This study examined the two-year death transition of the different status of activities of daily living (ADLs) among the elderly who were aged 70 and over. The study used the data from the Assets and Health Dynamics of the Oldest Old (AHEAD) data set, which contains a nationally representative sample within subgroups of the non-institutionalized population of the United States. Multiple logistic regression analyses were applied for each sex while socio-demographic factors were controlled. We found that both men and women with a higher number of ADL limitations indicated higher odds for death within two years compared with people without ADL limitations at the baseline interview (p<0.01). A significant higher odds ratio was also indicated for the death of people who had ADL limitations compared with the people without any ADL limitations in some ADL categories. There were somewhat different results between men and women. Different functional status for men and women at the baseline might result in the different death outcomes.

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Evaluation of disorders constitutes an important part of work in rehabilitation medicine. But all of the objective evaluation methods for quantifying ADL have both advantages and disadvantages, and they are often difficult to use. Evaluation and judgment of ADL should be carried out in terms of movements simplified as much as possible. An ADL Score Study Group, consisting of medical co-workers, has been organized, and they have proposed a tentative plan for patients with paraplegia due to spinal cord injury. Method; ADL items were limited to 10, with sub-items limited to two to three per item, to simplify the ADL score as much as possible. The evaluation was carried out in accordance with the followings; 0 point, requiring full assistance, 1 point, partial assistance, 2 points, possible to do activities with insufficient perfectness, 3 points, possible to do activities independently, with a maximum of 99 points. Subjects were 35 patients with complete paralysis due to spinal cord injury. Thirty four persons were males and one was female. Results; Evaluation scores were 81 points for Group A (Spinal cord injury T1-7), 85 points for Group B (Spinal cord injury T8-L1), 95 points for Group C (Spinal cord injury L2 or lower). It was demonstrated that the evaluation of two items, reach and walking, was sufficient for independent patients with paraplegia due to spinal cord injury.

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The aim of this study was to assess the effects of living circumstances on the locus of control of senior citizens with hemiplegia, and to research the factors that control the locus of control from among the 10 items (activities of daily living, quality of life, degrees of paralysis, age, sex, diagnosis, type of disorder, length of living at home/institution, whether or not s/he has hobbies, whether or not s/he has friends). The subjects of this study were senior citizens with hemiplegia who were living at home (n=31) or resided in the nursing homes (n=30), and elderly able bodied people who were living at home (n=35). The results showed that there were no significant differences in the locus of control between the hemiplegia group and able bodied people group, but in the stroke patients group, patients who were living at home got a high score in the locus of control which was significantly more than that of these who resided in nursing homes. The items which controlled the locus of control were abilities of activities of daily living among the senior citizens with hemiplegia who were living at home and quality of life among these who resided in nursing homes. The results suggest that a sensitive indicator of locus of control is not physical disability but place of living. The living at home group requires the formation of an environment in which activities of daily living ability can be drawn out to the maximum, and the institution group requires the offer of a lifestyle that is high in quality and which matches the individual preferences of the people entering the institution.

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Obstructive sleep apnoea (OSA) is a common problem which is more frequently seen in men than in women. It is associated with heavy snoring, cessation of breathing, destruction of the sleep architecture and results in burdensome daytime somnolence. Nasal continuous positive airway pressure (nCPAP) is the widely accepted and practiced therapy but is often not tolerated by patients. Therefore, in less severe cases a physiotherapeutic attempt, avoiding the body lying on the back (i.e. by a tennis-ball in the pyjama), can be an effective treatment.

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Twenty-one patients (21 shoulders) underwent open Bankart procedure using Neer’s reinforced capsular cruciate repair approach (modified open Bankart procedure) and received training. Postoperative changes in range of motion over time, and the status of ability to return to playing sports, were investigated. The average progress observation period was 12.8 months (range: 6 months to 2 years and 6 months). In the surgical procedure employed in this study, the capsule was reattached in the maximum external rotation position of the shoulder. Postoperative therapy consisted of flexion training, starting on postoperative day 5; external rotation (at the side) training, starting at postoperative week 2; and external rotation (in the abduction) training, starting at postoperative week 12. One patient experienced a postoperative subluxation. Results: The final range of motion was reached at 5 months in flexion, at 6 months in external rotation at the side and in the abduction, and at one year after surgery in internal rotation. The mean final range of motion was 168 degrees in flexion, 62.6 degrees in external rotation at the side, 93.8 degrees in external rotation in the abduction, and the seventh thoracic spinous process in internal rotation. The limitation of the range of motion, observed on the affected-side shoulder, was an average of 2 degrees in flexion, 7.5 degrees in external rotation at the side, and 9.5 degrees in external rotation in the abduction. Status of ability to return to sports: Preoperatively, 11 patients had played sports competitively, 9 recreationally, and one not at all. Postoperatively, one patient, who also had a knee ligament injury, shifted from competitive to recreational sports participation. Because of poor improvement in the range of internal rotation, it seems appropriate to also include internal rotation training as part of postoperative rehabilitation. It was also thought that external rotation training, in the abduction position of shoulder, should be started early, in order to improve external rotation in this position.

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We conducted a prospective study on the actual state of fall occurrence and the related fall factors of some dementia patients admitted to a certain geriatric hospital. Information on falls was obtained from the fall assessment recorded by staff. The number of these subjects totaled 110 (20 males and 90 females), The period of this study was 6 months. Their fall rate during that period was as high as 56%. The frequently occurring places and peak time of fall coincided with the places and times slots in which their activity was enhanced. Most of the injuries suffered due to falls were minor ones, and there were no bone fractures stemming from falls. As for the factors related to a fall, sex, age, complication, MMS score and administered internal medicine was no significant between fallers and nonfallers. Of the subjects affected with cerebrovascular diseases during or before this study period, those with vascular dementia showed the most remarkable trend to fall. It was thought that the results will be useful when applied to the carried out care of elderly persons with dementia.

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311 inpatients in a geriatric nursing hospital were interviewed and activities of daily life, etc. were studied. Out of 311 inpatients, 59 had femoral neck fracture in the past, and 43 patients (95.6%) were classified as having dementia. Out of 67 fractures of 59 patients, 40 fractures of 36 patients had received operations and 27 fractures of 26 patients had conservative treatment. According to the results of this study, although the ADL level of both groups were low, the operation group had a better prognosis than the conservative group. Patients who had conservative treatments were older and had lower levels of daily life, had severer dementia and lived smaller range of activities than patients who undergone operations. Furthermore, inpatients of the conservative treatment group had little desire for active treatments and rehabilitation, so they had many factors predicative of poor prognosis. However, in the conservative treatment group, some inpatients could walk with or without assistance even though their fractures didn’t unite. With the increase in the aged population, the chance of conservative treatment is likely to increase, and rehabilitation will play a key role for such patients in order to improve the quality of their lives.

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