Objective : To study the effect of repetitive facilitation exercises (RFE) on motor functional recovery in stroke patients with hemiplegia. Subjects and Methods : Fifty-two stroke patients in the recovery stage were divided randomly to receive RFE (RFE group) or conventional therapy (CT group) for 17 weeks. Motor functional recovery and activities of daily living (ADL) were evaluated using Ueda's motor paresis grading system and functional independence measure (FIM), respectively. ADL evaluations were done blindly. Results : The baseline characteristics of the RFE and CT groups did not significantly differ. After the intervention, the RFE group showed not significantly larger improvements than the CT group in Ueda's grades for the upper limb, hand, and lower limb. But isolated joint movement from synergy was observed more frequently in the RFE group than in the CT group (p<0.05). Furthermore, improvement in FIM in the RFE group was greater than that in the CT group, especially in both the total and motor FIM of subjects who underwent lower limb RFE (p<0.05), and in the subscore for self-care in subjects receiving RFE to their fingers (p=0.075). Conclusion : There is a possibility that RFE might promote the functional recovery of the hemiplegic upper limb, hand, and lower limb to a greater extent than CT.

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Objective : The aim of this study was to examine the influence of a liaison-clinical pathway for stroke rehabilitation. Methods : We initiated the pathway in January 2008. The patients enrolled in this study included 82 patients with acute stroke sustained during the 4 months after the initiation of the pathway and 151 patients with acute stroke sustained during the same period in the following year. Results : The mean length of stay in acute stroke centers was significantly reduced in the second year of employing the pathway. However, an evident reduction of the functional independence measure gain was observed in the convalescent rehabilitation wards, especially in severely physically handicapped patients. Conclusion : The liaison-clinical pathway is an effective approach for advancing a regional cooperation network among hospitals and for shortening the stay in acute stroke centers. On the other hand, the clinical outcome of stroke patients can deteriorate if enough efforts are not made to improve the medical management of severely physically handicapped patients in convalescent rehabilitation wards.

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In this paper, we report the various actions and administrative steps taken by the Miyagi Prefectural Rehabilitation Support Center (MPRSC) to aid the disabled, following the Great East (Eastern) Japan Earthquake. Among various problems we encountered, it was alarming that the shelters set up for victims were not always accessible for disabled persons. These non accessible shelters had various barriers. Also, we noticed that many disabled people had lost their technical aids, i.e. canes, wheel chairs, orthoses and prostheses, etc. After the administrative vacuum caused by the disaster, we were able to restart community services for the disabled through reestablishment of local support center activities under MPRSC direction. During this process, we received much support from across the nation and from various specialist groups related to rehabilitation services. We now realize the need for the Disaster Acute Rehabilitation Team (DART) and the undergoing change in needs for the disabled people since the disaster. Finally, we comment on the importance of building a guideline of rehabilitation services, especially in case of a disaster, and having an everyday working intimate network established among the local administration office, medical associations and the other related parties.

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