At this Center, we directly interviewed 393 applicants for prostheses, orthotics, or other assistive devices in the last year and assessed their activities of daily living (ADL) using the functional independence measure (FIM). By investigating the relationship between the FIM scores and the prescription of prostheses, orthotics, or other assistive devices, we analyzed ADL in persons prescribed for assistive devices at a rehabilitation counseling center for persons with disabilities. This analysis revealed that there were some ADL patterns on the occasion of preparing medical writings and prescriptions. The FIM scores were totally good with upper or lower limb prostheses. In the case of computer based communication systems, there appeared a specific pattern wherein cognitive ratings except “expression” were good. Some patterns in ADL covering a combination of physical aspects and cognitive ones were found with the lower limb prostheses. ADL patterns were found to be overlapping among seating systems, wheelchairs and powered wheelchairs. Some patterns were seen in active usage for locomotion, some in usage with low physical and cognitive aspects, and others in different usages. From the viewpoint of ADL, some prescription grounds became clear, and it was shown that these grounds could be one of the guidelines used for the indication of assistive devices.

　We report five cases of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. Five women (27-38 years), Who-presented with psychiatric symptoms, neurological complications, and decreased consciousness, were diagnosed with anti-NMDAR encephalitis after testing positive for serum anti-NMDAR antibodies. The mean（±SD）for hospitalization duration was 272.4（±144.8)days. All patients presented with respiratory failure due to central hypoventilation and required mechanical ventilation for 50.2（±13.1）days on average. Four patients showed no abnormal findings upon brain MRI, one showed high intensity lesions in the right temporal cortex and bilaterally in the hippocampus on T2 weighted images. Higher brain function assessment revealed an overall decrease in intelligence, attention, memory, and executive function in all patients. Temporal assessments revealed progressive improvement in these dysfunctions over several years. Four patients presented with deep venous thrombosis, articular contracture, ectopic ossification, and compression paralysis during the first immobility episode. Two had severely impaired communication and ability to perform activities of daily living when admitted for rehabilitation. However, eventually all the patients attained a premorbid state.
　Anti-NMDAR encephalitis possibly results from reversible synaptic dysfunction；therefore, it has a better functional prognosis compared with classical limbic encephalitis and other paraneoplastic neurologic syndromes. Previous studies found abnormalities in the limbic area on MRI in about 25％ of patients, although other findings were non-specific. Prevention of disuse syndrome due to prolonged immobility is important in acute phase rehabilitation. Our study shows that long-term temporal assessments of higher brain function are necessary and useful in the chronic stage.

Few case reports have documented patients with respiratory muscle paralysis due to spinal cord infarction or the need for ventilation. Objective：Herein, we report a case of non-invasive positive pressure ventilation (NPPV) -aided respiratory management. Patients：A 46-year-old man experienced sudden breathing difficulty, and, owing to respiratory failure, underwent tracheostomy and mechanical ventilation following tracheal intubation. The patient exhibited complete limb paralysis and was diagnosed with spinal cord infarction. Methods：Ventilator weaning was challenging, and necessitated patient transfer to our hospital. Results：Upon admission, the patient exhibited a forced vital capacity of 250 mL and required complete assistance. The ventilator settings were adjusted to a tidal volume of 20 mL/kg of the ideal body weight and positive end expiratory pressure off. One month post-admission, the patient was transferred for all day respiratory management with NPPV. One year after the onset, the patient's vital capacity improved to 1960 mL. The patient engaged in activities involving changes in body position or transfer training, gait training, and activities of daily living training with NPPV. Following training, the patient could independently propel a wheelchair and walk 40 m using a walker. The patient could also eat, brush his teeth using a self-help device, and independently wipe their face.Conclusion：Respiratory dysfunction in this case was a ventilatory impairment resulting from respiratory muscle paralysis. Pulmonary rehabilitation for cervical spinal cord injury facilitates respiratory management with NPPV, improves respiratory condition, and reduces the amount of assistance.

Few case reports have documented patients with respiratory muscle paralysis due to spinal cord infarction or the need for ventilation. Objective：Herein, we report a case of non-invasive positive pressure ventilation (NPPV)-aided respiratory management. Patients：A 46-year-old man experienced sudden breathing difficulty, and, owing to respiratory failure, underwent tracheostomy and mechanical ventilation following tracheal intubation. The patient exhibited complete limb paralysis and was diagnosed with spinal cord infarction. Methods：Ventilator weaning was challenging, and necessitated patient transfer to our hospital. Results：Upon admission, the patient exhibited a forced vital capacity of 250 mL and required complete assistance. The ventilator settings were adjusted to a tidal volume of 20 mL/kg of the ideal body weight and positive end expiratory pressure off. One month post-admission, the patient was transferred for all day respiratory management with NPPV. One year after the onset, the patient's vital capacity improved to 1960 mL. The patient engaged in activities involving changes in body position or transfer training, gait training, and activities of daily living training with NPPV. Following training, the patient could independently propel a wheelchair and walk 40 m using a walker. The patient could also eat, brush his teeth using a self-help device, and independently wipe their face.Conclusion：Respiratory dysfunction in this case was a ventilatory impairment resulting from respiratory muscle paralysis. Pulmonary rehabilitation for cervical spinal cord injury facilitates respiratory management with NPPV, improves respiratory condition, and reduces the amount of assistance.