To attract more Medical Students to become Physiatrists…Satoshi IKEDA 681

Educational Requirements for Physiatrist : From the Educational Committee Standpoint…Yasutomo OKAJIMA 685

Recruiting Physiatrists from amongst Doctors working in Convalescent Rehabilitation Wards or Different Specialties…Satoru SAEKI 688

Career Problems for Female Physiatrists…Toyoko ASAMI 690

Actions taken by the local Association of the JAPM to promote Physiatrist…Toshimitsu SUGA 696

Proposals from the Physiatrist Training Action-Plan Working Group…Naohisa KIKUCHI 701

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A 56-year-old man was admitted to our hospital for the purpose of rehabilitation. Because this patient developed apallic syndrome 21 days after he recovered from his first coma, he was diagnosed with the interval form of carbon monoxide (CO) poisoning. On admission, he showed paralysis of all limbs, motor dysfunction due to joint contractures, pain, and higher brain dysfunction. These symptoms were consistent with magnetic resonance imaging (MRI) findings that the frontal white matter was mainly affected while the involvement in the basal ganglion was mild. Rehabilitation was continued, and his motor dysfunction was improved in a few months, although the higher brain dysfunction needed a longer term to improve. An interruption of his rehabilitation resulted in the exacerbation of the motor dysfunction. Subsequent complications of CO poisoning have been reported to be linked to the areas of the involvement revealed by MRI. Since CO poisoning can show various symptoms, a diversity of rehabilitation is required, according to the patients' symptoms. We think that rehabilitation is the most effective therapy for the subsequent complications of CO poisoning. Since the symptoms require a long time to improve, it is difficult to deal with them within the application of the existing health insurance and nursing care support regulations. We consider that rehabilitation for motor dysfunction and higher brain dysfunction are important, in addition to hyperbaric oxygen therapy in the acute stage of CO poisoning.

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Disabilities in children with spina bifida include those due to central nervous system dysfunction, motor-and-sensory disturbances of the trunk and lower extremities, and excretory disorders. These lead to the necessity of a multidisciplinary approach by medical doctors, rehabilitation staff, nurses, and psychologists involved in the treatment. As motor weakness leads to disturbances in ambulation, physiatrists and physical therapists must deal with the patients with enough knowledge about the factors affecting ambulation, the assessment of motor function, and the indications/limitations of physical therapy and brace treatment. Ambulatory status is affected by motor and sensory deficits, deformities and contractures of the legs, spinal deformities, equilibrium, mental status and so forth, among which the neurosegmental level of paraplegia is the most important variable. Physical therapy in neonates and infants includes careful assessment of the neonate, manual exercise to correct deformities and to improve contractures, positioning and handling leading to sitting and standing exercises. Once the sitting balance is stable, standing and walking exercises should be considered. In patients with higher neurosegmental levels involved, the practical way of ambulation in the future is by wheelchair. Whether standing and walking exercises are indicated in these patients is controversial. In those with lower levels involved, braces may be prescribed considering the muscle strength and the joint stability. Treatments of hip dislocations and spinal deformities are also controversial. Finally, in the overall rehabilitation approach, the possibility of osteopenia and latex allergy should be kept in mind.

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[in Japanese]

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