Diagnosis and Up-to-date Treatments for Neurogenic Bladder Dysfunction…Yasuhiko IGAWA 87

Central Nervous System Control of Micturition…Ryuji SAKAKIBARA, Masahiko KISHI, Emina OGAWA, Fuyuki TATENO, Akihiro OGAWA, Keiichiro TERAYAMA, Hiroyuki HARUTA, Takashi AKIBA, Tomoyuki UCHIYAMA, Tatsuya YAMAMOTO 94

A Systematic Rational Team Approach for the Urinary Care of Hospitalized Diaper-dependent Elderly Patients…Eiji IWATSUBO 102

A Team Approach for Urinary Disturbance used in the Kaifukuki Rehabilitation Ward…Yoshiko NOMOTO, Noriaki HISAMATSU, Keisuke HORINOUCHI, Keizo SHIGENOBU 108

Is Hospital Care Manpower Sufficient? Official Staff Hours are Inadequate for establishing Patient Urinary Independence…Hiroko SHIKATA, Mayumi NAGANUMA 112

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We have developed a new gait assisting device for patients with hemiplegia, by which a single therapist alone can work with : 1) swing of the paretic limb, 2) stance of the paretic limb, and 3) alternate lateral weight-shift during gait. This device (ASSWS : Assistance of Swing, Stance and Weight Shift) imitates the kinesiological complex (patellar ligament, quadriceps, iliotibial ligament and gluteus maximus) to maintain a standing posture for the lower extremities. We compared the results of a gait analysis using a motion analyzer for gait with ASSWS and gait without ASSWS. With ASSWS, the walking speed was faster, stride length was longer, and stride duration was shorter. No differences in floor reaction force were identified. With ASSWS, the flexion peak of the hip joint became larger and the knee joint was in a more flexed position throughout the walking cycle. Also, the joint moment of hip extension, hip flexion and knee extension all increased with use of the ASSWS.

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Skeletal muscle is known to be set at an over-stretched length in clinical tendon transfer. Such chronic stretching of skeletal muscle increases the serial sarcomere number required for muscle adaptation. Passive tension of the muscle must be affected during the adaptation. Thus, the objective of this study was to clarify the origin of increased passive tension after stretched tendon transfer in an animal model. The distal tendon of the extensor digitorum of the second toe was transposed to the extensor retinaculum at 3.7 mm of muscle sarcomere length. The contralateral muscle served as control. Muscle passive length-tension curves were measured at 1 week and 4 weeks after the transfer to the bilateral muscles. After functional measurements were taken, the muscles were dissected into fiber bundles and single muscle fibers to measure their passive mechanical properties with a micro force transducer. Passive tension was increased in the transferred muscle with a steeper inclination and leftward shift of muscle length-tension curve. Elastic modulus of the transferred fiber bundle increased at both time points, while those of the transferred single fibers increased only at 1 week. Results of the study suggest that the transferred muscle increased passive tension mainly due to proliferation of extracellular connective tissue within the muscle. Increased passive tension was a characteristic feature for the transferred muscle, which may ultimately represent a target for therapeutic intervention to optimize muscle function.

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