Postoperative pulmonary complications are still a major cause of postoperative mortality, especially in elderly patients. We performed pulmonary rehabilitation in 98 patients who had undergone surgery under general anesthesia. Lung function (%VC and FEV_1.0%) was measured with a spirometer preoperatively and weekly until 3 weeks after operation. We divided patients into 4 groups according to operation types; thoracotomy incision with lung lobectomy, thoracotomy incision without lung lobectomy, upper abdominal incision and lower abdominal incision. The changes in %VC relative to preoperative values were significantly reduced within 7 days after surgery in all groups. This tendency was most remarkable in the group of lung lobectomy. The second most remarkable response was in thoracotomy, the third was in upper abdominal incision, the fourth was in lower abdominal incision. The incidence of postoperative pulmonary complication were 13.8% in lobectomy, 4.0% in thoracotomy, 3.0% in upper abdomen, 0% in lower abdomen. This study demonstrates the decrease in vital capacity relates to the clinical pulmonary complication and suggestes the importance of comprehensive pulmonary rehabilitation in acute phase after surgery.

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A secondary disability is a disability occurring later in the course of the disease but not occurring during the occurrence of the primary disability, which is directly caused by the disease. It has been said that many adults with cerebral palsy suffer declines in their motor abilities owing to the secondary age-dependent complications. It is predictable that the problems regarding secondary disabilities will become more serious as more persons with cerebral palsy become aged. Psychosocial problems as well as issues on disorders of circulatory and respiratory function also have been pointed out recently, but this paper will mainly discuss actual conditions of orthopedic problems and the present state of treatments. A cervical spondylotic myelopathy is a typical musculoskeletal complication seen in an athetoid cerebral palsy. Abilities related to daily activities often decline significantly as the symptoms progress. Because it is progressive, conservative treatments cannot be counted on and a surgery will be necessary. It differs from ordinary cervical spondylotic myelopathies in that involuntary movements are existent, which brings about arguments over methods of operation. Other major orthopedic problems include hip dislocation and scoliosis, and many also complain of back pains or pains in weight bearing joints. In order for adequate prevention and treatment to be put into practice, adults with cerebral palsy and those concerned with them must have a proper understanding of secondary disabilities, and facilities need to be equipped as a place for adults with cerebral palsy to exercise and promote health.

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