Kanagawa 243WATANABE, H. and TASHIRO, K. Brunnstrom Stages and Wallerian Degenerations : A Study Using MRI. Tohoku J. Exp. Med., 1992, 166 (4), [471][472][473] We studied the relationship between the Brunnstrom stages obtained after rehabilitations and Wallerian degenerations detected by magnetic resonance imaging (MRI). Forty-nine hemiplegic patients were retrospectively studied. The patients were grouped into a low stage group (30 patients) demonstrating Brunnstrom stages I -IV and a high stage group (19 patients) demonstrating stages V -VI . MRI detected Wallerian degenerations as changes of signal intensity in corticospinal tracts on T2-weighted images. The signals were hypointense or hyperintense compared to the normal side according to the intervals between the MRI examinations and the ictuses. MRI showed Wallerian degenerations in 27 of 30 patients in the low stage group and 5 of 19 patients in the high stage group . The difference between the two groups was significant (p <0.005).Brunnstrom stage ; Wallerian degeneration ; MRI There are several measures to evaluate functional recovery states of hemiplegic (Arsenault et al. 1988). Although the Brunnstrom staging (Brunnstrom 1970) is believed to be one of the most useful measures, pathological and physiological explanations of the measures are still incomplete. Magnetic resonance imaging (MRI) is useful in the imaging of central nervous diseases and can be used to detect Wallerian degenerations following strokes (Matthew et al. 1988(Matthew et al. , 1989. This report focuses on a retrospective study of the relationship between the Brunnstrom stages obtained following rehabilitations and Wallerian degenerations evaluated by MRI. MATERIALS AND METHODSSeventy-three hemiplegic patients were admitted and received MRI examinations between October 1990 and June 1991 in Nanasawa Rehabilitation Hospital . Forty-nine hemilegic patients (29 men, 20 women) were selected according to the following conditions of the Brunnstrom staging and of MRI examinations. The age of the patients was 58.0± 10.1 (mean±s.D.).Little neurological improvements occur after 12 weeks of the ictuses (Newmann 1972) . Hence, in this study, Brunnstrom stages I-IV were determined after the 90th day of the ictuses. Brunnstrom stagings were performed for arms, fingers and legs of each patient , thus each patient has three Brunnstrom stages, namely the stages of the arm, the fingers and the leg. Then those patients were grouped into a low stage group (stages I-IV) and a high stage group (V-VI) in the analysis of the data of this study. Cases were selected so that all the three stages of those patients in the low stage group consisted of stage I -IV , while

When assessing the extent of improvement in Functional Independence Measure (FIM) scores for stroke patients between rehabilitation hospitals-such as Japan's Kaifukuki Rehabilitation Wards-one must note with caution that ceiling effects are present in FIM gain, defined as FIM at discharge minus FIM at admission. In cases where significant differences are present in FIM scores at admission, a variety of techniques may be used, including stratification by FIM scores at admission, FIM effectiveness, and multiple linear regression analysis. Alternative indicators of FIM improvement, which are less sensitive to FIM scores at admission than FIM effectiveness, include corrected FIM effectiveness and the deviation value of FIM gain. When comparing the FIM improvement degree among different hospitals, these methods are augmented by additional techniques, including limiting patients based on FIM scores at admission, case-control study matching FIM scores at admission, and adjustment of FIM gain by standard severity distribution. When comparing FIM improvement degree between hospitals, it is necessary to understand the advantages and disadvantages of these eight methods and analyze it taking into account the difference in patients' severity.