We demonstrated the characteristics of bone metabolism in osteoporotic women who responded to activate-depress-free-repeat (ADFR) treatment for 6 months.
Forty female outpatients with postmenopausal or senile osteoporosis, aged 48 to 89 years (mean 72.6±1.8 years), were divided into an ADFR treatment group and a control group. ADFR treatment was as follows: activate stage, alfacalcidol (Alfarol^®) 1.0μg/day for 2 weeks; depress stage, elcatonin (Elcitonin^®) 10 units×6/2 weeks for 2 weeks; free stage, Alfarol 0.5μg/day for 4 weeks. The control group was treated with calcium lactate 5.0g/day. Bone mineral density (BMD) was measured by the digital image processing (DIP) method.
After 6 months of treatment, percent changes in BMD (BMD%) and alkaline phosphatase (Alp%) in the ADFR group were significantly higher than those in the control group (p<0.05 and p<0.01, respectively). The ADFR group was subdivided into a responder group (n=14) whose BMD% increased, and a non-responder group (n=6) whose BMD% decreased. Alp% in the responder group was significantly greater (p<0.05), whereas the percent changes in both urinary calcium/creatinine% (U-Ca/Cr%) and urinary hydroxyproline/creatinine% (U-HP/Cr%) were significantly lower than those in the non-responder group (p<0.05 and p<0.01, respectively).
These results showed that the bone metabolism characteristics of responders to ADFR treatment for 6 months were higher Alp% and lower U-Ca/Cr% and U-HP/Cr% as compared with those of non-responders.

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Maximum walking speed (MWS) for 10m distance was measured once a week for 8 weeks after starting computer-assisted gait training (CAGT) in 54 male hemiparetic stroke patients. The patients were divided into three groups based on their MWS at the start of CAGT: 18 cases with slow walking speed (9.9±2.8m/min), 18 with moderate walking speed (37.3±12.9m/min) and 18 with fast walking speed (78.4±15.2m/min). Relations between the MWS, sway path, distance of the center of feet pressure in voluntary shifting the body weight to the forth and back or the left and right, and isokinetic strength for knee extension of each side, were examined at the start and 8 weeks after CAGT. The determinants of MWS were different in each group at the start of CAGT. However, the determinant was same in three groups 8 weeks after CAGT, i. e., the isokinetic torque of the affected side. MWS of hemiparetic stroke patients was definitely related to the isokinetic muscle strength of the affected side and also the duration of gait training, including experience of walking in daily life.

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A 54-year-old man suffering from muscle weakness in his lower limbs was admitted to our hospital for further diagnosis and rehabilitation. He was seen to have remarkable muscle weakness and atrophy in the bilateral triceps surae muscles without any sensory deficit. EMG revealed polyphasic MUPs and normal MCVs and SCV. He was able to walk but unable to keep his balance while standing, and on questioning it was found that his father, uncle and elder brothers had the same symptoms. Therefore, he was diagnosed as having familial spinal progressive muscular atrophy, and we thought that this strange symptom was astasia without abasia or stilts phenomenon.
We made two plastic AFOs, a shoe horn brace and a KU half AFO, to resist ankle dorsiflexion during the stance phase. The AFOs improved his static standing balance, which was evaluated by Kistler's force plate, and the efficacy of walking, which was evaluated by the Physiological Cost Index. As the shoe horn brace was more effective for determining the Physiological Cost Index and subjectively better than a KU half AFO, we selected the shoe horn brace for the treatment of his stilts phenomenon. We concluded that the shoe horn brace resisting ankle dorsiflexion during the stance phase was able to improve the stilts phenomenon.

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