Although aneurysmal subarachnoid hemorrhage (SAH) is considered a subtype of stroke, functional outcome is not always predictable. The purpose of this study was to analyze the relevance of some acute-phase parameters for predicting the types of activities of daily living (ADL) three months after SAH. One hundred forty-one of 165 consecutive patients who were admitted to Kanazawa University Hospital between 1989 and 2001 were analyzed retrospectively. All patients were classified into two groups based on the Barthel Index (BI) three months after SAH. The Independent-group with BI≥85 comprised 96 patients, and the Dependent-group with BI≤80 comprised 45 patients. Severity was assessed using the World Federation of Neurosurgical Societies' grading system (WFNS) and the Hunt and Kosnik classification (H & K). WFNS showed ratings of the Independent-group of 88% for I, 80% for II, 75% for III, 48% for IV and 29% for V. H & K analysis showed a similar pattern. Differences in ratings were closely related to differences in grades for each severity scale (p<0.0001). The patients ranged in age from 36 to 89 years. Mean ages were 60.5 years in the Independent-group and 62.0 years in the Dependent-group. No significant differences were found in age analyses between the two groups. As for sex and hemorrhage site, there were also no significant differences between the two groups. None of the sites showed a characteristic pattern of patient distributions based on severity grades. We conclude that severity grades are predictable factors of functional outcome to some extent, but age, sex and site are not relevant.

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To improve gait ability in standing position, we repeatedly performed hospitalized intensive functional training for an average of 2 months, and any effects from this therapy were then examined and followed-up. The study subjects were 14 cerebral paretic children with GMFCS (Gross Motor Function Classification System) level III (consisting of 12 spastic type, 1 athetoid type, and 1 ataxic type), and 19 children with GMFCS level IV (consisting of 17 spastic type, 1 athetoid type, and 1 ataxic type). The mean age of the patients of the level III and IV groups at the first examination was 5 years and 5 months and 3 years and 8 months, respectively. The frequency of the training was 5 times a week for hospitalized physical therapy (40 minutes/exercise) and 1 to 4 times a month for ambulant training after discharge. The group with GMFCS level III showed improvement in their GMFM (Gross Motor Function Measure) score by a mean rate of 3.7% after 1 hospitalized intensive training course (for 2.1 months) and -0.9% after post-discharge ambulant training (for 8.6 months), and also the GMFCS level IV group showed a mean improvement rate of 2.1% after 1 hospitalized intensive training course (for 1.9 months) and 1.0% after post-discharge ambulant training (for 11.3 months), stepwise improvements in physical ability were observed and the efficacy of the repeated intensive training on gross motor function was confirmed.

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For 179 post-stroke patients with hemiplegia enrolled in rehabilitation programs, we requested their physical therapists to assess 93 kinds of gait or related actions and to rate the patient's performance for these on a scale of 7 stages. In addition, each rater was also requested to rate the comprehensive state of each patient on a scale of general physical performance divided into 6 stages. Subsequently, we respectively arranged the cases vertically and their test items scores horizontally, which formed a (93+1)* 179 cross-table of scores. Using this table, we counted first the sum total of the 93 test item scores for each patient and secondly calculated the mean of the scores of the 179 patients for each item, respectively. After that, we rearranged both the patients from top to bottom and the test items from left to right in the order of their numerical value. From the data generated by this table, we investigated the relationship between the comprehensive evaluation by the rater and the sum of all 93 test scores, between the grade of functional disturbance of the patients and the number of tests which could be performed successfully by the same patients, and the mutual correlation among all tests expressed by the scores. Our results showed that the sum of the 93 test scores for each individual changed in parallel with the subjective scores given by each rater in their comprehensive evaluation. Thus, this indicator could be assumed to be a useful quantitative measure of functional disturbance in post-stroke patients. In addition, we investigated how the order of the tests ranked by the difficulty in performing each item of each test was influenced by the level of ambulation and transfer disturbances. Using the results of this study, we plan to construct a more efficient test battery with fewer test items by selecting the pertinent indicators as determined in the current investigation.

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Purpose: To assess the effects of an information kit on stress, anxiety and depression in stroke patients' families in subacute stages of stroke. Methods: Patients admitted to a hospital with acute stroke were eligible for the study. If patients met inclusion criteria, patients and their families were approached and assessed. The information kit was either handed to the families or sent by post. Patient's functional outcome was measured using the Functional Independence Measure. The modified Caregiver Strain Index, the Hospital Anxiety and Depression Scale, and the Short Form 36 (SF-36) were included in the families' questionnaire. All assessments were performed at 2 weeks, 1 month and 3 months after stroke except SF-36 (1 month and 3 months only). Results: 14 stroke patients and their family carers, with the mean ages of 63.4 and 58.8 years respectively, were followed up. On initial assessment, families expressed mild stress, and were at risk of anxiety and depression. Even though patients showed significant functional improvement, the levels of family stress, anxiety and depression increased over time. With regard to health related quality of life, families reported lower SF-36 in comparison to the national normative data at 1 month follow up, and the scores did not change at 3 months. Conclusion: While this study sample was too small to make firm conclusions, the information kit did not affect family stress, anxiety and depression. Further investigation is required to enable rehabilitation specialists to provide more appropriate information targeted to individuals.

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Many stroke patients with hemiplegia have poor oral hygiene. To the best of our knowledge, there have been very few reports on the quantitative assessment of saliva and none regarding quantitative assessment of saliva related to the oral environment and oral hygiene of stroke patients. We examined the reliability of the Saxon test in which the amount of saliva secreted is quantitatively determined by weighing gauze before and after a subject bites down on it. We also investigated the relationship between the amount of saliva and age, the degree of motor impairment, and the existence of dysphagia in 29 stroke patients. The Saxon test was repeated three times to estimate reliability. The second test was performed 15 minutes after the first test and the third one was performed on another day but within five days. Since the intra-class correlation coefficient was 0.94 on the same day and 0.81 on the other day, the Saxon test was concluded to be a reliable measure in stroke patients. The mean saliva secretion was 3.6 grams for the stroke patients, which was less than in the amount found in healthy subjects (5 grams) and more than in a person with Sjögren's syndrome (1.4 grams) as reported elsewhere. There was no significant relationship between the amount of saliva and age, the degree of motor impairment, and dysphagia. It is suggested that we should pay close attention to oral hygiene for stroke patients, because poor oral hygiene may be exacerbated by the reduced amount of saliva in these patients. In conclusion, the Saxon test is useful to evaluate the amount of saliva secreted by stroke patients.

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While many reports mention the excellent efficacy of calcitonin preparations in patients with osteoporosis associated with pain, nowhere in the literature have thermographical changes before and after initiation of the injection been reported as far as we could ascertain. In the present study, we report a case in which the use of a calcitonin preparation led to remarkable improvement of activities of daily living (ADL) in a patient with steroid-induced osteoporosis. The patient was a 26-year-old woman with a chief complaint of low back pain. She had been taking oral steroids since 1992 for treatment of severe bronchial asthma. She was examined at our department for the first time on January 25, 1999, due to an intensification of her low-back pain. A simple X-ray examination at the initial examination revealed wedge-shaped changes in the third and fifth lumbar vertebrae. A weekly intramuscular injection of an elcatonin (Elcatonin^®) preparation was started. After three weeks, she improved greatly in ADL. Her skin temperature before and after initiation of the injections was examined using thermography. The examination showed a distinct increase in her skin temperature after the injection onset suggesting that an improvement of blood flow influenced her improved ADL scores.

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