The effects of continuous low-frequency electrical stimulation of rat muscles were studied using four different stimulation patterns at an earlier stage of stimulation. A stimulator was implanted in the rat body, and electrodes were connected directly to the peroneus longus (PL) muscle belly on the left side of the rat. The stimulator was controlled by magnetic transmission from outside the rat cage. The left PL muscle was stimulated electrically 24 hours per day for 1 week. Sixty-three rats were divided into 6 groups as follows: one group (11 rats) was stimulated with a uniform 10-Hz pattern; the second group (11 rats) was stimulated with 10 pulses at 20Hz every second (20-Hz stimulation pattern); the third group (8 rats) was stimulated with 10 pulses at 20Hz and 10 pulses at 10Hz every 2 seconds; and the fourth group (11 rats) was stimulated with a non-uniform, random pattern that had a mean frequency of 11.6Hz and ranged up to 20Hz. The total number of pulses per day was the same in all stimulation patterns except the random pattern. Both the group of 11 rats with implanted electrodes and the group of 11 without implanted electrodes were not stimulated and served as control groups. There were no significant differences among the groups in mean wet weight, twitch contraction time and half-relaxation time of single-twitch contraction, single twitch and maximum tetanic force. The fatigue indexes of the stimulated groups were significantly lower as compared with the control groups; this indicated increased resistance to fatigue. There were significant changes among the stimulated groups, and the 20-Hz stimulation pattern had a stronger improvement in fatigability than did the other patterns. Histochemical examinations using ATPase staining showed that there were no differences in fiber type composition and no differences in the cross-sectional area among the four stimulated groups and in the control group with implanted electrodes. The results showed that the low-frequency stimulation patterns produced a significant improvement in rat PL muscle fatigability without a significant change in the cross-sectional area or the composition of each fiber type; and the 20-Hz stimulation pattern could induce a more marked improvement in fatigability.

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We studied disynaptic Ia reciprocal inhibition between the soleus muscle and the tibialis anterior (TA) muscle before and after therapeutic electrical stimulation (TES) to the TA muscle with surface electrodes in fifteen stroke hemiplegic patients. The stimulation parameters were held at fixed values as follows: frequency at 20Hz, monophasic rectangular waveform, pulse width at 0.3ms, and full contraction intensity. A 5-second stimulation followed by 15-second rest was repeated for 15min. The amount of disynaptic Ia reciprocal inhibition was determined by the short latency suppression of the soleus or TA muscle H waves by conditioning stimulation of the antagonistic muscle nerves. Disynaptic Ia reciprocal inhibition from the peroneal nerve afferents to the soleus muscle was significantly increased after TES in 6 hemiplegic patients. On the other hand, the disynaptic Ia inhibition of the TA muscle by group Ia volleys from the tibial nerve was decreased in all subjects of 3 patients in whom H waves were detected in the TA muscle. TES might change transmission efficiency of two synapses originated from disynaptic Ia inhibitory interneurons of the TA muscle: one was the synapse to α-motoneuron of the soleus muscle and the other was the synapse to Ia inhibitory interneurons of the soleus muscle. We suggested that the facilitation of voluntary contraction in the agonist muscle and the reduction of the spasticity in the antagonist muscle by TES might result from enhancement of the synaptic transmission efficiency in reciprocal Ia inhibitory pathways.

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Determination as to whether a patient with distal myopathy with rimmed vacuoles (DMRV) would experience clinically significant effects of muscle strengthening exercise was made. The patient, a 43-year-old woman with DMRV underwent traditional physical therapy and muscle strengthening exercise using a Cybex machine. The effects of the exercise were quantified by measuring peak torque of knee extension and flexion and CT data for the leg muscles. After muscle strengthening exercise for fifteen minutes/time, two times/day, five days/week for two months, isometric peak torque of knee flexion was found to have increased significantly (p<0.01) and isokinetic peak torque of knee extension and flexion also increased (p<0.01). Gastrocnemius muscle volume increased according to CT findings in the largest cross section of the calf bilaterally. Medically supervised muscle strengthening exercise is thus shown to significantly increase muscle strength in patients with DMRV provided disease progress is slow.

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A 21-year-old man with CNS lupus presented recent memory disturbance (Wechsler Memory Scale-Revised; verbal 59, visual 70, general 51, attention/concentration 81, and remote recall 81), and was seen to have high intensity areas in the bilateral hippocampus and parahippocampal gyri by the FLARE method of magnetic resonance imaging. Hypoperfusion in the same and in the right temporal lobe was also found by single photon emission computed tomography. The lesions were regarded as being responsible for the recent memory disturbance, and the PQRST method was prescribed for memory training. After a 2-month training period, his recent memory disturbance improved, and scores of the WMS-R reached a normal level. We concluded that the PQRST method was useful for memory training of the CNS lupus.

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We report rehabilitation of a 73-year-old male who was living alone, and had bilateral legs palsy due to rhabdomyolysis caused by falling asleep with his legs in a crossed leg sitting posture. He was found to be in a complex position of a crossed leg sitting posture and in a prone position; he was transported to an emergency center. He had bilateral legs palsy, muscles atrophy and sensory disturbance. His laboratory data showed increase in serum creatine kinase, creatinine, blood urea nitrogen. A diagnosis of acute renal failure caused by rhabdomyolysis was made, and haemodialysis was instituted. At the beginning of his rehabilitation, he could not sit up and stand up from the bed due to bilateral legs palsy. We attempt to increase his legs muscle strength by physical therapy: siting up exercise, standing up exercise. Three months later, he could sit up, stand up from the bed, and walk in the parallel assist-bars. We considered that rhabdomyolysis caused by compression to his lower limb as crossed leg sitting for a long time (compartmental syndrome), due to difficulty in shifting his posture. And we have to care the patients who have been difficulty in shifting posture due to hemiplegia, dementia, sensory disturbance, living alone, as they might be rhabdomyolysis caused by compartmental syndrome with improper body posture for a long time.

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Pulmonary embolism and deep vein thrombosis are believed to be rare in Japan, whereas, they are an important cause of death in stroke patients in Europe or United States. However, a few studies have warned that incidences of them are underestimated in Japan. A 57-year-old woman with acute putaminal hemorrhage admitted to our hospital 11 days after stroke, and intensive rehabilitation program was applicated. Before her admission to our hospital, she was admitted to another hospital and forced to have complete rest. She presented symptoms of hypoxia 19 days after stroke. She was diagnosed as having pulmonary embolism. Clinical findings of pain or swelling of the paralized leg were absent. Greenfield vena cava filter was implanted immediately after diagnosis, and mild anticoagulant therapy was also started. Physical therapy was practiced with the supply of oxigen under the cardiac, hemodynamometric and oximetric monitoring. These special consideration enabled her to be applied physical therapy more safely. When she was discharged home at 38 days after stroke, her activities of daily living had already improved to be independent. We consider that physical therapy including standing is good indication for acute stroke patients to prevent deep vein thrombosis or pulmonary embolism.

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It was not until 1980, when Scott for the first time clinically applied Botulinum toxin (BTX) for the treatment of strabismus. Since then, it has been used for the management of focal dystonia and spasticity in many countries with encouraging results. In Japan, however, it was approved only for blepharospasm in 1996. In Japan as well, we are expecting to use the BTX for the management of spasticity, in addition to muscle relaxants, physical modalities and phenol blocks. In this article, we reviewed the physiological basis of spasticity, chemical characteristics of the BTX, and its clinical applications.

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