The purpose of this study was to investigate several factors related to loss of ambulatory ability in Duchenne muscular dystrophy (DMD) patients. Fourteen patients were divided into two groups according to the age at the time of losing ambulatory ability; young group: <10 years old (n=7), old group: ≧10 years old (n=7). We measured muscle strength, range of motion (ROM), height, weight and body mass index (BMI) before and after losing ambulatory ability for each patient. The interval of these paired tests was within 1 year (mean 9.2 months, range 4 to 12 months).
All 5 items were better in young group than those in old group before getting non-ambulatory. The mean ROM was worse in young group than in old group after getting non-ambulatory. Change in ROM was greater than the other 4 items in 6 out of 7 patients in young group, while all 5 items declined equally in old group. Furthermore, the difference in ROM between right and left lower extremity became significantly greater after getting non-ambulatory than before getting non-ambulatory in young group, but not in old group. These results indicate that loss of ambulatory ability was related to the decline and asymmetry of ROM in young group, and to the decline of multiple factors in old group. These facts imply the importance of ROM exercise, especially in the younger age of the patients with DMD to keep their ambulatory ability.

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The purposes of this study were to assess the continuous change of integrated electromyography (I.E.M.G) and mean of power frequency (M.P.F) of lower limb muscles against the load from sole in upright standing posture, and to discuss the “Sense of effort” from results obtained. “Sense of effort” was difined that remark the subjective required to maintain weights with it are increased when a muscle is fatigued.
The subjects were five healthy males and five hemiplegic patients following stroke. We analyzed E.M.G of the gastrocnemius and the tibialis anterior muscles for 240 sec in upright standing posture. The task is to maintain in upright standing posture against reaction force by the lord from anterior sole or posterior sole. We recorded I.E.M.G and M.P.F every five seconds. In all healthy males, as compared with initial value, the final value increased in the I.E.M.G and decreased in M.P.F as to gastrocnemius muscle when the load was applied from anterior sole. Also, as compared with initial value, the final value increased in the I.E.M.G and decreased in M.P.F as to tibialis anterior muscle when the lord was applied from posterior sole. However, the stroke patients did not recognize the same phenomenon same as healthy males changed. These results indicate that the healthy subject muscles showed the distinctive mark of “sense of effort”, but sense of effort may be damaged in the stroke patients.

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The coordination between swallowing and respiratory movements was studied in twenty-three young, nine elderly and two subjects with dysphagia. The swallowing was produced by administration of a small quantity of water (3 ml). Laryngeal and respiratory movements were recorded by mercury elastic strain gauges placed on the laryngeal cartilage and lateral rib cage, respectively.
In the young subjects, swallowing respiration occurred with retardation of 238±32 msec from the onset of upward movement of the larynx. Further, swallowing respiration shifted to the expiratory phase with retardation of 165±29 (mean±SEM) msec from the onset of downward movement of the larynx. This coordination between swallowing and swallowing respiration was maintained in the elderly subjects. In all the subjects, aspiration was never observed, It is therefore suggested that the coordination is necessary to produce complete swallowing. However, swallowing respiration was preceded by the laryngeal movement in the dysphagia subjects. Therefore the difference occurred with coordination between swallowing and respiration.
These results indicate that the inspiratory phase of swallowing respiration is produced after the elevation of the larynx, which produces complete respiratory passage occlusion and prevents water and bolus from entering the respiratory passage. We conclude that modification of the coordination seems one factor for aspiration and the method used in this research is useful for quantitative evaluation of dysphagia.

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The purpose of this study was to examine the relationship between the disabilities of daily living due to disease and self-esteem of patient. Subjects were 177 patients with physical disabilities and 99 healthy persons. We evaluated activities of daily living (ADL) and self-esteem using the question paper method. The modified Barthel Index and Rosenberg self-esteem scale were used for the evaluation. As a result, the patients showed lower points in ADL and self-esteem, compared with healthy persons. Furthermore, the patients with 4 limbs and trunk disavantage indicated the lowest points in ADL and self-esteem. Twelve-month follow-up surveys revealed no relationship between the improvement in ADL and self-esteem in 4 outpatients. These results suggest that recovery of self-esteem cannot be realized by only the improvement of ADL.

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The range of motion (ROM) of the knee can be limited by total knee replacement (TKR), which often makes the patients stand-up from the floor difficult. In the present report, 42 patients who were independent in every activities of daily living (26 bilateral TKR, and 16 unilateral TKR) participated, and their knee extensor torque, ROM of the knee, functional evaluation score of the knee and the time to stand-up from the floor were measured. In addition, their standing-up patterns from the floor were observed. As a result, body rotation pattern was observed in 38 patients; 4 people performed non-rotation pattern (these patients had unilateral TKR). A high positive correlation was observed between the time to stand-up from the floor and knee extensor torque as well as between the time to stand-up from the floor and functional evaluation score of the knee in the patients with bilateral TKR. No statistical correlation was observed in unilateral TKR group. These results suggest that functional loss of the patients with bilateral TKR affects the standing-up activities from the floor.

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Although knee laxity has generally been evaluated using KT-2000 knee arthrometer, few studies have paid attention to subjects' age, gender, and recurvatum. The purpose of this study was to clarify the influences of those factors. We measured the anterior-posterior displacement of the knee of 134 healthy subjects (218 knees) with KT-2000 knee arthrometer. The subjects (218 knees) were classified into ten groups according to age and sex. The laxity was decreased with age in women, but not in men. Women of twenties showed more significant anterior displacement compared men of the same age, but there was no gender difference in other age groups. The analysis of the non-injured knees of patients with ACL injury revealed that back-knees (10 knees). had greater laxity than the joint without hyperextension (10 knees). These results indicate that age, gender, and range of extension should be considered in the evaluation of the laxity of injured or reconstructed knee.

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This study investigated gender differences in isokinetic muscle endurance and recovery of the knee extensor muscle in healthy 52 adults.
Twenty-five male and 27 female subjects (age: 21.7±2.1 ys and 20.9±1.3 ys, body height: 169.0±5.0 cm and 157.6±5.3 cm, and body weight: 62.2±9.2 kg and 51.9±4.0 kg, respectively) performed single maximum isokinetic muscle contraction every 15 sec for 3 min following 30 repetitions of maximum isokinetic muscle contraction. All subjects performed two tests at different angular-velocities (90°/s and 180°/s) within 2-5 days. Decrease rates in average torque of every 5 repetitions and every 15-sec interval of recovery were calculated and expressed as the percentage of initial maximum peak torque at each angular-velocity. The student's t-test was used to investigate gender differences in decrease in endurance and recovery of peak torque for 3 min.
The results indicated no difference in every parameters between the male and female subjects.
To assess the usefulness of muscle endurance and recovery measurements, differences in angular-velocity and relative individual muscle strength will be examined in the future.

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The purpose of this study was to classify the patterns of sitting-potition balance as an indicator to estimate the prognostic walking ability in a patient with postapoplectic hemiplegia, also aiming at an improvement of the balance. The static and dynamic sitting-balances in 46 patients with postapoplectic hemiplegia could be classified into 4 groups according to the cluster analysis. Based on this classification, the differences in walking abilities between the times of admission and discharge were analyzed by the variance analysis method. In addition, the time-course changes in the walking ability and the sitting balance were compared in each group and the following results were obtained.
(1) Although there were no differences in walking ability among the groups at the time of admission, significant differences were found at the time of discharge.
(2) There was a specific correlation between the time-course changes in walking ability and sitting-position balance in either of the four groups.
These results suggest that the quantitative classification for sitting-position balance is available as an indicator to estimate prognostic walking ability inconsideration of its improvement.

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Pulmonary complications (PC) are common sequelae to acute cerebral vascular accidents (CVA). One hundred and twenty patients with acute CVA were examined to determine the factors which contribute to the development of PC. Data concerning the type of PC were obtained from the patients' medical records. Thirty other items including nutritional status and physical activity level were analyzed to establish the relationship between these factors and PC. Twenty eight patients (23.3%) had at least one PC during hospitalization. Factors associated with PC were patient's age, history of pulmonary disease, consciousness level (as classified by the Japan Coma Scale), level of physical activity, serum albumin level, severity of motor paresis on upper extremities (as classified by Brunnstrom-stages of recovery), duration of bedrest, presence of dysphagia and eating ability, and presence of methicillin resistant staphloccus aureus infection. Factors associated with the greatest risk for the development of PC in patients with acute CVA included serum albumin level, duration of bedrest and patients' age.

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We evaluated the isokinetic strength of quadriceps and anterior tibial displacement of the patients with the anterior cruciate ligament (ACL) injury (N=20), and recorded simultaneously electromyography (EMG) of rectus femoris and vastus medialis using surface electrodes. We determined premotor reaction time (PMT), electromechanical delay (EMD), which was considered to represent muscle response, and mean power frequency (MPF) from EMG.
The isokinetic strength decreased significantly (p<0.0001) and the anterior tibial displacement increased significantly (p=0.0001) in the lower extremity with the injured ACL.
EMD increased significantly (p=0.0216) and MPF of vastus medialis decreased significantly (p=0.0011) in the lower extremity with the injured ACL.
These suggested a decrease in quadriceps muscle strength and a delay in muscle response in patients with ACL injury.
This was considered to result from the Quadriceps-Avoidance-Gait, characterized by the injured ACL patient, and from the fact that vastus medialis is single-joint muscle.

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