We experienced a case of delayed-onset Wallenberg's syndrome following cervical spine fracture coexisting with suspected conversion disorder. A 69-year-old man was involved in a traffic accident, and was admitted to our rehabilitation unit for the purpose of posttraumatic rehabilitation. At first, he complained of right occipital and nuchal pain. But his complaints changed to ataxia, dysphagia and a suspected brainstem lesion four months after the accident. His brainstem MRI showed a small ischemic lesion in the right dorsolateral area of the medulla oblongata. The long time lag between the original traumatic event and his changing complaints made the diagnosis difficult. Accordingly, rehabilitation assessment and conventional rehabilitation approaches were prepared for all of his symptoms. The dysphagia and ataxia were gradually reduced and the hemiparesis lessened and disappeared. A couple of points were suggested by this case. The first is “We must never overlook a change of neurological symptom masked as conversion disorder, and never deny what the patient says without careful listening.” The second is “We should offer the patient a conventional rehabilitation program without the option for malingering and falsification. This case might suggest that our attitude toward so-called gray-zone cases has an influence on the functional/social prognosis.

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In the Great East Japan Earthquake and disaster, much of the Pacific coastline of Miyagi Prefecture was devastated by a tsunami. Though physical damage to our hospital was minimal, both the flow of information and the hospital's lifeline were interrupted. During this time supplies to our hospital were insufficient, yet we still gave medical assistance to the disaster victims. Physically handicapped people faced extreme difficulty in all aspects of everyday life such as moving to a refuge center, eating, going to the toilet and securing a place to lie down at the refuge center. Physically handicapped people left in homes cut off from the outside also faced many difficulties. We commenced medical assistance at the refuge center 3 days after the tsunami hit. Many assistants came from other hospitals affiliated with MIN-IREN (Japan Federation of Democratic Medical Institutions) throughout the country. We commenced rehabilitation support at the refuge center from April. While at the refuge center, handicapped people had to deal with many obstacles such as the distance to the toilets, toilet structure, stairs and steps etc. From June, we began assistance at the temporary housing sites. Going forward, our future problem is providing disaster victim health management support at the temporary housing sites, and also providing assistance in setting up a network of sympathetic residents to prevent isolation. In light of our experience, from the perspective of a disaster management strategy, there is a definite need to perfect a government-centered support system that focuses on physically handicapped people immediately after a disaster. This is particularly important from the perspective of rehabilitation, as the challenge is to create post-disaster rehabilitation support teams.

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The Japan Self Defense Force (JSDF) provided invaluable medical assistance after the Great East Japan Earthquake. The JSDF has medical units and many helicopters and ambulances. Utilizing these resources, the JSDF transported and treated many sick or injured refugees. The transportation capabilities of the JSDF are especially useful for disabled persons if they need to be transferred to another hospital. It is worthwhile and necessary to understand the JSDF's medical capabilities and to collaborate with them for other medical assistance teams.

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