The Modified Tardieu Scale (MTS) is an index for assessing muscle spasticity, and consists of measurement of Range of Motion (ROM) and Quality of Muscle Reaction (QMR). MTS is characterized by its measurement method where subject's position and velocity of muscle stretch are provided. There are a large number of research articles using MTS for parameters in western countries, but not in Japan, and little is known on its reliability and clinical usefulness. For the purpose of investigating clinical usefulness of the MTS for assessment of plantarflexors in hemiplegic patients, we analyzed the intrarater and interrater reliability of ROM and QMR (n = 13), relevance between QMR during muscle stretch at different velocities (n = 28), and relavance between QMR and Modified Ashworth Scale (MAS) (n = 30). We stretched plantarflexors of the subjects as slow as possible (V1) and as fast as possible (V3) in knee extension and flexion positions.
As a result, 1) the intrarater and interrater reliability of ROM was high (ICC = 0.98 - 0.99), and those of QMR was also high (intrarater: κ = 0.73 - 1.00, interrater: κ = 0.71 - 1.00), 2) QMR at V1 indicated a weak positive correlation to QMR at V3 in knee extension position (r_s = 0.39), and no correlation in knee flexion position. 3) QMR at V1 showed a strong positive correlation to MAS (r_s = 0.89 - 0.90), but QMR at V3 showed a weak positive correlation to MAS (r_s = 0.34 - 0.38).
The present study indicates that MTS has a high intrarater and interrater reliability, and that QMR is possibly applied for the assessment of peripheral and neural components of spasticity. The results suggest the clinical usefulness of MTS for the assessment of plantarflexors in hemiplegic patients.

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Recently, several novel post-stroke therapeutic approaches for the upper limb have been reported. Ramachandran developed mirror therapy (MT) for phantom pain treatment, and applied it to the treatment of the upper limb of post-stroke patients. The purpose of this study was to examine the effect of MT on sub-acute stroke patients with upper limb paralysis.
A randomized cross-over design was used for this study. Subjects were 15 in-patients within 3 months from onset, comprising the MT group and control group, consisting of 9 patients and 6 patients, respectively. While patients in the MT group made active movements of the unaffected hand (e.g., right hand), the patient watched the moving image of the unaffected (right) hand reflected in the mirror and passive movements were given to the affected hand (e.g., left hand) by the therapist behind the mirror inside the mirror box. The control group only received passive movements to the affected hand by the therapist without usage of the mirror. After four weeks of receiving therapeutic treatment, the applied methods were then exchanged between the two groups. The functional capabilities of the upper limbs were measured both before and after each therapeutic treatment. A therapist who had not participated in the therapeutic treatment evaluated the process, with the type of treatment being masked using the Fugl-Meyer Assessment scale. The data was statistically analyzed using the Mann-Whitney U-test and Wilcoxon signed rank test.
The MT group showed a significant improvement in upper limb function, but no significant improvement was seen before or after therapeutic treatment for the control group. These results suggest that MT is an effective method of treatment for upper limb paralysis in sub-acute stroke patients.

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The purposes of this study were: (1) to examine the short-term (10 weeks) and the long-term (1 year) effects of exercise training at high work rate on exercise tolerance in patients with chronic obstructive pulmonary disease, and (2) to detect the baseline physical conditions of patients who had shown decrease in exercise tolerance during the maintenance period. Fifty-seven patients underwent the exercise training, and were evaluated at baseline and 10 weeks and 1 year after the training. A significant improvement in 6-min walk distance was observed at 10 weeks and 1 year compared to the baseline. However, 6-min walk distance at 10 weeks was less than that at 1 year. Compare with patients who had not shown a decrease in 6-min walk distance, patients who had indicated the decrease (less than 54 m) exhibited poorer pulmonary functions, less 6-min walk distance, and poorer ADL and Health Related QOL at baseline in the former group. Furthermore, there was a significant correlation between changes in 6-min walk distance and those in ADL score. The results suggest that poorer baseline physical condition may be an indicator of a decrease in 6-min walk distance during the maintenance period, although exercise training at high work rate improves 6-min walk distance. Moreover, a change in 6-min walk distance was significantly associated with a change in ADL score, which suggests that exercise training at the early stage can lead to long-term maintenance in improved in exercise tolerance.

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Exercise-preconditioning attenuates muscle atrophy due to hindlimb suspension (HS). However, the molecular mechanism by which exercise-preconditioning exerts these effects remains poorly understood. The present study investigated whether exercise-preconditioning attenuates HS-induced muscle atrophy via inhibition of the ubiquitin-proteasome pathway and whether heat shock protein (HSP) mediates this inhibition in rat soleus muscle.
Rats were randomized to the following groups: 2-wk HS, treadmill running before 2-wk HS, and aged-matched control. HS-induced atrophy was associated with increased proteolysis (decreased myofibrillar protein), upregulation of components of the ubiquitin-proteasome pathway (ubiquitin ligase E3 mRNA activity) and downregulation of HSP72 mRNA in the soleus muscle. However, exercise-preconditioning attenuated HS-induced atrophy and reduced ubiquitin ligase E3 mRNA. Furthermore, exercise-preconditioning did not decrease HSP72 mRNA.
These findings suggest that exercise-preconditioning attenuates HS-induced atrophy through muscle-specific inhibition of the ubiquitin-proteasome pathway, and is an effective countermeasure to muscle atrophy induced by HS.

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The evaluation and training of muscle force is often limited to one side of the body, as seen in manual muscle testing and uniform movement devices. However, most physical movements result from the sophisticated coordination of the four limbs on both sides; and there is a view that it is necessary to take bilateral movement which involves the interaction between both limbs, into account during training. In this study, an exercise requiring unilateral muscle force control during lower limb movement was assigned to consolidate the direction of attention, and the change in mutual interference with the opposite side in response to a change in the control level was examined. The subjects were nine healthy adults. Muscle force control of the right knee extensor (100%Maximal Voluntary Contraction (MVC), 75%MVC, 50%MVC, and 25%MVC by isometric contraction) was demanded, and at the same time, the subject was asked to make a bilateral movement, in which the maximum isometric extension muscle force of the left knee, the contralateral side, was demanded. The maximum isometric muscle force of knee extension on the left side alone was measured. The control measure of right knee extension muscle force was conserved as an absolute requirement during measurement, and the directionality of attention was consolidated. The analytical subject of data was the change in maximum left knee extension muscle force during exertion for each movement exercise. The results showed the influence of control of the right knee extension muscle force on the maximum left knee muscle force to be a syntonic change in which the maximum left knee extension muscle force decreased as the control level of right knee extension muscle force decreased. We believe this to derive from following mechanisms: the segmentation of attention at the cognitive and psychological levels, which is a mechanism of bilateral deficit, is involved, and the demand of muscle force control on the lower limbs, which has a high innervation ratio, demanded more attention due to both the increased difficulty level of assignments and the need for improving movement accuracy.

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