園田 茂

The difficulty patterns of FIM (Functional Independence Measure) in Japan were determined and compared with patterns found in the United States to assess whether FIM can be used for worldwide comparisons of ADL (the activities of daily living). The FIM was measured for 190 stroke patients in several hospitals throughout Japan. The scores at admission and discharge were converted to an interval scale by Rasch analysis. Right and left brain lesion patients were analyzed separately. The FIM items were divided into two groups: motor items and cognitive items to minimize misfit, A degree of misfit was acceptable, except for bowel and bladder management, stairs, bathing, and expression. Motor items, eating, and bowel and bladder management were the easiest stairs, bathing and tub/shower transfers were the most difficult. The difficulty patterns of patients with left and right hemisphere lesions were almost identical. Bathing and tub/shower transfer were more difficult for Japanese patients than for those studied in the United States. Concerning the cognitive items, expression was easiest for patients with right hemisphere lesions but most difficult for those with left hemisphere lesions. Social interaction was easier for Japanese patients with left hemisphere lesions than the other patients. The item difficulty patterns in Japan differs slightly from those in the United States because of cultural differences. As countries show different patterns of difficulty, we must be careful when making international comparisons of FlM data converted by Rasch analysis.

Strokes are one of the most important subjects of clinical and research studies of rehabilitation medicine. A system for evaluating stroke patients, however, is not yet completely established. In 1980, WHO instituted International Classification of Impairments, Disabilities, and Handicaps (ICIDH). Since the introduction of the concepts of ICIDH, many studies and research on rehabilitation medicine utilizing this classification have been published. The concepts of ICIDH have been applied to some diseases of the neuro-musculo-skeletal systems such as those of stroke patients. This paper reviews the methods of functional assessment and evaluation of stroke patients categorized by using ICIDH, and also it aims at presenting a new system for evaluating the level of impairment that we originally developed.

The relationship between Wallerian degeneration in the brain stem and degree of motor impairment is discussed. Using MRI we studied 172 supratentorial stroke patients, whose motor impairment was graded according to Brunnstrom stage. Wallerian degeneration was represented by a T2 high-intensity area in the brain stem, and its cross-sectional extent was measured at the cerebral peduncle level. Wallerian degeneration was detected in 99 patients (57-6% The area of T2 high intensity was significantly correlated with Brunnstrom stage. Multiple regression analysis showed that the upper extremity stage contributed most to the visualization of Wallerian degeneration. This is partly because the pyramidal tract participates in fine and precise movement. The extent of the area of Wallerian degeneration is found to be helpful in making a prognosis with respect to motor impairment in the upper extremity. © 1992 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.