Objective: The present retrospective study aimed to clarify the involvement of knee extensor strength and autonomic indices (ΔHR) in the improvement of exercise capacity (peak VO_2) in acute myocardial infarction (AMI) patients with type 2 diabetes mellitus (DM) undergoing cardiac rehabilitation (CR) -related exercise training. Methods: A total of 41 consecutive male AMI patients with type 2 DM were divided into the supervised outpatient CR group (n = 24) and the non-CR group (control, n = 17). Physical training was prescribed for 8 weeks in the CR group. Cardiopulmonary exercise testing (peak VO_2, ΔHR) and isokinetic knee extension strength measurements were performed on all subjects at 1 (T1) and 3 (T2) months after AMI onset. Results: Significantly greater improvements in peak VO_2 (26.1→29.4 vs 23.5→24.4ml/kg/min, F=7.5, p < 0.01), knee extension strength (1.7→1.9 vs 1.7→1.7 Nm/kg, F=5.1, p=0.02), and ΔHR (71.3→77.2 vs 63.5→62.5 bpm, F=5.5, p=0.02) were measured from T1 to T2 in the CR group versus the non- CR group. Conclusions: In patients with AMI complicated by DM, only the exercise group showed significant improvements in knee extensor strength and ΔHR. Therefore, improvement in exercise capacity in such patients was considered to be related to improvements in knee extensor strength and ΔHR.

View full abstract

Purpose: We aimed to clarify the factors associated with transfer of cerebral infarction patients in the acute stage to rehabilitation hospitals.Subjects: From 277 consecutive patients admitted with cerebral infarction to the Stroke Center of our hospital, we chose 215 patients discharged to home (home-discharged group, n 121) or to rehabilitation hospitals (rehabilitation hospital group, n = 94). We designed this study as a retrospective observational study and investigated various factors including social factors obtained from medical records. Results: Compared with the home-discharged group, the rehabilitation hospital group did not show differences in patient background, such as presence of housemates and numbers of persons per household but did show greater dysfunction and disability. Factors associated with discharge destination by multiple logistic regression analysis included the National Institute of Health Stroke Scale (NIHSS), when the illness is serious; the Ability for Basic Movement Scale II (ABMS II), when a wheelchair is first used; higher brain dysfunction; and the Barthel Index at the start of rehabilitation. From the results of ROC curves, cutoff values for determining discharge direction were 3.5 points by the NIHSS and 21.5 points by the ABMS II. Conclusion: It is suggested that both the NIHSS and the ABMS II, which is an objective index for evaluating basic mobility, might be factors for early prediction of discharge to rehabilitation hospitals.

View full abstract

Purpose: The purpose of this study was to clarify whether stroke patients with different stepping patterns had the ability to ascend and descend stairs, based on their basic attributes and physical functions. Methods: Subjects were 64 persons with stroke in whom age, time since stroke, knee extension on non-paretic and paretic sides, leg weight bearing rate (WBR) on non-paretic and paretic sides, leg Brunnstrome recovery stage (Br-stage), presence or absence of disturbance of deep sensibility, and severity of spasms were surveyed or measured. Results: Subjects were divided into 3 groups for stair ascending and descending: 1 leg-i step; 2 legs-i step; and unable to use stairs. Significant differences were seen in leg strength on non-paretic side, leg strength on paretic side, WBR on non-paretic side, WBR on paretic side, leg Br-stage, and presence or absence of disturbance of deep sensibility. In a comparison of consecutive data, values for paretic side muscle strength and paretic side WBR were significantly higher in the i leg-i step group than in the 2 legs-i step group for both ascending and descending. Moreover, values for paretic side muscle strength were significantly higher in the 2 leg-i step group than in the unable group for both ascending and descending. Conclusion: In stroke patients, various physical functions contribute in ascending and descending stairs with different ascent/descent patterns. The results suggest that muscle strength and WBR on the paretic side is particularly important when using stairs.

View full abstract

Purpose: We examined our hypothesis that a 7-week program of plantar flexor training improves gait function, by using spatiotemporal and Center of pressure (COP) parameters. Subject: Three subjects with cerebral palsy (13.7 ± 5.4 years old), who are possible to serial walk 10 m or more, and understand oral instructions, were included in the study. Methods: We employed a single-subject ABA' design consisting of a 7-week baseline phase, a 7-week intervention phase, and a 7-week post intervention phase. The subjects were given training 3 times a week during the intervention phase. Result: Two cases showed a significant improvement in the walking ability and the walking efficiency, one case showed a significant improvement in the walking efficiency. These results support our hypothesis. Conclusion: It is not easy to improve gait function by increasing the amount of the activity of the muscle for people with cerebral palsy who have not haven a normal movement pattern since their birth. However, the approach of the amount which has been a contraindication, is one of the important approaches for it to improve and maintain gait function.

View full abstract

Purpose: When exercise by post-stroke hemiplegic patients is guided, there is often a lack of specific guidance regarding how much walking the patient should do. The purpose of this study was to examine exercise guidance for hemiplegic patients based on an analysis of energy consumption while walking. The assumption is that an energy consumption of about 300 kcal through daily exercise (equivalent to walking about 10,000 steps) is effective for health maintenance in an able-bodied person. Methods: Seventy-one hemiplegic patients were included in this study; the number of steps, walking distance, and energy consumption were measured while the subjects walked for 12 minutes. Next, the number of steps, walking distance, and walking time equivalent to the target energy consumption (300 kcal/60 kg) were calculated. Results: The number of steps and walking distance equivalent to the target energy consumption were reduced in subjects whose walking speed was slower. Conclusion: We must consider motor functions, such as walking speed, when prescribing the number of steps and walking distance because energy consumption per step and distance is influenced by motor paralysis in hemiplegic patients.

View full abstract