Visceral impairment (VI), including cardiac, renal, pulmonary, hepatic, intestinal, urinary and rectal, AIDS is a worldwide public health problem. Recently, the number of patients with VI dramatically increased, reaching 30% of the total population of disabled patients in Japan in 2006, which corresponds to 60% of patients with limb impairment. Visceral rehabilitation (VR) is a coordinated, multifaceted intervention designed to optimize a patient’s physical, psychological, and social functioning, in addition to stabilizing, slowing, or even reversing the progression of the disease, thereby reducing morbidity and mortality. VR includes five major components : exercise training, diet & fluid management, medication & medical surveillance, education, psychological & vocational counseling. VR is a feasible, effective (Class I, evidence label A) and safe secondary prevention strategy following VI, and offers a promising model for a new field of rehabilitation. Medical science basically aims to “Adding Years to Life” by increasing life expectancy. Rehabilitation generally aims to “Adding Life to Years” by helping patients with impairment achieve, and use, their full physical, mental and social potential. However, recent growing evidence suggests that rehabilitation for patients with VI not only improves exercise performance and quality of life, but also increases survival. Therefore, modern comprehensive rehabilitation for patients with visceral impairment does not simply aim to “Adding Life to Years” but “Adding Life to Years and Years to Life”, which is a new rehabilitation concept. Urgent efforts should be made to increase the implementation rate of VR.

The number of the patients requiring rehabilitation has been rapidly increasing. Rehabilitation patients and their families face various troubles and problems in their illness, their functional state, their convalescence, and a wide range of domains including their at-home life and care burden. And rehabilitation staffs must deal with these problems appropriately and take pride in their efforts and strive to provide continuing reliable care. However, most hospitals and rehabilitation centers only have one or at most a few physiatrists. Thus, most physiatrists and co-medical rehabilitation staff have few advisers and are frustrated by the many kinds of problems faced in providing medical service and management. In this lecture, I discuss how to build safety measures, how to write medical records to prevent future troubles, the proper on-site manner, and the 15 traits of a disliked physiatrist. I hope that this lecture can blow away the frustration from the rehabilitation scene and be helpful not only for patients and their families, but also for physiatrists and co-medical rehabilitation staff.

The worldwide population of elderly people suffering dementia is considerable. In 2005, 1.69 million persons in Japan suffered from Alzheimer's disease (AD) and other forms of dementia. Considering the ageing of the population, the number of elderly adults with dementia should rise to 3.78 million in 2045. The physical and mental benefits of exercise are universally recognized. Exercise training promotes extensive cardiovascular changes and adaptive mechanisms in both the peripheral and cerebral vasculature, such as improved organ blood flow, induction of antioxidant pathways, and enhanced angiogenesis and vascular regeneration. Clinical studies have demonstrated a reduction of morbidity and mortality from cardiovascular disease among exercising individuals. Exercise also regulates the brain function, but the mechanism by which it does so is unknown. In this article, I summarize current knowledge about the potential benefits of physical exercise in elderly adults with AD and other dementia, and then describe the development of a moderate-intensity aerobic exercise program for this population. Evidence from some longitudinal studies and randomized trials suggests that physical exercise enhances cognitive function in older adults with dementia. Accumulating evidence from human studies suggests that physical activity may reduce the risk of poor cognition and early cognitive decline. In conclusion, recent studies suggest that regular physical exercise can enhance cognitive function and functional activities (activities daily living, exercise capacity, muscle strength, flexibility, balance, cardiopulmonary function) in elderly adults with dementia and that engaging in physical exercise may, along with other health benefits, delay or prevent the onset and progression of dementia.

The Great East Japan Earthquake occurred on March 11, 2011. As a representative of a local earthquake relief headquarters, I report what we have done in the stricken area following the Great East Japan Earthquake for the three months afterwards. As a result of this report, I strongly recommend the establishment of a “Disaster Rehabilitation” and “Disaster Acute Rehabilitation Team (DART)” as well as creating a “Disaster Rehabilitation Manual or Guideline” in order to pass the knowledge learned through our experience on to future generations and to be able to respond to any forthcoming disaster quickly and efficiently.

Subacute myelo-optico-neuropathy (SMON) is a neurological disorder caused by an anti-diarrhea drug, chinoform. It was not easy to find the cause of SMON, because chinoform was believed to be one of safe drugs. Prescription of chinoform was stopped temporary to investigate the cause of SMON, then there were no new cases of SMON and SMON was confirmed to be caused by chinoform. It was not easy to find all of the side effects of new drug on clinical trials, especially adverse drug reactions (ADRs) emerged following a long administration. Because the duration of trials was not long enough and the number of patients was small. Drugs, especially new ones, should be kept under watch following marketing to find ADRs as soon as possible. Insert packages of most drugs for neurological or mental disorders give warn not to let patients to drive because of sleepiness induced by the drugs. However there are no information showing how much risky to drive on taking the drug. It is not appropriate to inhibit driving legally on taking the drug, but the drug should have any information in the insert package how it is risky on driving under the drug.
 Drug-drug interactions are one of important issues on the treatment. The information in the insert package says physicians should be careful in prescribing drugs on drug-drug interactions. However, in many drugs applied in the treatment, there are no information how much the interaction affects pharmacokinetics of the drug in the insert package. It is essential to know the pharmacokinetics of drug interactions. In putting the warning of drug-drug interactions, the information how much it effects the pharmacokinetics of the drug should be given in the insert package.
 Pharmacovigilance is an essential system to apply new drugs to the therapy. Research and development of new drugs is promoted by pharmaceutical companies and physicians are required to cooperated to develop new drugs, however, on pharmacovigilance, it is essential for physicians to collect the information from their patients properly and to report it promptly. All of physicians should have training on the idea and action of pharmacovigilance on drug treatments.