An epidemiological study on limb prosthesis users in Okayama Prefecture, an area with about 2 million inhabitants, was performed. We compared amputees who received prosthetic limbs from the fund of Law for the Welfare of Physically Disabled Persons during the period from 1981-1985 (Group I) with those who received prostheses between 1991-1995 (Group II). Analyses were performed based on the type of prosthesis and various parameters comprising the user profile, including sex, amputation date, cause, and level of amputation. In comparison to Group I, Group II showed a 26% decrease in the total number of upper limb prosthesis users, as well as a decrease in new upper limb prosthesis users. However, there was an increase in number of elderly users. The total number of lower limb prosthetic users in Group II was decreased by 17%, but there was an increase in new and elderly users. This was thought to be related to the increasing number of elderly dysvascular amputations.

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The goal of this study was to investigate the utility of inpatient rehabilitation in eleven recipients that underwent adult-to-adult living-donor liver transplantation (LDLT) using the Functional Independence Measure (FIM) scale. Following transplantation, muscle atrophy was noted in all patients and was worse in the lower limbs. Joint stiffness was also noted in the four limbs, especially in the upper limbs. Assessment with the FIM scale demonstrated low motor scores (mean 16) and low cognitive scores (mean 20) before rehabilitation. Of the six patients that received intensive rehabilitation and were discharged from our institution, inpatient rehabilitation resulted in improvement in joint stiffness but not in muscle atrophy. Of the six patients discharged, final FIM motor scores had improved markedly (mean 61), and the mean postoperative admission period and the mean rehabilitation period were 163 days and 59 days, respectively. However, of the five patients that died from postoperative complications, final FIM motor scores showed no improvement (mean 14). These results suggest that transplant recipients that do not experience critical complications do benefit from inpatient rehabilitation. However, improvements in functional outcome occur over a long time course, and we advocate initiating rehabilitation before LDLT or hospital admission.

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The objective of this retrospective study was to investigate the functional prognosis and other problems of 14 postresuscitation encephalopathy patients admitted to our hospital from May 2000 to November 2003. They were divided into two groups according to their present (1.5-6.5 years after onset) scores on the Supervision Rating Scale (SRS). Of these 14 patients, there were 6 good-prognosis patients (SRS 1-7) and 8 poor-prognosis patients (SRS 8-13). In a comparison of the two groups, significant differences were noted in the duration of severe consciousness disturbances evaluated by the Japan Coma Scale, the presence of diffuse brain atrophy and Mini-Mental State Examination scores. These were useful markers to predict functional prognosis. The “good” group showed significant improvement in their SRS scores during their first admission. On the other hand, in the “poor” group most of the patients did not show any SRS improvement and they also tended to have severe physical and cognitive impairment. Four patients in the “poor” group were so seriously impaired that they could not even perform the neuropsychological tests. After inpatient rehabilitation, family education and environmental preparation, all of the patients were able to return to their homes. When a family is cooperative and willing to take care of their loved one at home, our inpatient support program appeared to be quite useful.

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Portable chamber pot-type toilet bowls are now widely in use. However, when using these devices help from a care provider is still required because the excrement still needs to be disposed of and the toilet cistern must still be cleaned after each use. Recently, a biotoilet bowl has been developed, which is able to completely degrade excrement. This is accomplished by mixing the excrement with a microorganism carrier in the toilet. We investigated the function of the biotoilets commercially available now. Each of these three types has sufficient excrement disposing ability with a capacity of 2kg/day. One is heavy in weight and requires an exhaust pipe. We used one of the remaining two in a hospital setting. The patient who used the toilet, two fellow patients in the same room, two nurses, and two doctors, were all asked questions concerning the following points: odor, noise, size, stability, ease in handling, and the excrement disposal procedure. Their answers show that the biotoilet is useful and effective because no troublesome procedure is needed for excrement disposal, and it is also helpful in promoting a self-supporting attitude in those patients who use one. It reduces physical and mental stress and lightens the burden on the care receivers and it also provides a highly hygienic outcome and is cost effective. The bacteria culture results revealed only nonpathogenic bacteria. The only disadvantage is odor. If the odor problem can be solved and efforts can be made to promote its wider social recognition, the biotoilet will likely become a very useful tool in the social welfare field.

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We examined the waiting period in 101 patients with brain infarction who transferred from our hospital to rehabilitation hospitals. After the exclusion of 10 patients whose waiting periods prior to transfer were unclear, the average waiting period in the remaining 91 patients was 6.4±4.3 days (0-23 days). The proportion of waiting periods within 7 days was 69.2% and that over 15 days was 5.5%. Two hospitals (Hospital A and Hospital B) that specialized in rehabilitation received 48% of the transferred patients. On the other hand, the remaining 52% of the patients were transferred to 36 different hospitals. No significant difference in the waiting period prior to transfer among Hospital A, Hospital B, and the other 36 hospitals, was observed. The waiting period, 4.1±3.2 days, in the 18 patients who returned to their primary hospitals was significantly shorter than that in the other 73 patients (6.9±4.3 days). Nine patients whose transfers were refused were more severe in condition than the other 92 patients.

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