The Physiatrist’s Role in an Inclusive Development Support Team…Nobuhiko HIHARA 885

Total Care of Children with Developmental Disabilities in Children’s Hospitals…Noboru FUEKI 890

Developmental Disorder and Developmental Disability : Challenges for Rehabilitation Teams…Kaeko OGURA 895

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Drug Treatment for Depression in Clinical Rehabilitation Medicine…Takaharu HORI, Hiroshi YONEDA 899

Treating Patients Suffering with Delirium during Rehabilitation…Akira SENZAKI 903

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Objective : The purpose of this clinical research was to create an assessment for patients with muscle disease who wish to continue driving by investigating their motor function and driving experience. Methods : Twenty-four patients with muscle disease who visited our hospital from December 2009 to April 2010 were enrolled in our research. For patients who were still driving, physiatrists evaluated their motor functions, examined simulated driving motions and recorded their driving capabilities and techniques, their ability to get into and out of the vehicle and their ability to store and remove their wheelchairs. Patients no longer driving were asked why they had given up driving. Results : Fifteen patients who continued driving had enough upper limb strength and could simulate driving motions, though the location and degree of their muscle weakness were variable. Five of fifteen drove with the aid of a hand-operated brake and accelerator. Seven needed personal assistance: three to get into and out of the vehicles, six to store and remove wheelchairs. The nine patients who had stopped driving reported that the primary reason for discontinuing driving was that they recognized their muscles were insufficient to control the vehicle. Conclusions : We propose to evaluate muscle strength and to test simulated driving motions when assessing patients with muscle disease. A hand-operated brake and accelerator is efficient for patients with lower limb muscle weakness. However, since no efficient automobile modifications are available for those patients who cannot get into and get out of their vehicles or store and remove their wheelchairs by themselves, we suggest arranging personal assistance for such patients.

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A multi-institutional study using our protocol of low-frequency repetitive transcranial magnetic stimulation (rTMS) and intensive occupational therapy (OT) showed significant improvement of motor function of the affected upper limb in poststroke patients. The response to the treatment was not influenced by age or time after stroke onset. Our protocol is a safe, feasible, and potentially useful neurorehabilitative intervention for upper limb hemiparesis after stroke. The extent of the improvement seems to be influenced by the baseline severity of upper limb hemiparesis. The results suggest that patients with Brunnstrom stage 4 or 5 upper limb hemiparesis are best suited for this protocol. Botulinum toxin type A (BoNT-A) has been reported to be an effective treatment for limb spasticity after stroke. However, the spasticity reduction after BoNT-A injection alone does not ensure an improvement in the active motor function of the affected limb. Our proposed protocol of a BoNT-A injection, followed by home-based functional training seems to have the potential to improve the active motor function of the affected upper limb after stroke.

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