Making a disabled life to a more meaningful life is the philosophy of rehabilitation medicine. Sense of value of life and acceptance of disability by a society are different from one culture to the other. Some special features of rehabilitation therapies, among many, include orientation toward individual's function, comprehensiveness in patient management, encouragement of patient's and family's motivation to participate, and personalization of therapeutic prescriptions specifically designed on an individual basis. All of these may be significantly influenced by the unique nature of the culture to which the individual belong. In order for a disabled person to receive a more successful rehabilitation program, his cultural background must be seriously considered.

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The clinical course of unilateral spatial neglect (USN) were studied in 128 acute stroke patients who started rehabilitation within one week after onset. USN was evaluated by standard three tasks (cancellation test, line bisection test, copy test), which result was compared with the severity of patient's behavior disturlance and the findings of ¹²³I-IMP-SPECT. The incidence of USN was 26.6% in 128 acute patients and the 29.4% of USN were disappeared within 3.4 weeks on the average. Total score of three tasks had a close relationship to abnormal behavior caused by USN, however each task such as line bisection test often underestimated its severity. In comparison between cases with and without disappearance of USN, the characteristic of disappeared cases were as follow; the degree of hemiparesis was mild, the cause of disability was cerebral infarction, and their age was lower. Additionally we investigated IMP-SPECT findings about the size of low perfusion area and its redistribution at the right tempro-parieto-occipital region in 22 patients with right-sided hmispheric lesion. The cases which had large low perfusion area with poor redistribution were remained to have severe USN. On the other hand, the cases with good redistribution had better prognosis about USN. To predict clinical course of USN is one of the most important point when we try to determine rehabilitation goal of stroke patients. Total score method of three tasks and IMP-SPECT findings can be good indication to get exact information about USN prognosis.

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In order to elucidate the factors which have influence on return to work in aphasics, a correlation was studied between social prognosis and various factors: aphasia type, severity, educational level, age, WAIS-R performance IQ (PIQ). Subjects were 50 right-handed aphasics with following diagnoses: 16 Broca's, 9 Wernicke's, 5 Globals, 20 Anomics. In Globals and Wernike's, PIQ were significantly lower than that in other aphasics. On the other hand, rate of the return to work was higher in Broca's (mild) and Anomics (mild). PIQ showed that the group of the return to work (89.3±12.9) were significantly higher than shelterd employed group (75.1±12.6) and the group without the return to work (76.2±14.9). This study underlines the crucial role of aphasia type, severity and PIQ as predictor of vocational outcome in aphasic patients.

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In a randomly selected sample of 1, 000 persons aged 55 years and older (sampling rate: 2%), we investigated standard values of activities of daily living (ADL) scores as assessed with the Self-Rating Barthel Index (SR-BI). The final sample consisted of 752 persons who were living at home at the time of investigation, and their average age was 67.1±7.8 (mean±SD). Standard values of SR-BI scores were as follows: 99.9 for male and 99.2 for female 55-59 year old group, 99.6 for male and 99.0 for female 60-69 year old group, 97.3 for male and 98.0 for female 70-79 year old group, 96.9 for male and 93.2 for female 80-90 year old group. The standard SR-BI value decreased with age, but no significant differences were found between the two sexes (t-test). 97.7% of the sample scored 90 and over and 88.7% scored 100 on the SR-BI.

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Patients with HTLV-1 associated myelopathy (HAM) have gradual onset and slowly progressive course of spastic paraparesis with pyramidal signs and bladder dysfunction. In late stages, severe spastic contractures in the lower extremities can disturb walking and even sitting ability. We report a case of HAM, whose deformities were corrected operatively with functional improvement. A 45-year-old woman was referred to us about her disability on October 3, 1996. she first noted gait disturbance in 1986 five years after receiving a blood transfusion, with gradual deterioration. She was diagnosed as HAM in 1987, and a treatment with oral corticosteroids (40mg of prednisolone daily) was started next year. Although her gait ability improved, her spastic paraparesis took a turn for the worse when she stopped the medication. In 1993, she was unable to walk alone, and two years later, her sitting ability was lost because of adduction-flexion deformities of both hips and flexion contractures of bilateral knees. She underwent an operation on February 24, 1997, involving 1) bilateral adductor-gracilis-iliopsoas tenotomy and obturator neurectomy, 2) release of the right sartorius tendon, and 3) bilateral release of hamstrings. Postoperatively, her ability to sit on a chair improved, and she was discharged home on March 15, 1997. The improvement has been maintained for three years since discharge. In a patient with HAM with severe contractures, operative treatment should be considered as an alternative to improve functional abilities.

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A 57-year-old male who was diagnosed with pontine infarction and locked-in syndrome was admitted to our rehabilitation center. We mainly aimed to reduce the burden of the caregiver and to provide a means of expression for the patient. For dysphagia, we chose intermittent oro-esophageal tube feeding instead of continuous nasogastric tube feeding. For quadriplegia, prevention of contracture, sitting exercise, and instruction for his wife on how to transfer to a wheelchair were done. We then introduced the lift for moving the patient and the reclining wheelchair for locomotion. For the communicative disorder, we aimed to introduce a communication aid and an environmental control system (ECS). For this purpose, we developed a new input device for the communication aid and the ECS, triggered by the impedance change of the soft tissue that occurs with blinking. When the device was set at the orbital margin, the impedance change with blinking was clearly separate from both the impedance change from the blinking reflex and the impedance change from opening his mouth. He went back to his home after adjustments were made to his house and the usage of this input device had been mastered.

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In spite of the advancement of neonatology over the past 25 years, neonatal neurological deficits still occur. Rehabilitation professionals are required to assess neonatal neurological status and screen high risk infants. The indicators to predict developmental outcomes of the high risk infants in the neonatal periods are; 1) perinatal risk factors, 2) neurological examination, 3) general movements, and 4) neurobehavioral assessment. Severe complications of the central nervous system are risk factors for major neurologic problems. Particularly, periventricular leukomalacia and periventricular hemorrhage are significant predictors of subsequent cerebral palsy. Ultrasound brain scan, CT and MRI have helped in the non-invasive detection of brain damage in young preterm infants. Social class is related to problems in the primary school. The traditional neurological examination consists of the grading of the state, muscle tonus, posture, spontaneous movements, reflexes, and other neurological abnormalities such as neonatal seizures, repeated apnea, oral-motor dysfunction, or high-pitched cry. Qualitative assessment of general movement has been shown to be a good predictor of neurologic outcome in high risk preterm infants. Brazelton Neonatal Behavioral Assessment Scale combines both behavioral and neurological approaches. The following points should be kept in mind when assessing infants in the neonatal period. 1) To predict subsequent disabilities, we must consider findings of various assessment methods comprehensively. 2) The assessment should be designed to be easy, reliable, and non-invasive. 3) Children must be followed up at least until they enter primary schools.

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