Rehabilitation of Hemiplegic Patients / 日本温泉気候物理医学会雑誌

ABSTRACT

It is a well-known fact that the death rate from cerebrovascular accident has been highest in Japan since 1951. About 160, 000 persons died of cerebrovascular accident during the year 1962 in Japan. The mortality of cerebrovascular stroke being about 50%, it follows that the number of hemiplegic patients will increase by 160, 000 every year. Recently people are much concerned over the rehabilitation of hemiplegic patients and that is why we are making a report on the results obtained from physical therapy such as hot-spring bathing, therapeutic exercise, etc.<br>Cerebral hemorrhage, thrombosis and embolism are considered to be causative of hemiplegia, 34 cases resulting from cerebral hemorrhage, and 64 cases from cerebral infarction, the latter being much larger than the former in number, The duration from the stroke to admission for rehabilitation was less than a month in 9 cases (9.2%), 1 to 3 months in 27 cases (27.6%), 3 to 6 months in 31 cases (31.6%) and so within 6 months in 67 cases (68.4%). According to our method for evaluation, the ability of movement of the patients at the time of admission was more than 5 in their lower extremities, that is, they could manage to ambulate, but slow of recovery in their upper extremities.<br>Nine cases of hemiplegia who had not bathed since cerebrovascular stroke were made to bathe by the electric hoist apparatus at 37° to 38°C for 10 minutes, Of 9 cases, 6 showed a slight rise of blood pressure immediately after bathing, but all nine cases showed a fall in blood pressure below the pre-bathing value after 90 minutes. Of these cases, the one who was made to bathe at the earliest date from stroke did so 24 days after the stroke. It seems that there are no risk in making a patient bathe at an early date from the stroke.<br>Observation was made of the effects of luke-warm bath, electric bath, massage and active exercise of the upper limbs on blood pressure and plecysmogram. It was found that blood pressure fell after luke-warm and electric bathing, but that it slightly rose after massage and active exercise. As to the effects on the plecysmogram, it may be said that all four mentioned above will act effectively on blood circulation, among which the electric bath is most effective.<br>The effect of rehabilitation was most remarkable in 19 cases, remarkable in 27 cases, slight in 32 cases, invariant in 18 cases, death in 2 cases, showing effectiveness in 46 cases, 47.2%. Invariant cases included those who had been admitted after they had recovered their movement almost completely. The recovery was better in the cerebral hemorrhage than in cerebral infarction and the recovery was better in the lower limds than in the upper limbs, The larger of cases in which rehabilitation was most effective and remarkable were those in whom the rehabilitation was instituted soon after the stroke, but there were cases in whom the rehabilitation proved effective even though the program was instituted over a year after the stroke, which is suggestive of the importance of rehabilitation. No definite relation seems to be present between the age of patients and the effect of rehabilitation, nor there seems to be any definite relation present between serum cholesterol and such laboratory findings as the function of kidney and the eyeground. The electromyograms taken before and after rehabilitation showed that there were signs of improvement in all cases, though different in all cases, though different in degree. It can be verified from the electromyograms the improvement was better in the lower limbs than in the upper limbs.<br>The replies to the inquiries on prognosis sent to 104 patients who were discharged from this hospital and the National Narugo Hospital from 1955 to 1962 were received from 79 persons, Compared with the condition at the time of discharge, 32 cases showed some improvement, 20 cases slight improvement, 17 cases invariant, 5 cases recurrence and 5 cases of death. Of the five cases of