Lung transplantation (LT) has been successfully performed worldwide in patients with end-stage lung diseases, and pulmonary rehabilitation plays an important role in this treatment. Since the first LT from a brain-death donor was performed in March 2000, 11 LT from 9 donors were performed in Japan. Of these, 4 patients (3 cases were unilateral LT, 1 was bilateral) were operated on in our institute, one of only 4 official centers for performing lung transplants in Japan. We experienced pulmonary rehabilitation before and after the operations, and this report aimed to access the effects of rehabilitation and LT in those 4 patients. We measured FVC, FEV 1, 6-minutes walk distance (6 MWD) and peak oxygen consumption during a treadmill exercise test. We also measured activity of daily living (ADL), sickness impact profile (SIP), and the State-trait Anxiety Inventory (STAI). Before LT, while the patients were all waiting for surgery, rehabilitation improved exercise tolerance and ADL without significant change in FVC or FEV 1. Then, however, the improvement gradually deteriorated through the waiting period. After LT, FVC, FEV 1 and exercise tolerance significantly increased. SIP, which measures health related quality of life, also ameliorated to the level of unimpaired individuals in the physical dimension, but did not reach that level in the psychological dimension. STAI, general anxiety scores, did not significantly change. ADL tended to improve short of breathlessness, moving speed, and supplemental oxygen requirement, but these changes were not significant. After LT, 6 MWD increased from 148m at 62 post-operative days (POD) to 342m at their discharge from the hospital (121 POD on average). All cases were discharged to their homes. Three transplant recipients successfully returned to work, however, one patient died of aspergillosis in the native lung about 1 year after LT. These improvements cover a broad activity range, and lead to an increase in patients' stress. Environmental change, for example, being discharged from hospital or returning to work, causes the patients' STAI score to increase. These results indicate that careful management and comprehensive rehabilitation including mental care is needed for LT candidates both before and after LT.

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We reported on the clinical course of ischemic stroke patients using motor items of the Functional Independence Measure (motor FIM). Subjects were 183 ischemic stroke patients transferred to our department from 1999 to 2001. Re-admitted patients, patients with repeat-attacks or patients with severe co-morbidity were excluded. Nurses of the Rehabilitation Department scored patient motor FIM every week. We discuss the averaged motor FIM during the first five weeks after admission. Motor FIM scores at admission were at the 60 level in 1999, the 50 level in 2000, and at the 40 level in 2001. Motor FIM scores did not change in 1999 and 2000 but improved in 2001 during the 5 week periods. This is because in 1999 and 2000 there were many mild level patients and mild level patients who were discharged promptly and not so many severe patients who improved in 5 weeks. On the contrary, there were many severe level patients in 2001 and their conditions improved in 5 weeks. Motor FIM gain was high in the beginning period and high in 2001. We divided the subjects into 2 groups; low FIM group (motor FIM 13-52), high FIM group (motor FIM 53-91). Motor FIM gain was higher in the low FIM group. There were many patients in the low FIM group in 2001.

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[Purpose] To evaluate long-term outcomes after lower spinal cord infarction. [Subjects] Two adults (66- and 63-years-old females) with lower spinal cord infarction manifesting acute anterior spinal artery syndrome and paraplegia. [Methods] Spinal MRI and neurophysiological studies were sequentially performed. Neurological signs were assessed by ASIA (American Spinal Injury Association) motor score for the lower extremities (full score; 50 points) and daily activity was evaluated by the Barthel Index (BI). [Results] In both patients, T2-weighted MRI demonstrated areas of high signal intensity in the gray and white matter of the conus medullaris and epiconus in the acute phase. In the subacute phase at a few weeks from onset, areas of high signal were localized in the bilateral anterior horns of the gray matter in patient 1, and high signals were located in the whole white matter and partially in the posterior column in patient 2. In patient 2, the intramedullary lesions were enhanced after a Gd-DTPA injection, and the cauda equina and the ventral roots of the lumbar nerves were enhanced in both patients. Although both patients demonstrated an absence of an F wave with normal peripheral nerve conduction velocity on the posterior tibial nerve stimulation at the acute phase of illness, the F wave was evoked 3 weeks later in patient 1 and 7 weeks later in patient 2. The somatosensory evoked potentials on tibial nerve stimulation was evoked on the 8th day in patient 1, whereas they were not been evoked at all in patient 2. The ASIA motor score of patient 1 improved from 2 points at onset to 33 points at 12 months, and from 23 to 28 points for patient 2. Similarly, for patient 1, BI improved from 15 points to 85 points, and for patient 2 it improved from 25 points to 65 points. [Discussions] The extent of MRI lesions at the subacute phase of illness, the number of days until F wave appearance after onset, and presence of SEP may be the prognostic factors of long-term outcome, rather than neurological severity and MRI lesions at the acute phase.

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Baddeley and Hitch proposed a fundamental framework for working memory in 1974, emphasizing its transiently activated memory aspect for performing various cognitive tasks. This concept of working memory is quite useful in understanding human cognitive processes and has been widely used in the fields of cognitive and developmental psychology and neuropsychology. The idea of working memory has also been introduced to consider cognitive rehabilitation for patients with brain damage. In the present review, we first described a current theoretical framework of working memory and then reported on recent studies on the conceptualization of working memory. We subsequently reviewed neural substrates of working memory subsystems, i. e., the phonological loop, the visuospatial sketch pad and the central executive. We further referred to the contribution of working memory in understanding various language-related symptoms in patients with aphasia, one of the major targets in the field of cognitive rehabilitation. Working memory plays a crucial role in the everyday life of brain damaged patients. Future research is warranted to focus on the improvement of deficient working memory in order to ameliorate clinical problems of brain damaged patients.

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