The purpose of this study was to determine the reliability and validity of measuring the anaerobic threshold (AT) in patients with impairments of the lower extremities. The subjects were 20 patients with spinal cord injury (SCI), 14 patients with lower limb amputation (AMP), and 29 patients with orthopedic disease (ORTH). An arm crank ergometer (ACE) was used to establish the AT and peak oxygen uptake (VO₂Peak). Each subject was tested twice within 3 weeks to measure test-retest reliability. Test-retest reliability was assessed by intraclass correlation coefficient (ICC). The validity of AT was assessed using the relationship between AT and VO₂Peak based on Pearson's correlation coefficient (PCC). ICC values were 0.877 in SCI, 0.939 in AMP and 0.937 in ORTH, and ICC was good to excellent in all groups. PCC values between the AT and VO₂Peak were 0.748 in SCI, 0.762 in AMP, and 0.706 in ORTH. These results suggest that the AT as measured ACE, is useful for evaluating the physical fitness of patients with impairments of the lower extremities.

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The Counseling Centers for the Rehabilitation of People with Physical Disabilities are administrative agencies established in each prefecture as required by the Law for the Welfare of People with Physical Disabilities. With the enactment of this law in 1949, the Counseling Centers were designated as centers for specialized technology to perform a pivotal role in the implementation of welfare policy for the disabled. The Counseling Centers provide counseling, evaluation, and guidance, and conduct inquiries into the kinds of services required by disabled persons, in conjunction with the welfare services delivered by local governments. Specifically, the Centers evaluate an individual's need for medical rehabilitation services, introduce the use of rehabilitation facilities, and counsel on issues related to prosthetic, orthotic, and other technical aids. Counseling and support are also provided to individuals returning to work and community life. The Centers assist prefectural governments by offering specialized medical and technical expertise to aid in the official certification of physically disabled individuals and by promoting rehabilitation programs in the community. For villages, towns, and municipal governments, the Centers coordinate the delivery of welfare services, assist in collecting and disseminating technical and specialized information for educational purposes, and conduct training for staff of local government agencies. Physiatrists play an important role in each Center's counseling and evaluation programs by providing medical evaluations that serve as the basis for an individual's social and occupational rehabilitation objectives. When fitting prosthetic and orthotic devices, for example, because of the precision fit required to compensate for functional disability, the physiatrist is intimately involved in the entire process, from prescription of the device to final evaluation of the individual's adaptation to it. Social conditions have changed dramatically in the fifty plus years since the enactment of the Law for the Welfare of Physically Disabled Persons. Over this time the needs of disabled persons have also greatly increased and diversified in nature. In response to these changing conditions, the year 2003 will mark the beginning of a new welfare system. Accordingly, the services offered by the Counseling Centers for the Rehabilitation of People with Physical Disabilities will also be reviewed. The overall reform of the general medical system is also moving forward. The task confronting the field of rehabilitation medicine is one of developing a new system, and rethinking each aspect, from evaluating the occurrence of disabilities to implementing medical rehabilitation services and restructuring the lives of the disabled in the community.

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