S-1-05-04
REPEATED STANDING UP AND WALKING EXERCISE WITH KAFO IN ACUTE STROKE REHABILITATION
Fumio Ochi, Shigenobu Ishigami (National Defense Medical College, Saitama, Japan)
Main exercises of our acute stroke rehabilitation are repeated standing up exercise and walking with KAFO. Repeated standing up exercise 300 times per day is trained as a rythmic dynamic exercise. It doesn't only strengthen the sound leg but also facilitate the affected leg and improve the trunk balance which is necessary for walking and other ADL.
There is controversy over whether KAFO should be used for stroke patients or not. KAFO was used for knee instability or back knee of stroke patients as a orthosis of rectification. But it is said that the indication of KAFO is limited because they wearing KAFO cannot walk independently. In our hospital, KAFO that fixed the knee at 15 degree flexion was used as a orthosis of treatment in early stage of stroke for the patients who couldn't extend their affected knee. They usually had severe hemiplegia, sensory deficit and unilateral spatial neglect. We consider that KAFO is effective to improve lower limb paresis and ADL. If paresis improves, KAFO is cut off to the AFO. By these program we attained short period of inpatient rehabilitation and great improvement of ADL. In these 3 years, 112 acute stroke patients (cerebral hemorrhage 31, cerebral infarction 55, and SAH 26) were consulted to our rehabilitation service. Candidates for rehabilitation were 56, trial cases 26, impossible of rehabilitation 15, and no need of rehabilitation 15. The start of rehabilitation for candidates was 6.3 days after onset and the period of inpatient rehabilitation was 21.8 days in average. 44 of 56 candidates went back to their home. Total FIM score of candidates improved 78.3 to 106.4 in this period. In acute stroke rehabilitation, it is important to select candidates for rehabilitation. Repeated standing up exercise and walking exercise with KAFO are effective.
EL-1-01-01
PROGRESS IN NEUROPSYCHOLOGICAL REHABILITATION
George P. Prigatano, Ph.D. (Barrow Neurological Institute, Phoenix, AZ, USA)
While attempts to restore impaired higher cerebral brain function have been in existence for at least 75 years, progress in neuropsychological rehabilitation has been slow for at least two reasons. Underlying mechanisms responsible for the emergence of higher cerebral functioning remain largely unknown. Techniques for facilitating recovery and avoiding deterioration of higher brain functions have not been adequately investigated. The problem of impaired self-awareness after brain injury exemplifies this dilemma. Neurorehabilitation markers of impaired self-awareness do relate to the achievement of rehabilitation goals during both acute and postacute rehabilitation. Further exploration of the mechanisms responsible for this relationship is important for continued progress of neuropsychological rehabilitation.
