We examined the medical records of 125 patients with cerebral infarction who transferred from acute phase hospitals to our hospital, as to whether they contain information about clinical category, magnetic resonance image (MRI), magnetic resonance angiography (MRA), cervical ultrasonography, echocardiography, and PT-INR, the days between onset of stroke and transfer, and whether they were accompanied with copied film. We compared the data among departments in charge and among hospitals. The proportions of listed clinical category (96.5%) and patients accompanied with film (72.0%) in the Department of Neurology were significantly higher than those in the Department of Neurosurgery (50%/25%) and in the Department of Internal Medicine (60%/10%). The proportions of Holter electrocardiography (ECG) (44.7%) and transesophageal echocardiography (37.6%) in the Department of Neurology were significantly higher than those in the Department of Neurosurgery (10%/0%). MRI (90.6%), MRA (84.7%), and cervical ultrasonography (85.9%) in the Department of Neurology were significantly higher than those in the Department of Internal Medicine (65%/40%/60%). There was no significant difference in the days between onset of stroke and transfer among the 3 groups. Clinical category (93.9%), cervical ultrasonography (83.7%), echocardiography (75.6%), patients accompanied with film (64.2%) were significantly higher and the days between onset of stroke and transfer (20.5±11.0) was significantly lower in 6 hospitals from which many patients came than the other 14 hospitals (44.4%/59.3%/48.1%/18.5%/34.3±22.2). But even among these 6 hospitals, there was a significant difference in patients accompanied with films, MRA, cervical ultrasonography, Holter ECG, echocardiography, transesophageal echocardiography, and the days between onset of stroke and transfer. Acute phase hospitals should be expected to enrich their medical records in order to share medical data with rehabilitation hospitals.

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Based on the Regional Inter-hospital Referral Model, the rehabilitation of poststroke patients under long-term care insurance at home including associated problems is presented in this paper. 1. The tools for assessing visiting rehabilitation that we have developed from necessity to evaluate poststroke patients' overall activity are also introduced. 2. Thirty-five out of 39 poststroke patients, who were institutionalized at our Geriatric Health Service Facility from the Convalescence Rehabilitation Units, returned home and showed a significant improvement in their Barthel index scores. Eleven out of 39 poststroke patients improved their ambulation ability. 3. The focus of training has shifted from recovery of impairment to improvement in activity. Before returning home, transfer of the patients to Geriatric Health Service Facilities from Convalescence Rehabilitation Units meets the burden of long-term care insurance rather than that of medical insurance. 4. As for the function of the intermediate institution between Convalescence Rehabilitation Units and poststroke patients' homes, Geriatric Health Service Facilities are important for those patients who are predicted to require a wheelchair after returning home. Moreover, a social rehabilitation support system for poststroke patients in their forties and their elders is required. 5. Each Ambulatory Rehabilitation service is systematically shown in its use purpose-oriented function. 6. As a result of a 10-month visiting rehabilitation period, the Barthel Index in 30 poststroke patients showed a significant improvement, and the time taken in IADL also demonstrated a significant increase. This upward tendency of leisure-time activity led to a further spread to areas of everyday activity. Thus, visiting rehabilitation had some positive effect. 7. Each rehabilitation service under long-term care insurance plays a central role in supporting the independent living of poststroke patients at home and improving their QOL.

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Present and Future View of Vocational Rehabilitation in Japan…Ryosuke MATSUI 21

Relationship between Medical Rehabilitation and Vocational Rehabilitation…Kazunari FURUSAWA, Akihiro TOKUHIRO 24

Introduction of our Vocational Rehabilitation and the Prospective Valuation…Hironori YAMAZAKI 29

Vacational Rehabilitation of Persons with Higher Brain Dysfunction…Katsuo TAYA 34

Current Status and Problem of Employment for Persons with Disabilities in a Corporation…Hiroya ONO 40

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[in Japanese]

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