Journal of the Japanese Physical Therapy Association Vol. 17(2014) No. 1

Purpose: This study aimed to clarify the effects of therapeutic ultrasound on intramuscular local blood circulation (and oxygen dynamics) using near-infrared spectroscopy (NIRS). Participants: The participants were 11 healthy males. Methods: All participants performed all three trials; (1) the ultrasound (US group), (2) without powered ultrasound (placebo group), and (3) rest (control group). Ultrasound was applied at 3 MHz, 1.0 W/cm², and 100% duty cycle for 10 minutes. Evaluation index were oxygenated, deoxygenated, and total hemoglobin (Hb) concentrations in the intramuscular and skin surface temperature (SST). The experimental protocol was a total of 40 minutes, that is, 10 minutes before trial (rest), 10 minutes during the trial (ultrasound, placebo, and control), and 20 minutes after trial (rest). The NIRS and SST data collected before and after the trial were divided into 5 minutes intervals for further analysis. Results: Oxygenated and total hemoglobin levels were significantly higher in the US group than in the placebo and control groups for the 20 minutes after ultrasound ( p < 0.01). The SST was significantly higher in the US group than in the control for 15 minutes after ultrasound ( p < 0.05), while it was significantly lower in the placebo group than in the US and control groups for 20 minutes after the trials ( p < 0.01). Conclusion: The effects of ultrasound were maintained for 20 minutes after the trial on intramuscular blood circulation and oxygen dynamics. These effects were caused by a combination of thermal and mechanical effects of the ultrasound.

Purpose: This study was to determine whether non-habitual (isotonic) bilateral and unilateral mastication with eyes open and eyes closed exerts an influence on static balance in individuals without temporomandibular disorder (TMD). Method: An observational, cross-sectional study was conducted involving 20 volunteers aged 20 to 40 years without temporomandibular disorder. Static balance was assessed with the individuals in a quiet standing position on a force plate performing different types of mastication under six separate conditions. Results: Significant differences (p < .05) were found in the area of oscillation during bilateral mastication (eyes open) and the right unilateral mastication, significant differences were only found for oscillation area with eyes open and mediolateral center of pressure with eyes closed (p < .05). Conclusions: The findings of the present study reveal that the stomatognathic system (bilateral and unilateral mastication) promote changes in some variables of static balance.

Aim: To facilitate establishment of an effective thermotherapy for osteoarthritis (OA), we investigated the effects of the thermal environment on articular chondrocyte metabolism in vitro. Methods: Chondrocytes were isolated from porcine knee joints, and cultured at 32°C, 37°C and 41°C. Cell proliferation and viability were assessed at Days 2, 4 and 8. In addition, TdT-mediated dUTP nick end labeling (TUNEL) assay was performed at Day 3 to determine the proportion of apoptotic chondrocytes. Analysis of genes specific for factors related to the cartilage extracellular matrix (ECM), cartilage destruction, and cartilage protection was performed at Day 2. Furthermore, evaluation of heat stress tolerance, and heat shock protein 70 (HSP70) mRNA expression and protein synthesis was performed at Day 2 and 3, respectively. Results: Cell proliferation was more at 37°C than at 32°C and 41°C. Cell viability and the number of TUNEL-positive cells were not affected until Day 8 and 3, respectively. The expression of the ECM-related genes was up-regulated at higher temperature. The expression of MMP13, a type II collagen destructive enzyme, and that of TIMP1 and TIMP2, which are MMP inhibitors, were up-regulated at higher temperatures. Finally, the chondrocytes cultured at 41°C may acquire heat stress tolerance, in part, due to the up-regulation of HSP70, and may inhibit apoptosis induced by various stresses, which is observed in OA. Conclusions: The thermal environment affects articular chondrocyte metabolism, and a heat stimulus of approximately 41°C could enhance chondrocyte anabolism and induce heat stress tolerance.

We investigated the histopathological and immunohistochemical effects of loading on cartilage repair in rat full-thickness articular cartilage defects. A total of 40 male 9-week-old Wistar rats were studied. Full-thickness articular cartilage defects were created over the capsule at the loading portion in the medial condyle of the femur. Twenty rats were randomly allocated into each of the 2 groups: a loading group and a unloading group. Twenty rats from these 2 groups were later randomly allocated to each of the 2 groups for evaluation at 1 and 2 weeks after surgery. At the end of each period, knee joints were examined histopathologically and immunohistochemically. In both groups at 1 and 2 weeks, the defects were filled with a mixture of granulation tissue and some remnants of hyaline cartilage. The repair tissue was not stained with toluidine blue in both groups. Strong staining of type I collagen was observed in the repair tissue of both groups. The area stained with type I collagen was smaller in the unloading group than in the loading groups, and the stained area was smaller at 2 weeks than at 1 week. In the staining for type II collagen, apparent staining of type II collagen was observed in the repair tissue of both groups at 1 week. At 2 weeks, there was a tendency toward a higher degree of apparent staining in the loading group than in the unloading group. Accordingly, these results indicated that loading and unloading in the early phase of cartilage repair have both merits and demerits.

Background: Tension-type headache (TTH) is a disease with a great incidence on quality of life and with a significant socioeconomic impact. Objectives: The aim of this review is to determine the effectiveness of physical therapy by using manual therapy (MT) for the relief of TTH. Data sources: A review was done identifying randomized controlled trials through searches in MEDLINE, PEDro, Cochrane and CINAHL (January 2002 - April 2012). Study selection: English-language studies, with adult patients and number of subjects not under 11, diagnosed with episodic tension-type headache (ETTH) and chronic tension-type headache (CTTH) were included. Data extraction: Initial search was undertaken with the words Effectiveness, Tension-type headache, and Manual therapy (39 studies). In addition, a search which included terms related to treatments such as physiotherapy, physical therapy, spinal manipulation was performed (25 studies). Results: From the two searches 9 studies met the inclusion criteria and were analysed finding statistically significant results: 1) myofascial release, cervical traction, neck muscles trigger points in cervical thoracic muscles and stretching; 2) Superficial heat and massage, connective tissue manipulation and vertebral Cyriax mobilization; 3) cervical or thoracic spinal manipulation and cervical chin-occipital manual traction; 4) massage, progressive relaxation and gentle stretching, program of active exercises of shoulder, neck and pericranial muscles; 5) massage, passive rhythmic mobilization techniques, cervical, thoracic and lumbopelvic postural correction and cranio-cervical exercises; 6) progressive muscular relaxation combined with joint mobilization, functional, muscle energy, and strain/counterstrain techniques, and cranial osteopathic treatment; 7) massage focused on relieving myofascial trigger point activity; 8) pressure release and muscle energy in suboccipital muscles; 9) combination of mobilizations of the cervical and thoracic spine, exercises and postural correction. All studies used a combination of different techniques and none analyzed treatments separately, also all the studies have assessed aspects related to TTH beyond frequency and intensity of pain. Conclusions: The findings from these studies showed evidence that physiotherapy with articulatory MT, combined with cervical muscle stretching and massage are effective for this disease in different aspects related with TTH. No evidence was found of the effectiveness of the techniques applied separately.

Objective: Lower extremity training (LET) was implemented in patients with cardiac failure (CF) during an early stable phase to investigate differences in cardiovascular response, symptomatic response, and severity according to cardiovascular indices. These were investigated using cardiac autonomic nerve activity. Methods: The study was included 20 patients with CF. After 5 minutes of LET, we measured changes in heart rate (HR), blood pressure (SBP), heart rate variability [low frequency (LF), high frequency (HF), and LF/HF], and rating of perceived exertion (RPE). The objects were classified in slight illness group and the severe ill group, and the comparison between groups was carried out. Results: In all patients, HR and RPE significantly increased after LET, and these effect were observed for up to 20 min after completion of LET. The decrease in HF was also maintained for 20 min after completion of RT. Comparison of the mild and severe CF groups revealed that HF significantly declined due to LET, and the decline was maintained for 40 min after completion of LET in the severe CF group. Evidence of significant decline in the mild CF group disappeared 10 min after completion of LET. Recovery was observed in RPE immediately after completion of LET in the mild CF group. Conclusion: In our study, parasympathetic nerve activity was reduced by LET its RPE was around 3 until 20 min after exercise in all patients. The severe CF group demonstrated strong RPE and decreases in both parasympathetic nerve activity and heart rate response. The mild CF group demonstrated prompt responses in parasympathetic nerve activity.

Purpose: To assess the impact of left ventricular systolic dysfunction and cardio-renal anemia syndrome (CRAS) on activity of daily living (ADL) and walking ability in patients with heart failure. Methods: Two hundreds fifty-five patients (49 % of a woman, 79 ± 11 years) of decompensated heart failure were selected and divided into 2 groups depending on left ventricular ejection fraction (LVEF); 119 HFrEF groups (LVEF ＜40 % ) and 137 HFpEF groups (LVEF ≧40 ％). Serum hemoglobin (Hb): male ＜12 g/dl and female ＜11 g/dl was defined as anemia, estimated glomerular filtration rate ＜60 ml/min/1.73 m² was defined as chronic kidney disease (CKD), and CRAS was classified into three groups (A group: neither CKD nor anemia, B group: either CKD or anemia, C group: both CKD and anemia). We investigated the Barthel index (BI) and walking ability of pre-hospital admission and at discharge. Results: BI and walking ability of pre-hospital admission and at discharge in HFpEF group were lower than those in HFrEF group, respectively (p ＜0.05). There is no interaction between CRAS and BI in both HFrEF and HFpEF group. However, there was the main effect of CRAS to BI in only HFrEF group (p ＜0.05). Conclusion: ADL level and walking ability in HFpEF group were lower than that in HFrEF group. On the other hand, ADL level was deteriorated depending on severity of CRAS in HFrEF group.

Purpose: The present study was investigated to know the functional role of deep fascia enveloping thigh and fascia between muscles in vivo. Methods: We measured the length-force relationship, in vivo, in whole muscle preparations in knee extensor, triceps femoris muscle (TFM), of the frog, Rana catesbeiana. TFM consists of three muscles, Rectus femoris muscle (RFM), vastus madialis muscle (VMM) and vastus lateralis muscle (VLM). The sciatic nerve was exposed at dorsal portion of the pelvis and all the branches of sciatic nerve except for the one innervating VMM and VLM were cut. Experiments were performed on two different preparations of TFM; in one preparation, surface of TFM was totally covered with fascia (CTF), in the second one, hamstrings was removed from TFM (CRH)． Results: Length-force curve located at the longer length in CRH than in CTF. Both the ascending and descending limbs in the curves were steeper in CTF than in CRH. In muscle length of TFM in the posture for Jumping, the isometric contractile force in CRH was about 10 percent lower than that in CTF. Conclusions: The results in the present study indicate that the active force development in CTF is more efficient than in CRH, suggesting that one of the functional roles of deep fascia and fascia between muscles is to produce higher active outputs by bundling each component muscle that has different contractile property, into one whole muscle.

Purpose: The purpose of this study was to evaluate the effect of the 6-minute Pegboard and Ring Test (6PBRT) on the respiratory and cardiac response and the motor function of the upper-limb in patients with chronic obstructive pulmonary disease (COPD)． Methods: We evaluated the respiratory gas, the heart rate and the blood pressure during 6PBRT and Upper-Limb Ergometer eXercise Test (ULEXT) in 10 COPD patients (mean age 76.7 yr), 12 healthy young adults (22.0 yr) and 12 healthy elderly adults (77.3 yr)． Results: The values of V̇O₂/kg increased slight rapidly up to 120–150 second, then became constant. The value of 6PBRTpeak/ULEXTpeak was 71.8 ± 37.1 (mean ± SD) % . The mean ± SD scores of 6PBRT were 279±93 in COPD, 346±47 in elderly adults and 416±47 in young adults respectively (p ＜0.05). Conclusion: 6PBRT is the constant-load exercise test for the upper-limb and the high-intensity exercise test in COPD patients. The motor function of upper-limb was reduced significantly in COPD patients compared with age-matched elderly adults.

Purpose: This study investigated the effects of massage at two different hamstring positions on hip flexion angle (HFA) in healthy adult males. Methods: Thirty-two healthy adult males were randomly categorized into one of the following three groups: the group being massaged at the musculotendinous junction of the hamstrings (n = 11); the group being massaged at the muscle belly of the hamstrings (n = 11); and a control group being massaged at the muscle belly of the contralateral hamstrings (n = 10). Massage was performed for 3 minutes with the same pressure in all the three groups. HFA values was assessed by blinded raters before massage; immediately after massage; and 3, 6, 9, and 15 minutes after massage. Results: HFA value in the group being massaged at the musculotendinous junction of the hamstrings was significantly greater than that of the control group immediately after massage and 3 and 6 minutes after massage. Conclusion: These results suggest that massage at the musculotendinous junction of the hamstrings can induce greater HFA.

Purpose: The present study aimed to investigate the influence of degree of low back pain and psychological factors on impairment of activities of daily living (ADL) in care workers. Methods: Degrees of ADL impairment and low back pain, helpless, depressive tendencies, and beliefs about back pain prognosis were assessed in 126 care workers with low back pain. After modeling the inter-factor relationships based on a cognitive-behavioral theory, the model was revised or modified through path analysis, and the fit of the resulting model and relationships among measurement items were investigated. Results: The fit of the revised model was high (CMIN = 21.880, p = 0.189, AGFI = 0.923, RMSEA = 0.046), and the present findings demonstrate that degree of low back pain, helpless and beliefs about back pain prognosis directly or indirectly affect ADL impairment. Conclusion: In order to understand the factors that affect the ADL impairment on back pain subjects, in addition to the degree of low back pain, psychological factors are important.

Purpose: The aim of this study was to determine the reliability and validity of the Japanese version of the modified Gait Efficacy Scale (mGES) as a measure of walking confidence under challenging everyday circumstances in community-dwelling older adults. Methods: Two-hundred forty older individuals living at home aged 65 years or over (mean 73.5 years) participated in this study. Participants were assessed using the Japanese version of mGES and measures of physical performance (chair-stand test, one-legged standing time, walking speed, and 6-minute walking distance), fear of falling, and life-space assessment (LSA). In a subsample of participants (n = 31), the Japanese version of mGES was administered twice, within 14 to 20 days, to establish test-retest reliability through the intraclass correlation coefficient (ICC [2,1]). Results: The Japanese version of mGES demonstrated excellent test-retest reliability (ICC [2,1] = 0.945, 95％ confidence interval 0.891–0.973, p ＜ 0.001). The Japanese version of mGES was related to measures of physical performance and LSA. Logistic regression analysis revealed that sex (female), walking speed and the Japanese version of mGES were significantly associated with fear of falling. Conclusion: The Japanese version of mGES is a reliable and valid measure of walking confidence in community-dwelling older adults.

Objectives: To clarify the effects of lavender oil aroma on the excitatory state of spinal motor neurons, we performed F-wave measurements, which is an index for testing muscle tonus. Methods: The subjects were 19 healthy volunteers (7 males and 3 females for experimental group; average age, 25.9 ± 6.0 years, and 6 males and 3 females for control group; average age 29.1 ± 8.8 years) without any olfactory function disorder. All subjects had no prior experience with aromatherapy. F-waves were measured before and after inhalation of lavender oil in a supine position. The objective nerve was median nerve, and F-waves were elicited by supramaximal stimulation at left thenar eminence. After measurements, we asked the subjects whether they liked the smell of lavender. Results: The amplitude of the measured F-waves was significantly smaller at 5 and 10 minutes after aroma inhalation than before inhalation. The amplitude ratio of F/M was significantly lower at 1 min after inhalation than before inhalation. All subjects liked the smell of lavender. Conclusion: In subjects inexperienced with aromatherapy, the excitatory state of spinal motor neurons innervating upper extremity was lowered after inhalation of lavender oil. To decrese muscle tone, therefore, physical therapy that suppress muscle tone may be more effective after inhalation of lavender oil.

Objective: To examine the changes in motor patterns during walking on different floor materials. Methods: We obtained electromyograms and recorded the joint motion of the left lower extremity of 10 healthy participants when they were walking on a path on which the floor material changed from wood to sponge. The entire path was covered with a cloth so that the floor material could not be visually identified. Before the study, the participants were not informed that the path was made of different materials. We determined the amount of muscular activity, curve showing the coordination pattern of each joint pair, and curve length for 7 gait cycles before and after the change in floor material. The test was performed for 3 consecutive times. Values for each parameter determined during each gait cycle in the first and third test were compared. Results: During the first test, a significant increase (p ＜ 0.05) was recorded in muscular activity immediately after the participants entered an area with a different floor material. The coordination pattern of each joint pair significantly increased (p ＜ 0.05) immediately after a change in floor material during the first test, whereas this value significantly increased (p ＜ 0.05) just before a change in floor material during the third test. Conclusions: Our results indicate that human beings maintain stability during walking by predictively altering their gait motor pattern even after the circumstances changed.

Purpose: The purpose of this study was to examine the relationship between dart-throwing motion (DTM) plane range of motion (ROM) and DASH score in patients with distal radius fractures. Methods: The subjects were 18 patients who underwent treatment for distal radius fractures. Evaluation criteria included ROM (flexion- extension, radioulnar deviation, pronation- supination, and DTM plane), and grip strength. Grip strength of the injured wrist is expressed as a percentage of the grip strength of the uninjured wrist. DTM plane ROM was measured using the developed goniometer. We evaluated the activities of daily living (ADL) on the basis of the DASH score, which was used to access the locomotorium disease of the upper limb. Statistical analyses were performed to identify possible correlations between DASH score and the ROM and grip strength. Results: Correlations were observed between DASH score and the DTM plane ROM (r = –0.681, p = 0.002) and grip strength (r = –0.488, p = 0.040). We found no statistical relationship between the DASH score and the other ROM. Conclusion: The present study suggested that DTM plane ROM and grip strength are important for the recovery of ADL in patients with distal radius fractures. The movement direction that is most commonly involved in movements along the DTM plane after a fracture of the distal radius is the most important movement direction.

Purpose: We investigated the non-thermal effect of pulsed ultrasound therapy as an anti-inflammatory treatment and analgesic for shoulder pain due to acute adhesive capsulitis. Method: Our study population included twelve patients with acute adhesive capsulitis who were randomized to either a control(C) group or an ultrasound treatment(US) group. The ultrasound-treated patients underwent 6 sessions (three times/week) of pulsed ultrasound therapy for 10 min each at a frequency of 1.0 MHz, intensity of 0.5 w/cm² and pulse mode of 20% . Pain (VAS), range of motion, muscular strength, and quality of life (SF-36) were assessed before and after treatment. Results: Compared to the C group, the US group showed a significantly greater supraspinatus tendon thickness by ultrasonography, night pain, and range of motion (flexion, external rotation). Conclusion: These results show that non-thermal treatment by defined pulsed ultrasound therapy in this study may be effective for patients who have acute adhesive capsulitis.

Purpose: The purpose of this study was to observe the long-term change in physical function and quality of life (QOL) from perioperative to postdischarge phases and to examine the relationship between physical function and QOL in patients with gastrointestinal cancer. Methods: Subjects were 42 perioperative patients with gastrointestinal cancer [23 men and 19 women aged 60.6 ± 11.3 years (mean ± SD)]. Isometric knee extension force, Timed “ Up and Go” test, and 6-minute walk distance were measured for physical function; the acute version of Short-Form 36-Item Health Survey version 2 was used for evaluating the QOL index. These items were evaluated at three time points: before surgery, after surgery, and after discharge. Results: A significant decline in physical function and QOL was observed temporarily after surgery. Physical function improved equally before and after surgery. On the other hand, postoperative QOL and physical health were significantly lower than that observed preoperatively. Moreover, a significant correlation was observed between the preoperative and postoperative rate of change in physical function and the postdischarge QOL. Conclusions: This study suggests that the perioperative change in physical function is related with postdischarge QOL in gastrointestinal cancer patients.

Purpose: The purpose of this study was to investigate the relationship between muscle stiffness (transverse stiffness) measured by muscle hardness meter and passive torque as well as myotendinous junction (MTJ) displacement (longitudinal stiffness), which are considered indexes of the muscle-tendon unit (MTU) and the muscle stretching levels. Methods: Forty-one healthy young men volunteered to participate in this study. Passive torque and MTJ displacement of the medial head of the gastrocnemius were assessed using an ultrasound machine and a dynamometer during passive ankle dorsiflexion. Simultaneously, muscle stiffness of the medial head of the gastrocnemius was measured using a muscle hardness meter (Myotonometer). Relationship between muscle stiffness and passive torque or MTJ displacement were determined using Spearman rank correlation coefficient. Results: Significant positive correlations were observed between muscle stiffness and passive torque and MTJ displacement (p ＜ 0.01). Conclusion: These results suggest that muscle stiffness measured by muscle hardness meter may be an accurate indicator of MTU and muscle stretching levels.

Purpose: The purpose of this study is to evaluate the effects of low-intensity direct current (LIDC) with electrode placement of negative poles at wound site on pressure ulcer healing. Subject: The subjects were elderly patients having a pressure ulcer (sacrum, 2 cases; thoracic supine, 2 cases; ilium, 1 case; greater trochanter, 1 case; lateral malleolus, 1 case), and healings of these ulcers had been retarded. The DESIGN-R of these ulcers were between 13 and 19. Methods: The negative electrode of silver chloride was inserted into the foam dressing on the wound surface, and the positive pole was attached on intact skin around the wound. Electrical stimulation (intensity: 80 µA; frequency: 2 Hz; pulse length: 250 msec; duration: 40 minutes) were administrated five times per week. On every treatment, opposite electrodes were shunted by electrical cable after the stimulation. Result: Size reductions were observed on all ulcers treated with LIDC and these ulcers were healed completely at 5 ～10 weeks after the beginning of LIDC stimulation. Conclusion: The pressure ulcer healings were promoted by negative LIDC stimulation. It is suggested that LIDC stimulation with consideration for electrical polarity could be effective for shortening of the pressure ulcer healing period.

Purpose: To investigate differences in the mechanical and histological properties and in the collagen architecture, particularly the superficial layer, between the regions covered by menisci and those not covered by menisci. Methods: Osteochondral plugs were obtained from porcine tibial cartilage that was either covered or not covered by menisci. Plugs obtained from each region were subjected to mechanical analysis by the indentation method, histological analysis by safranin O staining, and analysis of collagen fiber ultrastructure by scanning electron microscopy. Results: The axial creep was larger in cartilage covered by menisci than in cartilage not covered by menisci. Safranin O staining revealed a low proteoglycan content in cartilage covered by menisci than that not covered by menisci. The superficial layer of the collagen was less dense in cartilage covered by menisci than in that not covered by menisci. Conclusions: The results of our study confirmed that cartilage covered by menisci that load through menisci has a low proteoglycan content. Thus, cartilage covered by menisci may be deformed by loading after meniscal injury or meniscectomy to a greater extent than that not covered by menisci.

Purpose: This study was performed to examine the effects of rhythmic exercise using a balance ball on parkinsonism in a patient with Binswanger disease. Subject: The study subject was a male patient in his 60s with Binswanger disease who had difficulties in sit-to-stand transition and walking due to parkinsonism with bradykinesia. Methods: This was a single-subject A-B-A-B design control study. The intervention phase A consisted of sit-to-stand training combined with rhythmic exercise using a balance ball, while the withdrawal phase B consisted of conventional sit-to-stand training. We measured the sit-to-stand time, walking speed, functional independence measure (FIM), and Unified Parkinson’s Disease Rating Scale (UPDRS) during phases A and B. Results: Sit-to-stand time showed significant improvement in the intervention phase (p < 0.05). Analysis using the split-middle line method showed a significant improving trend of sit-to-stand time during the intervention phase (p < 0.05) compared to the withdrawal phase. There were no significant changes in walking speed, FIM, or UPDRS during both phases. Conclusions: Rhythmic exercise using a balance ball improve sit-to-stand time in parkinsonism in cases of Binswanger disease. The results suggested that the effect of rhythmic cue improve response time to a start, and imbalance induced by the balance ball may facilitate stabilization of sitting position.

Purpose: We evaluated the combined effects of pedaling exercise and therapeutic electrical stimulation on gait performance in subacute stroke patients. Methods: Six patients were randomly allocated to one of the following three groups: (1) pedaling exercise combined with therapeutic electrical stimulation, (2) pedaling exercise alone, and (3) therapeutic electrical stimulation alone. We adopted a single-case design (ABAB) that included five sessions per phase. To evaluate gait performance, we measured the maximum gait speed, cadence, and length of stride. In addition, we measured the peak torque of leg extension initially (baseline) and at the end of the study. Results: Only the patients from the combined exercise and stimulation group demonstrated a maximum gait speed that was significantly improved during the intervention phase compared with that during the baseline phase. Conclusion: These findings suggest that pedaling exercise combined with therapeutic electrical stimulation might improve gait performance in subacute stroke patients.

Purpose: The purpose of this study is to determine the relationship between the preoperative nutrition state and the progression of rehabilitation after cardiovascular surgery. Methods: Consecutive 479 patients who underwent an elective cardiovascular surgery (male: 317, female: 162, age: 67 ± 13 years old) were recruited. The patients were classified into four groups according to the severity of preoperative GNRI; Geriatric Nutritional Risk Index. We retrospectively examined the relationship between the severity of preoperative GNRI and the progression of postoperative rehabilitation (the postoperative duration until the patient started sitting, standing, walking and completed 100-m walking without assistance). In addition, we examined whether the severity of preoperative GNRI would become a predictive factor of the delay of progression of postoperative rehabilitation. Results: The high-risk group in preoperative GNRI showed a significantly higher ratio of patients with chronic heart failure compared with other groups (p < 0.05). Moreover, the high-risk group in preoperative GNRI was delayed in the start of standing-up and walking (p < 0.05), and also showed a significantly higher ratio of the delay of progression of postoperative rehabilitation (p < 0.05). The preoperative GNRI was extracted as one of the predicted factors of the progression of postoperative rehabilitation (p < 0.001). Conclusion: The preoperative GNRI has a relation to postoperative progression of rehabilitation after cardiovascular surgery.

Purpose: The purpose of this study was to examine the relationship between physical performance and a decline in activities of daily living (ADL) in elderly people who were certified by Japanese longterm care insurance. Methods: The subjects were 2,695 elderly people who used day-care services (mean age: 81.9 ± 6.7 years; men: 916; women: 1,779). The 13 motor subscales of the Functional Independence Measure were used to assess ADL. The subjects were divided into two groups: the ADL independent group, who scored ≥ 6 points in all ADL measures, and the ADL care need group, who scored ≤ 5 points for at least one item in all ADL measures. Physical performance tests included grip strength, the chair stand test 5 times, one leg standing with the eyes open, walking speed, and the timed “up & go” test. The multiple logistic regression analysis was used to identify the relationships between ADL status and physical performances which were showed significant differences in univariate analysis. Results: The multiple logistic regression model showed that all physical performances were significantly associated with a decline in ADL. By the analysis for the level of care, the moderately disabled group, performance in grip strength, the chair stand test 5 times, walking speed and the timed “up & go” test were significantly associated with a decline in ADL. In the severely disabled group, walking speed was significantly associated with a decline in ADL. Walking speed showed a particularly strong correlation with a decline in ADL (moderately disabled: OR, 2.56; 95% CI, 1.57–4.16; p<0.01; severely disabled: OR, 2.36, 95% CI, 1.12–5.50; p<0.05). Conclusions: Our results suggest that targeted intervention to improve walking speed may be useful for preventing a decline in ADL in elderly people.

Purpose: Patients with sarcopenia experience an impaired state of health with various comorbidities, including mobility disorders, increased risk of falls and fractures, impaired ability to perform activities of daily living, and other disabilities. The prevalence of sarcopenia differs with population, age, and gender. The aim of this study was to assess the prevalence of sarcopenia and its association with functional and nutritional status in community-dwelling frail elderly people. Methods: Seventy-two community-dwelling frail elderly individuals (55 women) above the age of 75 years were included in the study. The European Working Group on Sarcopenia in Older People (EWGSOP) criteria were adopted. Accordingly, sarcopenia was diagnosed in cases with documented low muscle mass and either low muscle strength (grip strength) or low physical performance (short physical performance battery [SPPB]). We also assessed the participants’ nutritional status (Mini Nutritional Assessment Short Form [MNA-SF]), mental state (Mini Mental State Examination [MMSE]), and daily activities (Barthel Index [BI]). Results: Sarcopenia was diagnosed in 27 participants (37.5% ). MNA - SF score in elderly people with sarcopenia was significantly lower than that in those without sarcopenia. MMSE score were not significantly different between the participants with sarcopenia and those without sarcopenia. The multivariate logistic regression analysis showed a high increase in risk of sarcopenia for malnutrition (OR 5.94; 95% CI 1.62-21.81). Conclusions: The prevalence of sarcopenia was high in community-dwelling frail elderly people. Sarcopenia was associated with low nutritional status but not with cognitive status.

Purpose: The purpose of this study was to examine the accuracy of subjective judgments regarding motor learning in the elderly people. Methods: Healthy young adults (n = 14) and healthy older adults (n = 16) participated in this study. Participants were required to reach for a target key without visual information and to learn the location of the target key by using extrinsic visual feedback. Participants performed an initial session that including 20 trials before the learning phase. Then, participants performed three learning blocks, one block consisted of three sessions with 20 trials in each session. In addition, participants were asked to make the following subjective judgments: ease of learning (before performing experimental tasks), judgments of learning (between sessions), and judgment of performance (after completing all the tasks). Results: In both age groups, the success ratio increased with the progress of the task. There was no significant difference in the ease of learning between the two age groups. In younger adults, accuracy of the judgments of learning increased with the progress of the task, whereas this was not the case in older adults. Furthermore, judgment of performance in younger adults was more accurate than that in older adults. Conclusion: These results suggest that the subjective judgment during motor learning in the elderly people is inaccuracy.

Objective: The Purpose of this study was to investigate the effects of repetitive facilitation exercise of trunk (RFE-T) on the function of trunk and gait in post-stroke patients. Methods: An assessor-blinded randomized controlled trial was carried out at 2 inpatient stroke rehabilitation centers. Twenty-one patients (age = 63.7 ± 12.1 years: mean ± standard deviation) were assigned to a control group (CG; n = 10) or an exercise group (EG; n = 11). The EG underwent RFE-T in which a physical therapist provided the trunk rotation and lateral flexion (100 repetitions each of 2 types of facilitation exercise per day). All of the subjects participated in a conventional stroke-rehabilitation program 5 times a week for 8 weeks. Baseline and post-intervention measurements included the trunk rotation muscle strength, the Functional Assessment for Control of Trunk (FACT) score, the Berg Balance Scale (BBS) score, the 10-m walk test, and the Functional Independence Measure (FIM) score. Results: The EG demonstrated a significant improvement in all measurements, whereas the CG demonstrated a significant improvement in four of the five measurements excluding the trunk rotation muscle strength. The increases in the trunk rotation-muscle strength and the 10-m walk test were greater in the EG than these in the CG ( p < 0.05). Conclusions: These findings suggest that RFE-T will promote recovery of trunk function and improve gait ability in post-stroke patients.

Purpose: Hyperkyphosis in the elderly is associated with several adverse health outcomes such as diminished physical function and falls. The objective of this study was to evaluate the relationships of spinal curvature with physical function and the history of falls in elderly Japanese women. Methods: The subjects were 42 elderly women aged 65 to 95 years (mean age 78.0 years). To estimate spinal curvature, we measured the spinal inclination angle, thoracic kyphosis angle, lumbar lordosis angle, and sacral inclination angle. Data were collected based on 5-m walking time, timed up and go test (TUG), one-foot standing time, modified gait abnormality rating scale (GARS-M), Japanese physical performance test, motor fitness scale, fall efficacy scale (FES), and the history of falls in the previous year. Results: The spinal inclination and lumbar lordosis angle significantly correlated with physical functions. The spinal inclination angle significantly correlated with 5-m walking time, TUG, GARS-M, and FES, the lumbar lordosis angle correlated with TUG, GARS-M, and FES, with adjustment for age, height, weight, and spinal disorders. The thoracic kyphosis angle affected the existence of the fall history. Conclusion: The spinal inclination and lumbar lordosis angle were significantly related to gait function and the fear of falling. On the other hand, the thoracic kyphosis angle correlated with the history of falls.

Purpose: The purpose of this study was to investigate physical activity (PA) in peritoneal dialysis (PD) patients. Methods: The study population comprised 30 PD outpatients. Their PA was evaluated using an accelerometer and is expressed as the number of steps taken per day, average PA time in min/day, and activity-related energy expenditure (EE) in kcal/day. The intensity of PA was classified according to three PA levels: Light (< 3 METs), Moderate (3–6 METs), and Vigorous (> 6 METs), and PA times at these three PA levels were compared. Patients were further divided into four groups according to number of steps taken per day as < 5,000 (group A), 5,000–7,499 (group B), 7,500–9,999 (group C), and ≧10,000 (group D ), and the number of patients were compared among the four groups. Results: The mean values of PA included number of steps: 4,864.3 ± 3,365.7 steps/day; PA time: 53.6 ± 34.4 min/day; and activity-related EE: 135.6 ± 122.2 kcal/day. PA time according to PA level was Light: 37.0 min/day; Moderate: 10.6 min/day; Vigorous: 1.8 min/day. The number of patients in group A (n=18) was significantly higher than that of groups B (n=7), C (n=3), and D (n=2) (p< 0.01). Conclusions: Most PD patients were classified as performing low PA (number of steps per day < 5,000) at a Light PA level (< 3 METs).

Purpose: The purpose of this study was to examine the relationship between physical activity and gait during pregnancy. Methods: Physical activity measurement and gait analysis were performed on 7 women during the first trimester (Phase 1) and second trimester (Phase 2) of pregnancy. Physical activity was measured by the mean number of steps per day with a recording machine for 4 weeks. From the threedimensional acceleration data obtained by a hybrid compact sensor, the time of gait cycle (stride time, step time, stance time, swing time) and the coefficient of variation (CV) with respect to each time were calculated as the gait index. The index was compared with each phase using a paired t test, and to examine the relationship between the index and physical activity, correlation analysis were performed. Results: From Phase 1 to Phase 2, the stride time, step time, and stance time increased (p < 0.05). In Phase 2, strong negative correlations were found between physical activity and gait time, as well as between physical activity and the CV gait cycle. (r = –0.77 to –0.87). Although the index varied between the phases, the higher the physical activity, the smaller were the changes seen in gait. Conclusion: Based on these results, physical activity during pregnancy is suggested to have a positive effect on gait.

Differences in Cartilage Repair between Loading and Unloading Environments in the Rat Knee
Jpn Phys Ther Assoc Vol. 17: 22-30, 2014.
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