Children with spastic cerebral palsy (CP) have a strictly individual gait with numerous variations, which is also characterized by increased tonus and hyperreflexion of the muscles. These factors lead to a gait pattern that is inefficient in terms of consumption of energy. The purpose of this study was to clarify the major factor of the deterioration of walking ability on patients with cerebral palsy. Eighteen children (ten boys, eight girls, average age 12.7 years) with CP participated in the study. The children were divided into groups: the independent walking group and the walking aid group (walking with crutches and wheeled walkers); and the diplegia group and the hemiplegia group. The physiological cost index (PCI) for a 3 minute walk at comfortable speed was measured. PCI was compared to the reaction of the cardio-pulmonary system in basic motions (standing up from a table and 10 m walking). Through this test, the whole heart rate and 10 m walking time were measured. PCI and 10 m walking time in the independent walking group and the hemiplegia group were significantly lower than in the walking aid group and the diplegia group, but there was no difference in the endurance index between them. PCI had a significantly positive correlation with the 10 m walking time. However, PCI did not correlate with repetitions and difference in heart rate between before and after standing ups. From these results, it was concluded that the contracture, muscles weakness in the lower limbs, had a strong influence on ambulation level and energy expenditure in spastic CP.
The purpose of this study was to determine whether knee and ankle muscle fatigue affect one-leg static standing balance. We compared the affects of muscle fatigue between the knee and ankle joints on one-leg static standing balance. Sixty-four healthy subjects were used for this study: 44 men and 20 women, with an average age of 19.5. One leg static standing balance was measured at pre-fatigue and post-fatigue status by an instrumented balance assessment system (Kinesthetic Ability Training Balance Platform) which is commercially available for testing and balance training. Isokinetic exercises performed at 180 degree/sec on the Cybex 1200 were used to induce muscle fatigue. One-leg static standing balance ability was significantly decreased after knee and ankle muscle fatigue. There was a significantly greater decrease in one-leg static standing balance ability in ankle joint muscle fatigue as opposed to the knee joint muscles. Although these phenomena were not clearly understood, these results have important implications for rehabilitation of fatigable patients. These results suggest that excessive fatigue during rehabilitation may increase risk of reinjury and falling due to balance disturbance in patients with diseases involving fatigue. Further studies are required to determine the physiological mechanisms of muscle fatigue that play a role in decreasing one-leg static standing balance.
Chest physical therapy (CPT) is important to introduce and continue home oxygen therapy (HOT) of patients with chronic pulmonary disease. We examined the effects of CPT for twenty-five patients undergoing HOT. To compare the effects of CPT for HOT patients and non-CPT, we evaluated respiratory rate (RR), tidal volume (VT), rapid shallow breathing (RSB) index, muscle contraction of diaphragm and scalenus muscles while breathing (muscle contraction pattern while breathing), six minutes walk distance (6MD), Borg scale, rate of change of oxygen saturation (ΔSpO2) and heart rate (%HRmax) during 6MD, activities of daily living (ADL), and mood disorder. Our results show that VT, RSB index and the Borg scale were significantly better in the CPT group. These results show the efficacy of CPT for HOT patients to maintain their respiratory function.
To study the recovery of walking in an 85 year old man who had right hemiplegia after suffering a cerebral infarction, electromyograms (EMGs) were recorded from his leg muscles. We used signs for instability that we derived from EMG patterns seen in the developmental process of normal infants. The myoelectric activity at one month after the stroke showed many patterns indicative of unstable walking, closely resembling activity patterns seen in very unstable independent gait of a one year old baby in the first month of learning to walk. Seven months later, these patterns indicating unstable gait tended to have decreased or disappeared, although some marked activity betraying instability still remained. However, when the patient walked with the support of a hand cart and was able to hold his trunk upright, these excessive muscular activities decreased or disappeared, closely resembling the stable adult walking pattern. We recommend further study of the evaluation of recovery of walking after stroke by comparing the patient’s EMG patterns to those not only of normal adult human gait, but also of the development of human walking in early childhood.
The purpose of this study was to evaluate the effect of amezinium metilsulfate (amezinium) on orthostatic hypotension (OH) and physical fitness in cervical cord injuries. Eighteen patients with clinical tetraplegia (mean age of 23.6 years, mean period after injury 3.2 years) were administered amezinium (10 mg/day) orally every day for 8 weeks. Head up tilt test, measurement of CVR-R with cardiac beat-to-beat variation test and exercise testing using respiratory gas analysis with an arm ergometer were performed before and at 8 weeks after administration. The average minimum level of systolic blood pressure (SBP) with head up tilting rose significantly from 52.8 to 73.5 mmHg and decrease in SBP with tilting was reduced after administration, while the result of measurement of CVR-R did not change. Mean percentage oxygen uptake (%VO2) and percentage heart rate (%HR) increased significantly from 38.1 to 43.5% and 54.6 to 63.8% respectively in exercise testing. These results indicate that amezinium is of therapeutic value for the treatment of OH and improvement of physical fitness in cervical cord injuries.
With the primary objective of examining a useful index for appropriate knee joints of above-knee prosthesis, the effect on the human body was studied by measuring walking velocity (m/s), stride length (m), and walking. Subjects consisted of 4 above-knee amputees, and the measurement was conducted using a three-dimensional co-ordinate recorder and a gait analysis system of a force plate. The results suggest that the effect of knee joints can be evaluated by walking energy consumption per unit gait distance.
Glucose intolerance occurs frequently in patients with spinal cord injury (SCI). To clarify this better, 24 patiens with spinal cord injuries received an oral glucose tolerance test (OGTT) and the causal relationships between glucose tolerance and body fat composition were analyzed. More than 50% of SCI patients had elevated plasma insulin levels, although the subjects were not obese, suggesting adipose tissue resistance to endogenous insulin.
The purpose of this study was to investigate the effects of cervical traction on flexor carpi radialis H reflex amplitude in ten healthy men who were held in a fixed supine position. Cervical traction at intensities of 3, 6, and 9 kgf was applied for one minute and the H reflexes were evoked before, during and after the application of traction. At each intensity tested, cervical traction showed the tendency of facilitating the H reflex, and, especially, the H reflex amplitude during and after the application of cervical traction at an intensity of 3 kgf was significantly greater than that under the condition where no traction was applied. Cervical traction of greater intensity tended to have a stronger facilitatory effect on H reflex amplitude. These results were opposite to the findings in a previous study concerning the soleus H reflex performed by the same experimental procedure. These results suggest that a facilitatory mechanism and an inhibitory mechanism interact and the sum of these mechanisms modulates the gain of the FCR H reflex pathway. Flexor reflex afferents may play a role in the facilitatory mechanism.
Influences on dynamic balance were examined by comparing footwear with clog thongs such as slippers with clog thongs, to footwear without them such as slippers without clog thongs, leather-soled sandals, and Japanese socks. Forty three university students in good health took part in this examination. In the case of footwear with clog thongs, postural response latencies to horizontal movement of the platform were decreased when compared with that for slippers without clog thongs. In the case of footwear with clog thongs, standing strength was decreased when the platform moved horizontally, compared with that for slippers without clog thongs. Among footwear with clog thongs, in the case of Japanese socks, both latency and strength were minimal compared to slippers with clog thongs and leather-soled sandals. Therefore, it can be said that footwear with thin soles, low heels and clog thongs the most stable and the best for preventing a fall.
The purpose of this study was to assess the construct validity of the Berg Balance Scale (BBS) in stroke inpatients. We measured the BBS score of 46 stroke patients, and simultaneously assessed the following neurological conditions: attention, mental status, emotion, agnosia, visual perception, sensation and motor status of the affected lower extremity. We also assessed functional independence in the basic activities of daily living using the Barthel Index. Patients’ functional walking abilities were categorized into 4 levels (from with assistance to independent within hospital). The mean BBS scores were associated with attentional deficits, emotional distress, proprioceptive sensation problems and motor status. These neurological conditions explained 43% of the BBS scores. The BBS scores correlated with the Barthel Index and were associated with functional walking ability. The BBS scores and walking ability explained 67% of the Barthel Index. 83% of patients scoring above a score of 40 were independent within hospital in functional walking ability. These results provide information to support construct validity of the BBS in stroke inpatients.