Drivers with Dementing Illness<Review Article>…Naoto KAMIMURA, Akie FUKUSHIMA 87

The Neural Substrates while Operating a Driving Simulator<Review Article>…Shu WATANABE, Itaru TAKEHARA, Masahito HITOSUGI, Yasufumi HAYASHI, Kyozo YONEMOTO 93

Resumption of Driving after Stroke<Original>…Itaru TAKEHARA, Yasufumi HAYASHI, Masahito HITOSUGI, Shu WATANABE, Masahito ABO, Kyozo YONEMOTO 99

Resumption of Driving in Patients with Higher Brain Dysfunction<Review Article>…Noriaki KATO, Tetsuya OKAZAKI, Kenji HACHISUKA 105

Driving Aids for Post-Stroke Patients…Yoshio KUMAKURA 113

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Objective : To investigate whether the frequency of passive motion exercises during the early period after arthroscopic rotator cuff repair affects the range of motion at three months postoperatively. Methods : We retrospectively evaluated 64 patients with rotator cuff tears who underwent arthroscopic repair. Range of motion (ROM) in forward flexion, abduction, external rotation, and internal rotation were assessed preoperatively and at three months postoperatively. Patients were supervised to wear an axillar pillow for six weeks and to commence passive ROM exercise at seven days postoperatively. Passive ROM exercises for 9 hours per week or more were performed in 41 patients (group A), and 3 hours or less of exercises were performed in 23 patients (group B). Results : There were no statistical differences between the two groups in age or gender proportion. The mean differences from preoperative ROM to postoperative ROM were 4° and 17° (group A and B, respectively) in flexion, 5° and 18° in abduction, -14° and -12° in external rotation, and -3 and -2 spinous processes in internal rotation, and there were no differences in all directions between the two groups. Even when subjects were limited to the patients without shoulder contractures preoperatively, there was no difference between the two groups. Conclusion : Early passive motion exercise for long hours after arthroscopic rotator cuff repair did not give a positive effect on early improvement in ROM. Scar formation and adhesion at the subacromial space may influence this outcome.

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According to statistics from the Japanese Ministry of Health, Labour and Welfare for the last ten years, the number of people with physically disabled persons' certificates increased from about 4,370,000 in 2001 to more than 5 million in 2008 and reached about 5,110,000 in 2010. The incidence of stroke and various internal diseases are increasing following an increase in lifestyle-related diseases and the development of Japan's rapidly aging society. In this social background, the physiatrist has many chances to write a physically disabled persons' medical certificate during the patients' care-planning. The most important point to consider is to understand the reason why the patient wants to get a physically disabled persons' certificate. Patients have several needs in their care-plan requiring a physically disabled persons' certificate such as financial aid for medical bills and travel expenses, and also for the cost or supply for orthosis, prosthesis and other technical aids for the disabled. The degree of invalidity must correlate with the medical findings and impairment in the medical certificate. For example the medical findings are the grade of paralysis, joint range of motion and muscle weakness, etc. Activities of daily living (ADL) provide the evidence of those findings and the degree of invalidity. The best practice when writing a medical certificate for physically disabled is that there must be no discrepancy between the medical opinion for the degree of invalidity and the medical findings, impairment and ADL of the patients.

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