In order to investigate the prevention of Osgood-Schlatter disease (OSD) in adolescent athletes, the strength and flexibility of the quadriceps muscles were examined in 30 adolescent athletes with unilateral OSD and 20 adolescent soccer players as a control. The following three factors were examined: 1) quadriceps strength in concentric and eccentric contraction, 2) quadriceps flexibility, and 3) the laterality of the involved knee. There was no significant difference in quadriceps muscle strength between athletes with OSD and soccer players, while quadriceps muscle flexibility in athletes with OSD was significantly low in comparison with soccer players. Although there was no significant difference in quadriceps muscle strength between the uninvolved and involved sides in our patients with unilateral OSD, the left knee was more prone to be affected than the right knee in adolescent athletes. In the great majority of adolescent athletes, the left knee had a tendency to be a dominant leg which was defined as the take-off leg. Since the dominant leg is susceptible to eccentric quadriceps contraction during rapid deceleration while jumping, landing or running when playing sport, we consider that these factors may play a role in the decrease of the quadriceps muscle flexibility in adolescent athletes with OSD. With regard to the prevention of OSD, stretching exercises to relieve the decrease of the quadriceps muscle flexibility and training to reduce the load on the dominant leg are recommended in adolescent athletes.

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We compared histochemical characteristics and their changes during hindlimb unloading (HU) among proximal, middle, and distal regions (10%, 50%, and 90% of muscle length from the proximal end, respectively) along the longitudinal axis of the plantaris muscle in adult rats. Twenty-two female Fischer 344 rats (6 months old) were assigned to either the control (n=7) or HU (n=15) group. Rats of the HU group had their hindlimbs suspended for 1 (n=7) or 3 weeks (n=8). Muscle wet weight, water content, fiber types (IIB, IIA, and I), and cross-sectional area (CSA) were measured. Fiber types were identified in serial sections stained with myofibrillar ATPase techniques. In control rats, the proximal region had the greatest percentage of type IIB fibers (89.1±5.4%, mean±SD), followed in descending order by the distal (80.2±3.2%) and middle regions (68.7±4.2%) with concomitant lesser percentages of type IIA and I fibers. The relative contribution of type IIB fibers to cross-section was greater in the proximal and distal regions than in the middle region with a lesser contribution of type IIA and I fibers. The CSA of type IIB fibers gradually increased from the proximal to the distal region. The CSA of type IIA and I fibers was greatest in the middle region. HU resulted in a 21.5% loss of muscle weight after 1 week and a 27.1% loss after 3 weeks compared with control, although water content did not change. Type IIB fibers began to atrophy after 1 week of HU, and type IIA and I fibers began to atrophy after 3 week of HU in the middle and distal regions. In contrast, the CSA of no fiber types in the proximal region changed significantly with HU. No change was observed in fiber type distribution or relative contribution at any region with HU. These results demonstrate that 1) the histochemical characteristics of fiber type compositions and CSA differ along the longitudinal axis of the muscle and 2) the degree of muscle fiber atrophy is affected by fiber types, duration of HU, and longitudinal region.

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We reported a patient with Parkinson's disease (PD) developing recurrent episodes of postprandial vomiting, which was presumed to be gastroesophageal reflux disease (GERD), following percutaneous endoscopic gastrostomy (PEG). Although nasogastric (NG) tube feeding is popular treatment for patients with dysphagia, NG tube gives discomfort feeling and may be harmful for their quality of life. PEG is an another choice for improving dysphagia without giving discomfort feeling. However, our report suggests that careful choice of patients is needed to prevent postprandial vomiting resulting in aspiration pneumonia.

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As early therapeutic measures for rheumatoid arthritis (RA), physical therapy and occupational therapy have been provided during the past 20 years at the outpatient clinic. Based on this experience, the author engaged in therapy of RA has consistently stressed the importance of early detection of impairment and for this purpose daily activity checklist (Shiino, 1996) has proven to be useful. Nonetheless, the level of recognition of rehabilitation medicine for RA is low. The cause involved not only lies on the part of physicians engaged in the treatment of RA but also on the part of physical therapists and occupational therapists who have not received adequate education on RA. The author in order to overcome this situation established the Japanese Society for Rehabilitation Medicine of Rheumatoid Arthritis 15 years ago and activities have been continued for enlightenment. As early practical measure, it is first necessary to study the psychology of RA patients. This is because it is necessary to properly ascertain arthralgia, as there is no adequate scale available to evaluate pain. Next for evaluation of functional disorder, though ROM-T, MMT, and ADL-T are available at present, the objectivity of these tests cannot be said to be sufficient. Study must be made in the future on the management system for precision of various medical facilities. To increase muscle power, heavy load at lower frequency is more effective in therapy. However, for this purpose voluntary training must be made at home. The next problem is that a standard is not available for practical evaluation of therapeutic effect. In order to evaluate improvement of ROM, a method is presented to indicate that value of more than 10° after therapy. In increasing muscle power, as MMT itself is a subjective evaluation, a suitable method is still being studied. Lastly, it is important that adequate study of routine medical care should be made to carefully evaluate the therapeutic results before and after therapy and for cases not demonstrating any therapeutic effect, medical therapy should not be aimlessly continued. When DRG/PPS is introduced in the future, there is a possibility that physical therapy and occupational therapy may be amalgamated. Rather than treating an established impairment, it is important that treatment should be made of impairment at the reversible stage.

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