A multi-institutional cooperative study had been planned in order to standardize the conventional test for motor recovery in hemiplegia. Furthermore, the study group intended to establish a sensitive test which is essential in evaluating a given therapy in hemiplegia. For promoting the study as sure as possible, a fundamental plan was first prepared in which the whole study was divided into sequential Steps. The study started in 1971 and finished in 1975, and included 10 hospitals.
In this report are described the preparatory and methodological considerations (Step 1, 2). After Brunnstrom's Test which takes account of the regularity in recovery process, an initial tentative test was set up that gives 11 grades instead of the original 6 stages. The test is referred to as the 10-Grade-Test in this series of reports since it makes 10 intervals of recovery for both the upper and lower limbs.The test is constructed by a battery of subtests (test items); 20 for the upper and 23 for the lower extremity. The procedure and the categorical judgement for each subtest were defined, and the criteria for each Grade as well as for each Stage corresponding to that of Brunnstrom's were described. Some definitions are to be altered along with the progress of study.
The methodological considerations cover the principles in design, analysis and assessment for the reliability and for the validity of the test and subtests, and the procedure of quantification of the scale of recovery process.

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This report describes the fundamental examination of the 10-Grade-Test for motor recovery in hemiplegia. The inter-rater agreement of the test and subtest judgements was assessed on the data obtained from 18 raters and 12 subjects of Stages III and IV allocated according to a PBIB design (Step 3). Then the inter - rater, intra-rater and day-to-day variations in ratings or judgements were analyz ed on the data of 153 post-stroke patients, 142 upper and 107 lower limbs, of various Stages of recovery. The agreement in subtest judgement was higher than 70% for the majority of subtests, and the coefficient of determination of Gradein the upper limb was 0.984 and that in the lower 0.966. The proposed 10-Grade-Test seems to be practicable and reliable although few individual subtests are to be refined (Step 4).
On the same date of 153 subjects, the ordered arrangement according to difficulty of subtests was examined according to Guttman's scalogram analysis. Studies on the item-score matrix and the individual ogives (characteristic curves) of subtests revealed the subtests for the associated reaction of the upper and the lower limbs and few others of the lower lacking the monotonous nature of ogive. It is, however, that the peculiar pattern of ogive for the associated reaction seems rather reflecting the very nature of the recovery process in post-stroke hemiplegia.
The results of principal component analyses suggest that the subtests of both limbs are to be classified into 3 groups, namely, those for the associated reaction, the evolution and the dissolution of pathological synergy patterns. The proposed set of subtests appear to span at least a quasi-unidimensional scale with clinical meaning (Step 5).
At this end of study, a 12-Grade-Test which gives 13 grades is formulated as a candidate deemed more sensitive than the initial 10-Grade-Test.

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In this final report is decribed the quantitative consideration on the scale or grade of the test for motor recovery in hemiplegia. Crosssectional data of newly involved 161 patients were joined to the previous data, since they seemed alike. Thus the data of 314 subjects, 289 upper and 247 lower limbs, were subjected to the examination for eliminating the redundancy of test. With the aid of scaling me thods including Guttman's, merging the subtest categories and selecting the sub tests among those initially proposed were performed.
For each of the upper and lower limbs, were selected 11 subtests, 2 being redefined as 3categorical and 9 as 2categorical. Of this simplified test, 3 types of scalings which makes 11 or 12 recovery intervals have been elaborated: i) total score, ii) Grade (A) utilizing local total score to reduce the number of error responses, and iii) Grade (B) giving weight to the ordering of subtests. They give virtually the same results, Spearman's rho being nearly 1 among them. A test composed of mainly the remaining subtests and the simplified test mentioned above are found to be quite similar in giving the scale. The reliability and validity of the test composed of 11 subtests are deemed satisfactory for practice.
In 148 subjects, 129 upper and 133 lower limbs, followup data were available. Of these, the shift in the scale of recovery was examined with 3 types of scalings, which appeared practically of the same nature, Spearman's rho being around 0.9 among them. The extent of 8 week shift along recovery process varies depending on the initial, baseline Grade of the subject in both limbs, but the patterns of variation are definitely different between them. Among other factors, the age of the subject in the upper limb and the time lapse after stroke in the lower limb are also influential upon the extent of shift (Step 6).
From various standpoints the test composed of 11 subtests for each limb appears satisfactory for assessment of motor recovery in hemiplegia.

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An X-ray study was performed to evaluate the effects of Loperamide, a new antidiarrheic agent, on the gastrointestinal tract in 9 healthy male volunteers.
The antidiarrheal efficacy of Loperamide was evaluated in a double blind cross over study using a placebo as control.
One capsule each of the drug (Loperamide 2 mg and the placebo) were given, once a week.
The drug was given 60 min before giving barium sulfate (200 ml), and X-rays were taken 6 times, namely, 30, 60, 90, 120, 180 and 240 min after administration of barium sulfate.
From the X-ray films, examinations were made on the evacuating time from the stomach, time to reach the caecum, the foremost position of barium sulfate, major occupying sites of barium sulfate, and the width and mucosal pattern of the inte stinal tract.
The following results were obtained.
1) The degree of progression of barium sulfate in the intestinal tract was delayed, and the finding was mainly observed from the lower part of the small intestine to the transverse colon.
2) The maximum width of the upper and middle parts of the small intestine showed a slight increasing trend by the administration of this drug, however, no distinct difference was observed on the average and minimum widths.
3) Mucosal pattern showed a non-active type increase in a few cases by administration of this drug.

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