The author is of the opinion that the phantom limb has its origin in the central nervous system and that various peripheral factors act to protect it. In other words, by psychological treatment according to the theory of conditional reflex phantom limb can either be obliterated or made to reappear. Generally, it seems that the shift of phantom when it disappears is in the order of Type I to Type V, whereas when it reappears the order is reverse. A newborn infant (or foetus) assumes the so-called normal standard limb position at flexion, and from this so-called normal limb position, by the accumulation of conditional reflexes various ADL toward manhood (adult) are developed. Therefore, when the amputees are left untreated, it is possible to assume that the phantom limb reverses back to the so-called normal standard limb position. From these considerations about the phantom limb so far described, it is natural to place a special emphasis on the following points: that the amputation should be planned with an utmost care, that positive functional training including psychological treatment should be given, that a superior artificial limb needs to be devised, and the early attachment of the artificial limb and training are urgent, that every effort should be made so that the person with amputated limbs may resume mentally and physically his daily activity in the society at ease. It is, therefore, cooperation on the part of the society inclusive of the social security and rehabilitation programs is vital.
With the vocational adjustment of the cerebral palsied cases of 15 years of age and over-so-called productive age-, in order to know the real situations, an investigation of their living status-employed, unemployed, of living-standard, school-education and marital life-was made on October 1, 1964, throughout the whole area of Hiroshima Prefecture. Although it was found in the results obtained that the cerebral palsied cases were counted 799 in total number, more than 200 could be estimated not to be checked. The following 2 facts were also indicated there. 1. The ratio of the cerebral palsied of male to female is 3 to 2. 2. The oldest case with cerebral palsy is aged 74, both of male and female. In some aspects of employment status of the cerebral palsied persons, considerations were made as. follows: - Only 16.7% of the patients are supporting themselves. 15% are partially supporting and the rest 68.3% are completely dependent on their families and others. As the those completely dependent, it does not necessarily mean that they have no working ability. Among the partially supporting and self-supporting, there are number of severe cases. It was very difficult to find a suitable job for the disabled persons, especially for the cerebral palsied.
In order to deduce the rehabilitation potential of the hemiplegic patients after stroke, the author examined the relation between cerebral hemodynamics measured by nitrous oxide uptake method and the rehabilitation effect by means of activities of daily living (ADL). The conclusions obtained were as follows: 1) Compared with healthy persons, hemiplegic patients show the disturbances in cerebral hemodynamics, namely, the decrease in cerebral blood flow (CBF) and cerebral oxygen consumption (CMRO2) and the increase in mean arterial blood pressure (MABP) and cerebral vascular resistance (CVR). 2) A certain degree of correlation can be seen in hemiplegic patients between ADL and cerebral hemodynamics. In general, the rehabilitation potential tends to be poor in the cases of severe disturbances in cerebral hemodynamics. 3) In those patients in whom the advanced arteriosclerotic changes are to be seen in cerebral angiography, the disturbances in cerebral hemodynamics are of high degree and ADL are also poor, but no definite tendency is to be seen in the cases of cerebral artery occulsion. The arteriosclerotic changes are considered, therefore, to be an important factor for the rehabilitation potential. 4) In many cases of poor motivation and emotional incontinence after cerebrovascular accident, the disturbances in cerebral hemodynamics, in particular, the pronounced reduction cerebral oxygen consumption (CMRO2) are observable and ADL are also poor in such cases. 5) The muscle strength in the affected side of hemiplegic patients is lowered, but the muscle strength in non-affected side is also lowered by 26.9%. In many patients in whom the muscle strength in non-affected side is lowered, the disturbances in cerebral hemodynamics are marked and ADL are also poor, so that the muscle test in the non-affected side is useful in consideration of rehabilitation potential. 6) The comparison of cerebral hemodynamics between the age group older than 60 and younger than 45 in hemiplegic patients, revealed that the disturbances in the former showed a little higher than in the latter, but no great difference was observed in ADL between the two. It seems that many other factors are responsible for ADL. 7) After rehabilitation grogram, the improvement in cerebral hemodynamics is observed in general, especially in the improved cases in ADL. There are, however, cases in whom some improvement in ADL can be seen without improvement in cerebral hemodynamics. It is certain that many other factors are responsible for such results. 8) In most cases of poor ADL, namely, in most cases of dependent group in daily living, the disturbances in cerebral hemodynamics are of high degree and many other factors disturbing rehabilitation effect are observable. The cerebral hemodynamics measured by nitrous oxide uptake method has some limitation for clinical use, because it shows the blood circulation in the brain as a whole, but does not show them in the affected region of the brain. By summarizing the author's studies, however, it is conceivable that the measurement of cerebral hemodynamics in the postapoplectic hemiplegic patients is of significance as one of the means by which to deduce the rehabilitation potential.