The purpose of this study was to examine the reliability of the Japanese version of the Gross Motor Function Classification System (GMFCS) and to determine expert opinions on clinical use of this system using a Delphi survey. The reliability study was performed with 334 children (191 boys, 143 girls) with cerebral palsy, ranging in age from 8 months to 12 years (mean, 5 years 7 months ; standard deviation, 3 years 1 month). A total of 181 assessors participated in the study. Two assessors classified each child's level of gross motor function independently using a revised version of the GMFCS (Japanese version 1.1). This revision of the GMFCS was based on the results of previous pilot studies performed in Japan. A questionnaire was used for the Delphi survey, and the rate of positive response was calculated from the answers of 20 assessors at each institute that conducted the reliability study. In the reliability study, overall kappa was 0.67, but specific kappas <0.40 were found at level III and IV in the 4.6 year age group. In the Delphi survey, the rate of positive responses was not ≥80% only for the description of level III among the five levels. These findings and structural analysis of descriptions for level III and IV according to the results reported by Rosenbaum and coworkers suggest that reliability of the GMFCS was partly lowered because of the level III description for the age of 4.6 years, which might be set at a relatively lower level than actual development.

Videofluoroscopic examination of swallowing (VF) is widely used for evaluating swallowing function. However, pulmonary complications after VF are seldom evaluated. We checked residual barium sulfate on chest X-rays and early pulmonary complication after VF. One hundred and ninety-eight patients underwent VF and chest X-rays. Eighty-six patients who did not aspirate during VF had no residual barium on their chest X-rays. One hundred and twelve patients aspirated during VF, but only 40 of these patients showed residual barium on their chest X-rays. Ten patients had fever after VF, but no significant relationship was observed between fever and residual barium on chest X-rays or aspiration. Aspiration was not correlated with mobility or cognitive status. One case had pneumonia after VF, but VF did not seem to be the cause of the pneumonia. In conclusion, no severe early pulmonary complications after VF were observed. It is difficult to predict early pulmonary complications from chest X-rays.

We report three elderly patients in the extended care unit who were successfully treated orally with Chotosan. Case 1 was an 84-year-old male who was hospitalized for lowered volition after aspiration pneumonia in 1999. He received nutrition through a stomach fistula. Administration of Choto-san increased his volition, and he resumed eating normally after practicing swallowing. Case 2 was a 99-year-old woman who was hospitalized for lower volition after a thighbone fracture in 2000. She also could not eat orally, and received nutrition via nasal-tube feeding. After the administration of Choto-san, she developed a will to eat, and she could again have meals orally. Case 3 was an 84-year-old woman who was hospitalized for lowered volition after aspiration pneumonia in 1999. She had pressure ulcers and was often feverish, so she was fed by nasal tube. She was treated with Choto-san, and was able to eat normally again after practicing swallowing. Her pressure ulcers were cured. This suggests that the administration of Choto-san may be successfully utilized as part of a strategy for overcoming swallowing trouble in the elderly.

We report two elderly cases in the extended care unit who were successfully treated for emitting a strange squealing sound with Sansonin-to. Case 1 was a 97-year-old female who was hospitalized with a strange squeal after repeated aspiration pneumonia. She made this strange sound especially during the night. This sound disappeared with the administration of Sansonin-to (TJ-103: 7.5g/day) except at the times of position change and diaper change, and she also became able to eat after practicing swallowing. Case 2 was an 80-year-old female who was hospitalized after a cerebral hemorrhage. She also made a strange squealing sound during the night. After administration of Sansonin-to, this sound was decreased, and she became able to sleep well at night and live actively with rehabilitation training in the daytime. With an aging society, troublesome behaviors due to dementia will be an increasing problem. These cases suggest that there may be certain conditions of elderly nighttime delirium that are treatable with Sansonin-to.