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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半側空間無視(USN)の急性期の臨床経過を明らかにするために,急性期脳卒中症例128例を対象として,3種類の机上テスト(抹消試験,線分二等分試験,模写試験)と日常生活動作(ADL)からUSNの臨床経過を観察した.ADL上のUSNは個々の机上テストよりも3種類の合計点とより相関が高かった.発症初期にUSNは128例中34例(26.6%)に認められ,その34例中10例では平均3.4週(2～5週)で消失または著明な軽減を認めたが,USNの消失は机上テストの方がADL上のUSNよりも早く消失した.USN消失群では完全自立が30%と多く,全介助は認めなかったのに対し,残存群では自立は8%と少なく,全介助が71%であった.また,USNの予後予測のために¹²³I-IMP静注法SPECTによる脳血流評価を発症3週間以内に施行した.左麻痺22例について血流低下域の大きさと再分布の良否から検討したところ,再分布が良好な症例ではUSNは消失または軽症化し,病巣が大きく再分布不良な症例ではUSNが強く残存するという傾向が認められた.

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日常生活は自立しても,失語症者の復職は大きな問題となる.今回我々は,発症以前になんらかの職業に従事していた失語症者に対し復職状況を調査した.症例は脳卒中が原因の失語症者50例(平均年齢49歳)である.失語のタイプは,ブローカ失語(B type)16例,ウエルニッケ失語(W type)9例,全失語(G type)5例,健忘失語(A type)20例.全例バーテルインデックスで90以上,半側空間無視や失行を認めず,歩行は自立,机上の検査をする上での聴覚理解は保たれている症例を選択し,動作性知能検査(PIQ)を施行した.失語タイプ別では,W type(中等度),G type(軽度)で有意にPIQは低値であった.復職率はB type(軽度)とA type(軽度)で有意に高く,また全症例において,復職群の平均PIQは89.3であるのに対し,福祉的就労群,失職群では75.1,76.2と統計学的に有意に低値であった.復職内容は,管理職的職種および動作性要素の強い職種が多かった.失語症者の復職の可能性の1つの指標として,失語のタイプ分類と重症度,残存機能としての動作性知能指数は有益な情報を与えると思われた.

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K市Y区に在住する55歳以上の男女1,000名(抽出率2%)を等間隔無作為抽出法により抽出し,Barthel Index自己評価表を用いて在宅中高齢者のADL標準値を求めた.有効回答者のうち,その時点で自宅にて生活している者752名を解析対象とした.ADL標準値は55-59歳男性99.9,女性99.2,60-69歳男性99.6,女性99.0,70-79歳男性97.3,女性98.0,80-90歳男性96.9,女性93.2であり,ADL標準値は年齢とともに低下するが,年齢群内で男女差はなかった.また,Barthel Index値が90以上の者は97.7%,100の者が88.7%であった.

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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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