Independence in eating is one of the goals in the therapeutic intervention of people with severe disabilities of the upper extremities, who lack the voluntary movements and are completely dependent upon others to feed them. We performed a three-dimensional motion analysis using the Vicon system on a normal subject and found that the use of chopsticks and forearm supination/pronation are critical components. These were incorporated in a meal manipulator to help promote ease and accuracy of control of the device. The manipulator included a base that made positioning of the manipulator flexible; a swing arm that moves to the same point each time; a terminal device that holds the half-spoon-shaped chopsticks and produces supination/pronation movements; a table that moves the food into position for reaching; and, a control box that the user can manipulate by mouth or chin. Consequently, the user is not fed but uses his/her remaining functions to eat independently. The manipulator was evaluated on two high level quadriplegic subjects, who provided valuable feedback. The authors concluded that independent eating using a meal manipulator could be very beneficial psychologically. Collaboration between engineers and therapists may lead to more independence for the disabled.
Blood volume is influenced by physical activity. Physical activity in patients with spinal cord injury is lower than able-bodied individuals and associated with the level of lesion. We hypothesized that blood volume in patients with cervical spinal cord injury might be lower than able-bodied individuals and influenced by the level of lesion. To eliminate the effect of the lesion level, we determined blood volume by Evans blue dilution technique in 9 male patients with cervical spinal cord injury (age; 25.9 ± 1.9 years, mean ± SEM) whose level of lesions were C6 and compared them with 5 male able-bodied individuals (age; 27.6 ± 1.9). Plasma volume and blood volume in patients with cervical spinal cord injury were similar to those in able-bodied individuals. Despite the lower activity level of patients with cervical spinal cord injury in a wheelchair, blood volume did not change. Maintenance of blood volume in patients with cervical spinal cord injury is probably due to a reduction of central blood volume. The mechanism underlying reduced central blood volume appears to be lower vessel tension caused by autonomic nervous system dysfunction and/or lack of the muscle pump below the level of spinal cord lesion.
The objective of this study was to quantitatively analyze differences in diaphragmatic motion between supine and prone positioning during resting breathing using dynamic Magnetic Resonance Imaging. Total diaphragmatic motion (TDM), defined as total excursion of the anterior (ANT), central (CNT), and posterior (PST) diaphragm, was 61 mm in the supine position and 63 mm in the prone position. No significant difference in TDM was apparent in response to change in positioning. Diaphragmatic motion was greatest in the PST > CNT > ANT with supine positioning, and PST > ANT ∼ CNT with prone positioning. In both positions, motion tended to be greatest in the posterior diaphragm. However, relative changes in CNT and PST were less with prone than with supine positioning. These findings suggest that ventilation in the posterior lung fields is decreased to a greater extent with prone than with supine positioning.
The purpose of this study was to examine the transition with time of enthesopathy and the effect of guided stretching, in order to search for the possibility of physical intervention to prevent sports injury during the growth period. The subjects were 81 male soccer players who played in the extramural soccer team. They were divided into two groups: 13 who had experienced enthesopathy problems and a group of 68 who had not. Measurements were taken before and after intervention and were measurements of muscle tightness and alignment, etc. In all subjects, a significant improvement was found in tightness of the bilateral hamstrings and left quadriceps. However, when the results of subjects belonging to the group which had enthesopathy before intervention were compared, significant reinforcement of tightness of the right ilio-psoas was found. The reason for this is considered to be because the intervention method was inadequate. This suggests the importance of individual guidance, and especially confirmation of enforcement and guidance over time for players who have enthesopathy.
The purpose of the present study was to investigate the short latency motor response of the swallowing-related muscles evoked by the transcranial magnetic stimulation of the trigeminal nerve. The subjects were 10 healthy humans aged between 18 and 37. Magnetic stimulation was delivered to the cranial nerve through the scalp, and the EMG responses were recorded from the suprahyoid muscle complex. The EMG responses were effectively evoked when the center of the round coil was at the locus 8.8-12.5 cm lateral and -1.5-3.6 cm posterior to the vertex. The latencies of the EMG responses were between 3.5 and 5.6 ms. The precise locus of the stimulation evoking the EMG responses was searched for using a figure-eight-shaped coil, and it was found that the EMG responses were most effectively evoked when the hot spot of the coil was at the locus 14-16 cm lateral and 4-6 cm posterior to the vertex, and when the induced current flow was posteriorly directed in the brain. This technique should be applicable for investigating the swallowing-related motor system.
Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy and is often complicated by overuse the wrist in paraplegic and hemiplegic patients. The aim of this study was to determine the usefulness of ultrasound measurements and their best diagnostic criterion for CTS, and to reveal the feature of CTS among paraplegic and hemiplegic patients. Ninety-four patients with 132 wrists clinically and electrophysiologically diagnosed CTS, and 137 asymptomatic controls matched for age and sex were enrolled. Three ultrasound measurements were assessed: major and minor diameters, cross-sectional areas, and flattening ratios at pisiform bone and hook of hamate bone levels. Values for each of the three variables without flattening ratios of pisiform bone level were significantly different in CTS population compared to control population. Also, a strong relationship was found between the severity and the enlargement of the median nerve. Total cross sectional areas at the pisiform and hook of hamate levels larger than 16 mm2 proved to be highly predictive of CTS. The incidence of CTS among hemiplegic and paraplegic patients fully independent of ADL was 8.5%. These handicapped CTS indicated no significant ultrasound values compared to other non-handicapped CTS.
We investigated exercise tolerance for driving a wheelchair, the means of moving in daily life for patients with cerebrovascular disorder-associated hemiplegia who have difficulty with walking. The subjects were 15 inpatients with cerebrovascular disorder-associated hemiplegia at our center (62.3 ± 9.3 years old). Physical therapists selected an appropriate standard wheelchair for the patient's body, and analyzed expiratory gas while drividing the wheelchair. Using a respiratory metabolism measurement system, the patient kept a resting sitting position until the heart rate reached a steady state, then drove the wheelchair for 6 minutes. A positive correlation was observed between the VO2 and heart rate during exercise driving a wheelchair in patients with cerebrovascular disorder-associated hemiplegia (p<0.05). We suggest that driving a wheelchair is a useful means of moving that maintains stable posture for patients with cerebrovascular disorder-associated hemiplegia who have difficulty with walking, and that exercise by driving a wheelchair may be applied to HR management as training.
The purpose of this study was to investigate the correlations among motion control ability, joint position sense ability, and muscular strength adjustment ability in 15 healthy subjects. Motion control ability was measured by having participants jump with eyes closed to what they thought were distances of 25, 50, and 75% of their maximum jump in the vertical and standing broad jump. Joint position sense ability was measured by 8 tests at the left knee angle for subjects with closed eyes in seated and standing positions. Muscular strength adjustment ability was assessed by measuring the torque by Biodex System 3 of the demonstrated contraction when study subjects contracted their hip and knee extensors, and knee extensors to what they thought was 50% of their maximum voluntary muscle contraction. Results show relationships among the three abilities. We suggest that motion control ability is influenced by joint position sense ability and muscular strength adjustment ability.
The purpose of the present study was to investigate long-term prognosis of patients with stroke and to identify predictive factors for functional outcome. Subjects were consecutively hospitalized 1,056 patients with stroke due to unilateral hemispheric lesions at the Department of Neurology, Kitasato University Hospital from 1986 to 1997. One hundred and eighty-three patients died during hospital stay. The remaining 873 surviving patients were followed for 5 years after onset of stroke. Locomotive function (mobility status) of surviving patients was assessed by questionnaires mailed at 2 years and at 5 years after stroke. Outcome of locomotive function was classified into the following 5 categories: normal, walk alone, walk with device, using wheelchair, and bedridden. The following factors were tested by means of multiple regression analysis: age, sex, level of consciousness, location and size of lesion, history of previous stroke and 2 major risk factors for stroke (hypertension and diabetes mellitus). The results of multivariate analysis revealed that in patients with intracerebral hemorrhage, although level of consciousness on admission was the strongest predictor at discharge, locomotive function at discharge was the most important predictor at 2 years and at 5 years after stroke. Moreover, age was more strongly related to functional outcome than level of consciousness at 2 years and at 5 years after stroke. This trend was also found in patients with cerebral infarction. Multivariate analysis revealed that a linear combination of these predictors accounted for about 50% of the variance in the estimate of functional outcome at 2 years and at 5 years after stroke. The results of the present study suggest that the long-term outcome of stroke patients is more deeply influenced by unidentified factors which may not be present during the hospital stay.
The specific purpose of this case study was to investigate whether forced expiratory technique (FET) improves the peak expiratory flow compared to coughing in a 53-year-old man with amyotrophic lateral sclerosis (ALS) who presented with bulbar symptoms. Approximately 12 months after diagnosis, his peak cough flow did not exceed 160 L/min, and cough became ineffective. However, FET could generate peak expiratory flow to a point over the 160 L/min threshold until 14.5 months after diagnosis. As a result, FET delayed the need for tracheostomy. When the forced vital capacity (FVC) was observed to be markedly decreased and it was 1,600 mL, the patient was unable to achieve 160 L/min of peak expiratory flow generated by FET. Patients with bulbar onset ALS who have FVC greater than 1,600 mL may benefit from FET.
Accurate in vivo data concerning the movement of the menisci through the full range of motion of the knee joint are lacking. Using a superconductive open-type magnetic resonance (MR) imaging system, we investigated the movement and morphological changes of the menisci during non-weight-bearing deep knee flexion. In 20 healthy adult subjects (mean age, 21.5 years), the knee was moved from 0° to passive maximal flexion (mean angle, 147°), and sagittal images of the knee were taken using a superconductive open-type MR system. In each meniscus, backward movement distance during deep knee flexion and the ratio of anteroposterior internal diameter at deep flexion to that at extension were calculated. For both menisci, the backward excursion of the anterior horn was significantly greater than that of the posterior horn. No difference was significant between the excursion of the anterior horn of the medial meniscus and that of the lateral meniscus during deep knee flexion, but the excursion of the posterior horn of the lateral meniscus was significantly greater than that of the medial meniscus. When the knee was deeply flexed, the anteroposterior diameter of the meniscus was significantly reduced for both the medial and lateral menisci, as compared with the diameter when the knee was extended. In young healthy individuals, the movement and morphological changes of the menisci during deep knee flexion suggest that the menisci might adapt to the environment formed by the combination of the femoral condyles and tibial plateaus throughout the full range of motion.
The objective of this study was to show how gait was controlled on low friction surfaces in young subjects after they had had sufficient practice of walking under such conditions. Twenty healthy adults were examined using a force plate and a motion analysis system. Slip distance, gait speed and step length showed no significant difference between the normal and low friction floors. The peak of required coefficient of friction (RCOFpeak) on the low friction floor was significantly smaller than that on the normal friction floor (p<0.01), as was the distance between the forward-backward position of the center of mass (COMy) and that of the center of pressure (COPy) during the landing phase. The RCOFpeak showed a significant correlation with the distance from the COMy to the COPy. The peak moment of hip joint extension during the early landing phase on the low friction floor was significantly larger than that on the normal friction floor (p<0.01). These findings suggest that, on a low friction surface, the COMy during the landing phase is closer to the landing foot, and that this transition of COM reduces the RCOFpeak. It also suggests that this larger moment of hip joint extension on a low friction surface may assist in shifting COM ahead just after heel strike.
Achievement of optimal level of functioning of a patient or client must be one of the main goals of any physical therapy intervention. To achieve this, the physical therapist must look at the interaction of multiple body systems, evaluate and identify disabilities and impairments based on these interactions, and design treatment plans that treat the person as a whole. This evaluation may become complex as the clinician recognizes the significant contribution of associated medical conditions and risk factors in the individual's prognosis and expected outcomes. This case report illustrates the importance of these concepts in the optimal rehabilitation of an individual who sustained an elbow fracture with displacement, and has numerous preexisting medical conditions and risk factors that at the outset may appear to be significant complicating factors in her progress following therapy. Central to her achievement of favorable results included early medical and physical therapy intervention. Key components of the therapeutic intervention include AROM/ PROM to the joint, appropriate scar tissue mobilization and steady progress into functional activities. From the therapist's perspective, it was important to address the injury at hand as well as the various comorbidities affecting the main problem. From the standpoint of the subject, empowerment of the individual to her own health and well-being provided the necessary motivation to achieve optimal function.