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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The purpose of this study was to clarify the basic characteristics of two movement related potentials, the BP (Bereitschaftspotentia1) and the NS’ (negative slope). Differences in the muscle power output level of the major acting muscle and wave-changes of BP and NS’ depending on the starting procedure of movement were investigated. Ten healthy men were used as the subjects and comparison of MRCPs from C3 and CZ were made under the following conditions: 1) Comparison of MRCP in right flexor pollicis longus between the MVC (maximal voluntary contraction) conditions of 20 and 60%; 2) Comparison of MRCP between initiating conditions in which the task exercise was started by a sign or self-initiated. Neither amplitudes nor latencies of BP and NS’ were significantly different between the conditions of MVC, 20 and 60%. The amplitudes of BP and NS’ from C3 and CZ were larger in the signal-related condition than the self-initiated one. These results suggest that the wave forms of MRCP might significantly change depending on the start conditions of movement, but not on the magnitude of MVC in the major acting muscle.

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We conducted physical therapy for patients suffering from cervico-omo-brachial pain (n=22) with high frequency hyperthermia equipment by a capacitive electric transfer method, MD-303 (0.65 ± 0.05 MHz), which is employed in Europe and America. The 22 patients comprised 6 with cervical spondylosis deformans, 6 with cervico-omo-brachial pain syndrome, 4 with periarthritis scapulohumeralis, 3 with cervical sprain, 2 with tennis elbow, and 1 with RA hand. The electrotherapy was performed 10 times in total, for 20 min per time. A rise in skin temperature was observed even 15 min after treatment, with no occurrence of adverse reactions, and this therapy was highly effective in relieving pain, with an efficacy rate of 81.8%. This paper reports the results of the use of this therapy.

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Many forms of treatment are utilized by physiotherapists for the treatment of soft tissue injuries. One of these is the use of low powered laser (LPLT). The purpose of this study was to determine the effects of LPLT (lj/cm², daily 10) on acute blunt trauma to muscles in controlled animal experiments. A reproducible model of single acute blunt trauma to the lower leg muscles of anaesthetized male rats (n=28) was used. The level of contractile protein content and collagenous protein content were determined 12 days post-trauma in control, injured, laser-control and laser treated animals. Our data demonstrated an overall decrease in the levels of contractile protein content, in the various groups, which were not statistically different (p>0.05), and an overall significant increase in the levels of collagenous protein content (p<0.005). It was concluded that the LPLT protocol used for the recovery of injured muscle was not of significant benefit during the time period employed in this study (day 3 to day 12 post-trauma) following acute blunt trauma. The data confirmed a decrease in the levels of contractile proteins and an increase in the levels of collagenous proteins in muscle following injury.

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Spina bifida is often complicated by physical^{1, 6)} and mental disabilities⁸⁾ in various forms. Long-term rehabilitation is therefore necessary not only to inhibit the occurrence of the disabilities but also to develop faculty in ambulation, to establish independence in ADL (Activities of Daily Living), to train patients in rehabilitation efficiently, and to systematically encourage patients to acquire the knowledge and techniques required in their social life for promoting their social independence. Many papers on infants are reported in the literature^2-4), but unfortunately we have never found rehabilitation of adults with spina bifida among them. Our subjects were 50 patients examined between 1981 and 1997. Their ages varied from 18 to 47 years old with a mean age of 20.3, and there were 18 men and 32 women. Their spinal cord lesions ranged from T5 to S2. Patients with spinal cord lesion L3 were the most, and lesions of most patients (80.5%) ranged from L2 to S1. There were 13 cases of community ambulators with spinal cord lesions L4 to S2. Household ambulators using crutches or apparatus at 20 were the most. Non-ambulators in wheelchairs numbered 17 and the spinal cord lesions of most of them ranged from T5 to L2. More than half the patients (53%) urinated by self-cathterization and the others urinated naturally with urine bags or tapping. According to intravenous pyelography (IVP) findings in the admission, hydronephrose or renal atrophy was found in 48% of patients. The results of intelligence-tests measured by WAIS-R found that patients IQ ranged from 61 to 124 with a mean of 88.6. After rehabilitation training, 37 patients (74%) were employed in ordinary paid occupations, 9 (18%) in sheltered workshops or welfare-factories, and 2 were self-employed. The others were unemployed. The IQ’s of those employed in paid occupancy and those employed in sheltered workshops were 92 and 87, respectively. Compared with the general employment rate of patients with thoracic or lumbar injury, 80% or more, that of those with spina bifida was low.

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Rehabilitation of flexor tendons in zone 2 is very important in order to have satisfactory results after the surgical repair. This study reports the results of the rehabilitation program which was applied to 25 patients (36 digits) after zone 2 repair. A treatment approach that combines early controlled passive motion and early controlled mobilization was used. Patients were evaluated regarding the total active motion (TAM), grip strength, pinch strength, finger dexterity and the disability in daily living activities at the 24th week. TAM results were excellent in 4%, good in 68%, fair in 23% and poor in 5% of the repaired digits. Grip strength results were good in 69%. Pinch meter results were improved in 76%. Hand disability which existed in all patients before the rehabilitation program was found to appear mildly in 72% of the patients. Finger dexterity was rated normal for 64% of the group after the therapy. We conclude that zone 2 is a critical zone in flexor tendons and immediate postoperative mobilization should be allowed for minimal formation and adhesion.

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This study compared the physiological responses and the mechanical efficiency during both arm cranking exercise and leg pedaling exercise with identical work loads, and determined whether arm cranking or unilateral leg pedaling performance could be used to estimate bilateral pedaling exercise capacity. Seven healthy adult males [mean age: 32 (27-36) years old] participated in this study. Arm cranking and leg pedaling exercise tests were carried out using an identical electrically controlled bicycle ergometer. The cranking/pedaling rate was set at 60 rpm. Exercise was performed under the following conditions: Bilateral leg pedaling (BLP), Unilateral leg pedaling (ULP), Bilateral arm cranking (BAC), and Unilateral arm cranking (UAC). By ramp load protocol in gradually increasing 20 W/min stages, peak oxygen uptake (peak VO₂) and peak heart rate (peak HR) were obtained using BLP, ULP, BAC, and UAC. The oxygen uptake and heart rate obtained using BLP, ULP, BAC, and UAC were compared under three exercise work loads (20 W, 40 W, 60 W). In comparison with ULP and UAC, the values of peak VO₂ and peak HR in BLP and BAC were high, and the response to the 20 W to 60 W exercise intensities rose in tandem with work load. Differences in physiological response due to disparities in the exerted muscle mass became large and showed a rising trend, particularly in ULP and UAC. There were no significant correlations between BLP and the other types of exercise (BAC, ULP, UAC) in peak VO₂ and peak HR. In conclusion, the physiological responses in bilateral and unilateral arm/leg exercise at an identical work load depend on the amount of muscle mass exerted. It is hard to estimate the aerobic work capacity (peak VO₂) using BLP from the results of exercise performed with BAC, ULP, and UAC.

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