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We describe four male patients suffering from quadriplegia caused by axonal Guillain-Barré syndrome. They were diagnosed with axonal Guillain-Barré syndrome based on their clinical course and electrophysiological findings. Three patients had severe pain, two had marked elevation of serum creatine kinase, one had finger contracture, and two required mechanical ventilation. Two of the patients recovered during the period from nadir to discharge in the Hughes functional grading scale and Barthel index. A physical therapist should understand the characteristics of severe axonal Guillain-Barré syndrome in an acute stage, and consider the psychological status of the patients.

Purpose: The aim of this study was to investigate the characteristics of disabilities in patients with subacute myelo-optico-neuropathy (SMON), and to reveal whether the satisfaction in daily life (SDL) or short form-36 (SF-36) correlated with these disabilities., Method: The subjects consisted of 97 patients with SMON living at home, who were mailed a questionnaire concerning the patient's profile, SMON severity (disability scale for SMON), basic activities of daily living (self-rating Barthel Index, SR-BI), lifestyle (self-rating Frenchay Activities Index, SR-FAI), SDL and SF-36. A relationship with SDL, SF-36 and disabilities was analysed by using Spearman's rank correlation coefficient., Results: Fifty-eight out of 97 patients with SMON responded, and their mean age was 76.1 years. The mean of SMON severity was 8.0; SR-BI, 70.8; SR-FAI, 11.1; SDL, 27.3; physical component summary of SF-36 (PCS), 26.3; mental component summary of SF-36 (MCS), 39.5. The SMON group had significantly lower scores for SDL than those for the age- and sex ratio- matched elderly persons. With respect to SDL, a significant correlation was observed with SMON severity, SR-BI, SR-FAI, SDL, and PCS and MCS of SF-36, but no significant correlation was observed regarding SMON severity and either the PCS or MCS., Conclusions: The subjective domains of the quality of life in patients with SMON were observed to have decreased. SDL was considered to closely reflect the characteristics of the disabilities observed in patients with SMON.

Unlabelled: We conducted neuropsychological tests of patients with higher brain dysfunction to examine the characteristics of barriers to employment., Subjects and Methods: We tested 92 patients with higher brain dysfunction (average age of 36.3 +/- 13.8 years old, ranging between 16 and 63 years old, with an average post-injury period of 35.6 +/- 67.8 months) who were hospitalized at the university hospital between February 2002 and June 2007 for further neuropsychological evaluation, conducting the Wechsler Adult Intelligence Scale-Revised (WAIS-R), Wechsler Memory Scale-Revised (WMS-R), the Rivermead Behavioral Memory Test (RBMT), Frontal Assessment Battery (FAB) and Behavioral Assessment of Dysexecutive Syndrome (BADS). The outcomes after discharge were classified between competitive employment, sheltered employment and non-employment, and the three groups were compared using one-way analysis of variance and the Scheffe test. The WAIS-R subtests were mutually compared based on the standard values of significant differences described in the WAIS-R manual. Verbal performance and full scale Intelligence Quotient (IQ) of WAIS-R were 87.7 +/- 15.6 (mean +/- standard deviation), 78.5 +/- 18.1 and 81.0 +/- 17.2, respectively, and verbal memory, visual memory, general memory, attention/concentration and delayed recall were 74.6 +/- 20.0, 76.6 +/- 21.4, 72.0 +/- 20.4, 89.0 +/- 16.5 and 65.2 +/- 20.8, respectively. The competitive employment group showed significantly higher scores in performance IQ and full IQ on the WAIS-R and verbal memory, visual memory, general memory and delayed recall on the WMS-R and RBMT than the non-employment group. The sheltered employment group showed a significantly higher score in delayed recall than the non-employment group. No difference was observed in the FAB or BADS between the three groups. In the subtests of the WAIS-R, the score for Digit Symbol-Coding was significantly lower than almost all the other subtests. For patients with higher brain dysfunction, IQ (full scale IQ > 53.2) and memory (general memory > 74.1) are important indicators in returning to work under the conditions of competitive employment.

Sonolysis and photolysis often exhibit synergistic effects in the degradation of organic molecules. An assay of fish oocyte maturation provides an appropriate experimental system to investigate the hormonal activities of chemical agents. Oocyte maturation in fish is triggered by maturation-inducing hormone (MIH), which acts on receptors on the oocyte surface. A synthetic estrogen, diethylstilbestrol (DES), possesses inducing activity of fish oocyte maturation, and a widely used biocide, pentachlorophenol (PCP), exhibits a potent inhibitory effect on fish oocyte maturation. In this study, the effects of the combined treatment by sonolysis with photolysis (sonophotocatalysis) to diminish the hormonal activity of DES and the maturation preventing activity of PCP was examined. By sonophotocatalysis, hormonal activity of DES was completely lost within 30 min and the inhibiting activity of PCP was lost within 120 min. These results demonstrated that sonophotocatalysis is effective for diminishing the endocrine-disrupting activity of chemical agents.

The use of robotic-aided therapy in a patient with residual damage from a previous stroke was an attempt to improve function in a moderate to severe hemiparetic arm. Cortical activities associated with motor recovery are not well documented and require investigation. A chronic stroke patient with a severely affected arm underwent a robotic-training program for 12 weeks. The robotic-aided therapy improved motor control and spasticity in the proximal upper-limb. An increased oxygenated hemoglobin level was observed at the motor-related area in the affected hemisphere. A 12-week robotic-aided training program used in a chronic stroke patient demonstrated elements of motor recovery, and was also associated with direct activation of the affected hemisphere.

Purpose: To measure life satisfaction in Japanese stroke outpatients and randomly-sampled community residents and to investigate variables influencing their life satisfaction., Method: Data on the demographic and clinical profiles, Satisfaction in Daily Life (SDL), other measurements, were obtained from 869 stroke outpatients (552 males, 317 females) and 748 community-dwelling elderly (360 males, 388 females), aged 55 years and older. Differences in categorical variables and continuous variables were tested by chi-square test and ANCOVA with age as the covariate, respectively., Results: The 11 SDL items were subjected to a factor analysis, which extracted two factors. Factor 1 (F1), labeled as 'satisfaction with one's own abilities', included satisfaction with housework, self-care, gait, physical health, hobby and leisure, social intercourse and mental health. Factor 2 (F2), 'satisfaction with external factors', included satisfaction with partner/ family relationship, economic state and social security, and house facilities. Both F1 and F2 scores were significantly lower for stroke outpatients (M = 19.7 and 10.9, respectively) than for community-dwelling elderly (M = 28.2 and 12.0, respectively) (p < 0.001). Living conditions were significantly associated with F2, but not with F1. Males living alone scored lowest on F2 than the others for both groups. Among stroke outpatients, both F1 and F2 scores differed significantly by the type of hemiparesis and the severity of aphasia., Conclusions: SDL of stroke outpatients, which was lower than community-dwelling elderly, differed by the type of hemiparesis, the severity of aphasia, and living conditions. The effects of living conditions might vary with gender.

To evaluate subacute myelo-optico-neuropathy (SMON) and stroke patients and elderly persons by using the Barthel Index (BI) and Frenchay Activities Index (FAI) and to reveal the disability and lifestyle of SMON patients, cross sectional comparison study was performed. Forty SMON patients, 92 age-matched stroke patients with the same level of BI score and 92 age-matched elderly persons living at home were subjected in this study. The SMON patients responded to a self-administered BI and FAI at their yearly health counseling, and the score of the BI and FAI of stroke outpatients and elderly persons were sampled from the databases. The differences in age distribution and sex ratio between the three groups were analyzed by the chi2 test and one-way analysis of variance, respectively, and the differences in BI and FAI between the three groups were analyzed by the Kruskal-Wallis test, followed by the Mann-Whitney test. The BI total score of the SMON patients was the same as that of the stroke patients and lower than that of the elderly persons. The 4 items of self-care index and 2 items of mobility index in the SMON patients were rated significantly higher and lower than the stroke patients respectively, and all items except eating and toileting in the SMON patients were rated lower than elderly persons (Mann-Whitney test, P < 0.05). The FAI scores in the SMON patients were lower than the elderly persons and higher than the stroke patients. These results suggest that the scores of the BI and FAI differentiated the features of disability and lifestyle of the SMON patients from those of stroke patients and elderly persons.

Objective: To examine, for polio survivors, whether walking with a carbon-fibre reinforced plastic knee-ankle-foot orthosis (carbon KAFO) is more efficient than walking with an ordinary KAFO or without an orthosis., Design: Consecutive sample., Setting: Post-polio clinic, University Hospital of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan., Participants: Eleven polio survivors who had a carbon KAFO prescribed at the post-polio clinic., Interventions: A carbon KAFO was prescribed, fabricated and inspected., Main Outcome Measures: Oxygen consumption, oxygen cost and physiological cost index., Results: An ordinary KAFO weighed 1403 g (standard deviation(SD) 157 g), whereas a carbon KAFO weighed 992 g (SD 168 g). Subjects walking with a carbon KAFO showed a tendency to increase step length, and to increase speed significantly compared with walking without an orthosis and with an ordinary KAFO (paired t-test, p < 0.05). Oxygen consumption per body weight, oxygen cost (O2 consumption for 1-m walk divided by body weight) and physiological cost index ((heart rate at 3-min walk - heart rate at rest) /speed) were significantly lower than those walking without an orthosis (-16%, -35%, -33%; paired t-test, p < 0.05) and were lower than those walking with an ordinary KAFO (-9%, -14%, -15%; paired t-test, p < 0.05)., Conclusion: The gait efficiency of polio survivors with a carbon KAFO was objectively better than those without an orthosis or with an ordinary KAFO.

At the request of a polio survivor, a partially flexible thigh cuff made of leather and canvas for a carbon KAFO was devised to allow the wearer to feel more comfortable while sitting on a toilet seat. The original, acrylic resin, thigh cuff was partially excised to make an opening (15x10 cm), which was stuffed with rubber sponge, and was sealed with leather and canvas. The opening's surround was vertically and horizontally reinforced with carbon fibres. This modification provided relief to the polio survivor from the discomfort previously experienced while sitting on a toilet seat, and satisfied her needs in daily life.

To reveal the influence of chronic moderate smoking on physical fitness and local muscle oxygenation profile, we compared the oxygen uptake (VO2), CO2 output, respiratory rate, minute ventilation and blood lactate accumulation between six moderate smokers and ten non-smokers during incremental exercise. In order to know the difference of the peripheral oxygen supply to the muscles between the two groups, oxygenation profiles based on the changes of oxygenated hemoglobin (O2Hb) in the right vastus lateralis muscles were observed using near-infrared spectroscopy (NIRS). The intensity of incremental exercise using a bicycle ergometer was from 10 W to 80% of the maximum heart rate (80% HR(max)) of each subject. There were no significant differences between the two groups in VO2 and work rate at the level of 2 mmol/ l lactate or 80%HR(max) (P < 0.05). However, as to the local muscle oxygenation profile during exercise, 5 out of the 6 smokers showed a decrease of O2Hb throughout the incremental exercise, but 8 out of the 10 non-smokers showed a gradual increase of O2Hb throughout the exercise. In conclusion, our results suggest that chronic moderate smoking might cause a change of local muscle oxygenation profile during incremental exercise, even if the smokers have shown no decrease in physical fitness.

We examined the dynamics of capsule swallowing by healthy young men using the anterior-posterior view of videofluoroscopy as a first step in a study on capsule swallowing by dysphagic patients. The subjects were 14 healthy men who did not have any complaint of dysphagia. They were asked to swallow a #4 hard gelatin capsule filled with barium sulfate with 15 ml of water during the videofluoroscopic examination. This examination was repeated three times for each subject (total of 42 trials). In four of the 14 subjects, a swallowed capsule was retained at the upper esophageal sphincter, or the broncho-aortic constriction of the esophagus, or the lower esophageal sphincter. Except where retention occurred, the average capsule transit time from the mouth to the stomach was 6.0 +/- 2.4 s. Three of the four subjects who had capsule retention did not realize that the swallowed capsule was retained en route to the stomach. By considering the dynamics of swallowing a capsule with 15 ml of water in healthy men, we should be able to reveal the dynamics of capsule swallowing in dysphagic patients, and the capsule transit time from the mouth to the stomach.

Objective: To examine the concurrent validity of the Community Integration Questionnaire (CIQ) by comparing actual participation in community activities by individuals with traumatic brain injury., Design: Cross-sectional survey., Subjects: A total of 148 community-dwelling patients in Japan with a medical diagnosis of traumatic brain injury., Methods: A postal questionnaire survey examined the relationships between individual's actual participation in community activities (working or attending school; undergoing rehabilitation at home or hospital; other) and productive activities evaluated by the CIQ in the community., Results: Responses were received from 115 subjects (response rate 78%). Total CIQ scores and scores on the 3 subscales of the CIQ significantly differed among the 3 groups based on community participation. Total CIQ scores among individuals in the "working or attending school" group were significantly higher than for individuals in the "undergoing rehabilitation at home or hospital" and "other" groups. In addition, scores on the Productive Activity subscale of the CIQ were significantly higher among the "working or attending school" group than for the other 2 groups., Conclusion: These results suggest that the CIQ has concurrent validity for patients with traumatic brain injury.

A prospective study was carried out on the clinical application and features of a carbon fibre reinforced plastic leg orthosis (carbon orthosis) for polio survivors. The subjects comprised 9 polio survivors, and 11 carbon knee-ankle-foot orthoses (KAFOs) were prescribed, fabricated, and checked out at the authors' post-polio clinic. Walking was classified based on the functional ambulatory category, and the features of walking with a carbon orthosis were self-evaluated by using a visual analogue scale. The period from modelling a cast to completion was 55 +/- 25 days; the weight of a carbon KAFO was 27.8% lighter than that of the ordinary KAFO; the standard carbon KAFO was 50% more expensive than the ordinary KAFO. The carbon KAFO remained undamaged for at least 2 years. It improved the scores in the functional ambulation categories, but there was no difference between walking with an ordinary and with a carbon KAFO. The self-evaluation of walking with a carbon KAFO revealed that the subjects using a carbon KAFO were satisfied with their carbon KAFO. The carbon KAFO is lightweight, durable, slim and smart, and is positively indicated for polio survivors.

To investigate role(s) of thioredoxin-related antioxidant proteins in disuse muscle atrophy, we examined the levels of thioredoxin-1 (Trx-1), peroxiredoxin-3/SP-22 (Prx-3) and thioredoxin-binding protein-2 (TBP-2) in rat soleus muscle subjected to hindlimb unloading (HU) for 2, 4, 7 or 14 days. The muscle weight loss was initially observed on day 4. The increases in aclorein- and malondialdehyde-modified proteins, and the decreases in the levels of Trx-1, Prx-3 and Mn-SOD were observed in the late phase of muscle atrophy, whereas, the increase in mRNA expression of TBP-2, a negative regulator of thioredoxin, preceded muscle atrophy. These findings suggest that the decrease of those antioxidant proteins, particularly a marked decrease of Trx-1, may be responsible for the enhanced oxidative damage during the late phase of disuse muscle atrophy. Furthermore, the increase in TBP-2 preceding the muscle atrophy may suppress the thioredoxin-mediated redox signaling, which can be an initial trigger leading to disuse muscle atrophy.

We searched for mutagens that react with 2'-deoxyguanosine (dGuo) in model systems of lipid peroxidation. To autoxidation systems of methyl linoleate (model of omega-6 fat), methyl alpha-linolenate (MLN) (model of omega-3 fat), and commercial salad oil, dGuo was added. The reaction mixtures were analyzed by HPLC. Six adducts were detected, and their structures were determined by 1H and 13C NMR, UV, and mass spectra and by comparison with synthetic authentic samples. The mutagens that reacted with dGuo to form these adducts were proposed as glyoxal, glyoxylic acid, ethylglyoxal, and 4-oxo-2-hexenal (4-OHE). The formation of 8-hydroxy-dGuo, an oxidized product of dGuo, was also detected in the model reaction mixtures. Among them, glyoxal and glyoxylic acid are known mutagens, while ethylglyoxal and 4-OHE, produced from MLN, have not been reported as mutagens thus far. We confirmed the mutagenic activity of 4-OHE with Salmonella strains, TA100 and TA104, without S9 mix. These compounds may be involved in lipid peroxide-related cancers.

To identify mutagens formed in a model reaction of lipid peroxidation, linolenic acid methyl ester and hemin were reacted with dG. As a result, a 4-oxo-2-hexenal-dG adduct (dG*) was identified in the model reaction mixture. The 4-oxo-2-hexenal (4-OHE) showed mutagenic activity in the Salmonella typhimurium strains TA100 and TA104. After 4-OHE was orally administered to mice, dG, 4-OHE-dC- and 4-OHE-5-methyl-dC adducts were detected in esophageal, stomach and intestinal DNA. In the vapor phase released from the methyl linolenate-hemin model system, and in the smoke released during the broiling of fish, 4-OHE was detected by GCMS. The 4-OHE seems to be produced by the auto-oxidation of omega-3 polyunsaturated fatty acids. These results provide a warning to workers dealing with omega-3 fats, who may be exposed to this volatile mutagen.

Despite good recovery from a stroke, the quality of life (QOL) of most stroke patients living in the community is not always restored in their acute or recovery phase. Our aim of this study was to evaluate the relation between basic/social functional disabilities and life satisfaction (one of the indicators of QOL) in long-term survivors after a first stroke. Sixty three consecutive outpatients who had received comprehensive inpatient rehabilitation after their first stroke participated in this cross-sectional study. The profile, basic activities of daily living, life style and life satisfaction of these outpatients were evaluated based on their interview. More than half of the subjects had a decrease in life satisfaction. There was mostly weak positive correlation between functional/social disabilities and the life satisfaction, and both age and sex were not predictors of their QOL. Therefore, functional disabilities had a weak impact on QOL in the long-term survivors after the first stroke.

Objective: To determine whether hemiplegic patients can propel a leg-pedalling wheelchair and whether it is easier and faster for them to pedal the wheelchair using both legs alternately than to propel an ordinary wheelchair with their unaffected hand and leg., Design: Within-subject comparison., Subjects: Subjects comprised 10 hemiplegic in-patients (8 males, 2 females), aged 63.7 (SD 12.7) years with severe or moderate gait disturbance due to stroke., Methods: Subjects were asked to practice propelling the leg-pedalling wheelchair and ordinary wheelchair on both slalom and rectangular courses for a period of 7-10 days. Once they had become skilled in this, the wheelchair speed and patient's heart rate were measured, and a physiological cost index was calculated., Results: Subjects could pedal the leg-pedalling wheelchair using both legs alternately. The speed of this wheelchair was faster than that of the ordinary wheelchair, and the physiological cost index for pedalling it was lower than that for propelling the ordinary wheelchair. However, subjects needed some help in transferring to the leg-pedalling wheelchair., Conclusion: The hemiplegic patients could pedal the leg-pedalling wheelchair using both legs alternately faster and more effectively with regard to speed and physiological cost index.

Although various factors, including age, race, job category, disability, and cortical function, have been associated with return to work (RTW) after stroke, few studies have examined the influence of stroke location on RTW. We conducted a retrospective cohort study on the association between stroke location and RTW after first stroke. The patients were all younger than age 65 years and were working at the time of their stroke (n = 126). A follow-up questionnaire evaluated RTW. Data were analyzed using the Cox proportional hazards model for hazard ratios (HRs) of successful RTW, taking potential confounding factors into consideration. The Cox model revealed that maximum weakness (HR 3.74, normal vs severe), apraxia (10.7, no vs yes), and occupation (2.11, white collar vs blue collar) were significant predictors, but stroke location was not a significant predictor. We conclude that stroke location is less important than other easily measured factors in predicting RTW.

The purpose of this study was to investigate validity and reliability of measuring the quadriceps femoris muscle strength on the affected side in hemiplegic patients with a hand-held dynamometer(HHD) to prepare for a multi-center cooperative study. Measurements of the known weights(8.972 and 18.665 kg) with HHD were 8.98 +/- 0.00 kg and 18.57 +/- 0.00 kg, respectively, and measurements with HHD were almost consistent with those with KIN-COM (gold standard), because the Pearson's product-moment correlation coefficient was 0.99 (P < 0.001). There were significant differences in measurements of the quadriceps femoris muscle strength on the affected side in a hemiplegic patient between just anterior to the face of the ankle and 7 cm proximal to the ankle, and on a chair with or without a backrest (t-test, P < 0.05), but no significant difference was found between the 90 degrees and 60 degrees flexed position of the knee (t-test, 0.1 > P > 0.05). There were also no significant differences in muscle strength measured by three different examiners and on four trials, but significant differences were found among three patients (General Linear Model, P < 0.001). Therefore, by using the standardized measuring procedure, the HHD is reliable to measure strength of the quadriceps femoris muscle on the affected side in hemiplegic patients.

Return to work for the disabled worker is one of the critical issues for both the person himself and his employer. The early return to work is a manifestation of social restoration for the disabled worker as well as an effective way to reduce social cost-related disabilities. Several studies on effectiveness of the formal return to work program have been reported. This program is one of the workplace disability management systems that promote the workplace accommodation for the disabled. The purpose of a medical assessment of fitness for return to work in this program is to make sure that an individual is fit to perform the task involved effectively and without risk to his own or to others' health and safety. Decision-making, the process of assessment of medical fitness, and the design for a return to work are discussed.

Objectives: To determine the number of polio survivors living in Kitakyushu, Japan, and the prevalence of post-polio syndrome., Design: Cross-sectional survey in Kitakyushu., Subjects/patients: A total of 342 possible polio survivors were selected from the list of physically disabled persons' certificates administered by the Department of Health and Welfare, Kitakyushu City Government., Methods: A self-administered questionnaire concerning the diagnosis, paralysis, limitation in daily living, and use of adaptive devices was mailed to the 342 possible polio survivors., Results: By confirmation of the diagnosis, 241 of the 342 turned out to be polio survivors, and the number of polio survivors per population of 100,000 amounted to 24.1. Of the polio survivors, 85% complained of new health problems such as difficulty in climbing stairs, muscle weakness, difficulty in walking, or fatigue. According to Halstead's criteria, 180 polio survivors suffered from post-polio syndrome, and the prevalence of post-polio syndrome in Kitakyushu was 18.0 per population of 100,000., Conclusions: This survey revealed the number of polio survivors, and the prevalence of post-polio syndrome in Kitakyushu, Japan.

The purpose of this study was to investigate the influence of the lateral wedge on asymmetrical weight bearing and posture in hemiplegic gait. The subjects were 2-female and 4-male moderate stroke patients, average age 54 +/- 6 yr. The time from onset was 127 +/- 69.7 days. A 7 mm-thick wedged insole was applied to the affected side for a week. Before and after that, the vertical ground reaction force, single supporting period and side movement of the trunk were recorded during walking. As a result, we found that the vertical ground reaction ratio and single supporting period ratio of the affected side (affected/unaffected) were significantly increased (P < 0.05), and also that the lateral sway of the trunk was remarkably decreased (P < 0.05). Our results indicate that the application of the lateral wedge for a week improved asymmetrical weight bearing and gait ability in moderate hemiplegic patients. Also we believe that a randomly sampled comparison study should be performed in the near future.

Immunoreactivity for desmin, plectin and alpha-actinin was investigated in rat atrophic soleus muscle fibers induced by hindlimb suspension between 1 and 4 weeks (hindlimb suspension group, HSG), and compared with that of the control group (CG). Some of the HSG for 4 weeks were allowed unrestricted cage activity for 2 weeks as the recovery group (RG). In the cross-sectioned muscle fibers of the CG, desmin and plectin showed honey-comb immunoreactive patterns extending throughout the sarcoplasm. Superimposed images by double immunofluorescence labeling showed overlapping of both immunoreactivities. In the longitudinally sectioned profiles, superimposed images of alpha-actinin and desmin were overlapped at the level of Z-discs. The focal disorganization of the above honeycomb immunoreactive patterns, followed by the reduction of the cross-sectional area (CSA) of atrophic soleus muscle fibers and the appearance of Z-streaming, uniquely arose in the HSG from the first week and extended throughout the sarcoplasm in proportion to the suspension period. Such honey-comb patterns of both desmin and plectin were already restored in the RG at 2 weeks, followed by the disappearance of Z-streaming, prior to the recovery of the CSA. These findings indicate that the disorganization of topological and structural relationships of desmin and plectin with Z-discs surrounding individual myofibrils is primarily evoked, which leads to Z-streaming of atrophic soleus muscle fibers, and that the restoration of the muscle activity results in an early arrangement recovery of desmin and plectin around myofibrils.

We investigated the outcome after patients with traumatic brain injury (TBI) were treated in our hospital. Subjects were 51 patients with TBI (43 men, 8 women; mean age 34.9 +/- 20.3 yr), who had been admitted to the department of rehabilitation in our hospital between 1980 and 2000. Data were collected retrospectively from the medical records. Most injuries were due to motor vehicle accidents. The percentage of patients who suffered impaired cognitive and behavioral functions was 86.3%. The percentage of patients who were discharged to their homes was 70.6%, but none of them could return to work. Patients who were severely disabled in their daily activities or had cognitive and behavioral disturbances were difficult to discharge. We need to establish a comprehensive rehabilitation approach to cognitive and behavioral disturbances for patients with TBI.

Postpolio syndrome (PPS) is generally defined as a clinical syndrome of new weakness, fatigue, and pain in individuals who have previously recovered from acute paralytic poliomyelitis. These new problems may lead to loss of employment as well as new deficits in instrumental activities in daily living (cleaning, washing, shopping, transportation, etc.), walking, climbing stairs, and personal assistance. We presented three cases of PPS with working disabilities in Japan, and stated the issues confronted with. Particularly at the workplace, PPS individuals need special supports from both rehabilitation medicine and occupational health services, including improved nutrition, achieving ideal body weight, regular and sensible exercise, frequent checkups, and modifying working conditions.

The objective of this study was to determine what items were important for satisfaction in the daily life of elderly Japanese people living at home. The subjects consisted of 996 persons living in Yahatanishi Ward, Kitakyushu City, Japan, two percent of residents aged 60 years or over, who were randomly selected from the official register of voters. A questionnaire was sent to the subjects to determine their profiles and asking them to select the five items they considered most important for satisfaction in daily life from 35 predetermined items. The items with a significant difference using a chi 2 test between age groups, gender, place of residence, living conditions and level of disability were analyzed by logistic regression analysis. The top five items selected were "good health" (86%), "social security and pension" (47%), "self-care independence" (45%), "marital satisfaction" (34%), and a "good relationship with relatives" (33%). Logistic regression analysis showed gender, age group, living conditions, and level of disability significantly affected the preference for selection of 12 items. Men or younger persons regarded "health" and a "good relationship with a spouse" as very important, whereas women, older persons, or persons with a disability considered "self-care independence" and the "ability to walk" as important. The items selected for satisfaction in daily life and the order of preference yield important information about rehabilitative and social welfare services for elderly persons living at home.

Objective: To determine whether washing the residual limb and silicone liner reduces the associated skin problems in transtibial amputees who wear a total surface bearing (TSB) socket., Design: Case series., Setting: General community., Patients: Eighty-three transtibial amputees (65 men, 18 women; mean age, 53.4 yr) in western Japan who used or had used a TSB socket with a silicone liner in the previous 5 years., Intervention: Participants took a self-administered questionnaire that included items concerning their personal profile, daily life activities, period of TSB use (yr), hours of TSB use daily, washing frequency of the residual limb and silicone liner, the method of washing, and any associated hygiene problems., Main Outcome Measures: Logistic regression analysis was applied to examine factors related to hygiene problems. Predicted values include hygiene problems (perspiration, eruptions, itching, odor) and explanatory values include TSB use, daily life activity, and washing of limb and prosthetic., Results: Fifty-five subjects washed the residual limb, and 44 subjects washed the silicone liner every day. Itching, perspiration, eruption, and odor were frequent hygiene problems. Perspiration was noted less by women, eruption more by older subjects, and itching and odor more by younger subjects. Washing the silicone liner every day was associated with fewer reports of skin eruption., Conclusion: Keeping the residual limb and silicone liner clean is important to reduce skin problems, but hygiene problems of the residual limb and silicone liner still remain to be resolved.

The purpose of this study was to examine the moisture permeability properties of materials used for total surface bearing (TSB) socket with a silicone liner, a combination of Silicone Suction Socket or Icelandic Roll-On Silicone Socket (ICEROSS) and an acrylic plastic sheet (Degaplast), patella-tendon bearing (PTB) socket, a combination of Pe-Lite and Degaplast, and wooden socket made of poplar. Moisture permeability of the socket materials was measured as the diminution of water in a container after 12 hours in a climatic chamber. Eight containers with their open, top side were uncovered (no material) or sealed with one of the socket materials; the experiment was repeated four times. One-way analysis of variance followed by Bonferroni's test was applied to examine the differences in moisture permeability. Moisture permeability levels were as follows: no material, 85.9 +/- 1.3 g; poplar, 4.3 +/- 0.4 g; Silicone Suction Socket, 1.1 +/- 0.2 g; ICEROSS, 1.0 +/- 0.2 g; Pe-Lite, 0.8 +/- 0.1 g; 3S + Degaplast, 0.8 +/- 0.1 g; ICEROSS + Degaplast, 0.8 +/- 0.2 g; and Pe-Lite + Degaplast, 0.8 +/- 0.1 g. There were significant differences between the uncovered container and the others, and between poplar and the others (P < 0.05). We concluded that the TSB socket with a silicone liner is not superior to the PTB socket with regard to moisture permeability, and that it is necessary to develop a new prosthetic socket that allows heat release and drainage of sweat.

We conducted a phase III randomized study to investigate effects of supportive chemotherapy with oral doxifluridine (group A, 75 patients) or 5-fluorouracil (group B, 75 patients) in advanced gastric cancer when intensive chemotherapy was not an option. Although there were no significant differences between the groups with regard to survival, hospital-free survival and time to progression, median values of 3 endpoints were superior in group A. Secondary analysis showed that group A patients with prior chemotherapy tended to have longer survival and hospital-free survival and significantly longer time to progression.

The purpose of this study was to examine for gender-related differences in activities of daily living (ADL) and lifestyle of elderly persons living at home, and to support our hypothesis that the gender-related difference in lifestyle of stroke patients derives from their lifestyle prior to the stroke. Participants were randomly sampled elderly persons living at home. Questionnaire sheets including subject profile, Self-Rating Barthel Index (disability index), and Self-Rating Frenchay Activities Index (activity index) were mailed and collected, and the data were analyzed with the t-test and General Linear Model (factorial model with interaction). A total of 752 subjects were recruited, and their average age was 67.1 years. No significant gender-related differences were evident in the disability index including self-care and mobility domains (t-test, P > 0.05). In contrast gender-related differences in the activity index were significant (t-test, P < 0.05) for three factors; gender, age group, and living conditions, and in a covariate disability index (GLM, P < 0.05). Because randomly selected elderly persons in this study exhibited a prominent gender-related difference in lifestyle, we believe the lifestyle difference in stroke patients that we have previously described derives primarily from their premorbid attitude to daily life.

Objectives: To localise the brain lesion that causes disturbances of sound lateralisation and to examine the correlation between such deficit and unilateral visuospatial neglect., Method: There were 29 patients with right brain damage, 15 patients with left brain damage, and 22 healthy controls, who had normal auditory and binaural thresholds. A device was used that delivered sound to the left and right ears with an interaural time difference using headphones. The amplitude (an index of ability to detect sound image shifts from the centre) and midpoint (an index of deviation of the interaural time difference range perceived as the centre) parameters of interaural time difference were analysed in each subject using 10 consecutive stable saw toothed waves., Results: The amplitude of interaural time difference was significantly higher in patients with right brain damage than in controls. The midpoint of the interaural time difference was significantly more deviated in patients with right brain damage than in those with left brain damage and controls (p<0. 05). Patients with right brain damage with lesions affecting both the parietal lobe and auditory pathway showed a significantly higher amplitude and deviated midpoint than the controls, whereas right brain damage with involvement of only the parietal lobe showed a midpoint significantly deviated from the controls (p<0.05). Abnormal sound lateralisation correlated with unilateral visuospatial neglect (p<0.05)., Conclusions: The right parietal lobe plays an important part in sound lateralisation. Sound lateralisation is also influenced by lesions of the right auditory pathway, although the effect of such lesions is less than that of the right parietal lobe. Disturbances of sound lateralisation correlate with unilateral visuospatial neglect.

The purpose of this study was to investigate what items elderly persons living at home consider important for satisfaction in daily life and what factor structure is obtained by a principal components analysis. Two percent of the residents 60 years old or over of Yahatanishi Ward, Kitakyushu, were randomly sampled as subjects. A questionnaire asking residents to select items considered important in daily life was sent by mail, and 722 responses (72.5%) were eligible for analysis. "Health", "social security and pension" and "self-care" were considered important in daily life with the highest selection rates. A five-factor solution for 25 items with a selection rate greater than 4.5% was obtained by an oblique rotated principal components analysis: "health and disability", "social environment and activity", "socio-economic condition", "emotional stability in marital and family life" and "social intercourse and companionship". These factors appeared to be the fundamental framework of the subjective domain of health-related quality of life of elderly persons living at home.

We report a case of a woman with primary progressive aphasia (PPA) who presented with conduction aphasia. A 60-year-old, right-handed, Japanese female suffering from progressive aphasia had difficulty in repeating words and phrases. She displayed phonemic paraphasias but had preserved comprehension and had no cognitive or behavior disorder for more than 6 years after the onset of the condition. She was able to continue to work successfully and to perform all her normal daily activities. T1-weighted magnetic resonance imaging revealed minute dilatation of the left inferior horn and sulci in the left hemisphere, and positron emission tomography revealed mild hypometabolism in the left supramarginal gyrus and its surrounding areas. Therefore, she was diagnosed as suffering from PPA presenting as conduction aphasia. We believe that the progressive conduction aphasia of the patient belongs to one of the fluent forms of PPA, and the ability to continue normal work along with the clinical portrayal of preserved memory and cognition skills may be features of a form of PPA presenting as conduction aphasia.

We examined 12 transfemoral amputees, 6 using the IRC socket and 6 the QL socket, to confirm whether the ischial-ramal containment (IRC) socket is truly superior to the quadrilateral (QL) socket. In subjective evaluation, the IRC group was significantly better in the total score and in items of comfort, that is, to sit on a chair and lumbar lordosis at heel off (Mann-Whitney test, P < 0.05), better but not significant in the items of comfortable to wear, comfortable to go up and down stairs, and truncal sway during stance phase. By computed tomography, the femur of the IRC group was kept in a position significantly more medial than that of the QL group (Mann-Whitney test, P < 0.05); but no significant difference in gluteal medial muscle atrophy ratios between the two groups was found (Mann-Whitney test, P > 0.05). By X-ray, the stump of the IRC group was maintained significantly more adducted during one foot standing on the prosthesis (Mann-Whitney test, P < 0.05), but the lateral force ratio during mid-stance of the IRC group was smaller, but not significantly, than that of the QL group. Physiological cost index (PCI), an indirect simple method for evaluating oxygen consumption of gait, had no significant difference between the two groups (Mann-Whitney test, P > 0.05), and a multiple regression analysis revealed that the stump length ratio and lateral force ratio during mid-stance were significant explanatory variables for predicting PCI (adjusted R square: 0.87, F-value: 11.85, P < 0.05). The results of this study have revealed that the advantage of the IRC socket is a tender feeling of the stump, but that the metabolic efficiency is not superior to the QL socket at the most comfortable speed.

The purpose of this study was to elucidate the effects of human immunodeficiency virus (HIV) on haemophiliacs with physical functional disabilities induced by haemophilia in Kyushu, Japan. The subjects were 38 adult haemophiliacs who were selected from 129 patients registered with the North Kyushu Haemophilia Centre. They were divided into 21 asymptomatic HIV-positive and 17 HIV-negative adult haemophiliacs. Coagulation factor levels, modified DePalma classification, Arthritis Impact Measurement Scale 2 (AIMS 2), and a satisfaction in daily life (SDL) questionnaire were used to investigate the clinical severity of their haemophilia and arthropathy, physical functional disabilities, and satisfaction. Although there were no significant differences in the objective assessments of health status between the HIV-positive and -negative haemophiliacs, the HIV-positive haemophiliacs were significantly more dissatisfied with their social activities and mood, according to AIMS 2, and with social intercourse, job, self-development, and social security and pension according to SDL assessment. These dissatisfactions were due to the effects of HIV, in addition to the physical functional disabilities that were caused by haemophilia. Dissatisfaction with social security and pension may be a specific feature in HIV-positive haemophiliacs in Japan resulting from the origin of HIV infection.

The purpose of this study was to investigate the properties of the flexible pressure sensor under laboratory conditions simulating the internal environment of the total surface bearing (TSB) socket to determine optimal conditions for measuring normal stresses on the stump. The equipment used in the study was the Pressure Distribution Sensor System for Sockets. In a climatic chamber maintained at 37 degrees C and 70% humidity the sensor sheet was mounted on a measuring apparatus loaded with three 10 kg weights, and output from the sensor was recorded. Because of sensor creep, a sample 60 seconds after loading was adopted as the measured output. Output was greater when weight was decreased than when weight was increased because of hysteresis (paired t-test, p<0.05). The sensor had temperature sensitivity but differences in output were not statistically significant (paired t-test, 0.10>p>0.05). There were no significant differences in output among five sensor sheets or among five sections of four sensor sheets (two-way ANOVA, p>0.05), but repeated loading on the same section of the sensor sheet increased output (two-way ANOVA, p<0.05). Reproducibility and sensitivity distribution of the sensor are considered satisfactory under laboratory conditions, but measurements of rapid and repetitive movements may not be accurate and comparing subtle changes in output from a single sensor is not suitable. The reliability of the sensor in a clinical setting for measuring normal stresses on the stump with the TSB socket should be examined.

We evaluated functional disabilities of disabled workers at vocational aid facilities and a social welfare factory to reveal whether evaluation of the functional disabilities is useful for occupational health care activities. Subjects were 121 persons with a physical disability working at Fukuoka Colony (FC workers) and 35 persons with mental retardation working at Nanomi Kogei (NK workers). The Self-Rating Barthel Index, Self-Rating Frenchay Activities Index, and Satisfaction in Daily Life (SDL) were used for the evaluation of basic activities of daily living (ADL), lifestyle, and subjective domain of quality of life, respectively. The FC workers were almost independent in basic ADL: had a high capability in self-care activities and moderately disturbed capability in mobility activities, and had a more active lifestyle than the NK workers. The total SDL score indicated that the FC workers were less satisfied with overall daily life, although not significant, and were less satisfied with the SDL items of physical health, gait, house facilities, and having a job than the NK workers. Because these results indicated the features of disabled workers and gave an occupational health physician valuable information about disabilities, the evaluations used in this study can be regarded as useful for occupational health care activities.

Objective: To examine whether there were differences in lifestyle and performance of activities of daily living (ADL) between men and women in a population of elderly stroke patients., Design: Case-comparison study., Material and Methods: Sixty-eight men and 34 women who were elderly stroke patients living in the community with a spouse or family members were evaluated with the self-rating Barthel Index (SRBI), Frenchay Activities Index (FAI), Stroke Impairment Assessment Set (SIAS), Functional Independence Measure (FIM), and a pedometer for physical activity. Control subjects, 30 men and 30 women, were assessed with the FAI., Results: Among the stroke subjects, there were no significant differences in age, SRBI, motor score of the SIAS, or physical activity between men and women; however, men had significantly lower values than did women for three FIM items and the total FIM score and for 6 FAI items and the total FAI score. Among control subjects, men had significantly lower values than did women for 7 FAI items and the total FAI score (Tukey's test, p < .05)., Conclusion: Among elderly stroke patients, men received more support from family members in ADL performance and had less active lifestyles than did women, possibly because of cultural gender roles.

Objective: To investigate the total surface bearing (TSB) prosthesis for below-knee amputee patients and to determine its clinical indications., Design: Case series., Setting: University hospital and the Welfare Center for the Disabled., Patients: Thirty-two subjects who could walk with the TSB prosthesis and had already used the patellar-tendon bearing (or Kondylen-Bettung Münster) socket., Main Outcome Measure: Subjective assessment of the TSB socket, consisting of an overall rating and ratings of 13 individual items, was performed, and results were analyzed with Fisher's exact test., Results: Seventy-five percent of the subjects were satisfied overall with the TSB socket. Of the 13 items, comfort, ease to swing, pain, piston movement, tightness, skin irritation, appearance, and durability were regarded as good by more than 75% of the patients. Donning, perspiration, odor, and staining were regarded as poor by more than 20%. Items that were significantly related with overall satisfaction with the TSB socket were comfort, ease to swing, and piston movement, while donning was significantly related to dissatisfaction., Conclusion: The TSB socket is suitable for and preferred by many amputee subjects, but some problems remain to be solved.

This study was undertaken to determine muscle strength of trunk flexion-extension in hemiplegic patients after stroke compared with that of normal controls. The design consisted of a nonrandomized control trial in a secondary care setting (a rehabilitation unit at a hospital facility). The subjects included 25 post-stroke male hemiplegic patients and 25 male healthy controls. The maximal peak torques of trunk flexion-extension at angular velocities of 0 degrees (isometric contraction), 60 degrees, 120 degrees, and 150 degrees/s were measured by using an isokinetic dynamometer (Cybex Trunk Extension-Flexion Unit, Cybex, Ronkonkoma, NY). Peak torque of trunk flexion and extension in hemiplegic patients was significantly smaller than that of healthy controls (P < 0.05), except isometric trunk flexion (P > 0.05). The weakness of trunk flexion-extension muscles in hemiplegic patients might be accounted for by the bilateral innervation from the motor cortex, the insufficient use of high threshold motor units, and disuse atrophy.

The histopathologic study was performed to elucidate whether the fiber type atrophy of the vastus lateralis muscle in patients with hip or knee joint disorders is related to the activities of daily living (ADL) or habitual physical activity. Subjects were 16 female patients, 52.4 +/- 16.0 yr of age (mean +/- standard deviation), who underwent a vastus lateralis muscle biopsy at the time of total hip or knee replacement. At the time of referral to the rehabilitation center, the Functional Independence Measure (FIM) motor score and habitual physical activity at home were evaluated, and the diameter and atrophy factor for each muscle fiber type were measured on the histopathologic preparations of the biopsied muscles. The data were analyzed using ttest, one-way analysis of variance (ANOVA), Kruskal-Wallis one-way ANOVA, Spearman's correlation coefficient, and partial correlation coefficient. The patients showed muscle fiber atrophy and small angular fibers, and the atrophy factor was significantly increased in type 1, 2A, and 2B fibers, in that order (one-way ANOVA, P < 0.05). The patterns of the fiber type atrophy, consisting of normal, type 2B atrophy, type 2AB atrophy, and type 1 and 2AB atrophy, had a significant relationship with the fiber type atrophy (Spearman's correlation coefficient; rho = 0.834, P < 0.001). The FIM motor score showed a significant correlation with the atrophy factor (r = -0.584, P < 0.05), and significant differences were recognized among the four patterns of the fiber type atrophy (Kruskal-Wallis one-way ANOVA, P < 0.05). In conclusion, the muscle atrophy and patterns of the fiber type atrophy of the vastus lateralis muscle in patients with joint disorders may be related to changes in the FIM motor score.

To examine the usefulness of Dorsiflexion Assist Controlled by Spring Ankle-Foot Orthoses (DACS-AFO), 5 hemiplegic patients in Brunnstrom's recovery stage IV were prescribed the DACS-AFO, after which their gait with the DACS-AFO was clinically evaluated. Clinical observation did not reveal that their gait with the DACS-AFO was better than that with an AFO which the patients usually used, except when one patient walked on a slope. No significant difference in 10 m walking time was found between when the DACS-AFO and shoehorn type AFO were used. Subjective evaluations by the patients indicated that the DACS-AFO was as good as a shoehorn type AFO in walking on flat and sloped surfaces, though its weight, noise, and appearance caused by the cylinder of the DACS-AFO were regarded as poor. In spite of the excellent biomechanical characteristics of the DACS-AFO, the patients did not adopt it. The subjects in this study had already walked well with their own shoehorn type AFO, and their selection may have been biased toward poor results. However, we did not conclude that the DACS-AFO is superior to the shoehorn type AFO for hemiplegic patients in the stage IV.

This study was undertaken to determine whether the direction of trunk rotation would have any effect on trunk muscle performance of post-stroke hemiplegic patients. The design consisted of a nonrandomized control trial in a setting of secondary care (rehabilitation unit at hospital facility). The subjects included 65 hemiplegic patients (50 males) and age-matched 80 healthy controls (38 females). Isokinetic trunk rotatory muscle performance at angular velocities of 60, 120, and 150 degrees per second was measured by using an isokinetic dynamometer (Cybex Torso Rotation Unit). There were no significant differences in the peak torque and best work between the right and left directions of the trunk rotation in the hemiplegic patients or in healthy controls, regardless of the gender of the subjects (paired t test, P > 0.05). The muscle performance of the hemiplegic patients was significantly lower than that of the controls for both genders (t test, P < 0.05). In the hemiplegic patients, the direction of trunk rotation does not affect the trunk rotatory muscle performance, although the performance itself was slightly decreased.

To confirm concurrent validity of the final revision of the self-rating Barthel index (SB) and its test-retest reliability, we investigated 171 stroke outpatients without severe aphasia or dementia who were seen by a doctor on predetermined days at eight different hospitals. For 41 patients, the differences in scores among the original Barthel index (BI) and Granger's BI and SB were examined by the Friedman two-way analysis of variance and Wilcoxon matched-pairs signed-ranks test, and the difference in scores between Functional Independence Measure motor score (FIM-MS) and three-level scale FIM-MS was determined by the Wilcoxon's matched-pairs signed-ranks test. Concurrent validity of the SB was confirmed by Spearman's correlation coefficients with the original BI and FIM-MS, and internal consistency of the five measuring instruments was examined. For all 171 patients test-retest reliability of the SB was examined with the Spearman's correlation coefficient for total scores and kappa coefficients for each ADL item. Regression analysis was performed to determine what factors were related with test-retest reliability. Total scores of the SB and Granger's BI and the three-level scale FIM-MS were significantly higher than those of the original BI and FIM-MS, respectively. Correlation coefficients of the SB with the original BI and FIM-MS were 0.994 and 0.904, respectively, and its alpha-coefficient was 0.842. Test-retest reliability of the total score was 0.835 by the correlation coefficient, and kappa coefficients of 1 and 12 ADL items were fair and good, respectively. Regression analysis revealed that self-rating by a patient with a high SB total score is more accurate. Therefore, the SB has good concurrent validity and is well-related with the original BI and FIM, and its test-retest reliability is sufficiently high for practical use.

Objective: To investigate the role of weakness of the bilateral triceps surae muscles-the gastrocnemius and soleus muscles-in astasia without abasia and whether compensating for muscle weakness with ankle-foot orthoses improves this disability., Design: Case-control study of clinical findings and before and after trial of ankle-foot orthoses., Setting: Clinics of the departments of rehabilitation medicine of two university hospitals., Patients: A stilts group consisting of 23 patients with astasia without abasia, and a non-stilts group without this phenomenon consisting of 12 patients with hereditary motor sensory neuropathy, 15 patients with lumbosacral spondylotic radiculopathy or spondylolisthesis, and 20 healthy volunteers., Main Outcome Measure: Clinical findings of the stilts and non-stilts groups were compared and the sensitivity and specificity of each clinical finding was calculated. The length of the centre of foot pressure (COP) while standing was measured in a bilateral below knee amputee and 16 consecutive patients in the stilts group with and without ankle-foot orthoses., Results: Weakness of the triceps surae muscles was the only finding that differed significantly between the two groups and was both sensitive and specific. The amputee was unable to stand in place without dorsiflexion bumpers, which functioned similarly to the triceps surae muscle. Bilateral ankle-foot orthoses improved the COPs of 14 out of 16 patients., Conclusion: The main cause of astasia without abasia is weakness of the triceps surae muscles, and this disability is improved by bilateral ankle-foot orthoses.

Objective: To develop a self-rating Barthel Index questionnaire (SB) for assessing stroke patients living at home, the test-retest reliability of SB versions 1 and 2 and the inter-method reliability of SB version 3 were examined., Design: Case series., Setting: Clinics of the Department of Rehabilitation Medicine at the University Hospital and two affiliated hospitals., Patients: Thirty-one, 140 and 65 chronic stroke patients living at home, being seen for regular follow-up, and having no severe aphasia for SB versions 1, 2 and 3, respectively., Main Outcome Measure: Kappa coefficients of items in SB versions 1 and 2 for test-retest reliability, intra-class correlation coefficients of the self-care index, mobility index and total score, kappa coefficients of items and Friedman's two-way ANOVAs of ranking in SB version 3 among the self-ratings, family ratings and occupational therapist (OT) ratings; a regression analysis of age, gender, duration, time for filling in the SB, OT ratings, Mini-Mental State score and aphasia., Results: Kappa coefficients in SB version 2 were higher than those in version 1. Intra-class correlation coefficients in SB version 3 among the three ratings were good, and kappa coefficients in each item were also good or excellent. By Friedman's two-way ANOVA, all the items except walking up/down stairs had no significant difference in ranking. Regression analysis revealed that OT ratings and time for filling in the SB affected the absolute difference of scores between the self-ratings and OT ratings., Conclusions: SB version 3 is sufficiently reliable for practical use.

Objective: To clarify the histopathologic findings from lower limb muscles in hemiplegic patients and determine whether the findings are related to the severity of paralysis or daily physical activity., Design: Nonrandomized control trial., Setting: Referral center., Patients: Eight patients were selected from 21 hemiplegic persons who underwent a muscle biopsy, and the controls were four men who had no abnormal findings in their histopathology., Main Outcome Measures: Morphometric evaluations of bilateral vastus lateralis muscles on the involved (I-VL) and non-involved (N-VL) sides in eight hemiplegic subjects, five flexor hallucis longus muscles on the involved side (I-FHL), and vastus lateralis muscles of four controls (C-VL) were performed. Muscle fiber diameters were measured with an image analyzer, and atrophy factors, hypertrophy factors, and fiber type proportions were calculated based on the data., Results: The morphometric measurements revealed that the hemiplegic patients had type 2 fiber atrophy, type 2B fiber atrophy, and type 2 fiber atrophy with type 1 fiber hypertrophy in the I-VL, N-VL, and I-FHL, respectively, and that the controls had no muscle fiber atrophy or hypertrophy. The muscle fiber atrophy in the hemiplegic patients was not related to the period after the onset, the severity of paralysis, or activities of daily living score but was related to daily physical activity., Conclusions: Although the hemiplegic patients had undergone rehabilitative treatments, which did not include muscle strengthening exercises, in a hospital without a board-certified doctor of rehabilitation medicine, a considerable amount of muscle atrophy was found characteristic of changes seen in disuse.