Ambulation in patients with spina bifida is affected by many factors, of which neurosegmental level is the most influential. In addition, some ambulatory patients experience deterioration over time, though longitudinal studies are scarce. This study investigated patient ambulation and its related factors in 21 patients with open myelomeningocele who were followed from infancy until over 15 years of age. In five patients, ambulation at the final visit exceeded the goal set up by Oki according to the patient's neurosegmental level. As these patients had L3 or L4 paralysis, our estimation of their neurosegmental level made according to Menelaus, which differs from that made using Sharrard's classification, may have influenced this result. Ambulation in five patients was below the goal, and two patients among this group experienced ambulatory deterioration during the follow-up period. In these five patients, as compared with the remaining 11 patients, the incidence of scoliosis, hip dysplasias, and obesity was higher, which may have influenced their lower ambulation status.

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To facilitate safer operations, we provided a preoperative rehabilitation and educational program covering exercise and diet for obese patients with severe osteoarthritis. Participants totaled 11 patients of which 9 had metabolic syndrome. Exercises included the usual muscle strengthening ones, a range of motion exercise and 30 minutes of walking within parallel bars four times a day. This was combined with a diet program. The averaged results showed that body weight changed from 73.5kg to 64.7kg, body mass index from 31 to 27, and waist size from 106 to 94cm. Blood tests indicated that the average triglyceride level changed from 219 to 127mg/dL and fasting blood glucose from 146 to 94 mg/dL. Total steps walked per day changed from 2840 to 6953 and SF36 improved in all items. Significant improvements were noted in all items tested. Our program provided an effective rehabilitation for patients before operation by reducing patient' symptoms due to metabolic syndrome, reducing leg pain and body weight - while increasing activity, and improving quality of life, while simultaneously decreasing the risk of postoperative venous thromboembolism.

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Recent Trend of Prosthetic Rehabilitation in Geriatric Amputees…Takaaki CHIN 331

Prosthetic Prescription and Functional Outcome of the Elderly Lower Limb Amputee…Kazuya MIZUOCHI 335

Medical and Medico-social Issues in Prescription for the Elderly Leg-amputees…Kazutoshi YOKOGUSHI, Shigeki HASHIMOTO 339

Trends in Lower Limb Amputation…Noriko MARUNO, Masahiro MIKAMI 343

Aging of the Traumatic Amputees…Akihiro TOKUHIRO 345

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Spinal Cord Injury Treatment with Autologous Bone Marrow Stromal Cell Transplantation…Fukuki SAITO, Toshio NAKATANI, Masaaki IWASE 349

Transplantation of Neural Stem Cells for Spinal Cord Injury…Masaya NAKAMURA, Yoshiaki TOYAMA, Hideyuki OKANO 353

Bone Marrow Stromal Cell Transplantation for Injured Spinal Cord…Yasuhiro CHIBA, Satoshi KURODA, Masaaki HOKARI, Shunsuke YANO, Kazutoshi HIDA, Yoshinobu IWASAKI 356

Olfactory Mucosa Autografts in Human Spinal Cord : Progress Status Clinical Trial in Foreign Countries and Experimental Study in our Department…Koichi IWATSUKI, Toshiki YOSHIMINE, Haruhiko KISHIMA, Masanori AOKI 361

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