Objective: The purpose of this study was to investigate the adequacy of timed large amplitude rapid alternating movement patterns (RAMPs) as a measure of motor status following stroke. We were specifically interested in the reliability (internal consistency), responsiveness, and validity of timed large amplitude RAMPs. Design: A retrospective, descriptive, and correlational study. Setting: Inpatient rehabilitation unit of a university hospital. Subjects: The records of 91 patients with a primary diagnosis of stroke were retrieved for this study. Of these records, 32 were complete enough upon admission and discharge for use in this study. Main Outcome Measures: Large amplitude RAMP measures were obtained for each upper and lower extremity using a digital stopwatch. Additionally, the strength of eight muscle actions was assessed bilaterally using hand-held dynamometry. Functional independence of three activities (transfers, gait, and stair climbing) was graded using the Functional Independence Measure (FIM). A sum FIM score was then obtained by adding the score of the three activities together. Results: The timed large amplitude RAMPs were found to have good reliability (alpha>.80) at both admission and discharge. There was a significant difference in RAMP scores between admission and discharge (F=41.824, p<.001), demonstrating that the RAMPs were responsive. Discriminant and convergent construct validity were good. Predictive validity varied depending on the RAMP and outcome measures correlated. Conclusions: Use of large amplitude RAMPs in the examination of patients with stroke is supported by their reliability, responsiveness, and validity.
Exercise testing was used to examine 38 type 2 diabetes mellitus (DM) patients without cardiovascular complications, aged 47-74 years (body mass index [BMI], 23.8 ± 1.6 kg/m2), and 18 healthy volunteers, aged 45-68 years (BMI, 22.5 ± 1.5 kg/m2). A graded cycling exercise test was performed, monitoring gas exchange to evaluate physical fitness and exercise endurance by oxygen uptake (VO2) kinetics. The following results were obtained. (1) Oxygen deficit (O2deficit) and time constant (τ on) at the onset of exercise were significantly higher in subjects with type 2 DM compared with controls (p<0.01). (2) Maximum oxygen uptake (VO2max) and maximum work load were lower by 12% and 15%, respectively (p<0.05). These data suggest a notable abnormality in the cardiopulmonary response at the onset of exercise and a lower exercise endurance in subjects with type 2 DM. These findings may reflect impaired cardiac response to exercise, although an additional defect in skeletal muscle oxygen diffusion or oxygen utilization is also possible.
The isometric knee joint extension muscle strength required for walking was investigated in stroke patients. The subjects were a group of 17 patients who could walk outside parallel bars with a T-cane (ambulation group) and a group of 13 patients who could not walk outside parallel bars with a T-cane (impossible group). The proportion of muscle strength in the affected side to body weight (%) in the ambulation group, 29.7 ± 9.29%, was significantly larger than the impossible group, 9.68 ± 6.94%, at p<0.01. In addition, the non-affected side muscle strength (%) in the ambulation group, 40.9 ± 11.1%, was significantly larger than the impossible group, 32.0 ± 8.80%, at p<0.05. The discrimination point of the affected side muscle strength (%) was 18.3% for the discrimination of ambulation group and impossible group by Mahalanobis distance using only 1 factor, and the positive discrimination rate was 93.3%. In the discrimination using non-affected side muscle strength (%) by Mahalanobis distance, the discrimination point was 36.0%, and the positive discrimination rate was 66.7%. In the discriminant analysis using affected side muscle strength (%) and non-affected side muscle strength (%), using 2 factors, the positive discrimination rate was 93.3%, and it was equal to the discrimination using only the affected side muscle strength (%). Thus, walking outside parallel bars with a T-cane was possible in patients with knee joint extension muscle strength over 20% body weight on the affected side.
The purpose of this study was to clarify the effect of adaptation to and expectation of postural sway caused by perturbation of a platform on initial stances prior to postural response. Twenty healthy university students participated in this study. The joint angles of the ankle, knee, hip, and the neck in initial stance were measured. Adaptation to backward postural sway through repeated perturbations caused the body to tilt backward. However, expectation of backward body sway caused the body to tilt forward, compared with the initial stance when forward body sway was expected. It is suggested that expectation induces the initial stance to stabilize against postural sway mechanically prior to postural response. However, adaptation affects the efficiency of the postural response itself.
This study investigated the oedema-preventing effect of calf muscle pumping (CMP) during and after whirlpool therapy (WT), and whether or not supine lying with or without elevation of the leg would be effective in preventing swelling of the lower leg following WT. Twenty participants underwent 20 min of WT to the experimental leg while performing CMP by means of vigorous dorsi- and plantarflexion of the ankle. Post-treatment conditions consisted of supine lying with or without CMP and supine lying with the experimental leg elevated with or without CMP. Volumetric measurements of the experimental leg were carried out before and after WT. The results showed no effect of CMP on prevention of swelling in the lower leg during WT. However, WT followed by supine lying with the experimental leg elevated resulted in the least amount of swelling. These findings were attributed to increased venous return augmented by gravity. Contrary to the results of a previous study, there was no apparent effect of CMP during and after WT on swelling in the lower leg. A rest period of 10 minutes in supine lying with the leg elevated is recommended following WT to reduce post-treatment swelling of the lower leg.
Public attitudes towards disability and the resulting prejudicial behaviour affects the lives of physically challenged persons. This article explores the attitudes of residents of a provincial city in Japan towards physically challenged persons. It involved measurement of attitudes on the 20-item, Form O of the `Attitudes Toward Disabled Persons (ATDP) Scale'. The 211 respondents consisted of 142 female and 68 male non-physically challenged adults with a mean (and standard deviation) age of 47.30 (15.98) years. The respondents were asked to answer certain statements about physically challenged people and to indicate how much they agreed or disagreed with each of the statements on a 6-point Likert scale. The mean ATDP score of all respondents was 68.84. The highest mean ATDP scores were the 30's age group, followed by 20's, 40's, 50's, 60's, and 70's age groups. Those with a more positive ATDP were either pursuing a helping profession or had experienced such work. The males and females showed no difference in ATDP. Physiotherapists should be aware of the gap in perception between the ideal attitude that health professionals would like society to have and the reality. They should, therefore, endeavour to promote a `barrier-free' mind among members of the community.
Objective: Efficacy of collar treatment on clinical symptoms and vertebral blood flow was examined in 23 patients with cervical spondylartrosis complaining of vertigo. Methods: In pretreatment and posttreatment periods, the following parameters were studied: 1) frequency of cervicocephalic symptoms, 2) influence of severity of the vertigo on daily life activity, 3) range of active cervical joint movement, 4) pain in cervical palpation, 5) vertebral blood flow by Doppler ultrasonography, and audiologic and brainstem auditory evoked potential (BAEP) examinations for hearing. Results: Following 1 month of collar treatment, vertigo and amnesia were the only symptoms which were significantly relieved (p=0.01, p=0.03). In addition, the severity of the symptoms were noticeably decreased. Range of cervical joint movements on extention, lateral flexion and rotation were increased. Cervical palpation was reduced and the pain was less. However, no change was observed in vertebral blood flow, audiometric and BAEP examinations. Conclusion: It was concluded that vertigo in cervical spondylartrosis was not a consequence of vertebrobasillar insufficiency. Hypertonicity in cervical muscles was the primary reason for vertigo in these patients.
The Sensory Organization Test (SOT) is a well accepted and commonly used method to quantify stance stability under varying sensory conditions. However, the accuracy of each machine may vary thus hindering the comparison of results from different laboratories. The purpose of this study was to investigate the consistency of postural stability measures of the SOT conducted on two machines made in 1991 and 1997. Three postural stability measures (equilibrium score, sway area, sway velocity) were obtained using standardized static weights (20-80 kg), swaying weights (21-81 kg), and human subjects (n=10, mean age=22.2 years) on the two machines. The testing sequence was balanced between machines. The results showed good consistency between machines while using the swaying weights and while human subjects were tested. However, a significant difference between machines was found while using the static weights (p<0.05). It was concluded that the computerized postural stability measures of SOT have good inter-machine consistency with non-stationary weights and humans, but that the static weight should be added to the calibration routine to detect abnormal machine behaviors.
Objective: to investigate the long-term functional outcome in patients with ischemic stroke, and to investigate whether there is a functional difference between the left and the right cerebral hemispheric lesion. Methods: 489 subjects who had supratentorial ischemic lesions ≥20 mm in diameter by MRI. We sent a mailed questionnaire to these patients two years after stroke onset. Two hundred and ninety-one patients responded to our letters. One hundred and fifty patients had left cerebral hemispheric lesion (LHL), and 141 had right hemispheric lesion (RHL). We graded the stage of the locomotion function into 5 categories: normal, walk alone with cane and/or brace, walk with aid, wheelchair, and bedridden. Results: were as follows; 1) There was no significant difference of locomotion function between LHL and RHL at the time of discharge as well as 2 years after onset, although patients with RHL had a tendency to poor prognosis for bathing activities and dressing activities (p=0.0994, p=0.0728, respectively). 2) Long-term outcome of locomotion function in patients with LHL <65 years was significantly better than that in patients ≥65 years (p=0.0199). Conclusion: In patients with ischemic stroke there was no significant difference of locomotion function between left cerebral hemispheric lesion and right cerebral hemispheric lesion at the time of discharge as well as 2 years after onset. Although the functional prognosis did not differ with regard to left versus right cerebral hemispheric lesions if the age was not considered, there was a difference when age was taken into consideration.
The human cervical structure is a complex arrangement in which an important array of bones, soft tissues and vital organs are collected in a closely-packed area. There are numerous small and large muscles which act together to induce head and neck motion in a certain direction. The cervical muscles are also involved in many audiovisual reflexes, which are a complicating factors in clinical evaluations. Because of this anatomical compaction and the complexity of the upper motor neuron reflexes involving the cervical muscles, there is as yet no general understanding of the anatomy and function of the neck muscles. This gap in our knowledge may in part be due to a lack of proper examination tools or to a failure to examine the applicability of the present methods for evaluating cervical muscle function. Today the field of biomechanical evaluation of the cervical spine needs an easy and practical method which would also be replicable in follow-up studies such as rehabilitation assessments. Within the last decade, parallel to methods like electromyography and muscle strength tests, a few imaging techniques, particularly computerized tomography, magnetic resonance imaging and ultrasonography have been used to evaluate the function of the cervical muscles. In the present article, the application of the current biomechanical methods in the assessment of the individual cervical muscle function is discussed.
We investigated the disturbance of physical condition following evacuation of the bowels in patients with chronic cervical spinal cord injuries. The cases dealt with 17 patients who had incurred spinal cord injuries a year or more before. We measured patients' blood pressure, heart rate, and fingertip plethysmography during the evacuation procedure. Also blood pressure, heart rate and fingertip plethysmography were measured before and after the tilting test. Fourteen patients out of 17 complained about their physical condition with such complaints as feelings of exhaustion, listlessness or dizziness after evacuation. We observed a rise in blood pressure and a lowering of fingertip plethysmography during evacuation. Immediately after getting on the tilt table, these patients experienced a decrease in blood pressure and an increase in heart rate; however, compared to the day before evacuation, the heart rate increase was not considered significant and the wave height for finger plethysmography was low. The strain on the sympathetic nerves due to evacuation causes autonomic dystonia which means the parasympathetic nervous system is dominant and causes impairment of circulatory function.
Once low back pain (LBP) occurs, it is easily prolonged and may become a chronic problem. LBP is an occupational problem among nursing staff at welfare facilities, and we investigated LBP and related matters in nursing staff, who work in health and welfare facilities for the elderly and at a special nursing home. The results concerning staff with LBP and those without LBP were analyzed statistically. There were significant differences between staff with LBP and those without LBP in pain, physical tiredness, mental tiredness, and the physical condition of the pain. Result items without significant difference were stress on the job, master of the basic nursing techniques, and LBP as an occupational injury. Because there is no difference when considering the mastering basic nursing techniques, there is a possibility that many of the people with LBP are contributing to the injury unconsciously, due to improper posture and environment. Especially, the posture used in changing diapers was suggested to be closely related to the appearance of the disease of LBP.
It is clear that maximal mouth pressure (PEmax, PImax) is influenced by sex, aging, anthropometric data, lung function and activities. However, the influence of posture has not been studied, and in this study we studied the influence of postures on maximal mouth pressure. Nineteen healthy, young adult students from WCMAS comprised a STANDING study group, and 27 healthy, young adult students from IUHW comprised a LYING study group. Maximal mouth pressure was assessed in the sitting, sitting with elbow on knee (the orthopneic position), standing and supine postures. Changing posture was significantly related to maximal mouth pressure. PEmax and PImax in the orthopneic position were stronger than in other postures, and in the comparison of supine and standing posture, PEmax while standing was significantly lower than PEmax while sitting. It was concluded that respiratory muscle strength changes with posture because of the tension generated by changing interabdominal pressure, and muscle length change with changing posture.
We studied the influence of posture on maximal mouth pressure in Part I. The study of Part II was aimed at determining the influence of trunk flexion on maximal mouth pressure. Nineteen healthy, young adult students from WCMAS comprised a STANDING study group, and 27 healthy, young adult students from IUHW comprised a LYING study group (same subjects of Part I). Maximal expiratory mouth pressure (PEmax) and maximal inspiratory mouth pressure (PImax) were measured at 0, 30, and 60 degrees of trunk flexion. Posture changes were significantly related to maximal mouth pressure values, and trunk flexion from the standing posture statistically influenced maximal mouth pressure. PEmax and PImax in standing were enhanced with trunk flexion. Respiratory muscle strength changes with trunk flexion, because respiratory muscle tension occurs with the change in interabdominal pressure and the muscle length-tension relationship.
It is well known that active horseback riding therapy is effective for body muscle function and psychological well-being. Initially, we wanted to introduce this horseback riding therapy into Japan. But, there are practical difficulties with regard to keeping horses in our country, especially in hospitals of urban areas. Therefore, we think the only (practical) method of reproducing horseback riding conditions is the simulator. One purpose of the development of a horseback riding simulator is to make an assessment system and to establish a training system for body-balance functions. Another purpose is for the strengthening of leg and trunk muscles through active prevention of loss of balance. Consequentially, the muscles are trained, and the simulator leads to the treatment of Lower Back Pain. In 1985, KIMURA developed a prototype horse back riding simulator. It was a machine, which made six movements, which reproduced the movement of a horse's saddle. Six motors were used for the machine. The six movements were: ¨ pitching movement, ¡ roll movement, ¬ twist movement, movement forward and backward, side to side movement and vertical movement. Although individual movement was possible, the six movements were not synchronized. After the passage of ten years, we have now succeeded in the reproduction of the movement of a horse's saddle by using a parallel mechanism and motion capture. A computer memorized a horse's movement, and reproduces the horse's back movement in the simulator. We could make the electro-myographical analysis of the rider.