The purpose of this study is to investigate patients' resumption of work after a first stroke including the kind of work. One hundred five cases were followed-up by letter about their resumption of work and related information. The patients were all younger than 60 years old and working at the time of their strokes. We also investigated their characteristics at discharge. Their occupations were classified using a modified version of the Standard Occupation Classification of Japan. Sixty three percent of the patients interviewed returned to work and 52% returned to their previous jobs. Concerning patient pre-stroke occupations, the resumption rates were highest for supervisors and office workers. On the other hand, the resumption rates were lowest for construction workers and sales people. Concerning the severity of paresis, the resumption rates tended to be lower for those patients who had severe paresis. In patients who returned to work, their total score on the Functional Independence Measure at their discharge was higher. We reconfirmed that the resumption of work in stroke patients depends not only on medical factors but also on social factors. These results obtained should prove useful for stroke treatment, stroke rehabilitation and cooperation with industrial hygienists.

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In order to clarify the influence of an external cue (paced sound) on the activation of the presupplementary motor area (pre-SMA) and supplementary motor area (SMA proper), we scanned 10 right-handed healthy subjects by functional MRI while they performed (1) self-initiated finger-to-thumb opposition movements on once every 1 sec, and (2) externally triggered the same movements using a metronome's paced sound. During self-initiated movements with the right hand, the right and left SMA proper were significantly activated in 6 and 3 out of 10 subjects, respectively. These activations were diminished or disappeared in 5 out of 6 and 2 out of 3 subjects during the paced sound trials. With the left hand, the right and left SMA proper were significantly activated in 5 and 1 out of 10 subjects respectively. During the externally paced sound trials, these activations were respectively diminished or disappeared in 4 out of 5 and 1 out of 1 subject. On the other hand, pre-SMA activation was minimal for either hand during the self-initiated task. These preliminary results are consistent with previous reports that the SMA proper plays an important role, especially in self-paced movements rather than externally triggered movements, which might explain the paradoxical movements in Parkinson's disease because the basal ganglia tightly connect with the supplementary motor area.

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