We studied 32 sequential elderly (85 year old) patients with first-ever brain infarct who admitted to our hospital and characteristics were compared with younger patients under 85 years old (n=269). The characteristics we specified were type, risk factor, impairment level (Brunnstrom stage), ADL (activity of daily life: Barthel Index) score, and outcome. Fifty-three percentages of elderly patients were suffered from lacunar stroke, showing milder Brunnstrom stage at admission, lower mortality and high percentage of returning home. Those suffered from cardioembolic or atherothrombotic stroke showed higher mortality. Atrial fibrillation was seen more frequently in elderly group than in younger group. Seventeen cases (53%) could return home, but elderly group showed higher mortality rate and needed more long term institutional care. Fifty-three percentages of the patients could return home, twenty-eight percentages of patients were admitted to facility of health care services for the elderly, nineteen percentages of the patients were dead. Average score of Barthel Index in the patients who could return home was 61.5, higher than the score of those who needed longer institutional care (32.2), but no difference was found in Brunnstrom stage between both groups. In conclusion outcome of brain infarct in elderly aged 85 years old and over depend on Barthel Index score, showing that the rehabilitation should be focused on the ADL training rather than recovery of functional status. Outcome depends on clinical disorders rather than age.

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Ideational apraxia was defined as “Difficulties or errors of tool utility without motor palsy and disturbed tool perception and cognition.” In aphasic patients, however, the tool perception and cognition of the patients have not well been examined. In the present study, we investigated tool perception and cognition with non-verbal method using pictures and photographs. The subjects were 53 patients with left brain damage (mean age: 58.6±11.0 years; 36 men and 17 women). All had different types and degrees of aphasia and r-hemiplegia. Test trial: To choose a drawing out of 6 drawings same to offered one. Test 1: Evaluation of actual use of single tool and serial multiple tools. Test 2: Visual perception was examined to choose the same figure or picture as the offered one. Test 3: Cognition on single tool utility was examined to select a photograph showing the correct utility. Cognition on sequential tool handling was examined to arrange correctly the photographs showing the sequential procedure. The insight was also evaluated by counting the time of demonstration repeated to understand the patients what to do. Ideational apraxia (IA) who showed the disturbance in serial tool utility were observed in 25 patients out of 53 patients. Twenty-three patients out of 25 patients with IA also failed actual use of single tool. Although 25 patients with IA showed no errors in single tool perception and cognition, 18 patients failed the arrangements of multiple serial tools. The insight of apraxic patients was inferior to non-apraxic patients. The foci in apraxic patients on CT were greater than in non-apraxic patients showing wide distribution including the parietal lobe and the frontal lobe. From these results, as the tool perception and cognition was preserved even in aphasic patients with IA, IA was considered to be derived from the lesions of the pathway leading to the set up of motor program at frontal lobe.

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We assessed the frequency and the characteristics of higher brain dysfunction in COPD patients undergoing pulmonary rehabilitation and controls. The COPD patients showed significant decrease in neuropsychological examination scores especially in verbal memory compared with control patients. The decline of verbal memory paralleled that of other cognitive functions. Significant positive correlation was found between cognitive function and PO₂ is the severe COPD group. The finding of Brain Magnetic Resonance Imaging has not been associated with neuropsychological examination scores. These results indicate that higher brain dysfunction is seen in most of the COPD patients, and suggest the need for devising an appropriate way of instructing pulmonary rehabilitation program in these patients.

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A 56-year-old male with pontine bleeding showing locked-in syndrome was admitted to our hospital. As his only reliable motor functions consisted of vertical eye movement, eye closing and opening (blinking) movements, these retained movements had to be used for communication. A communication aid was used, taking advantage of the blinking eye movements that the patients could perform. The training with the communication aid and environmental control system was continued at home after discharge. The burden reduction of the caregiver, and the improvement of the patient's QOL were achieved.

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We assessed the effect of pulmonary rehabilitation (PR) and lung volume reduction surgery (LVRS) on higher brain dysfunction in COPD patients. The COPD patients undergoing PR and LVRS showed significant improvement not only in pulmonary function and exercise endurance, but also in higher brain dysfunction especially in verbal memory (AVLT: Auditory-Verbal Learning Test) compared with those before PR and LVRS. These results indicate that PR and LVRS improve their higher brain dysfunction, especially verbal memory impairment in COPD is reversible through the improvement of their pulmonary function.

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The instrumented gait analysis has been widely recognized by Japanese physiatrists for years. However it has not been used in daily clinical practice for the treatment of gait disorders. There have been changes of the status in gait analysis such that significant advance of computer technology making the gait analysis easier to apply. This is the review of English written monograms in the last 10 years that appeared in Medline. Within 362 monograms, cerebral palsy was the disease that was most frequently needed the gait analysis for outcome measurement and pathophysiological investigations. It becomes evident that Botulinum type A toxin and selective dorsal rhizotomy are frequently applied for the treatment of spastic gait disorders of cerebral palsy in the U. S. A. Monograms presented in a web site of the Veterans Administration Affairs are introduced since they are reviewing the state of the art of the gait analysis nicely.

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