Oxygen uptake and energy expenditure in ambulation were studied in patients with spinal cord injury. In addition to basal metabolic rate (BMR), O2 consumption and CO2 production were studied at rest and ambulation periods using the “breath analyser”. BMR of paraplegics was lower by 15 to 20% than that of normal individuals. During the wheelchair propelling, RMR (relative metabolic rate) of paraplegic patients was 0.3 to 1.0. A linear relationship appeared to exist between the RMR and the speed at wheelchair propelling. The RMR in patients with thoracic lesions during swing through gait, with speed of 11m/min., was 4.83 on an average. The RMR in patients with lumber lesions was 4.62 at swing through gait and 4.02 at four point gait. Speed was 30m/min. at swing through gait and 11m/min. at four point gait. Certainly RMR of thoracic paraplegics in ambulation was higher than that of lumbar paraplegics. RMR, above 4.0 was seem a heavy work for paraplegic patients, and ambulation at this RMR was considered not to be functional, whereas patients with distal segment lesions were considered as functional ambulators. In conclusion, walking with crutches for paraplegics was not functional. On the other hand, wheelchair propelling required less energy. Since inadequate amount of daily physical activity causes loss of physical strength, it is important to encourage the patient to walk with braces and crutches.
Motor nerve conduction studies of the median and ulnar nerves were carried out in twenty healthy normal subjects by conventional techniques. The amplitude of motor action potential (M-wave) and the distal motor latency time were measured by stimulating at the wrist. The amplitude from negative to positive peak was considered to the M-wave response. The time from stimulus artifact to the first deflection was taken as the distal motor latency time. The pick-up electrode was firstly placed on the middle portion of the muscle belly and the conduction study was performed, then the pick-up electrode was placed 1cm distally and same study was carried out. Thus, the amplitude and latency time were compared according to the different site of pick-up electrodes. The results were shown in the following table: In 1cm distal part of muscle belly, the amplitude of M-wave was approximately 70% of that of the middle portion in both median and ulnar innervated muscles. But distal motor latency times at the two different portions were statistically unchanged. It is concluded that the distal motor latency time is more valuable indicator in motor nerve conduction study. Also if the pick-up electrode was placed precisely over the middle of muscle belly tested, the amplitude of M-wave is reproducible, then it will become good indicator in motor nerve conduction study.
The cardiac function of the patients with myocardial infarction was examined by the quantitative exercise tolerance test with an ergometer at discharge. Results of the tests were compared with clinical findings in the acute stages and clinical records during their hospitalization. 52 male patients with average age of 58, who were admitted due to acute myocardial infarction, were examined in this study. At the time of discharge, an intermittent multiple load test (25W, 50W, 75W and 100W for five minutes each) was conducted using a bicycle ergometer in the upright position. ST changes of more than 2mm compared to the level at rest, frequent extrasystoles, and appearances of marked arrhythmias on the electrocardiographic recordings were the criteria for discontinuation of loading. Subjective symptoms as the criteria for discontinuation included appearance of chest pain, dyspnea, or high degree of fatigue in legs. Clinical findings in their acute stages and clinical records during their hospitalization were compared and examined in relation to the results of exercise tolerance test for each case aforementioned. The maximum physical work capacity (max. P. W. C.) at discharge, that was at around ten weeks after the attack of myocardial infarction, was 25W for 18 of 52 cases (group I), 50W for 18 cases (group II), and 75W or higher for 16 cases (group III), being almost equally divided to one third. Tests with 100W loading were performed in 9 cases in the group III, showing 3 cases with max. P. W. C. of 75W, and 6 cases with max. P. W. C. of 100W or higher. Groups with poor cardiac function at discharge were composed of cases with old age, extensive infarction, reattack, heart failure, arrhythmia, or with interfering factors for rehabilitation. Durations of bed rest were 30, 23, and 17 days for group I, II, and III, respectively. Periods of hospitalization were 86, 68, and 51 days for these groups, respectively. Both were apparently longer in groups with poorer cardiac function. Young patients, patients with limited infarction, or initial attack, or with good clinical findings, or without interfering factors for rehabilitation showed good cardiac function despite of relatively short period of hospitalization. Early mobilization and discharge after myocardial infarction should be recommended to such cases.