ロボット技術の進歩とともにリハビリテーション医療の現場にもこれらが応用されるようになってきている．今回我々は3次元動作を可能とし，さらにバーチャルリアリティ技術を応用して視覚及び力覚フィードバックを可能とした上肢機能訓練装置を開発した．これを脳卒中片麻痺患者に応用し，その効果を検討した．対象は慢性期の脳卒中片麻痺患者 6 名とし，40 分間の訓練を 1 週間に3 回，6 週間受けるものとした．Fugl-Meyer Assessment，Motricity indexなどにより訓練期間前後の上肢機能を比較した．Fugl-Meyer Assessmentにおいて統計学的に有意な改善を得た．特に本装置の主な訓練対象となる上肢近位項目の改善が大きかった．本装置はバーチャルリアリティ技術を応用し，長時間の自主訓練を集中して行えるよう設計している．脳卒中慢性期患者の自主訓練装置として実用化を進める．

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随意運動介助型電気刺激装置（Integrated Volitional control Electrical Stimulator : IVES）と手関節固定装具の併用により，上肢機能の改善を認めた慢性期片麻痺の1例を経験した．症例は脳腫瘍術後1年を経過した 32 歳男性で，右片麻痺が残存し，上肢の痙縮が強く，手指の分離運動は不能であったが，伸展がわずかに可能で，関節可動域制限や感覚障害は軽度であった．本例にIVESと手関節固定装具を 1 日 8 時間，8 日間装着することにより，手指の分離運動が可能となり，上肢実用度が著明に改善し，筋電図上も手指伸展運動時の手指屈筋群の過剰な筋活動の減少を認めた．本例のように，痙縮が高度で，手指分離運動の障害を認める片麻痺患者において，関節可動域制限や感覚障害が軽く，総指伸筋の筋活動の導出が可能であれば，慢性期であってもIVESと手関節固定装具の併用により，上肢機能が改善する可能性があると考えられた．

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We report a case of a 39-yr-old man with a bilateral occipito-parietal contusion. After conservative treatment at an emergency hospital, he was transferred to our hospital for rehabilitative intervention. On admission, he presented with mild cortical blindness and visual agnosia. As his visual acuity gradually improved, Bálint's syndrome became apparent. This syndrome is characterized by difficulties with visual scanning, dysmetria secondary to visual perceptual deficits, and an inability to perceive more than one object at a time. After rehabilitative intervention, consisting of both visuo-perceptual retraining and a functional adaptation program, he was able to bathe and toilet independently. However, neuropsychological findings over 3 years remain consistent with Bálint's syndrome.

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There have been a number of recent reports in the English literature regarding false recognition of unknown faces, although it has attracted little attention in Japan. The false recognition of unknown faces may have severe negative consequences in daily life, and this condition should be investigated in more detail. Here, we report a patient who showed false recognition and misidentification of unknown faces. The patient, a 37-year-old right-handed woman, had suffered right cerebral infarction due to Takayasu arteritis at the age of 16. The patient showed mild unilateral spatial neglect and mild impairment of recognition of familiar faces, but showed no signs of anosognosia or anosodiaphoria for false recognition. Neuropsychological investigations suggested that her symptoms may be due to a delayed information processing speed regarding faces. The patient's impairment has been ameliorated by continuous instruction urging her to think carefully before coming to a conclusion regarding the identities of faces. We also present a review of the literature regarding false recognition of unknown faces.

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The exercise capacity of the patients with renal dysfunction declines and this phenomenon is distinctly related to the extent of renal function deterioration. It is suggested that appropriate exercise training may improve the physical strength and the quality of life in patients with chronic renal failure(CRF)besides the improvement of glucose and lipid metabolism. However, it is required to consider the influence of exercise on renal function thoroughly, because acute exercise causes proteinuria and decreases renal blood flow and glomerular filtration rate. At present, there are few reports concerning the optimal intensity and duration of exercise training for patients with CRF. Moreover, there has been no definite conclusion as to whether or not chronic exercise training(EX)has any renal protective effect in animal models of CRF. Recently, the renal and peripheral effects of long-term moderate to intense exercise training in various rat models of CRF has been extensively reported. The effects of a combination of EX and rennin-angiotensin system inhibitors(ARI)on renal function were also assessed. The results indicated that moderate to intense EX and ARI can yield a renal protective effect in some models. They also suggested that the simultaneous treatment of moderate EX and ARI provided a greater renoprotective effect than treatment by ARI alone. Further investigations will be needed to examine the mechanism of the renal protective effect of EX. A better understanding of the mechanism may lead to improved exercise strategies and the establishment of a renal rehabilitation regime for CRF patients.

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【訂正】リハビリテーション医学 43巻 5号掲載の「平成 18年度リハビリテーション医学に関連する社会保険診療報酬等の改定について」（pp. 268.276）のなかで下記の誤りがありましたのでお詫びして訂正いたします．

p. 270 表 3「脳血管疾患等リハの（ク）」（誤）急性憎悪→（正）急性増悪

p. 271 表 4「心大血管疾患リハ（I）の医療職の文章」（誤）専従の常勤 PTまたは専従の常勤看護師それぞれ 2名→（正）専従の常勤 PTまたは専従の常勤看護師併せて 2名

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