Effects of cold and warm water bathing of hemiplegic lower limb on its isokinetic muscle strength were studied in 12 chronic stroke patients (9 males and 3 females, 53.3±14.2 yo, Ueda's grading 8.5±1.6 Grade). Measurements of the isokinetic muscle strength of the knee flexion/extension were repeated three times; 1) after sitting for 10min at room temperature (21-22°C) as a control, 2) after cold water bathing (18°C) of hemiplegic lower limb for 5min, 3) after warm water bathing (41°C, 700ppm artificial CO2 bath) of hemiplegic lower limb for 10min. The measurements were performed, using Cybex 6000 (Cybex international Co) at velocities of 60, 120, 180 and 240°/sec. Artificial CO2 bath was prepared by dissolving Kao Babu (Kao Co) in 41°C warm water. Peak torque of the knee flexions at any velocity decreased significantly after cold water bathing and imcreased after warm water bathing. Change in the maximum power and total work were similar to that of the peak torque. The muscle strength of the knee extension were not changed by neither cold nor warm water bathing. The correlation coefficient between Ueda's Grade and its isokinetic muscle strength ranged from 0.3 to 0.6 and significantly improved after warm water bathing at velocity of 120 (°/second) in flexion. Warm water bathing might make it easy to exert their muscle strength at 120°/sec in flexion corresponding to their severity of their hemiplegia. Regarding to the influence of spasticity, patients with no ankle clonus or pseudoclonus showed a tendency to increase in muscle strength of flexion and extension after warm water bathing. In patients with evident clonus, a tendency to decrease on extension and increase on flexion was seen after warm water bathing. Further studies on the effects of warm water bathing of partial and full immersion in the treatment for spasticity of hemiplegic limb would contribute to stroke rehabilitation.
Although it is well known that orthopedic complaints such as lumbago and shoulder pain can be reduced by hot spring bathing, the mechanism of such reduction is not yet fully known. Therefore, to clarify the mechanism, how the metabolism of glycosaminoglycans, which form connective tissue of articulations and cartilage, changes during hot spring bathing was investigated. Urine was sampled from those visitors at a hot spring who have orthopedic complaints such as lumbago but with no internal disease immediately before the session of hot spring bathing and at intervals of 1 week for a period of 5 week after starting hot spring bathing. The glycosaminoglycan fractions were separated from urine using the cetylpyridinium chloride precipitation and ethanol precipitation methods. Uronic acid contents were then estimated by the carbazole reaction method. The glycosaminoglycan levels in urine increased temporarily one week after starting hot spring bathing, then decreased to the level before starting bathing. The results of investigations using two-dimensional electrophoresis on cellulose acetate membranes revealed that chondroitin and chondroitin sulfate increased one week after beginning hot spring bathing. Because chondoritin is a progressive degradation product of chondroitin sulfate, the increase in chondroitin means that the metabolism of the chondroitin sulfate in the connective tissue was temporarily accelerated by hot spring bathing and was reflected as a reduction in complaints.
Phthalides and ligustilide in Senkyu extract and limonene and fravonoids in Chimpi extract have been reported to have strong vasodilation effects. In the present study the circulatory effects of Senkyu and Chimpi extract (crude drug extract) were studied as bath agent in 40.0°C bath water (Senkyu ext. 224mg and Chimpi ext. 272mg/2001). Thirteen healthy men (36.2±5.8 years old) took a bath at 40.0°C for 10 min with and without (only with flavor and dye) crude drug extract and the circulatory effects were followed for 30 min after bathing. Heart rate and cardiac output were increased equally by 10 min bathing either with or without crude drug extract. Although systolic blood pressure was slightly increased during bathing, diastolic blood pressure and total peripheral resistance were significantly decreased during and after bathing with and without crude drug extract. Forehead skin blood flow and sublingual temperature were significantly increased during bathing, and remained at higher level for 10-30 min after bathing with crude drug extract. Venous blood pO2 and pH were significantly increased and pCO2 was decreased equally with and without crude drug extract. Plasma NE was significantly increased by bathing with crude drug extract. Bath agent with Senkyu and Chimpi extract are considered favorable as bath agent to keep high skin blood flow and sublingual temperature probably due to its vasodilating effects.
In 61 patients with hemiplegia who were under a rehabilitation program, the grade of gait disturbance of each patient was examined by 6 physical therapists. The examination consisted of observation on 46 kinds of gait or related actions; of which 14 were with a handrail, 16 with a cane and 16 with empty hands. Each rater was requested to rate the patient's performance on the basis of 4 stages: impossible, possible with human assistance, possible but not practical, and practical from the standpoint of ADL (activities of daily living). We assigned 1 to the former two cases, whereas 0 to the latter two, respectively. The data collected in this way were analysed by making the cross-table and counting the number of possible tests in each patient and that of possible patients in each test, respectively. By using these results, we rearranged the order of both cases and tests. We found that the rank of this new arrangement of the tests roughly paralleled to that of the difficulty of the tests and could be diverted to be utilized for the scaling of the latter.