Prescriptions and Physiatrists…Junko FUJITANI 449

Rehabilitation for Stroke Patients with Unilateral Spatial Neglect…Katsuhiro MIZUNO 452

Rehabilitation Prescription for an Leg Amputee with Diabetes Mellitus and Renal Insufficiency…Tsuyoshi YOKOI 458

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Longer-term results of Orthopaedic Selective Spasticity-Control Surgery (OSSCS) on gross motor function in 25 patients with cerebral palsy were investigated and compared to the natural history of 70 non-surgical patients with brain-related disabilities, who were visiting this center, in GML using longitudinal and stratified analysis. Participants were 9 females and 16 males, who had previously undergone OSSCS at 13.1 years (5.3 to 38.9) on the average. There were 8, 2, 3, 5, and 7 patients from level 1 to 5 in the Gross Motor Function Classification System (GMFCS), respectively. Gross Motor Function Measure (GMFM) and Gross Motor Level (GML) were evaluated at pre-operation, one year after surgical intervention and every year thereafter. The average passage observation period was 6.4 years (3.7 to 8.4). A good one year postoperative outcome was obtained in 25 cases (100%) in GML and 23 (92%) in GMFM. Good maintenance was recognized in 22 cases (88%) in GML and 17 cases (68%) in GMFM as observed by postoperative progress. The gross motor function began to deteriorate from around 20 years of age in the no-operation group and experienced a drop for many cases in their late thirties. Even this ages, all of 8 patients of operative group with this ages maintained good results in GML. From these results, we found that OSSCS is an effective surgical intervention and that its effect was maintained for many cerebral palsy cases for the postoperative middle term.

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We examined the effect of the liaison critical pathway for stroke among the inpatients in an acute hospital (AH) from 2007 to 2008. The average length of hospital stay in the AH was reduced by 5.7 days compared with 2006 by means of the critical pathway. Among 155 patients who had been transferred from the AH to a convalescent rehabilitation ward (CRW), 148 were discharged from the CRW. Ninety-seven patients returned home and 44 patients were transferred from the CRW to a nursing home type unit or an institution. One patient died in the CRW, six were returned to the AH. From among the clinical factors, that included sex, age, modified Rankin Scale (mRS), total, motor and cognitive scores of Functional independence measure (FIM) at discharge from the AH, total FIM scores and FIM gain at discharge from the CRW, mRS at discharge from the AH and total FIM scores at discharge from the CRW exerted an influence on outcome. Patients living with their spouses and / or children before the onset of stroke were more inclined to return home.

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