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.

A 68-year-old woman received aortic valve replacement (AVR) with a Freestyle stentless valve using a subcoronary technique for aortic stenosis and regurgitation in September 2000. She complained of chest pain, had low grade fever and findings of inflammation and was admitted to our hospital with a diagnosis of acute myocardial infarction in December 2000. She suffered from repetitive or recurrent myocardial infarction. Transesophageal echocardiogram revealed no abnormal findings of the Freestyle stentless valve, but her blood culture was positive for methicillin-resistant coagulase negative Staphylococcus aureus (MRCNS) and she underwent an emergency operation. The Freestyle stentless valve was removed and replaced with a mechanical valve. The patient's intraoperative tissue grew MRCNS and parenteral antibiotics were administered for 8 weeks after surgery. Her condition was complicated with multiple cerebral infarction, however she was discharged on the 113th postoperative day and is doing well without recurrence of infection 12 months after the operation.

OBJECTIVEMany elderly patients with hip fracture (HF) present with gait deficits. As such, an HF both indirectly and directly increases the number of elderly people requiring care, making it a major medical and economic problem in an aging society. To facilitate the treatment of HF and attempt to resolve the consequences, we have attempted to derive an equation that would predict gait ability. The prediction equation was developed by multivariate analysis using standard evaluation methods, with inclusion of guaranteed objectivity where possible. We attached greater importance to the prediction of gait ability early in the period of hospitalization, since this allows for early determination of an efficient therapeutic strategy.

METHODSThe subjects were 54 HF patients (six men, 48 women; mean age: 78.0 +/- 8.4 years) admitted to general hospitals in Hirosaki, Aomori prefecture, between 1998 and 2007. All were aged 60 years or older and were able to walk immediately before injury; physical therapy was initiated for all individuals during hospitalization. Evaluation items related to physical function, psychological function, and complications that may affect gait were evaluated; these included the manual muscle test, motor age test, Katz's index, dementia (HDS-R), consciousness disturbance, among others.

RESULTSBased on data for 35 patients who could gait at discharge and 19 patients who could not, a model including MAT, HDS-R, and the New York Heart Association classification of cardiac function scores (P < 0.001) was obtained using multiple logistic regression analysis (discriminant hitting ratio: 94.4%).

CONCLUSIONSThe effectiveness of the derived model suggests that both physical and psychological functions should be considered for gait prediction.