The Journal of The Japanese Society of Balneology, Climatology and Physical Medicine
Online ISSN : 1884-3697
Print ISSN : 0029-0343
ISSN-L : 0029-0343
Volume 77 , Issue 5
Showing 101-123 articles out of 123 articles from the selected issue
Section15 [ Climatotherapy and thalassotherapy2 ]
  • Shiori HASHIMOTO, Tetsuji SAWADA
    2014 Volume 77 Issue 5 Pages 531
    Published: August 29, 2014
    Released: January 15, 2015
    JOURNALS FREE ACCESS
    Background: High-altitude headache (HAH) is defined by the International Headache Society (IHS) as the headache that occurs within 24 hours after ascending to 2,500 m or above and subsides within 8 hours after descending. The Japanese and Chinese women climbers performed a joint expedition on Mt Qomolangma (Everest 8844m) in 2005. During the expedition, we investigated whether there was a difference in clinical manifestations of HAH between the native inhabitants of highland (Lhasa) and those of lower heights.
    Method: The expedition team consisted of 39 members (26 males and 13 females), in which 26 individuals were Lhasa inhabitants and 13 individuals lived at lower altitude. Vasodilative reaction was assessed by digital volume plethysmography at Lhasa (3,780m), Base Camp (BC, 5,200m) and Attack Base Camp (ABC, 6,500m).
    Results: Development of headache was associated with younger age, gender (female) and a history of HAH. As for lower inhabitants, 15.3% experienced headache at Lhasa (3,780m), and the incidence of headache increased up to 46.2% at BC and 61.5% at ABC. In contrast, none of the Lhasa inhabitants developed headache at Lhasa, and only 7.7% presented with headache at BC. However, the incidence of headache increased to 65.4% at ABC, which was as high as that observed in inhabitants of lower heights. We have previously demonstrated that vasodilative reaction at high altitude is primarily mediated through hypoxia, since vasodilation was completely abrogated by administration of oxygen. During the current expedition, vasodilative reaction was also observed in Lhasa inhabitants as they climbed to higher altitude.
    Conclusion: Exposure to more pronounced hypoxic/hypobaric conditions was associated with vasodilation of peripheral vascular system and with the development of headache even in individuals of high-land inhabitants. Therefore, it is considered that high-altitude headache is also common in high-altutde inhabitants.
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  • Avraham I KUDISH
    2014 Volume 77 Issue 5 Pages 532
    Published: August 29, 2014
    Released: January 15, 2015
    JOURNALS FREE ACCESS
      The broad-band normal incidence UVB beam radiation has been measured at Neve Zohar, Dead Sea basin, using a prototype tracking instrument composed of a Model 501A UV-Biometer mounted on an Eppley Solar Tracker Model St-1. The diffuse and beam fraction of the solar global UVB radiation have been determined using the concurrently measured solar global UVB radiation on a horizontal surface. The diffuse fraction was observed to exceed 80% throughout the year.
      The application of the results of these measurements to the possible revision of the photoclimatherapy protocol for psoriasis patients at the Dead Sea medical spas is now under investigation. The suggested revision would enable the sun-exposure treatment protocol to take advantage of the very high diffuse fraction by allowing the patient to receive the daily dose of UVB radiation without direct exposure to the sun, viz., receive the diffuse UVB radiation under a sunshade. This would require an increase in sun-exposure time intervals, since the UVB radiation intensity beneath a sunshade is less than that on an exposed surface.
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Section16 [ Analysis of medical water ]
  • Dariusz R. DOBRZYNSKI, Lucyna RAJCHEL
    2014 Volume 77 Issue 5 Pages 533-534
    Published: August 29, 2014
    Released: January 15, 2015
    JOURNALS FREE ACCESS
      Silicon generates interest in ecology, biology and medicine due to the recognized role it plays in living organisms in controlling bio-available aluminium and its toxicity. In Poland, silicon is regarded as a desired component in balneotherapy, with threshold value for siliceous medicinal water of 70 mg/L H2SiO3 (〜0.9 mM). In the Carpathians, mineral/medicinal waters occur in flysch rocks, in hundreds of sites where they are partly used for balneology. Most of these waters represent the acidulous (CO2-rich) type. In contrast, only seven intakes are documented as sources of siliceous medicinal waters. Three main groups of acidulous waters occur in the Carpathians: 1) “simple” acidulous waters of HCO3-Ca-Mg type (TDS=1-5 g/L), 2) waters of HCO3-Cl-Na and Cl-HCO3-Na types (TDS=10-30 g/L), and 3) waters from mixing of the above-mentioned types (Rajchel, 2012). Usually, high silicon concentration is found in thermal and/or alkaline groundwater. Unfortunately, Carpathian acidulous waters have low-enthalpy (T=6.4-20.3°C) and are slightly acidic or near-neutral (pH=5.2-7.7).
      The presented geochemical study of water from 93 intakes throughout Polish Carpathian Mountains aimed at determining hydro-geochemical conditions conducive to finding new sites with Si-rich groundwater as viable source of medicinal water. It was reported that groundwater rich in silicic acid provide benefits in detoxifying body from aluminium and therapy of aluminium-related diseases (e.g. Exley et al., 2006). This study was focused on waters containing above 0.5 mM Si, suggested to be more effective in therapy (op.cit.). Silica-enriched groundwater is present in various geological-settings (Dobrzynski & Exley, 2010; Dobrzynski et al., 2012), but its therapeutic potential seems to be still underrated.
      We found that silicon in concentrations above 0.5 mM occurs in mineral waters with ionic strength (I) of 0.02-0.3 M. The pH of Si-enriched waters varies between 5.8 and 6.6, which corresponds to free CO2 content of 1600-3200 mg/L. The CO2-mediated hydrolytic decay of silicate minerals is responsible for increased concentration of dissolved silicon. Geochemical modelling demonstrates that waters are close to chemical equilibrium with rock-forming feldspars. The prospective areas for finding new siliceous waters in Polish Carpathian Mountains are Poprad River Valley and Kroscienko-Szczawnica spas. The highest Si concentrations are expected to be found in groundwater which originate in the deeper part of the simple-acidulous water zone, and in geological structures where these waters mix with deeply-occurring chloride waters.
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  • Dariusz R. DOBRZYNSKI, Luiza Galbarczyk-GASIOROWSKA, Anna KOSTKA
    2014 Volume 77 Issue 5 Pages 535-536
    Published: August 29, 2014
    Released: January 15, 2015
    JOURNALS FREE ACCESS
      Silicon (28% wt.) and aluminium (8%) are second and third most abundant elements in Earth’s crust. In groundwaters, including the medicinal ones, both elements occur in proportionally lower concentrations than the less abundant elements of lithosphere, such as Ca, Mg, Na, K. The primary sources of Si and Al in water are represented by alumino-silicate minerals. Various minerals have been indicated as a phases which could control the solubility of silicon and/or aluminium in water. Hydroxyaluminosilicate (HAS) colloids have been also suggested as such a phase (Schneider et al., 2004). In conjuction with that the formation and structure of synthetic HAS colloids, along with their ecotoxicological role were studied (e.g. Doucet et al., 2001; Exley, 2012). Evaluation of a large set of natural water chemical analyses suggested that one of HAS colloids, the HASB type of a Al2Si2O5(OH)4 composition, might be formed in groundwaters (Dobrzynski, 2007).
      This work presents an attempt to confirm this hypothesis by investigating the presence of HASB colloid in groundwater. It includes analysis of 219 fresh and mineral groundwater samples from Poland, Spain, and Malaysia. An analytical method involving ion-exchange resin was first tested on synthetic solutions and then applied for indirect identification of HASB in groundwaters. Additionally, the investigated water samples were subjected to micro- and ultra- filtration, and then the collected solids were analysed by XRD, EDS and SEM. The HAS colloids may have an important place in Si and Al hydro-geochemistry, especially in near-surface environments, and in eco-toxicology due to their role in limiting the concentration of bio-available and toxic aluminium species.
      This study concludes that the most promising conditions for the HASB presence were found in silicon-rich medicinal waters from the Sudetes Mountains (Poland), especially from Swieradow Health Resort. The Si:Al molar ratio found in this work in eluates from resin prepared using waters from Swieradow showed values close to the theoretical ratio of 1:1.
      This work also discusses and indicates that the most preferential settings for formation of HAS colloids occur at the short groundwater turn-over time zone in crystalline aquifer-rocks. It also discusses the mechanism for masking the presence of HASB colloids in water by other aluminosilicates. The presented results are still preliminary and require additional work aiming at development of analytical methods applicable for water suspensions rich in silicates.
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  • Lourdes MOURELLE, Carmen Paula GÓMEZ, Maria Carmen MARTIN, Cristina FE ...
    2014 Volume 77 Issue 5 Pages 537-538
    Published: August 29, 2014
    Released: January 15, 2015
    JOURNALS FREE ACCESS
    Objectives: The study and use of marine and fresh water microalgae in therapy is a very recent phenomenon. Fresh water microalgae are used in food and to a lesser extent in cosmetics, however, not much is known about the applications of marine microalgae.
      The Department of Applied Physics at the University of Vigo (Spain) has developed a marine microalgae culture system, and the species obtained are used to prepare products fit for thalassotherapy and spa treatments.
      The aim of this study is to develop a procedure for designing, manufacturing and characterising spa products made from marine microalgae.
    Method: The growing interest in natural tested quality products for use in Spas has stimulated the search for product mixtures frequently used in Spas, such as clays and medicinal-mineral waters, with laboratory cultivated microalgae to guarantee quality and optimum growth.
      A review of scientific literature on the applications of marine microalgae in skin care was the first stage in this study.
      Marine microalgae are a source of vitamins, pigments, proteins and other beneficial substances for the skin (Spolaore et al, 2006). Only a few microalgae species are consolidated in the skin care market, wherein the principal ones are Chlorella and Spirulina (Stolz et al, 2005). Protein rich extracts of Spirulina have been used in cosmetics for preventing stretch marks and extracts from Chlorella vulgaris have been used to stimulate collagen synthesis in skin, thereby fostering tissue regeneration and reduction of wrinkles (Stolz et al, 2005). Other microalgae used are Nannochloropsis oculata and Dunaliella salina. Tests done with an extract of Nannochloropsis oculata have shown that this microalga acts as an optimum protective sheath against oxidative stress and positively influences collagen synthesis (Stolz et al, 2005). An ingredient of Nannochloropsis oculata has excellent skin elasticity properties (short and long-term) and was already in the market in 2005 (Stolz et al, 2005).
      Microalgae culture has been on the rise in the past years. This is generally done in tanks or pools using a controlled culture medium and with either natural or fluorescent light that imitates the natural solar cycle (photobioreactors).
      A species of Nanocloropsis was selected to study its use in Spas. This is an alga which can be cultivated using photobioreactors such that its growth and profitability can be controlled.
      Mixtures with varying proportions of clays and mineral waters and seawaters were prepared.
      Research equipment was used to analyse the behaviour of the mixtures. To that end, density, specific heat and thermal conductivity, which are important thermophysical properties, were used to assess these products for heat therapy.
    Results and Discussion: The preliminary studies have provided results on culture conditions of the microalgae. Results of heat behaviour were also collected using varying mixtures of clays and waters.
      These results show that marine microalgae can be used in Spa treatments either in baths or as poultices, thus indicating that thermal retention capacity is improved upon mixture with clays, an aspect which is important for their use in heat therapy.
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  • Krzysztof Tadeusz MARCZEWSKI, Barbara MARCZEWSKA, Rafał KUZIOA& ...
    2014 Volume 77 Issue 5 Pages 539-540
    Published: August 29, 2014
    Released: January 15, 2015
    JOURNALS FREE ACCESS
    Introduction: The dream of mankind since immemorial times is opportunity to drinking water from the source of life, water that restores health. The healing waters, which include spring and mineral waters derived from groundwater and deepwater. Depending on the geological origin of water they contain different content of minerals including metals like vanadium. Data available from animal studies, cell culture, and few clinical observations suggest the benefit from vanadium supplementation in diabetes.
    Objectives: Vanadium, depending on the consumed dose may be toxic or therapeutic. Unfortunately the WHO or other comparable authority did not rule definitively on this matter. Because of it, the aim of this study was, based on literature, to compare vanadium concentrations in some waters, particularly derived from the ground and deepground,
    Methods: Literature review. Measurements of the concentration of vanadium in publications included in this review, in the tested water samples were performed with spectroscopic techniques
    Results: The concentration of vanadium in mineral water and groundwater ranges from 0-138μg/l, this means that some water content was below the detection limit. The survey of the chemical composition of 571 European bottled mineral waters from Austria, Belgium, Bosnia Herzegovina, Croatia, Czech Republic, Denmark, Finland, Great Britain, Ireland, Italy, Netherlands, Norway, Poland, Portugal, Russia, Spain, Switzerland, Ukraine shows that the concentration of vanadium was above the detection limit (1μg/l ) only in about 12% of the samples 1). while 132 samples of water from Australia, Belgium, Brazil, Canada, Czech Republic, Denmark, Dominican Republic, England, Finland, France, Germany, Hong Kong, Iceland, Israel, Italy, Japan, Kenya, Mexico, Netherlands, Peru, Poland, Slovenia, Spain, Sweden, Switzerland, Trinidad, the US and Yugoslavia vanadium concentration contain within 0.0006-93.1μg/l 2). The content of vanadium shows a fairly close relationship with the geological structure of the region of origin. In volcanic regions concentration increases in relation to the water of the river as much as 100 fold. The vanadium content in groundwater in Spain in the areas of Grenada ranged from 10.8-13μg/l 3), in Italy in area of Etna 18-138 μg/l, Lake Bracciano 17-30μg/l and the Costello 1-82μg/l 4), whereas, at the Lake Biwa in Japan 0.26 μg/l mm and in rainwater in Kyoto 0.37 μg/l 5).
    Conclusions: There is an urgent need to identify desirable and maximum permissible content of vanadium in the waters, especially in the waters used in medical hydrology. They can be useful here, observations of the state of health of the population living in regions with varying vanadium content.
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  • Krzysztof Tadeusz MARCZEWSKI, Barbara MARCZEWSKA, Rafał KUZIOA& ...
    2014 Volume 77 Issue 5 Pages 541-542
    Published: August 29, 2014
    Released: January 15, 2015
    JOURNALS FREE ACCESS
    Introduction: In the world there are numerous sources to which the population pilgrimage and is convinced of the healing power of incurable diseases. Category of beneficial medicinal waters are waters which include spring and mineral water derived from ground and deepwater. Groundwater is contaminated with substances from agriculture wastewater, for example, pesticides that are toxic substances. Unfortunately was noted down more and more cases of contamination of the deep water.
    Objectives: Pesticides are employed in agriculture and in public health. Toxicity to humans includes along-term and acute effects. Therefore, knowledge of their concentration in drinking water treatment seems to be very important. The aim of this study was based on the literature indicate the presence of certain pesticides and pesticide metabolites in selected drinking water coming from the ground and deepground.
    Methods: Literature review. Measurements of pesticide concentrations in the test water samples in publications included in this review were performed by chromatographic techniques.
    Results: Seven water spring (mountain Vermion-Greece) were studied during the 12-months. Atrazine, diazinon and DEA [deethylatrazine] Their concentrations levels were below 0.060μg/l1). The concentrations of pesticides detected in underground waters were 0.089μg/l for alachlor, 0.098μg/l for atrazine, 0.205μg/l for desethylatrazine, 0.090 μg/l for carbofuran, 0.041μg/l for metolachlor, 0.077μg/l for molinate, 0.018μg/l for propanil, 0.007μg/l for parathion methyl and 0.037μg/l for simazine. Research pesticides atrazine, alachlor, cyanazine in groundwater2) showed the absence of the first two, but altrazine concentration was in the range 0.16-3.7μg/l. In the groundwater below 1.5m concentration was higher than in 3m below. Altrazine was sporadic detected even at a depth of 4.6m, but not below. It has been tested concentration of 10 pesticides in groundwater from Argentina3). Azinphos methyl is the most widely used pesticide. Its concentration was 3.22μg /l. In the groundwater can also identify metabolites of pesticides4). From 150 pesticide metabolites 37 were detected with a concentration <0.025μg/l and median total concentrations of pesticide metabolites was 0.62μg/l.
    Conclusions:
    1. From the selected work indicate that pesticides and metabolites of pesticides pollute water sources, underground water and deepwater.
    2. Concentrations of pesticides in most cases are lower than the 0.1μg/l, which is the general limit concentrations of pesticides, and pesticides metabolites in drinking water5), 6).
    3. Only in the case of the pesticide azinphos methyl was found elevated concentration of 3.22μg /l, which realises the necessity Identification concentrations of pesticides and their metabolites in mineral and spring waters.
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  • K’tso NGHARGBU, Przemyslaw ADAMCZYK, Irena PONIKOWSKA, Krsyzstof SCHOE ...
    2014 Volume 77 Issue 5 Pages 543
    Published: August 29, 2014
    Released: January 15, 2015
    JOURNALS FREE ACCESS
    Introduction: Two springs namely Bitrus (flowing borehole) and Ruwan Zafi, both in Awe - North Central Nigeria were sampled and analysed for elements of pharmacodynamic significance.
    Methods: The electrometric method was used to determine electrical conductivity, pH value, iodide and fluoride content. The spectrophotometric method was used for the determination of ammonium, iron, magnesium, nitrate, nitrite, silicate, bromate, and sulphate content. Furthermore, the flame photometric method was used for the determination of sodium, and potassium content. Finally, the complexometric titration was used to determine calcium, and magnesium, the argentometric titration to determine chloride, while the acidimetric titration was used in the determination of hydrocarbonate.
    Result: Their rich mineral endowment is easily traced to their ancient marine source in the Cretaceous. These waters interact with host-beds of shale, silt, sandstone, which are sometimes calcareous on their way up under natural artesian conditions. With average temperature of 40 degree Centigrade, they make for invaluable balnear resources. Both springs have mineralization greater than 1000 mg/l and as such qualify as mineral/medicinal waters.
    Conclusion: Due to their Isotonic nature and moderate mineralization, they are suitable for use in drinking cure as their chemistry compares favourably with that of a well-known spring water in Poland used for the same purpose-Inowroclaw(mineralization 0.29%).
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  • K’tso NGHARGBU, Irena PONIKOWSKA, Teresa LATOUR, Ewa KUROWSKA, Krsyzst ...
    2014 Volume 77 Issue 5 Pages 544
    Published: August 29, 2014
    Released: January 15, 2015
    JOURNALS FREE ACCESS
    Introduction: In the Upper Benue Trough of Nigeria near Numan is a thermal spring flowing to the surface under natural conditions. Geologically, it is believed that this water passes through the Continental Bima Sandstones of the Albian, the transitional to marine Yolde Formation of the Cenomanian, and eventually through the continental Gombe Sandstones of Maastrichtian age, thus deriving their unique chemistry. Bottled mineral waters have been served in several parts of the world as a dietary water. They are a common source of essential micro and macro nutrients, needed by the human body.
    Materials: A sample of the thermal spring water was taken and analysed using the following techniques- electrometric method to determine electrical conductivity, pH value, iodide and fluoride content, the spectrophotometric method for the determination of ammonium, iron, manganese, nitrate, nitrite, silicate, bromate, and sulphate content, the flame photometric method for the determination of sodium, and potassium content, and finally the complexometric titration to determine calcium, and magnesium, the argentometric titration to determinate chloride, while the acidimetric titration was used in the determination of hydrocarbonate.
    Results: The following results were generated from the analyses done; temp 44.2°C, pH 7.38, mineralisation 442.63mg/l, Ca2+ 9.62, SO42- <1.00, NH4+ <0.05, Na+ 93.34, K+ 10.00, Mg2+ 2.43, Fe2+3+ <0.01, Mn2+ <0.01, F- 0.69, Cl- 20.20, Br- <0.05, J- <0.02, HCO3- 273.80, NO2- <0.02, NO3, <0.88, HB2- <0.05, H2SiO3 32.55, Total Hardness (mg/cm3, CaCO3) 32. Comparing these with the results of two bottled mineral water from Poland, namely: Jurajska, Ca2+ 66.1, SO42- 40.5, Na+ 10.0, K+ 2.2, Mg2+ 32.8, F- 0.4, Cl- 7.8, HCO3- 329.9 and Polaris, Ca2+ 102.2, Na+ 11.25, K+ 2.34, Mg2+ 16.0, F- 0.23, Cl- 2.50, HCO3- 432.7.
    Conclusion: One can conclude that the Ruwan Zafi- Numan is possibly a good source of dietary water which if exploited will improve the health needs of its consumers as well as boost national GDP.
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Section17 [ CO2, NaCl, Sulfur1 ]
  • Christoph GUTENBRUNNER
    2014 Volume 77 Issue 5 Pages 545
    Published: August 29, 2014
    Released: January 15, 2015
    JOURNALS FREE ACCESS
      In the literature relevant knowledge is available about the properties and physiological effects of CO2 and H2S. Both gases penetrate the skin easily and increase microcirculation of the skin. Additionally, effects on thermal receptors (CO2) and pain perception (H2S) have been demonstrated in several trials. Other effects of H2S refer to a modulation of immune cells. From this knowledge indications and contraindications may be derived. However, there is a need for prospective controlled trials to prove the efficacy of such treatments. Future directions and perspectives of research using these balneological remedies will be discussed.
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  • Christian François ROQUES, P JEAMBRUN
    2014 Volume 77 Issue 5 Pages 546
    Published: August 29, 2014
    Released: January 15, 2015
    JOURNALS FREE ACCESS
      A limited number of randomised clinical trials investigated drinking mineral waters benefit.
      Alcaline sodium bicarbonated waters demonstrated their ability to enhance gastric motility and emptying (Bertoni, 2002; Wakisaka, 2012); vesicular emptying (Toxqui, 2012). But it also acts on lipid metabolism (Schoppen, 2005; Toxqui, 2012; Perez granados, 2010), insulin sensitivity (Schoppen, 2007), oxalo-calcic and uratic compounds urinary excretion (Karagülle, 2007).
      Calcic carbonated waters act mainly on the calcium homeostatsis; they can reduce bone modeling with a significant decrease of PTH and bone modeling markers levels (Guillemand, 2002; Roux, 2004; Meunier, 2005; Wynn, 2009).
      Magnesium and/or calcium rich waters can offer a profitable income of such minerals (Aptel, 1999; Galan, 2002; Sabatier, 2011).
      Sulfide waters can be damageable for erythrocyte through their deleterious action on enzymatic pathways (GAPDH, G6PDH) and methemoglobin (Albertini, 2008).
      Epidemiologic studies emphasized the ability of some tap waters to facilitate some disorders, mainly acid waters and type I diabetes (Skenes, 2002), poorly silicated waters and Alzheimer’s disease (Gillette Guyonnet, 2005).
      If the studies demonstrated actual pharmacological effects of mineral waters, the clinical relevance of these properties as the medical benefit in real life conditions have still to be established.
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  • Hirofumi KANOH, Yuji SAKASHITA, Chihiro MORIYAMA, Shuji MATSUMOTO
    2014 Volume 77 Issue 5 Pages 547-548
    Published: August 29, 2014
    Released: January 15, 2015
    JOURNALS FREE ACCESS
    Objectives: The warm-water foot bathing is widely used as a clinical method for hemiplegic limb. Recent research have reported that the artificial high concentration carbon-dioxide (CO2) water foot bathing have a potent vasodilative action. However, the definite effects of the artificial high concentration CO2 water foot bath for hemiplegic limbs remain uncertain. We examined that the effects of the artificial high concentration CO2 water foot bath for patients after stroke.
    Patients: Three inpatients after stroke were recruited for this study. The age and duration after onset were 58.3 ± 21.4 years and 63.0 ± 38.9 months, respectively. Of the three patients (two males and one female), two were diagnosed with cerebral hemorrhage, one with cerebral infarction.
    Methods: The artificial high concentration CO2 water foot bath and tap water foot bath were prepared. The concentration of CO2 water foot bath was approximately 1000-1,200 ppm, and both lower limbs (under the knee joint) were immersed in 38 °C water for 20 minutes. Foot bathing in tap water was also carried out under the same conditions in the another day. The following physiological data were measured before foot bathing and after the end of foot bathing. Not only the deep body temperature at axillary, the surface skin temperature at the front of femur, the calf of the leg and the dorsal foot, but also the muscle stiffness at triceps muscle of calf were evaluated.
    Results: None of the subjects experienced discomfort before and after both the high concentration CO2 water and the tap water foot bath. The physiological examination was completed safely in all subjects. The results were as follows: The deep body temperature and the surface skin temperature had increased, and the muscle stiffness had been relieved in the high concentration CO2 water foot bath compared with the tap water bathing. The deep body temperature of the high concentration CO2 water foot bath have risen from 36.4 °C to 36.9 °C, the surface-skin temperature of the front of femur (from 26.7 °C to 28.1 °C), the calf of the leg (from 29.5 °C to 31.9 °C) and the dorsal foot (from 29.9 °C to 32.3 °C) have risen, respectively. The muscle stiffness have been relieved from 55.3 to 51.8 before and after. There was no change that the tap water had increased in the deep body temperature and the surface-skin temperature, and the muscle stiffness had been relieved before and after.
    Conclusion: These results suggested that the use of the high concentration CO2 water foot bath was more effective in hyperthermia compared with the tap water. Furthermore, we considered that carbon dioxide had promoted to increase the skin and the muscle blood flow by vasodilative action to the arteriole, and use of the high concentration CO2 water foot bath contribute to improve the circulatory dynamics for the hemiplegic limb. These findings may suggest that the use of the high concentration CO2 water foot bath is an effective physiotherapy for circulatory dynamics treatment that might facilitate stroke rehabilitation
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  • Yasuaki GOTO, Shinya HAYASAKA, Shigeo KURIHARA
    2014 Volume 77 Issue 5 Pages 549
    Published: August 29, 2014
    Released: January 15, 2015
    JOURNALS FREE ACCESS
    Purpose: Tsukioka Onsen is the prominent hot spring which contains the largest amounts of sulfur in Japan. The purpose of this study is to clarify the benefits of bathing in Tsukioka Onsen by comparison between the bathing in Tsukioka hot spring and with natural water.
    Methods: Subjects were 20 females aged from 30 to 60 y.o. On 21th of November, we applied them to bathe in Tsukioka hot spring for 10 minutes (42 celcius) and to bathe in natural water for 10 minutes (42 celcius) using cross-over methods. The interval of the two way bathing was 2 hours. We conducted a questionnaire survey using visual analog scale in which participants answered their subjective health and the sensory evaluation of skin with hot water. Statistical analysis was performed using paired t-test. This research was approved by ethical committee of the Japan health & research institute.
    Results: Warming effect of full body, blood circulation, stiff shoulder and back pain were all improved after bathing either with hot spring and natural water. The effects were particularly stronger with hot spring than natural water. Recovery from fatigue, sense of relaxation, sense of refresh, most feeling of skin, refreshing touch of skin were improved only after bathing with hot spring.
      Regarding to sensory evaluation of skin, smooth feeling and moist feeling of skin were significantly notified predominantly with hot spring not with natural water.
    Conclusion: This study showed that bathing in Tsukioka Onsen may cause thermal, cleaning, and moisture effects more than the one with natural water. We think that the alkalinity and the rich containing of chloride in hot water in Tukioka Onsen may contribute to these effects. We also suggested that one reason for these effects is that the large amounts of containing sulfur in Tukioka hot spring penetrated through skin may cause particular dilation of blood vessels in addition to the thermal effect of hot water.
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  • Keiko IKEDA, Shuji MATSUMOTO, Kodai MIYARA, Tomohiro UEMA, Takuya HIRO ...
    2014 Volume 77 Issue 5 Pages 550-551
    Published: August 29, 2014
    Released: January 15, 2015
    JOURNALS FREE ACCESS
    Objectives: Recently, it has been reported that the effects of artificial high concentration carbon-dioxide (CO2) on core temperature, cutaneous blood flow, thermal sensation. However, the effect of artificial high concentration CO2 water foot baths for spasticity, lower extremity motor function and walking ability was not identified. The purpose of this study was to investigate whether the newly artificial high concentration CO2 water foot bath inhibits spasticity and improves lower extremity motor function and gait speed in spastic paraplegia patient.
    Case Presentation: The patient was a 37 years old man with spastic paraplegia of human immunodeficiency virus encephalopathy, without signs of cognitive impairment. The patient was able to walk without assistance using a T-cane or an ankle-foot orthosis. He had no medical condition that limited footbath usage (such as uncontrolled cardiopulmonary disease, severe joint disability and severe sensory disturbance), severe aphasia that made it impossible to follow verbal instructions, and cognitive dysfunction that interfered with outcome assessments. Informed consent was obtained from him according to the ethical guidelines of the hospital, after he fully understood the purpose and methodology of the study. This work was carried out with permission from the Ethical Committee of Kagoshima University.
    Methods: This case study was before and after intervention trial. Six outcome instruments were used at baseline and after the artificial high concentration CO2 water foot bath: the modified Ashworth scale (MAS) score for the gastrocnemius muscles as a measure of spasticity, ankle clonus, muscle stiffness at triceps muscle of calf, deep body and surface skin temperature as a monitor for physical condition, the active range of motion as an assessment tool for motor function, and the 10-m walk test as a measure of walking ability. Lower-extremity movement acceleration was also measured using an accelerometer. The subject rested in a chair for 10 min and the above-noted physiological reactions during the last 5 min of the resting period were recorded as baseline values. Next, the subject received a 20-min foot bath in water at 38 °C, with a 10-min recovery period. The artificial high concentration CO2 water foot bath improved the acceleration of the spastic lower extremities and this improvement in acceleration lasted for 10 min after the footbath usage.
    Results: The subject experienced no discomfort before, during or after the intervention, and all assessments were completed safely. The deep body temperature and skin temperature increased immediately after and 10 minutes after the artificial high concentration CO2 water foot baths. The MAS score, ankle clonus and the muscle stiffness for the triceps muscle of calf were decreased. The active range of motion for ankle dorsiflexion and gait speed improved after the 20-min intervention.
    Conclusion: These findings suggest that artificial high concentration CO2 water foot bath is an effective method for controlling spasticity, and improves motor function and walking ability in spastic paraplegia patients.
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  • Masaharu MAEDA, Jun YAMAMOTO, Osamu KINOSHITA, Akari SHIODA
    2014 Volume 77 Issue 5 Pages 552-553
    Published: August 29, 2014
    Released: January 15, 2015
    JOURNALS FREE ACCESS
      Less than 0.5% of hot springs in Japan is natural carbonated hot springs.
      Therefore, the spread of artificial bicarbonate (CO2) water in Japan starts by developing the gas-permeable membrane.
      There are two methods to produce artificial CO2 water. The first is gas-permeable membrane method and the second is pressurizing stir method. Both are widespread. Because the gas-permeable membrane method is provided by stable concentration in medical treatment, generally the stirring methods spread because a price is cheap.
      There is a custom of whole body bathing in Japan from old days, and the CO2 warm water bathing has spread all over Japan in about ten years recently.
      The vasodilation effect can be caused by the CO2 in warm water of 41 degrees Celsius (approximately 1,000ppm: max saturation under conditions of atmospheric pressure), which is the temperature favored by Japanese people. This differs from the vasodilation caused by the nitric oxide (NO) by thermal, and the reason is thought to be the participation of hormone from a blood vessel endothelium such as prostaglandin E2.
      When CO2 penetrates from the epidermis and it reaches the dermis, it enhances the entering blood vessel to the capillary of the dermis.
      The blood vessel is enhanced according to the concentration of CO2.
      A wide capillary increases volume flow of blood, sends the tissue oxygen and nourishment, and accentuates the renewal of the skin.
      By the use of this mechanism, arteriosclerosis obliterans using the footbath and the pressure sore treatment in the medical, and cosmetics with CO2 water are widespread in the beauty industry in Japan.
      Moreover, a vasodilated vessel carries the febris easily from the warm water to the inside of the body, and raises the body temperature high early.
      Body temperature increases CO2 water 1.5 degrees Celsius, tap water 1.0 degrees Celsius by the warm water hole body bathing of 41 degrees Celsius 15 minutes from before bathing.
       This phenomenon of CO2 warm water raises the body temperature easier than the tap water, and works as a heat stress for the human body.
      It provides to increasing of the immunity (natural killer cell activities) and the heat shock protein (HSP) caused by this stress, and it consequentially enhances health promotion.
      In addition, using the bulla from unstable CO2 to clean the hair and the hair root and to improve the blood circulation of the scalp is becoming popular in Japanese hair salon.
    Though custom of the drinking CO2 water has been performed in Europe from long ago, it became popular in Japan several years ago, for the appetite increase with small and for the diet with large amount. These spread as one of the dieting methods of a woman from last 2 years.
      Japan is a country that can use the favor of high concentrate artificial CO2 warm water anywhere, for the development and the widespread of the high concentrated artificial CO2 producting apparatus.
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Section18 [ CO2, NaCl, Sulfur2 ]
  • Yasuhiro HOSAKI, Nobuyoshi SHIOZAWA, Kozo ASHIDA, Satoshi WATANABE, Ta ...
    2014 Volume 77 Issue 5 Pages 554-555
    Published: August 29, 2014
    Released: January 15, 2015
    JOURNALS FREE ACCESS
    Purpose: We have previously reported the physiological and biochemical effects of bath salts. In this study, we used bath additive containing artificial carbon dioxide and sodium chloride (S bath additive), and the acute effects of bathing once with S bath additive and chronic effects of daily bathing with S bath additive for 15 consecutive days were compared with the effects of bathing once in plain water. Improvement in 10 symptoms was investigated using a 5-point verbal rating scale (VRS).
    Methods: Nine patients aged 51-82 years (mean, 66.6 years) with cold intolerance and lower leg pain were treated with balneotherapy. Whole-body bathing at 40°C was performed for 10 min daily (day 1, bathing in plain water; days 2-16, bathing with S bath additive). On days 1, 2, and 16, changes in patient’s subjective symptoms were evaluated using a VRS ranging from -1 to +3.
    Results: Compared with bathing once in plain water, bathing once with S bath additive was improvement of coldness, body warmth, blood circulation promotion, limb warmth, lightness of foot, and coldness in limbs. Daily bathing with S bath additive for 15 days significantly improved all symptoms compared with bathing in plain water. A comparison between single and daily bathing with S bath additive showed that relieving fatigue and lumbago were significantly improved after consecutive bathing, demonstrating the benefits of long-term usage.
    Discussion: Bathing once with S bath additive had acute effects on symptoms associated with peripheral circulation, such as coldness in limbs, body warmth, and limb warmth. Daily bathing with S bath additive improved bone- and joint-related symptoms, such as lumbago and shoulder stiffness, demonstrating that the chronic effects of S bath additive differ from the acute ones. These results are consistent with previous studies on natural hot springs which found that the efficacy of short-term treatment was distinct from that obtained after >2 weeks of treatment.
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  • Jacques Pierre BODY
    2014 Volume 77 Issue 5 Pages 556-557
    Published: August 29, 2014
    Released: January 15, 2015
    JOURNALS FREE ACCESS
      Of course, they rest on physiologic effects: vasodilatation, scar healing and pain relief 1)-3), 6).
      Hence, in the vascular field, at the first rank, and for a century, the queen indication is Intermittent Claudication4), at the level of ischemic effort in all sites: whether the claudication is in the calf, in the foot or/and in the hip. The patient notices in 7 to 8 days, a decrease in the onset of discomfort and improved recovery, the pain being more bearable. This good result is maintained because the patient is able to follow the walking advices .
      Atherosclerosis subclavian stenosis with arms’ claudication is also quickly improved.
    Buerger’s and Takayashu’s diseases (aside from acute episodes) are an indication for upper and lower limbs.
      Adequate and long-term results are obtained in erectile dysfunction, which is present in 70% in patients suffering from intermittent claudication, especially using strictly sub-cutaneous CO2 injections.
      Primary and secondary Raynaud’s phenomenon is the second major vascular indication5).
      The most significant indication is the scleroderma hand for:
    - increased finger flexibility (as well as the entire body skin surface).
    - scar healing.
    - and of course, improved Raynaud’s syndrome.
      28°C CO2 baths applied to venous and lymphatic insufficiency enables a decrease in volume, including elephantiasis with long-term dry baths.
      At the border of vascular and esthetic fields, LDS is nowadays a classic indication.
      A long list of rheumatologic indications thanks to antalgic effects: all arthritis, with most significantly the thumb and cervical spine, but also shoulder stiffness, osteoporosis, algo-dystrophy and fibromyalgia.
      A page remains to be written about the following items:
    - loss of balance with cervical spine arthritis,
    - the onset of migraine headaches,
    - macula degeneration,
    - visual field in patients affected with glaucoma,
    - tinnitus,
    - cognitive functions
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  • Toshiki YOSHIOKA, Tomomi IMAMURA, Kento USUI, Genta IKUBO, Rie FUJII, ...
    2014 Volume 77 Issue 5 Pages 558
    Published: August 29, 2014
    Released: January 15, 2015
    JOURNALS FREE ACCESS
    Background and Aims: The gastrointestinal motility effects by carbonated water have not yet been sufficiently investigated. The aim of this study was to determine whether single pre-prandial carbonated water administration might have an effect on the rate of liquid gastric emptying using the 13C-acetic acid breath test.
    Methods: Eight healthy volunteers (F/M; 3/5) participated in this randomized, 3-way crossover study. The subjects fasted overnight and were randomly assigned to receive 200mL of carbonated water before ingestion of the liquid test meal (200 kcal per 200 mL, containing 100 mg 13C acetate) or 200mL of carbonated water before the test meal or the test meal alone. Under all conditions, breath samples were collected for 150 min following the meal. Liquid gastric emptying was estimated by the values of the following parameters: T1/2, Tlag, the gastric emptying coefficient (GEC) and the regression-estimated constants (β and κ), calculated using the 13CO2 breath excretion curve using the conventional formulae. The parameters between the 3 test conditions were compared statistically.
    Results: Carbonated water significantly decreased k and beta, but T1/2, Tlag and GEC remained unchanged.
    Conclusions: The present study revealed that carbonated water has dual effects on liquid emptying: an initial acceleration with a subsequent deceleration in asymptomatic volunteers.
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  • Shuji MATSUMOTO, Keiko IKEDA, Kodai MIYARA, Hirofumi KANO, Yuji SAKASH ...
    2014 Volume 77 Issue 5 Pages 559-560
    Published: August 29, 2014
    Released: January 15, 2015
    JOURNALS FREE ACCESS
    Objectives: To preliminarily assess the effects of a single warm-water bath (WWB) on the quality of sleep, we measured sleep pattern after WWB in healthy volunteers. The primary objective of the present before-after study was to evaluate whether a single 10-minute WWB at 41°C could modulate sleep pattern in a single group of healthy subjects. In this pilot study, we also assessed the difference in general fatigue and subjects’ satisfaction responses to WWB under two conditions: WWB using tap water (WWB with tap water) and WWB using a bath additive that included inorganic salts and artificial carbon-dioxide (CO2) (WWB with ISCO2).
    Methods: Eleven healthy volunteers aged 20 to 48 years (29.8±8.9 years, mean ± SD) participated in this study. Inclusion criteria were as follows: age 20-50 years; free of cardiovascular disease; not taking medications or supplements. In this within-subject, two-way crossover study, all subjects underwent WWB with tap water or WWB with ISCO2 in random order for two consecutive nights. Objective sleep measures from sleep sensor mat (sleep-scan) and subjective subjects’ reports were collected. This study was approved by the Ethics Committee of Kagoshima University Hospital and written informed consent was obtained from all of the subjects.
    Results: None of the subjects experienced discomfort before, during or after the study period. The objective sleep measures and subjects’ reports were completed safely in all subjects. WWB with ISCO2 bathing produced significant improvement in objective and subjective sleep latency compared with WWB with tap water bathing (P<0.05). Sleep-scan-determined wake time after sleep onset (WASO), sleep efficiency, and number of awakenings (NA), and patient-reported measures of WASO, NA, sleep quality, sleep depth, and daytime functioning significantly improved following WWB with ISCO2 bathing versus WWB with tap water bathing (P<0.05). WWB with ISCO2 bathing also increased deep sleep time and sleep score (P<0.01 for both comparisons), but did not alter REM or slow-wave sleep.
    Conclusion: In conclusion, in our group of healthy volunteers, a single warm-water bath was shown to have the potential to modulate the quality of sleep. These findings demonstrate that WWB with ISCO2 bathing might be effective in improving some domains of sleep quality of healthy volunteers, and the subjects showed acceptance towards the intervention. Strengths and limitations of the present study as well as suggestions for further studies were considered. Further evaluations with larger and longer-term randomized double-blind placebo-controlled trials based on the present study are needed.
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Section19 [ Aquatic therapy ]
  • Julie Ishan TZENG, Pei-Hsin KU
    2014 Volume 77 Issue 5 Pages 561-562
    Published: August 29, 2014
    Released: January 15, 2015
    JOURNALS FREE ACCESS
    Original missions: Aquatic therapy in Cheng Hsin General Hospital was founded specifically for patients with poliomyelitis in 1960s. At that time, Taiwan was shrouded in darkness due to the outbreak of polio. Many children were paralyzed overnight and thousands of families broke down. Desperate as they were, they had caught a glimmer of hope when the First Lady, Madam Chiang, decided to run a national shelter for children with polio. Cheng Hsin Children’s Home was built and involved in educational and medical systems to provide full time care for free. Aquatic therapy was also included at that time.
    Following Missions: After poliomyelitis being eradicated in Taiwan in 1983, our team was dedicated in aquatic rehabilitation for people with all kinds of disabilities. Since Taiwan National Health Insurance System being established in 1995, the population receiving rehabilitation kept on rising. As a pioneer in the field of aquatic therapy, we delivered our experience to assist in construction of aquatic rehabilitation nationwide. Learning from the numerous cases, we have accumulated much experience, especially neurological deficits. Thus, physical therapists in Cheng Hsin General Hospital have designed some treatment guidelines for neurological patients. These guidelines, though not standardized, provide therapists various aspects to evaluate clinical problems and to design programs (See Table).
    Further missions: From the polio to all kinds of special needs, aquatic therapy in Cheng Hsin General Hospital has prosperously developed. In order to broaden our horizon, our team is eager to joining international society of medical hydrology and adopting professional advices and collaboration.
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  • Julie Ishan TZENG, Erl-Mo Wayne WU, Pei-Hsin KU
    2014 Volume 77 Issue 5 Pages 563-564
    Published: August 29, 2014
    Released: January 15, 2015
    JOURNALS FREE ACCESS
      Hydrotherapy refers to therapy conducted in water. The most advanced aquatic therapy of all is the therapeutic swimming. Therapeutic swimming is to use swimming, with adjusted strokes and changed moves, as a fashion of treatment based on patients’ diagnosis. Almost everyone is indicated.
      It’s much easier to those who already know how to swim. Making local adjustment of the strokes for special needs is all therapist has to do. For instance, a scoliosis case, having C curve at thoracic region with concave to left, can use modified breaststroke. By extending elbow during power phase, the muscles on upper back and shoulder can be recruited. These muscles are protectors of the thoracic spine. Freestyle stroke can be in use, too. The left hand enters the water when the arm reaches out to the farthest; in addition, the head rotates to the opposite side of the reaching hand. These movements can stretch and elongate the shortened side. As for the lengthened side, the right side, strengthening should be emphasized more. Hence, patients put their right hand on their sacrum. This is not only effective for upper back and shoulder strengthening, but also good for chest expansion.
      However, the therapy won’t jump to therapeutic swimming for beginners. New patients usually start with basic exercise, for example, walking, marching, stretching, and strengthening. Therapeutic swimming is saved to the last. “Be friend with water” is the primary mission. The therapy cannot work until the patients feel at home in water. There are seven characteristics of water, which are buoyancy, hydrostatic pressure, resistance, visual feedback, audio feedback, and balance and coordination. All exercise programs are derived from the seven characteristics. Through thousands of times of practice, patients ought to be adapted to water, to like it, to know the benefits that they can gain from water. Most importantly, patients need to understand how safe they are in the water. The mean density of human is smaller than the density of water, which means patients can always float. Once they realize this fact, they should be able to embrace water and relax. It’s easy to move by pushing water toward the opposite direction they are heading to. After they learned the skills, staying in water becomes a joy instead of fear. Do remember, therapeutic swimming is never a pageant. Speed and stunts are not our emphasis.
      Once they catch up the skills, therapeutic swimming is more than a rehabilitation program. It is a part of their life. It is something they are enjoy doing. Some patients are extraordinarily talented, and they will further perfect their performance. Moreover, they can seek for professional advice of contest rules, and the speeding skills from swimming coach. At this point, they might have the chance to attend Paralympics!
    Therapeutic swimming was initially a rehabilitation approach. Then, people with special needs find delight from it. It becomes their recreation. Finally, this advanced exercise will likely bring them to an international stage. Therapeutic swimming realizes their dreams to outshine!
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  • Yusuke SAKAGUCHI, Yu IMAIZUMI, Chie EBIHARA, Satoko ISHIHARA, Go HORIK ...
    2014 Volume 77 Issue 5 Pages 565-566
    Published: August 29, 2014
    Released: January 15, 2015
    JOURNALS FREE ACCESS
    Objective: While electromyographic data on healthy individuals during aquatic exercise have been reported, few studies have examined long-term changes in patients’ muscle strength after 30-day intervention. This study aims to study the long-term effects of repeated hot spring aquatic exercise combined with physical therapy on patients’ muscle strength and endurance.
    Methods: A total of 12 patients (mean age: 71.9±13.1; FIM score: 117±7.5; the number of patients with cerebrovascular disease: 5; and the number of patients with orthopedic disease: 7) who suffer decreased muscle strength and endurance in addition to sensory and balance dysfunction due to paralysis or fracture, were studied. Each hot spring aquatic exercise session consisted of walking forward and backward, hip abduction, flexion, and extension, lunge, and squat, which lasted approximately 15 minutes. The loading level was set at a pulse of 77±11.2 → 84±13.5/minute, with a perceived exertion rate (modified Borg Scale) of 0.7±1.0 → 2.4±2.3. During the intervention period, conventional physical therapy was also performed on the patients in parallel. Measurement was performed 4 times, immediately, 10, 20, and 30 days after the initiation of intervention. Measurement items were the 6-minute walking distance (6MD) for an index of endurance, CS-30 score for an index of muscle strength, and hip flexor, extensor, and abductor, knee flexor and extensor, and ankle plantar and dorsiflexor strength using a hand-held dynamometer (HHD).
    Results: The 6MD and CS-30 scores improved 20 days after, and the hip flexor and extensor, knee flexor, and ankle plantar and dorsiflexor strength improved 30 days after the initiation of intervention. Those patients with higher ADL levels showed improvements markedly in 6MD score. Measurements conducted on some patients 60 days after the initiation showed improvements in the 6MD and CS-30 scores.
    Discussion: While it has been reported by other studies that the muscle activity level in the aquatic exercise is lower compared to that in the ordinary physical therapy, the results of CS-30, 6MD and HHD scores after the 30-day intervention in this study show the improvements at the muscle strength and endurance of each joint. This may be because the buoyancy and viscosity of water have contributed to the adjustment of the suitable exercise intensity level, which depends on each patient’s disability, the endurance and strength of the muscles involved in standing up and walking are improved. Based on these results, it is said that the intervention combining hot spring aquatic exercise and physical therapy should be continued for more than 20 days to improve the CS-30 score and 6MD, and more than 30 days to promote the muscle strength of each joint.
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  • Akira SANO, Aya SOMA, Masumi NUMAO, Akitoshi WATANABE, Tomomi OGATA, K ...
    2014 Volume 77 Issue 5 Pages 567
    Published: August 29, 2014
    Released: January 15, 2015
    JOURNALS FREE ACCESS
    Objective: Our previous studies suggested that hot spring aquatic exercise may immediately improve the balance ability. As the long-term effects of such repeated exercise have not yet been examined, this present study aims to analyze them, focusing on the balance-related physical indexes.
    Methods: A total of 12 patients (the number of cerebrovascular disease patients: 5; the number of orthopedic disease patients: 7; mean age: 71.9±13.1; FIM: 117±7.5; and FBS score: 46.4±6.7), who had been treated with hot spring aquatic exercise therapy in our hospital were studied. Each patient showed decreased balance ability due to paralysis, sensory disturbance, or fracture. The measurement indexes were the ability to bend forward while sitting with their legs straight, Functional Balance Scale (FBS), Functional Reach Test (FRT) and Timed Up and Go (TUG) scores, sensory function was measured by the instrument (Semmes-Weinstein Monofilaments), and skin stiffness. Those were measured immediately, 10, 20, and 30 days after the initiation of the intervention.
      Furthermore, indexes of eight patients out of those were measured 60 days after the initiation. Each exercise session consisted of walking forward and backward, hip abduction, flexion, and extension, lunge, and squat, which lasted approximately 15 minutes. The loading level was set at a pulse of 77±11.2 ≧ 84±13.5/minute, with a perceived exertion rate (modified Borg Scale) of 0.7±1.0 ≧ 2.4±2.3.
    Results: The ability to bend forward while sitting with their legs straight, TUG, FBS and sensory function, scores have improved significantly. Any significant improvements were not observed on FRT and skin stiffness.
    Discussion: The improvement of the sensory function was observed in patients with cerebrovascular disease. This would be because these therapies have the effect on the improvement of higher neuronal function. It is assumed that training efficiency in itself was improved, as the buoyancy and hydrostatic pressure assisted the patients to keep balance.
      This exercise showed more effectiveness on the complicated balance indexes. On evaluation of each balance index, the TUG scores significantly improved significantly, while the FRT scores did not show any effects. As the balance-related indexes started to show improvements 30 days after the initiation, it should be recommended to continue this exercise for 30 days or more. Furthermore, in those who had not reached the maximum FBS score 30 days after the initiation, the improvement in scores was observed after 60 days. Further studies will be necessary to analyze these physical indexes, which showed improvements so that more effective exercises for each patient can be programmed taking the relevant balance-related physical indexes into account.
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