Rehabilitation Robots in the Medical and Welfare Fields: An Overview…Taisuke SAKAKI 483

Randomized Control Trials of Upper Extremity Robot-assisted Training…Kenji HACHISUKA 489

Advanced Gait Rehabilitation with a Driven Gait Orthosis (Lokomat)…Noritaka KAWASHIMA, Tetsuya OGAWA, Toru OGATA, Masami AKAI, Kimitaka NAKAZAWA 495

Effect of a Balance Exercise Assisting Robot…Satoshi HIRANO, Eiichi SAITOH, Norihide ITOH, Shigeo TANABE, Kenichi OZAKI, Ryosuke MIYAUCHI, Junpei KAWABATA, Kazuki ITOH, Yuri UEKI, Ryo MURAKAMI, Hitoshi KONOSU, Kosuke WATANABE 500

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Pathophysiology of Spasticity…Yoshihisa MASAKADO 505

Botulinum Toxin Type A for Upper and Lower Limb Spasticity Poststroke…Tetsuo OTA 511

Botulinum Toxin Injections in the Treatment of Upper Limb Spasticity…Takayo CHUMA 515

Improving Upper Limb Function in Stroke Patients…Yasuyuki MATSUSHIMA, Akiko HACHISUKA, Kenji HACHISUKA 520

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Drug Therapy and Cognitive Function…Katsunori IKOMA 525

Evidence Based Cognitive Rehabilitation <Review Article>…Shu WATANABE 530

Insights from a Medical Rehabilitation for Higher Brain Dysfunction Outcome-study : Bridging from Medical to Social Welfare Centers <Original>…Yuko URAKAMI, Masahiro YAMAMOTO, Yasoichi NAKAJIMA 536

Social Reintegration for Patients with Higher Brain Dysfunction…Tetsuya OKAZAKI 543

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Protraction of RA induces joint function disorders resulting in a deterioration in the activities of daily living (ADL), which can cause a change in the patient's household role and limit their social participation. As there is not at present a curative treatment for RA, once functional disorders develop, they cannot be recovered easily or completely. However, it was recently reported that disorders progress rapidly within a few years from RA disease onset in terms of the changes wrought by joint damage and the resulting functional disorder inflicted on the patient. Therefore, it is proposed that adequate administration of methotrexate should be started initially and that RA treatment should be based on the recommendations under the regime of Treat to Target (T2T). Rehabilitation for RA patients includes various kinds of exercises and approaches such as physical therapy in the early stage and nursing home service with caregiver insurance in the terminal RA phase. In terms of the principles of T 2 T, the aim of the RA treatment is to improve the patients' long-term QOL as much as possible during their lifetime through the restoration of body functions and their participation in social activities. The ultimate aim of rehabilitation is the same as that of T 2 T because it is to let people with disabilities live normal lives by diminishing the difficulties RA patients face in daily life and improving their QOL. It is therefore very important to keep in mind that RA is a complex condition that includes people with various afflictions and difficulties in meeting their daily living tasks and not just one disease.

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Objectives : Muscle imbalance poses a problem for adequate motor function in patients with cerebral palsy. The adductor and flexor muscles around the hip become dominant, leading to a high risk of hip dislocation. When left untreated, flexion and adduction contracture progresses, leading to various impairments ; hence, it is important to undertake preventive measures at an early stage. Selective muscle release is one form of surgical treatment that has been proven effective, but there is no consensus on the timing of the surgery. Here, we investigated the difference in outcome after muscle release surgery with respect to age. Subjects and methods : The subjects were 26 patients (52 hips) from our medical center who underwent muscle release (partial modification of Matsuo's method) around the hip and were followed up for at least 6 months. Abduction was retained postoperatively by using a cast or prosthetic device. Migration percentage (MP) was measured by simple hip radiography image, and the rates of improvement (preoperative MP . final MP during observation/preoperative MP ×100%) were compared. Results : Higher rates of improvement were observed among patients aged 5 years or less at the time of surgery than those among patients aged 6 years or more. Conclusion : We consider that surgery performed at the age of 5 years or less could lead to favorable results.

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The most important factors in determining the outcomes of patients with traumatic brain injury (TBI) is the degree of severity and types of primary brain damage, and the secondary damage to the brain such as low-oxygen and low-blood pressure et al. For severe TBI patients, prompt and appropriate decompression to reduce intracranial pressure (ICP) and ICU management are commonly required. The second edition of "Guidelines for the Management of Severe Head Injury" was published by the Japan Society of Neurotraumatology (JSNT) in 2006. These guidelines include a wide range of topics in the management for severe TBI, from prehospital care, primary care, ICU management and surgical treatment. The essence of extended decompression and neuroprotection for TBI is also focused in the JNST Guidelines. The pathophysiological event in the acute stage of severe TBI is quite variable ; therefore, an appropriate individual based approach in ICU management is necessary under experienced medical teams.

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