認知症と自動車運転〈総説〉…上村　直人，福島　章恵　87

総論・運転中の脳機能画像〈総説〉…渡邉　　修，武原　　格，一杉　正仁，林　　泰史，米本　恭三　93

脳卒中患者の自動車運転再開〈原著〉…武原　　格，林　　泰史，一杉　正仁，渡邉　　修，安保　雅博，米本　恭三　99

高次脳機能障害者の自動車運転再開〈総説〉…加藤　徳明，岡﨑　哲也，蜂須賀研二　105

脳卒中患者の運転補助装置…熊倉　良雄　113

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目的：鏡視下腱板修復術後早期の他動運動訓練時間が術後3 カ月の肩関節可動域に影響するかを調査すること．方法：鏡視下腱板修復術63 例，64 肩，男37 例，女26 例，平均年齢64 歳（45～79 歳）を対象とした．後療法；術後6 週間外固定，術後7 日目より肩関節他動運動，術後7 週目より介助自動運動，術後9 週目より自動運動を施行．リハ時間が9 時間／週以上のA群と，3 時間／週以下のB群で，術前，術後3 カ月の肩関節可動域を比較した．結果：A群が41 肩，B群が23 肩であり，両群間の男女比，年齢，断裂サイズに有意差はなかった．術前後可動域変化は，A群B群の順で屈曲が4，17 度増加，外転が5，18 度増加，外旋が14，12 度減少，内旋が3，2 棘突起減少であり，両群間で有意差を認めなかった．結論：術後に長時間他動運動訓練を行うことは術後3 カ月の可動域に優位な影響を及ぼしていなかった．

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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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