We examined unipedal standing times and history of falls during 1 month for 245 psychiatric patients who were being treated with the psychotropic drugs(male 137, female 108, age from 17 to 88, average 55 years). We also examined the effect of exercise for 31 cooperative patients who could carry out the standing balance exercise every day for 2 months.[Results]Compared with healthy people, the unipedal standing times of these psychiatric patients were extremely shorter even in the younger patients. During one month investigation, 22 patients fell at least one time. The average standing times for these 22 patients were 9.1 seconds(right leg)and 8.4 seconds(left leg)and for those patients who did not fall they were 16.9 seconds(right leg)and 15.8 seconds(left leg)(p<0.05). A five minute unipedal standing exercise was carried out every day for 31 cooperative patients. After 2 months, the average unipedal standing time was statistically improved(from 26.5 seconds to 32.0 seconds p<0.05).[Conclusion]Psychiatric patients treated with psychotropic drugs are in greater danger of falling if their unipedal standing times are shorter than 10 seconds, and the attending physicians should give careful consideration to changing or decreasing the dosage of the psychotropic drugs these patients receive. Finally, unipedal standing exercises may improve standing balance and prevent falls in the psychiatric patients.

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Since 1989, we have been actively involved in the prevention of progressive spinal deformity in Duchenne Muscular Dystrophy. We have targeted our treatment specifically towards establishing an early straight or hyperextended spine, which was found to be the most stable condition in D.A. Gibson's study. From 1989 to 2005, nine patients with Duchenne Muscular Dystrophy have successfully gone through our target-treatment program. Nine patients from this group, ranging in age from 20 to 30 years, and seven other patients, who had never gone through the target-treatment program, were selected for the comparison study. The incidence of straight or hyperextended spines and the Cobb method were used to determine spinal deformity. In terms of overall success rate in establishing of a straight or hyperextended spine, the first group was 88.9 % and the second group, 28.6 %. Especially, a comparison of the lateral curvature was quite remarkable, in which the first group showed 17.4±17.2 degrees on average, and the second group, 42.0±24.1 on average. This treatment is very effective for the management of spinal deformity in Duchenne Muscular Dystrophy.

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Prospective memory is a memory feature in humans which involves activities for remembering to do something in the future. The aim of this study was to investigate how many cases had an impairment of prospective memory, also to determine the relationship between prospective memory and other cognitive functions and activity of daily living. Subjects were 50 senile patients 60 years of age or over having amnesia as a complaint including 25 patients with Alzheimer's disease, 14 with vascular dementia, 7 with mild cognitive impairment(MCI)and 4 others. A prospective memory task which required retaining and remembering a planned action was used and this task was to find the location of a hidden item in the Rivermead behavioral memory test. As for the results, prospective memory impairment was present in 42 cases. Patients with dementia had impairment in both presence of intentions to remember and contents of the intentions, but MCI patients had only impairment in contents of the intentions. The patient's age was important for determining the existence of prospective memory impairment. Patients with prospective memory impairment had lower scores on delayed recall than patients without prospective memory impairment. In the contents of the intentions of prospective memory, right hippocampus hypoperfusion was demonstrated. In the presence of intentions to remember of prospective memory significant CBF reduction also was seen in right parietal, angular and pericallosal and both hippocampi regions. Patients with prospective memory impairment had lower scores on amnesia list in daily life than patients without prospective memory impairment.

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A woman in her early 30s suffered from paraparesis with bilateral lower leg weakness and sensory disturbance a few hours after scuba diving to a depth of 40 m. Neurological examination revealed pyramidal tract signs of the lower legs, mild muscle weakness, mild sensory disturbance below Th6, severe disturbance of position sensation in the lower legs, and vesicorectal dysfunction. She was unable to stand due to severe ataxia in the truncus and lower legs. After administering 13 sessions of hyperbaric oxygen therapy and intravenous injections of sodium methylprednisolone succinate in 2 days and edaravone for 2 weeks, her lower leg muscle power recovered to the normal level; however, due to ataxia, she was still unable to stand and walk. An MRI of the spine revealed abnormal signals in the intramedullary lesion from C4 to Th6 that spread to the dorsal column of the spinal cord. Three months later, the lesion decreased in size; however, some parts of the lesion remained at the dorsal column. A study of the somatosensory evoked potentials of the bilateral posterior tibial nerves showed that the P36 signal was absent on the 9^th day. Six weeks from the accident, P36 appeared with a prolonged latency and small amplitude. The patient was diagnosed with spinal ataxia. Although we expected that the prognosis might be poor with regard to her ambulatory function, 5 months after rehabilitation admission, her ambulatory ability almost fully recovered. However, slight ataxia and severe vesicorectal dysfunction persisted.

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A thirty-six-year-old man who developed maladaptive behavior after a traumatic brain injury suffered 18 years ago was admitted to our hospital for evaluation. His maladaptive behavior was so severe that he could not continue to use facilities designated for the physically disabled or mentally ill. The result of our evaluation revealed that he had intellectual deficits, memory dysfunction and disinhibition. However, he could perform easy tasks and follow engagements such as not smoking or asking for money while he stayed in the hospital. Our evaluation was that he was able to use a rehabilitation facility for the mentally handicapped. We advised the facility that he should be kept under a tight daily schedule with a behavioral check sheet and rules. Also, he should be kept away from situations that might trigger maladaptive behavior and any appropriate behavior exhibited by him should be reinforced positively. As a result of such an approach in the facility for about 9 months, his maladaptive behavior lessened and his smoking tapered off, as did his need for psychotropic drugs. A structured environment and behavior modification in a facility for the mentally disabled might be effective for treating those patients who have cognitive and behavioral problems such as this patient.

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In this paper, the role that biostatistics can play in enhancing scientific evidence in rehabilitation research is discussed. The importance of biostatistical support throughout all phases of clinical research is described with an emphasis on good mutual communication between the clinical researcher and biostatistician as a prerequisite condition for successful research. Two distinct modes of data analyses, namely “model-based” data analysis and “data-based” data analysis, are introduced. The choice of a particular mode of data analysis is based on the current stage of clinical knowledge in a given research and/or a particular research area. For illustrative purposes a data-based analysis with linear additive models is presented.

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Wrong:Mizuho YOSHIDA 1), Yoshihiro TAKAYAMA 2) and Masazumi MIZUMA 2)
Right:Mizuho YOSHIDA 1,2), Yoshihiro TAKAYAMA 1) and Masazumi MIZUMA 2)

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