Long-term stroke survivors do not necessarily have a stable disability after a period of recovery. The purpose of this study was to test predictability of degree of decline in activities of daily living (ADL) late after stroke.
Subjects were outpatients with a more than one-year history of stroke at one local hospital. Ninety-six outpatients, who maintained mobility and had adequate cognitive function, were included. ADL was measured twice over a 12-month interval by the 5 item of Barthel Index (Hobart & Thompson, 2001). Before the follow-up investigations, 36 subjects dropped out. The remaining 60 subjects (36 males, the mean age of 71.4 years) provided full data for the analyses of ADL decline. Latent curve analysis method was used to predict longitudinal linear change in ADL. Predictor variables were age at baseline, motor dysfunction of lower limb, and walking outdoors, which were identified as a potential prognostic factor, using odds ratio of logistic regression analysis. Dependent variables were an intercept factor (the initial level of ADL) and slope factor (the degree of subsequent ADL annual change).
Comparisons between the analyzed and drop-out subjects showed no significant difference in the characteristics. The analyzed subjects showed that initial ADL disability was associated with the subsequent ADL decline. Increasing age and persistence of severe motor dysfunction of lower limb were both significantly associated with a larger degree of annual ADL decline. Walking outdoors had the opposite effect.
The results show the possibility of identifying subjects with worse prognoses (faster ADL deterioration) in chronic period of stroke, suggesting the predictability of individual variations in ADL decline late after stroke.

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The purposes of this study were to clarify recovery trend of slow vital capacity (SVC) and the SVC recovery related factors, and to determine the effect of incentive spirometry on SVC recovery after cardiac surgery. Of the 120 patients who underwent cardiac surgery via sternotomy, 60 patients participated in study 1, and the other 60 patients participated in study 2. In study 2, the patients completed a prospective randomized controlled study comparing two physiotherapy protocols. All patients received instruction in supported huffing and coughing and the importance of early mobilization. Group C patients received no additional physiotherapy. Group IS patients received instruction in deep breathing exercise using an incentive spirometry preoperatively and assistance in performing the same for one week postoperatively. Mean SVC value at the first day after the operation decreased to about 48% of the SVC preoperative value and the SVC did not recover to the postoperative value three weeks after operation. Recovery of SVC (%SVC) was not influenced by the age, period of operation, type of operation, sex, and smoking history. However, significant differences of SVC recovery were found between class Ⅱ and class Ⅲ in the preoperative NYHA classification. Moreover, the negative correlation was partially found between % SVC and the recovery of walking ability. There was no difference in SVC recovery and the incidence of respiratory complication between group IS and group C in study 2. We concluded that there was no effect of incentive spirometry on SVC recovery after cardiac surgery.

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Reciprocal inhibition in animal has been studied during voluntary movement of ankle joint or at rest, and lately in man. But there is not any research to investigate the relationship between muscle strength exercise and plasticity of upper motoneurones in our physical therapy. In addition, a physical therapist has not studied the effects of therapeutic exercise with the viewpoint of central nervous system. We therefore investigated the reciprocal inhibitory conjunctions of afferent Ia fiber and inhibitory Ia interneurone to muscle strength exercise. Ten young adult subjects were given informed consent, and were divided into two speed groups of isokinetic motion. The subjects were fixed on supine with hip and knee flexions at 45 and 90 degrees respectively, and they were asked to move ankle joint rapidly with 60 and 120 deg/sec and to take 10 sets once a day by Cybex machine 6000. Soleus H-reflex and peak torque among 30, 60, 90 and 120 deg/sec were examined four times every 3 weeks. Soleus H-reflex was evoked by electrical stimulation of the tibialis nerve in the popliteal fossa. The reflex was conditioned by electrical stimulation of the common peroneal nerve at caput fibulae. The effects of reciprocal inhibition were calculated as percentage reduction of the test H reflex amplitude to the control H reflex at rest. Statistical comparisons were made using ANOVA and unpaired t-test, and then probability values less than 0.05 were considered significant. A reduce of the soleus H-reflex amplitude attributable to reciprocal inhibition was seen at conditioning test interval 2 and 3 ms in two groups, and there were significant differences (p < 0.05) before and 6 weeks as well as 9 weeks after trainig. In addition, there were significant differences among conditioning test interval 0 and 2, 3 ms before and 6 weeks as well as 9 weeks after training. However, there was no improvement in muscle power in both groups throughout the 9-week experimental period, showing no increase in the peak torque.
We have found that the reciprocal inhibitory conjunction is changed in Spinal Neural Network by therapeutic exercise. That is, as soon as muscle strength had improved, it was thought that the any circuits of reciprocal inhibition might be made. It was considered important for the maturation of reciprocal inhibition to continue physical therapy. Further investigations are necessary to examine the relationship between the effects of physical therapy and functional changes in the neurological organization, such as reciprocal inhibitory conjunctions.

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The purpose of this study was to evaluate practicability of prophylaxis using neuromuscular electrical stimulation (NMES) to prevent deep venous thrombosis after total knee arthroplasty. Sixteen patients (2 men, 14 women, mean age: 68.6 ± 8) were included into this study. All patients were given informed consent before this study. Practicability of current method was evaluated by compliance with the use of electrical stimulation, balance of stimulation intensity, and presence of electrode-induced skin trouble. Deep venous thrombosis was evaluated by obvious swelling, Homan's sign and FDP D-dimer value. With regard to compliance with the use of electrical stimulation, 15 patients were tolerable for NMES from postoperation to remove drainage tube from operated legs. Regular adjustment of intensity was often needed. None of patients showed electrode-induced skin trouble. Only one patient showed redness of skin under electrodes. Although 3 patients showed obvious swelling in operated legs and 3 patients showed tenderness of gastrocnemius, all patients demonstrated normal value of D-dimer. These results suggest that the prophylaxis using NMES to prevent deep venous thrombosis is practicable in the clinical setting, and if necessity for regular adjustment such as stimulation intensity is improved, our technique will obtain greater improvement in practicability. Further studies will be needed to demonstrate the preventive effect of deep venous thrombosis using more reliable examinations such as venography.

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The purpose of this study was to clarify the change of frequency characteristics before and after IEMGT (Integrated Electromyogram Threshold) during incremental cycling exercise. Eight men underwent an incremental exercise test, i.e., a symptomatic marginal test, using a bicycle ergometer.
At each load, integrated EMG signals in rectus femoris muscle for five revolutions were analyzed with frequency analysis using continuous wavelet transform. After obtaining the power spectrums, we divided them into fifteen frequency ranges and computed the power of each frequency band. Also, after finding two regression lines before and after IEMGT, we calculated the inclinations and compared the angles formed with the two regression lines among each frequency band.
The inclinations of regression lines showed a significant increase in all the frequency ranges. The angles were smaller in the range from 66.0 Hz to 132.0 Hz, being centered between 81.2 Hz and 93.3 Hz. The high frequency ranges greater than 81 Hz reflected the contractions of type Ⅱ fibers. The data of frequency analysis with wavelet transform, suggested that IEMGT showed the results of additional recruitment of type Ⅱ fibers that follow the size principle.

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Patients with progressive or end stage arthrodesis often receive a Chiari pelvis osteotomy operation combined with ectropion bone cutting operation. Those patients shall be subject to postoperative exercise therapy for reinforcing muscle strength of the abductors of their hip joints. This report is to examine the ideal method of abductor strength reinforcing exercise.
We made a survey on 21 hip joints of 21 patients with progressive and/or end stage arthrodesis to determine when we should start such a exercise for the patients, how much amount of exercise we should increase for the therapy and what target values we should achieve in the exercise therapy. The survey result showed that the safer exercise therapy could be started by the face-up position in case of 1/3 loaded walking and by lateral recumbent position in case of 1/2 loaded walking. This idea reflects the resultant relationship between hip joints which occurs in case of abduction, in case of relief and in case of fully loaded walking.
As for the target value of abductor, the result also showed that the Trendelenburg symptoms all became negative with the below-mentioned conditions in case of good occlusion of joints with Sharp Angle less than 50°and with AHI more than 70%. The conditions go that the afferent or efferent contraction shall be over 1.00 Nm/kg when the rate of lever is under 2.5〜3.0 and shall be over 1.10 Nm/kg when the rate of lever is under 3.0〜4.5. The conditions also go that the even contraction shall be over 0.60 Nm/kg when the rate of lever is under 2.5〜3.0 and shall be over 0.70 Nm/kg when the rate of lever is under 3.0〜4.5.

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[in Japanese]

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