This study was conducted to investigate the discriminant construct validity of two measures of knee extension strength: hand-held dynamometry and manual muscle testing. The study employed a retrospective analysis of medical records and comparison of patient data with published reference values. The knee extension strength of 38 consecutive patients with a variety of problems requiring home based rehabilitation were measured bilaterally by hand-held dynamometry and manual muscle testing. Data were examined using analysis of variance, a Wilcoxon test, and contingency table analyses. Hand-held dynamometry was able to distinguish between the knee extension strength of patients and healthy subjects and between the stronger and weaker sides of both groups. Manual muscle testing was also able to differentiate between the strength of the stronger and weaker sides of patients. The sensitivity of manual muscle testing to differences between sides, however, was poor. The agreement between hand-held dynamometry and manual muscle testing as to the presence of a difference between sides was only fair (k=.240). If the identification of knee extension weakness relative to an external standard or a stronger side is important, hand-held dynamometry may be a better measurement procedure than manual muscle testing.
Questionnaires were posted to 220 Japanese physiotherapists to investigate on what their choice of treatment was based for stroke clients and to compare these results with those from Sweden. As in Sweden, the respondents attached most importance to ‘hands-on’ experience working with clients and to participation in practical courses in which they learned various techniques. Among the treatment methods taught during the respondents’ basic training, only Bobath's method commonly continued to be used after graduation in both countries. Asked to treat a client with right hemiparesis, the majority of Japanese respondents chose functionally meaningful movement of the right side, whereas the Swedish respondents preferred weight bearing on the affected side. The attitude of physiotherapists towards new methods of treatment revealed that 77% of the Japanese respondents and 91% of those in Sweden were interested. This could imply that Japanese physiotherapists are already satisfied with their choice of treatments and are not looking for new approaches to treatment. It appears that it takes more time for foreign-developed methods to be introduced and accepted in Japan than it does in Sweden. This suggests that the availability of post-registration courses on newer approaches to stroke management may be limited in Japan.
We studied the effect of transcutaneous electrical nerve stimulation (TENS) on phantom limb pain (PLP) in amputees. The TENS was applied to the sites of the contralateral limb which corresponded to the portion of the amputated limbs where the patients felt their PLP. The stimulation was carried out three times a day for 30 min each. A total of ten amputees (8 lower extremities and 2 upper extremities), mean age of 57 years, suffering from severe PLP which hampered prosthetic and walking training, were included in this study. Using the visual analogue scale (VAS), the patients themselves evaluated the immediate and accumulated effects of the treatment on their pain. As a result of the treatment, 9 weeks on average, there was significant pain relief with a final VAS of 1.2 ± 1.9 compared with the initial VAS of 5.5 ± 1.7 (p<0.001). An immediate excellent effect was obtained in 8 patients and good in 2, although the accumulated effect was ascertained in 8. The effect was not only on the degree and duration but also on the area of the pain. Reduction of the pain resulted in better appetite and sleep as well as prosthetic and walking training. The TENS of the contralateral limb was considered to be the preferred choice for treatment for the PLP.
Abnormal muscle tone with a specific motor pattern is observed in the affected side of a hemiplegic patient, who receives motor stress on the unaffected side of the upper limb during therapeutic exercise. In order to clarify the relation between the intensity of motor stress on upper limbs and changes in muscle tonus of lower limbs, we examined the changes in the H-reflex of the bilateral soleus muscle induced by grasping with the left hand, using repetitive evoked electromyograms at a stimulus frequency of 5 Hz. Eight healthy male subjects volunteered for this experiment. Subjects grasped a sphygmomanometer cuff by the left hand at five degrees of load intensity, 0, 20, 40, 60 and 80% of maximum voluntary contraction, and 10 consecutive H waves were recorded from the bilateral soleus for each intensity. The H-reflex of the right soleus increased significantly (p<0.01) with increasing grasping strength of the left hand, but that of the left soleus showed hardly any change. Right hemisphere dominance in the left upper limbs concentrated on grasping with the left hand resulted in disinhibition of the left cerebral hemisphere. The H-reflex from the right soleus was consequently increased.
In the present study we examined the effect on physiological cost of different arm positions when standing up using physiological measurements. Ten healthy young women were used as subjects. They stood up at their own speed from a sitting position on a seat of 40 cm and 20 cm height. Their actions were captured on video and from stills we measured the knee angles at which they found it easiest to stand up. With reference to these measurements, we then set the knee angles at 95° and 125°, respectively, and compared standing up with the arms extended forward in a horizontal position with standing up with the arms held downwards at the sides of the body in a vertical position. Each subject was required to stand at a prescribed frequency while we measured Oxygen Uptake (VO2), Heart Rate (HR) and Ratings of Perceived Exertion (RPE). The results were, that compared with the vertical position, a reduction of the trunk flexion angle was observed when standing with the arms in the horizontal position. Also, in the case of standing from the seat of 40 cm height alone, VO2 showed a significantly high value with the arms in the horizontal position, but no significant differences were noticed in HR or RPE. Furthermore, when standing from the seat of 20 cm height, no significant difference was seen between the two arm positions in any of the measured values. From these results we conclude that the movement of standing up with the arms held in the horizontal position does not necessarily have the effect of reducing the physiological cost.
The aim of this study was to examine the reliability and validity of the Japanese version of the Self Esteem Inventory (SEI) for use in Japan. Internal consistency and split-half for the scales’ reliability, criterion-related validity and construct validity were tested on 244 primary school children. At the same time, the subjects responded to the Father, Mother and Child Relationship Inventory (FMCI) and the General Anxiety Test (GAT) questionnaires. Cronbach’s α coefficient for each of the above three scales was 0.84, 0.94, and 0.93, respectively, and the split-half was 0.80, 0.91, and 0.85, respectively, indicating satisfactory reliability. No difference was observed between male and female for the SEI or the FMCI but a significant difference was observed between the sexes in the GAT results (p<0.01). Criterion-related validity was supported by significant correlation of the SEI and the FMCI (r=0.49, p<0.01), and of the SEI and the GAT (r=-0.50, p<0.01). The results of factor analysis, however, showed construct validity to be extremely low, negating the validity of the Japanese version of the SEI and indicating room for further study. The results also demonstrated a need to clarify the constructs for self-esteem.
The purpose of this study was to know whether we could predict the prognosis of locomotion function of a patient by using age, sex, and clinical findings on admission. Demographic, anamnestic, and clinical data were collected on 487 consecutive patients (mean age ± SD, 64.4 ± 13.1 years) with unilateral supratentorial infarction admitted to the Department of Neurology, Kitasato University Hospital. Functional prognosis was assessed at one month after admission. The outcome state was graded by 5 stages: normal, walk alone, walk with aids, wheelchair, and bedridden. The following predictors of the prognosis were tested by means of multiple regression analysis: age, sex, stroke type, size and side of brain lesion, level of consciousness, severity of paresis on admission. The analysis revealed that the prognosis depended on age, level of consciousness, size of brain lesion and severity of paresis. On the other hand, the prognosis did not depend on sex, and side of the lesion. Multiple correlation coefficient between observed and predicted outcome of the patients was 0.64. The results of this study will make it possible for physicians and therapists to better predict locomotion function during the acute stage.
The purpose of the current study was to clarify the effect of corticosteroid on muscle fibers and intramuscular connective tissues in mice. Fifteen male mice (C57BL/10ScSn) were randomly divided into three groups: control (C), steroid (S), and exercise with steroid (SE). We injected S+SE mice with 2 mg/kg dexamethasone sodium phosphate by a hypodermic, 6 days per week for 5 weeks. The group SE was made to run on a treadmill, at a speed of 10 m/min for 20 min/day. The exercise was conducted for 6 days per week for 5 weeks. After five weeks, the extensor digitorum longus (EDL) muscles from both legs were biopsied from all mice. We measured muscle fiber diameters and collagen fibrillar diameters in the endomysium. Muscle fiber diameters and collagen fibrillar diameters in group S decreased significantly compared with group C, and in group SE increased significantly compared with group S. We conclude that muscle fibers and collagen fibrillies are atrophied by corticosteroid causing muscle dysfunction in steroid myopathy. However, physical training can be effective in preventing muscle dysfunction in steroid myopathy.
The present study was conducted to determine effects of oxidative stress on mitochondrial genome caused by disuse atrophy of skeletal muscles by hindlimbs suspension. We used rats as subjects, and produced hypokinesia by hindlimbs’ (tail) suspension. With electron microscopy, confirming previous results, we found mitochondrial swelling, accompanied by blurred matrix changes in the soleus muscle. Surprisingly, in these muscles, we were able to detect two types of large-scale deletions (about 3.9 and 5.2 kb) of mitochondrial DNA (mtDNA) by the polymerase chain reaction. Our study showed that hypokinesia for two weeks caused not only oxidative damage to the histology of skeletal muscular mitochondoria and but also deletion of mtDNA. Situated close to the energy-generating system, mtDNA is susceptible to oxidative stress and is likely to generate mutations.
We investigated the changes in the H-reflex amplitude at various stimulus frequencies, in order to identify the stable index in a relatively short period. 10 subjects volunteered for experiment. The H-reflex was obtained from the left soleus. The H wave was induced by 29 degrees of stimulus frequency: 10 degrees from 0.1 to 1.0 Hz with an increase of 0.1 Hz, and 19 degrees from 1.0 to 20.0 Hz with an increase of 1.0 Hz. The decrease in H wave amplitude tended to become greater with an increase in stimulus frequency. The frequency depression curve at stimulus frequencies from 1.0 to 20.0 Hz indicated a significant frequency depression (p<0.01) with an increase in stimulus frequency. Disinhibition of the H-reflex amplitude at stimulus frequencies from 4.0 to 8.0 Hz is a specific response, and the change rate of the H-reflex amplitude at the stimulus frequency of 6.0 Hz (62.9%) was almost the same as that of 1.0 Hz (62.5%). We found that repetitive evoked EMG using a stimulus frequency of approximately 5 Hz is a great value in examining the change in the H-reflex amplitude and has a good possibility of clinical application.