[Objectives] Although the aerobic power of stroke patients has been studied with bicycle ergometry or treadmill exercise, they are not suited to moderate-to-severely involved patients. Arm ergometry (AE) is potentially more widely applicable to the disabled. The purposes of this study are to examine methodological issues of AE and compare exercise responses of stroke patients to normal controls.
[Methods] AE was performed with Cybex MET 300 ergometer, and heart rate (HR) and oxygen consumption (VO₂) were monitored with a Morgan Magna 88 system. The work rate was increased by 1 watts/3sec. in young adults and 5 watts/min. in strokes and matched controls till exhaustion.
1) Reproducibility was examined in 15 young adults (mean age: 27.7yr) and 8 strokes (mean age: 58.8yr). In the former, the differences between single and bilateral AE, and between right and left sides were also studied.
2) With single AE, 87 strokes (mean age: 58.4yr) were compared to 35 matched controls (mean age: 59.9yr).
3) The relatioship between aerobic power and muscle strenght was studied.
[Results and discussion] 1) The intraclass correlation coefficients of two trials were over 0.83 for maximal VO₂ (VO₂max) and 0.70 for maximal HR (HRmax). 2) Single AE VO₂max corresponded to 70 -80% of bilateral AE VO₂max. 3) VO₂max and HRmax were not significantly different between the two sides. 4) VO₂max and HRmax were not significantly different from controls, but HR-O₂ coefficient or the regression coefficient between HR and VO₂ were lower in strokes (Student t-test, p<0.05). It is suggested that differences are difficult to detect in maximal exercise since it is more limited by peripheral (muscular) factors, and hemiplegics are well conditioned to use their sound arms. On the contrary, differences are easier to detect in submaximal exercise that is more limited by central (cardiopulmonary) factors, as reflected by lower HR-O₂ coefficient. 5) VO₂max and HR-O₂ coefficient were lowest in the wheelchair dependent group, followed by wheelchair independent, household ambulatory and community ambulatory groups (Kruskal Wallis, p<0.05). 6) No complications were observed. 7) 61% of the variance of VO₂max was explained by grip strength.
[Conclusion] The aerobic power of strokes can be safely and reliably measured with single AE. There is cardiopulmonary deconditioning as evidenced by lower HR-O₂ coefficient. Grip strength could be a good predictor of VO₂max measured with single AE.

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There have been many devices for paraplegic standing and walking, but they are not used in daily living because of their inconvenience. The Walkabout^® is a new HKAFO system with a medial single hip joint (MSH-KAFO) invented by McKay S in 1992. Compared with other HKAFO systems, the hip joint of MSH-KAFO is compact and removable, so it has a distinguish merit in the point of reality, that is, ease of donning-doffing the device, compatibility with W/C, cosmesis, and cost. We had clinical experiences with using MSH-KAFO for five paraplegic patients due to spinal cord injury. They were all males, aged 26 to 36 years old. Their functional levels were L1 (2 cases), T10 (2 cases) and T5 (1 case). Results: 1) All patients could stand stably without crutches and walk in P/B immediately at the first time of wearing braces. 2) After a few hours of crutch walk exercises, all of them could walk independently with Lofstrand crutches. 3) Their walking speeds were ranged from 10.0 to 37.5m/min (mean 19.94m/min) at the follow-up points (mean 7.1 months). 4) With 4 cases, we measured oxygen consumption. At comfortable walking, predicted energy costs were from 1.31 to 3.89 METs (mean 2.75 METs). Compared with the data in literature, it seemed to be the same level with normal walking, and lower than the KAFOs walking. Our results suggest that MSH-KAFO is a very convenient standing and walking device for paraplegics, which is compatible with W/C using.

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We studied the cases of twenty-six patients (all female, age from 27 to 63 years) with osteoarthritic hips which had total hip arthroplasty (over 10 years follow-up). The correlation between hip joint function at the time of this study and post-operative patient activity were evaluated with the results as follows:
1) Younger patients tended to have lower hip joint function than older patients.
2) Patients who had a professional work also tended to have lower hip joint function than housewives.
3) There was no significant correlation between body weight and hip joint function.
4) High frequency of going up and down stairs or squatting and standing was considered to be a factor to make worse hip joint function.
5) Patients who kept on doing non-weight beared muscle strengthening exercise of hip abductors appeared to preserve good hip joint function.
These results indicate that it is important to advise patients who had total hip arthroplasty on their daily living in detail, in order to maintain good hip joint function for a long time.

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The purposes of this study are to clarify cardiopulmonary responses to bedside activities in the hemiplegics, to obtain a widely applicable testing protocol, and to compare the exercise responses of the hemiplegics to normal controls.
Methods:
1) Preliminary study: 15 hemiplegics performed various bedside activities at their comfortable speeds. Oxygen uptake (VO₂) and heart rate (HR) were measured and stress level of each activity was determined.
2) Comparison between the hemiplegics and controls: 52 hemiplegics (61.5±11.4yrs, 33 males, 19 females) and 10 normal controls (64.4±7.3 yrs, 5 males, 5 females, ) performed the activities at a pace predetermined from the preliminary study.
3) Reproducibility of the testing was examined in 17 hemiplegics within 2 weeks from the first testing.
4) Changes of exercise parameters after more than 4 weeks of rehabilitation were tested in 13 hemiplegics.
Results:
1) A bedside exercise testing protocol applicable to most hemiplegics was determined consisting of supine lying, sitting, standing, elevation of bilateral arms (10rpm), rolling over (7rpm), bridging (13rpm), sit ups (5rpm), stepping (60steps/min) and stand ups (10rpm).
2) Absolute HR and HR increase from the resting level was significantly higher in the hemiplegics in sitting, standing, stepping and stand ups.
3) VO₂ was not significantly different between the two groups in most activities, but relative increase in VO₂ from the resting level was higher in the hemiplegics in sitting, standing, rolling over, stepping and stand ups.
4) Relationship between HR and VO₂ was linear with this protocol, and the slope of the regression line (HR-VO₂ coefficient), predicted maximal VO₂ and VO₂ at HR 100 (VO₂ 100) as indices of fitness were lower in the hemiplegics.
5) Reproducibility of VO₂ and HR for each activity was satisfactory.
6) After more than 4 weeks of rehabilitation, decrease of HR for the same activities and improvement in the indices of fitness were observed.
Conclusions:
According to the level of cardiopulmonary stress for the bedside activities, we determined an exercise testing protocol in the hemiplegics. The linearity between HR and VO₂ observed with this protocol enabled us to use the indices of fitness obtained from this relationship.

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