【目的】肩，肘，前腕，手関節の両手鏡面対称動作を行うことができる上肢機能リハビリテーション支援ロボットを開発し，その効果を評価する．【方法】亜急性期脳卒中初回発作患者を無作為にロボット訓練群と自己介助両手動作体操を行う対照群とに分け，通常の訓練に追加して1 日20 分 41～104 日間 (16～30 セッション) 訓練施行．脱落者を除いた18 人，ロボット訓練 (R) 群9 人，対照 (C) 群9 人について，Fugl-Meyer assessment上肢項目 (FM) (0-66)，modified Ashworth scale合計 (0-12)，上肢(肩，肘，前腕，手関節)徒手筋力検査合計 (0-35)，握力，Barthel Index (BI) および訓練の楽しさ (10 段階)，難易度 (10 段階)，持続性(3 段階)のインタビュー結果を評価した．【結果】ロボット訓練で有害事象はなかった．R群でFM，握力，C群で上肢筋力合計，両群でBIが有意に改善した (p<0.05)．R群はC群と比較してFM手指項目改善量，楽しさ，持続性で有意に優っていた (p<0.05)．【結論】新しく開発した上肢機能リハビリテーション支援ロボットによる訓練は，対照群と比較して手指機能および繰り返し訓練に対するモチベーションを向上させた．

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【目的】脳卒中患者の回復期での栄養療法の基準に関する報告は少ない．今回我々は回復期リハビリテーション目的で入院した初回脳卒中患者の安静時エネルギー消費量 (以下REE) を測定し，ハリス・ベネディクトの式より算出した基礎エネルギー量 (以下BEE) と比較した．【対象ならびに方法】対象は当院に入院した初回脳卒中患者76 名 (年齢45～95 歳，平均69.1±11.9 歳)である．性別，病型，麻痺側，発症からREE測定日までの期間，嚥下障害の有無，麻痺の重症度を診療録より後方視的に調査した．REEは携帯用簡易熱量計を用い，2 時間の安静後3 分間の測定を計3 回行い，平均値を算出し，BEEと比較した．【結果】REEの平均値は1231.3±245.7 kcal/day，計算上のBEEの平均は1185.6±177.7 kcal/dayであり，両者に有意な差を認めなかった (paired t-test)．REEをBEEで割った値の平均は104.3±16.4％であった．男性と女性，脳出血と脳梗塞，テント上とテント下，右片麻痺と左片麻痺，嚥下障害の有無の比較では，REE/BEEは有意な差を認めなかった．麻痺の重症度，ADLの介助量での層別化でも同様であった．【考察】回復期患者のREEは計算上のBEEはほぼ同等であり，これは回復期の脳卒中患者の栄養量，ストレス係数を決定する上で参考となる結果と考えられた．

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Paragraphia due to cerebellar cognitive affective syndrome (CCAS) has not been reported previously. This report presents a patient with cerebellar hemorrhage, showing cognitive dysfunctions including paragraphia. A 74-year-old right-handed man was hospitalized with sudden dizziness. CT demonstrated a small hemorrhage in the right cerebellar dentate nucleus. He also exhibited gait disturbance due to mild truncal ataxia and became aware of errors while writing his dairy. Neuropsychological assessments showed phonological paragraphia with Kana characters and semantic paragraphia with Kanji characters, as well as mild auditory comprehension and verbal memory disorders. Although MRI did not detect any abnormality in the cerebral hemispheres, SPECT demonstrated decreased cerebral blood flow in the left angular gyrus, frontal lobe and parieto-occipital lobe, predominantly on the left side. On neuropsychological assessment 3 months after stroke, the patient's paragraphia and auditory comprehension disorder had subsided, but his verbal memory disturbance remained. The clinical features in this case differed from those of CCAS cases previously reported. In particular, the lesion considered responsible for the cognitive dysfunctions in this case involved the right dentate nucleus, which is supplied by the superior cerebellar artery, but not the posterior inferior cerebellar artery, and especially the presence of dis-orders in writing ability, such as paragraphia. The possible mechanism of paragraphia in this case might be a reduction of cerebral blood flow in the angular gyrus due to a crossed cerebello-cerebral diaschisis. However, this case suggests that the right dentate nucleus contributes to the neuropsychological mechanism of writing.

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The 9.0-magnitude under sea megathrust earthquake and the subsequent extremely destructive tsunami waves on March 11 2011 brought an extensive and severe disaster to the Tohoku and Kanto areas. This natural disaster has been markedly complicated by a series of nuclear power plant failures, leading to radioactive contamination, power shortages and ungrounded rumors. Faced with this most difficult crisis, the JARM set up an earthquake disaster headquarters, and has so far taken the following actions, with an emphasis on supporting its members in the disaster stricken areas, preventing immobilization syndromes and providing necessary rehabilitation services for the frail elderly and persons with disabilities, in collaboration with other specialists organizations, local and central governments : 1) Activities in the disaster zone including support of the physiatrists there, dispatch of JARM members, medical caravans for isolated home-dwelling persons with disabilities, and relief activities as a part of multidisciplinary specialists teams ; 2) Organizing a nation-wide system for transferring persons needing rehabilitation and care services ; 3) Activities in the non-disaster areas for victims relocated from the disaster zone ; 4) Information support services to collect and provide useful information ; 5) Proposals to the government for enlightenment of the importance of rehabilitation disaster relief and for relaxation of regulations for eligibility for rehabilitation and care services. The scope of the disaster is too extensive, both in magnitude and geographical area, and too complex. The situation on the ground and the needs of affected persons are constantly changing. Therefore, well-coordinated, creative, and long-term efforts will be needed, and the JARM is determined to be actively involved in the reconstruction process.

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