The terminal stage of Fukuyama-type congenital muscular dystrophy was investigated. Sixteen patients (7 males, 9 females) were examined. Eleven of them suffered from chronic respiratory failure. Three died without ventilatory support. Three received tracheostomies and five received noninvasive positive pressure ventilation. These 11 patients also suffered from progressive swallowing disturbance. Ten patients were fed via a nasogastric tube and one ate devised food. Progressive swallowing disturbance and chronic respiratory failure were recognized at the same time in 3 patients. The former presented first in 7 patients. But chronic respiratory failure followed within a year in 3 of these patients. This means that when a swallowing disturbance deteriorates in a patient with late stage Fukuyama-type congenital muscular dystrophy, the possible advent of respiratory failure should be kept in mind.

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Objective : To evaluate the effect of heat and steam generating sheets on osteoarthritis of the knee. Methods : Subjects with osteoarthritis of the knee (n=41) were randomized into 2 groups : a heat and steam generating sheet group or a heat generating sheet group. Functional impairment [Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Japan Orthopaedic Association score (JOA score)] in the index knee were measured at baseline and then again after 2 and 4 weeks of wear. Results : At both the 2 and 4 week patient evaluations, the heat and steam generating sheet group showed improved total WOMAC scores. Although the heat generating sheet groups' WOMAC scores were improved after 2 weeks, the difference between the 2 and 4 week evaluations was not statistically significant. As for individual WOMAC scores, patients in the heat and steam generating sheet group especially demonstrated a highly significant decrease in WOMAC stiffness score. In comparison, patients in the heat generating sheet group showed no improvement in WOMAC stiffness score. Gait ability improvement, as measured by JOA score, showed similar results for both groups. Conclusion : This study showed that using heat and steam generating sheets decreased pain and stiffness, and increased gait ability in patients with osteoarthritis of the knee.

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The Progress and Practice of Japan Sun Industries…Taro NAKAMURA 317

New Findings due to Experience of Urological Management for more than 20 Years…Takatoshi OGAWA 322

Prevention of Decubitus and Health Care in Home Livers with Spinal Cord Injury…Takeshi NAKAMURA, Fumihiro TAJIMA, Takashi MIZUSHIMA 326

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Preferable Direction in the Rehabilitation Health Care from the Viewpoint of Medical Economics : For Effective and Efficient Rehabilitation…Ryu NIKI 331

Transition of Physiotherapy Fees and Physical Therapist's Specialty…Ryuichi KUSAKA 334

Present State of Speech-Language-Hearing Therapy and Prospects for the Future : Relationship with the Revision of the Fees for Medical Treatment and Care…Kenichi HASEGAWA 338

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