We investigated the effect of surgical treatment (release or elongation) on ambulatory function of young children with cerebral palsy. Thirty-seven children of 3 years old and under were operated upon their lower extremities, and were followed with physiotherapy and occupational therapy. The degree of lateralization of the hip on plain radiogram and ambulatory function were assessed twice before surgery and at the final follow-up. The mean follow-up period was 4 years and 7 months. According to the classification by GMFCS (gross motor function classification system), the severity of the children were: 15 cases in level V, 13 cases in level IV, eight cases in level III and one case in level II. Twenty-nine cases (85%) had subluxated or dislocated hips. Twenty-four cases (65%) showed an improvement on their ambulatory function. The improvement was seen in any group of GMFCS level. Especially six of eight cases in level III and 11 of 13 cases in level IV improved their function. Apart from the existence of hip lateralization, more than 60% cases improved their function. Orthopaedic surgery of the lower extremities before 4 years old and postoperative continuous rehabilitation are expected to have a great benefit for the children with cerebral palsy in order to develop ambulatory function.

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The incidence of femoral neck fractures in elderly people is high, and most fractures are caused by falls. Decreased postural stability, which is related to falls, is a problem in elderly people. The purpose of this study was to evaluate dynamic postural control in middle-aged and elderly people, and to determine the test-retest reliability. Quantitative posturography (EquiTest^®) was performed to determine subjects' response to sudden perturbations. Ninety-eight subjects (27 men, mean age: 58.4 years, and 71 women, mean age: 60.8 years) were included in this study. They did not have any complications that could have affected their balance, such as, ataxia, osteoarthrosis of the knee. Subjects received forward and backward perturbations while standing on a movable force platform. Balance responses were analyzed in terms of latency (the time between the onset of a translation and the onset of the active response), amplitude (relative response strength) and weight symmetry. And they also received toes-up and toes-down perturbations to evaluate sway energy score (the effort to stabilize against postural sway) and its adaptation. The test was administered to 10 subjects on two separate days 1 month apart to determine the test-retest reliability. Postural control between men and women was compared. Because aging is an important factor in postural stability, we also compared postural control between two age groups in women (45-55 years and 65-75 years). The intraclass correlation coefficients for the test-retest ranged 0.66 to 0.98. The relative response strength was significant higher in men. No gender difference was observed in the response latency, sway energy score and its adaptation. The relative response strength, sway energy score and its adaptation were impaired in the elderly subjects (65-75 years). The research revealed good test-retest reliability for the test. The results indicated that dynamic postural control was impaired in elderly people.

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The objective of this study is to identify physical and cognitive disturbances of brain injured patients who have risks of escape from the ward or the hospital. We performed a retrospective study for 140 brain injured patients (107 traumatic brain injuries; 12 cerebrovascular disease cases; 9 brain tumor cases; 5 cerebral anoxia cases; 4 encephalitis cases; 1 brain abscess case; 1 Korsakoff syndrome case; 1 normal pressure hydrocephalus case; 1 frontal/parietal focal resection for refractory epilepsy case) with various impairments. They admitted to our hospital during last one and a half-year for rehabilitative treatment. We performed Functional Independence Measure (FIM) and several neuropsychological tests on admission. The group with high risk (51 cases who actually escaped or tried to escape from their ward or the hospital without permissions) had lower admission cognitive FIM scores than the group of no risk (89 cases who never escape from their ward). The neuropsychological test results, such as Mini-Mental State Examination, Miyake-shiki Memory Test were significantly lower in high risk group than no risk group. The result of this study revealed the characteristics of those who have a risk of escapes. We have to pay attention to prevent escaping in the patients who can walk or drive a wheel chair with disorientation and memory disturbances besides gross cognitive dysfunction by FIM.

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When normal subjects eat solid food, the bolus is formed in the oropharynx prior to swallowing. Bolus formation for liquids, however, is usually in the mouth. The purpose of this study was to determine whether the act of chewing alters the relationship between bolus position and swallow initiation. Ten healthy volunteers aged 29.2±4.1 years were imaged with videofluorography while consuming barium-mixed foods included 10ml-liquid (LQD), 8g-corned beef hash (CBH), 8g-cookie (COK), and a mixture of 5ml-liquid with 4g-CBH (MIX). They were instructed to chew and then swallow. For liquid, an additional recording was made with command swallow. Swallow onset was defined as the moment hyoid began its rapid elevation. The position of the leading edge of bolus at swallow onset and the duration of bolus transition were measured. The position of the leading edge of bolus was classified in Oral cavity (OC), Upper-oropharynx (UOP), Valleculae (VAL), or Hypopharynx (HYP). With LQD, the leading edge of bolus was in OC or UOP at time of swallow onset in 89.5% of swallows without chewing. In contrast, bolus entered VAL and HYP before swallow onset in 45% of swallows of LQD with chewing. For CBH and COK, the leading edge of the bolus entered VAL before swallow onset in 55.0% and 50.0% of swallows, respectively. For MIX swallows, the leading edge reached VAL or lower before swallow onset in 100% of swallows. From these findings the act of chewing seemed to be a prime determinant of a manner of chew-swallow complex characterized by the existence of the stage II transport. And for observation of this phenomenon clinically, MIX chew-swallowing is the most suitable because of its high reliability. In chew-swallow of food including liquid properties (LQD and MIX), high frequency of bolus entering in HYP before swallow onset was observed. The food transport to hypopharynx seemed to be influenced by gravity. This finding was very important in consideration of aspiration mechanism of dysphagic patients especially with falsenegative results of videofluorographic study. High correlation was recognized in the chewing time and the oropharyngeal transport time, and hypopharyngeal transit time was long in LQD with chewing and MIX. Steadiness of hyoid bone movement time indicated that this parameter should be suitable for standardize of time measurement. The manner of chew-swallow complex was obviously different from that of command swallow. It seemed to be important clinically to assess chew-swallow complex additionally to the conventional videofluorography.

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We reported a 33-year-old man with a severe neurologic type of Wilson's disease. Neurological examinations revealed apathy, dysphagia, rigidity, bradykinesia and loss of postural reflexes. He was treated with a low copper diet, a combination of trientine and zinc, and rehabilitation. However, no significant change in ADL was observed in the first 11 months of therapy. After that, improvement began and continued for a period of an additional 9 months. Ultimately, neurologic and psychiatric manifestations disappeared and the Barthel Index improved from 30 to 100. A long period was required until substantial improvement began and reached a plateau. The rehabilitation during the period prevented disuse, and then promoted the recovery of functions. On the initiation of therapy, it is difficult to estimate the onset time of recovery or ultimate state of functions. Therefore, it is important to maintain a positive attitude toward the disease during the long-term follow-up.

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