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Abstract. When patients with chronic spinal cord injuries have pain as an accessory symptom, ADL training is delayed, and it is often difficult to take measures to cope with this situation. There have been very few reports on pain experienced by patients with spinal cord injuries in the world literature to date, and medical science today still does not know how to treat patients with spinal cord injuries accompanied by pain systematically. Against this background, to clarify the actual state of pain in chronic spinal cord injury patients, we investigated the severity of impairment due to the pain and patients' independence when they underwent rehabilitation training. 1) Out of patients with chronic spinal cord injuries, 43 that had pain (incidence, 51.2%) were enrolled in this study. 2) Many patients in the vertebral fused group had pain in the back, and the pain was likely to disappear following removal of internal fixation. 3) Pain in the nonsurgery group frequently occurred in a sensory extinction area and was intractable. 4) The period until independence in ADL was achieved was 5.6 ± 1.71 months for the complete paraplegia group with no pain, 7.5 ± 3.34 months for the group with disappearance of previous tentative pain, and 11.6 ± 4.89 months for the group with remaining pain. These findings indicate that pain associated with spinal cord injury is a factor that interferes with rehabilitation.

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Abstract. Spina bifida is often complicated by physical 1,6) and mental disabilities 8) in various forms. Long-term rehabilitation is therefore necessary not only to inhibit the occurrence of the disabilities but also to develop faculty in ambulation, to establish independence in ADL (Activities of Daily Living), to train patients in rehabilitation efficiently, and to systematically encourage patients to acquire the knowledge and techniques required in their social life for promoting their social independence. Many papers on infants are reported in the literature 2-4) , but unfortunately we have never found rehabilitation of adults with spina bifida among them. Our subjects were 50 patients examined between 1981 and 1997. Their ages varied from 18 to 47 years old with a mean age of 20.3, and there were 18 men and 32 women. Their spinal cord lesions ranged from T5 to S2. Patients with spinal cord lesion L3 were the most, and lesions of most patients (80.5%) ranged from L2 to S1. There were 13 cases of community ambulators with spinal cord lesions L4 to S2. Household ambulators using crutches or apparatus at 20 were the most. Non-ambulators in wheelchairs numbered 17 and the spinal cord lesions of most of them ranged from T5 to L2. More than half the patients (53%) urinated by self-cathterization and the others urinated naturally with urine bags or tapping. According to intravenous pyelography (IVP) findings in the admission, hydronephrose or renal atrophy was found in 48% of patients. The results of intelligencetests measured by WAIS-R found that patients IQ ranged from 61 to 124 with a mean of 88.6. After rehabilitation training, 37 patients (74%) were employed in ordinary paid occupations, 9 (18%) in sheltered workshops or welfare-factories, and 2 were self-employed. The others were unemployed. The IQ's of those employed in paid occupancy and those employed in sheltered workshops were 92 and 87, respectively. Compared with the general employment rate of patients with thoracic or lumbar injury, 80% or more, that of those with spina bifida was low.