of ventilation-perfusion in equality becomes minimized by supine posture.

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Cardiovascular complications included arrhythmias and sweating dysfunction are frequently encountered manifesting of autonomic failure in stroke patients. They are commonly associated with impaired activity of the autonomic nervous system. SSR (Sympathetic Skin Response) is an electrophysiological technique for assessing sympathetic function by monitoring a change in skin potential. SSRs are easily elicited by magnetic stimulation of the neck. The suppression of SSRs, which may be caused by disturbance of the sympathetic sudomotor pathway, were observed in stroke patients. Power spectral analysis of heart rate variability from electrocardiographic recording provides a useful method for evaluating quantitative both sympathetic and parasympathetic autonomic effects on the heart. The components of heart rate variability, especially high frequency component were reduced, and the circadian fluctuation of heart rate variability was observed in stroke patients. Cerebrovascular disease seems to cause the damage to the cardiovascular autonomic regulatory system. SSR and heart rate variability are useful and noninvasive methods for evaluating the autonomic nerve function in stroke patients.

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The most commonly used EMG method for daily routine is that obtained with concentric needle electrodes, and a number of parameters have been used to characterize the motor unit action potential (MUAP). It is important to understand the physiological meaning of each parameter and pathology of neuropathic and myopathic disease. Amplitude is measured as maximal peak to peak voltage. It determined by muscle fibers within 0.5mm from the electrode, i. e. a few fibers in normal subjects. Reduced amplitude means atrophy of muscle fibers, decreased numbers of the muscle fibers just near the electrode, excessive jitter and bocking. Incresed amplitude means focal grouping (reinnervation with sprouting, regeneration of split fibers), hypertrophy of muscle fibers. Duraion is the time between the starting-point and end-point of the slow component of the MUAP and related to number of muscle fibers within radius of 5mm. Reduced duration means loss of muscle fibers and increased duration indicates increased number of muscle fibers, e. g. collateral sprouting. Increased number of phases means increased slow conduction in terminal axons, and/or increased variability of muscle fiber diameter. Pathological changes in acute denervation are the appearance of non-functional motor unit, muscle fiber atrophy, and slow conduction in terminal axon branch; then polyphasic but not high amplitude and long duration MUAPs are detected. In chronic denervation, grouping and increased numbers of muscle fibers was occurred by reinnervation with sprouting are appeared; then high amplitude and long duration MUAPs are detected. In myopathy, atrophy and/or loss of muscle fibers and variation of muscle fiber diameters (compensatory hypertrophy) are the main pathological changes; then MUAPs in myopathy are low ampulitude (high amplitude MUAPs are also detected near the hypertrophic muscle fibers), short duration, and polyphasic. Evaluation of interference pattern is also very important. Loss of motor units is the main pathologial change in neuropathy even in the acute and chronic neurologenic changes. Early recruitment or pathological interference is chracteristic in myopathy. Evaluation of interference pattern is also very important. Loss of motor units is the main pathological change in neuropathy even in the acute and chronic neurologenic changes. Early recruitment or pathological interference is chracteristic in myopathy.

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