Cerebral autoregulation is mediated by blood pressure and the resistance of arteries, which are under the control of the autonomic nervous system. We examined the heart rate variability (HRV of stroke patients to clarify the impairment of both autonomic nervous activity and blood pressure variability (BPV), in relation to the degree of arteriosclerosis of the carotid artery (plaque score). We studied three parts. There are as follows: Study 1 is relationship between HRV and localization of stroke. The subjects consisted of 68 stroke patients (50 men and 18 women). The average age was 61.4±10.6 years. About one month after their strokes, we analyzed HRV by a 24-hour ECG (Holter recording. Study 2 is the relation of HRV and BPV and the degreee of arterioscerosis. The subjects consisted of 40 thalamic stroke patients (22 men and 18 women). The average age was 60.9±9.6 years. The degree of arteriosclerosis was evaluated using plaque score by ultrasonography of the carotid artery. We applied a portable automatic BP recorder over 24-hour periods to study BPV after one month from the onset of stroke. The sympathetic variable of the frequency domain of HRV was analyzed in relation to BPV and the degree of arteriosclerosis. Study 3 is consecutive change of HRV. A 24-hour ECG recording for 40 patients was implemented consecutively at 1 week, 1 month, and 3 month after the onset of stroke. The control subjects were 12 age-matched healthy adult volunteers. The essential components of HRV were significantly lower in stroke patients with lesions in the thalamus and brainstem. The sympathetic variable of the frequency domain of HRV (LF/HF was significantly correlated with short-term BPV and the degree of arteriosclerosis. HRV was lower during the acute phase, and continued to be low through to the chronic phase. The autonomic nervous function in stroke patients, especially with thalamic lesion, was reduced. This might cause the fluctuation of blood pressure associated with the reduction of the baroreceptor response caused by arterio sclerosis. It is therefore suggested that HRV is a useful measure for predicting the unstable blood pressure of stroke patients.

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We measured the bone mineral density (BMD) in stroke and spinal cord injury (SCI) patients at our outpatient clinic to investigate the effect of paralysis on the progression of osteoporosis. Thirty-six stroke patients and 18 SCI patients (39 men, 15 women; mean age: 55 years) were enrolled. The BMD of the femoral neck was firstly measured at the time of 45 months after the onset on an average and measured again average 14.1 (10-19) months later using DEXA. There were no significant differences in the demography, gender, age, ambulation status, weight, height, diagnosis, and disease period between the etidronate-administered and non-etidronate-administered groups. The change of BMD significantly correlated with SCI patients (t=-2.976, p=0.0037), disease period (t=2.107, p=0.0377), and etidronate administration (t=2.017, p=0.0466) as demonstrated by multiple regression analysis (r²=0.276, p=0.0002). In conclusion, the BMD decrease positively correlated with SCI, but negatively correlated to etidronate-administration and disease period.

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A study was undertaken to investigate the life conditions of individuals in the Tokyo metropolis with higher brain dysfunction due to neurological disease. Data for this study was collected via interviews. Three hundred subjects were randomly selected from among 1, 234 respondents to a survey designed to determine the prevalence of higher brain dysfunction. Of these 300 subjects, 66 agreed to be interviewed. Many of the subjects had multiple diagnoses, including aphasia (n=32), attention disorders (n=32), and memory disorders (n=29). The interview was designed to determine what their daily activities were, what problems they faced in their daily routines, and who assisted them. The subjects indicated a higher rate of independence in performing three activities of daily living (eating, using the toilet, and ambulating) than in performing five instrumental activities of daily living (conducting business at banks and public offices, managing money, having relation with neighbors, shopping, and going out) (p<0.05, p<0.01, Wilcoxon rank sum test with Bonferroni correction). The individuals requiring assistance in their daily activities most often were helped by family members (97%). Half of the subject reported that they went out every day for a short time but that they stayed close to home. Only a few of the subjects took part in social involvement. The study revealed how people living with higher brain dysfunction due to neurological disease deal with various aspects of daily living.

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This paper presents a preliminary analysis of the ratio of costs to outcome of brain injury rehabilitation. The subject cohort receiving post acute comprehensive rehabilitation comprised 48 people (43 males, 5 females) with 40 severe, 6 moderate and 2 mild brain injury. The patients were subdivided into three groups based on the ability of indoor ambulation at admission; Group A; independence of walking, Group B; independence of wheel chair driving, Group C; dependence of locomotion. The mean FIM score (motor item) in Group A, B and C was significantly improved from 83.8±9.7 to 89.7±4.1, from 54.8±17.0 to 71.2±17.4 and from 24.5±18.4 to 39.0±25.0, respectively. The mean hospital cost per person was 1, 211, 000±535, 000 yen, 2, 367, 000±666, 000 yen and 3, 979, 000±4, 306, 000 yen, respectively. After discharge, all patients could go back to home and 8 patients returned to premorbid work. From this analysis it seems that brain injured patients who receive comprehensive rehabilitation gained better ability of daily living and social outcome, which suggest great cost effectiveness. However, this study may be limited by sample size. It is clear that future research on quality of life must be considered in the investigation of cost effective aspect of brain injury rehabilitation.

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We assessed the effects of treadmill exercise on the renal arterial blood flow and the renal energy metabolism in both fed and starved rats. Male Wistar rats were randomly assigned to one of four groups. The first group did treadmill running on fed condition (fed-EX (+) group). The second group did no treadmill running on fed condition (fed-EX (-) group). The third group did treadmill running after fasting for 24 hours (starved-EX (+) group). The fourth group did no treadmill running after fasting for 24 hours (starved-EX (-) group). Treadmill running was done with 30m/min, grade 0 for 30 minutes. Immediately after the exercise, renal arterial blood flow was measured using an electromagnetic flowmeter. Afterwards, blood samples were collected from both abdominal aorta and renal vein for the measurement of concentrations of glucose, lactate, pyruvate, free fatty acid and immunoreactive insulin. The kidneys were removed for the determination of the contents of lactate, pyruvate and adenine nucleotides. Renal arterial blood flow, the atriovenous difference of the concentration of glucose, and the renal uptake of glucose in both fed-EX (+) and starved-EX (+) groups were significantly lower than those of both fed-EX (-) and starved-EX (-) groups. Renal content of adenosine triphosphate in the fed-EX (+) group was lower than that of the fed-EX (-) group. Meanwhile, the arteriovenous difference of the concentration of the free fatty acid, and renal uptake of the free fatty acid both in the fed-EX (+) and starved-EX (+) groups were significantly higher than those of both fed-EX (-) and starved-EX (-) groups. Renal content of pyruvate, the ATP/ADP ratio, and the energy charge in the starved-EX (+) group were significantly higher than those of the starved-EX (-) group. There was no significant difference in the concentration of immunoreactive insulin among the 4 groups. These results suggest that aerobic exercise after a meal may not give good influence to the renal energy metabolism, and suggest that aerobic exercise before a meal may not be harmful to the renal energy metabolism.

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Horse-riding therapy is applied as an empirical therapy for both physical and mental disease. The purpose of this study was to realize the artificial horse riding systems that include this unique exhaustiveness. Using horse robot as a feasible technology, the method to give the choreography was developed. Another aspect of the exhaustiveness was the virtual reality content displayed to the user. The vision-induced program was proposed and we compared the horse-riding motion with the horse-riding robot motion, controlled motion programs well. We developed and introduce the horse-riding robot system.

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Pulmonary rehabilitation is one of the most important components of compre-hensive treatment for patients with chronic pulmonary diseases. Pulmonary rehabilitation improves muscle fatigue, dyspnea scores for activities of daily living. Pulmonary rehabilitation now has also become an established treatment for those patients to improve quality of life. Pulmonary rehabilitation includes elements of physical therapy, exercise training, education. Exercise training especially lower-limb exercise (e. g., walking, cycling) improves dyspnea sensation after exercise, prolongs walking distance. Upper-limb exercise training improves arm activity with greater increases in unsupported arm training than in supported arm training. Education program decreases the number of hospitalization in patients with asthma but not with chronic obstructive pulmonary diseases (COPD). Some rehabilitation programs contain inspiratory muscle training. However, evidence of clinically important benefits of the inspiratory muscle training has been shown only in inspiratory resistance more than 30% of maximal inspiratory mouth pressure. Pulmonary rehabilitation has these great benefits on patients with chronic pulmonary disease. However, the benefits after the pulmonary rehabilitation program tend to diminish over time and are absent 1 to 2 years. To keep the benefits, home care and/or outpatient pulmonary rehabilitation program are necessary.

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