It has become one of the primary objectives of gait training program for hemiplegic patients after stroke to estimate the prognosis for walking ability. In the present study, we tried to estimate the walking ability on a flat road and the maximum walking speed after 3-month training using the data 2 weeks after hospitalization. Subjects were 52 patients with hemiplegia who had spent 1 year or less since onset and were expected to improve their walking ability. The estimation was made by the multivariate statistical analysis - Quantification analysis type I, and 6 related variables were selected; age, periods from the onset, Brunnstrom Recovery Stage (BRS), rising from a step, start step length, and abilities of perception and compensation. It was concluded that rising from a step, BRS and start step length exerted an influence on walking ability and maximal walking speed with a double correlation coefficient of 0.85.

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For the purpose of examining the appropriate evaluation method for practical gait endurance of hemiplegic patients, 2-min, 3-min, and 6-min walk distances, physiological cost index 2 min, 3 min, and 6 min after the gait initiation, aerobic work threshold, and maximum oxygen intake were measured. Thirty-six hemiplegic patients were divided into 2 groups; those who could and could not walk more than 1 km without rest. There was a significant difference in 2-min, 3-min, and 6-min walk distances, and maximum oxygen intake between the groups (p<0.05). Two-minute, 3-min, and 6-min walk distances highly correlated with each other. These results indicated that 2-min walk distance is most useful for the clinical evaluation of practical gait endurance of hemiplegic patients.

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Twenty hemiplegic stroke patients and 15 healthy controls were asked to walk 10-m distance at maximum and usual walking speeds, and their walking speed, stride length, and cadence were measured in order to investigate the effect of stride length and cadence on walking speed. The hemiplegic patients were divided into two groups according to walking speed (Group A:≥60 m/min., Group B:<60 m/min). In all three groups, both stride length and cadence exerted an effect on a change in maximum and usual walking speeds. Although a difference in maximum walking speed between A and B grpuos was affected by both stride length and cadence, that in usual walking speed was primarily affected by stride length.

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Physical therapy program for stroke patients of our hospital mainly consists of stand-up to sitdown exercises on the basis of Hirschberg and Miyoshi's therapy, with a major goal of strengthening the muscle power of non-paralysis lower extremity. In this study, 58 stroke patients who could walk alone before training participated in the program. They were classified into 3 groups according to walking function at discharge from hospital; those who could walk alone, could walk with a help, and could not walk. In the 3 groups, age, paralysis side, term of exercise from onset, training period, term of admission, place after discharge from hospital were investigated. There was no statistical difference in age, paralysis side, term of exercise from onset, and term of admission between the groups. Patients who could walk alone showed significantly (p<0.01) shorter training period, compared with the other groups. A significant difference was observed in place after discharge among the 3 groups (p<0.01); those who could walk alone returned to their homes, but those who could walk with a help and could not walk tended to go to another hospital or institution.

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We investigated the relationship between muscular endurance of the uninvolved leg and gait performance in hemiparetic stroke patients. Subjects are 32 male stroke patients. Isokinetic testing was performed on uninvolved knee extensors at 180 deg/sec. Muscular endurance was calculated by Endurance Ratio (EDR; %) and Total Work (TWK; J). The numbers of measurement were 10, 15, 20, 25, and 30 times, and gait performce was determined by Maximal gait speed (MaxV) and free gait speed (V; m/min). It was obtained that EDR of 10, 15, and 25 times and TWK significantly correlated with gait performance (V and MaxV).

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Of 35 patients, their knee function was evaluated 6 months after anterior cruciate ligament reconstruction. Isometric (60° and 90°) and isokinetic (60°/sec and 180°/sec) thigh muscular strength were measured by Cybex II, and KT-1000 measurement was made for identifying anterior-posterior knee stability. In the thigh muscular strength, peak torque/body weight × 100 (%) of knee extension at 60°/sec (% peak torque) was calculated. Fourteen patients showed more than 65 % peak torque (A group), while 21 patients showed less than 65 % (B group). Significantly higher values were found in the A group in isometric 60° and isokinetic 60°/sec and 180°/sec testing conditions. In the results of KT-1000 measurement, mean side-to-side difference in manual maximal anterior displacement was 2.7 ± 2.8mm in A group, and 0.8 ± 2.7mm in B group. Moreover, for the A group, functional ability test (FAT), which included one-legged figure-of-8 hopping, one-legged side-hopping, and one-legged long hopping, were performed in order to estimate their performance. Only 3 patients indicated results “normal” in all the three tests of FAT. In conclusion, at the 6-month post-operative follow-up period, we should examine not only knee stability and thigh muscular strength but also functional performance to identify restoration of their knee function after anterior cruciate ligament reconstruction.

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We applied positively isokinetic muscle strengthening exercise and aerobic training to two patients with polymyositis. Their muscle strength and endurance were examined by Cybex II and EMG before and after exercises, and they also performed motor stress test with bicycle ergometer. Both showed improvements in muscle strength, endurance, VO₂ MAX, and VT. Throughout the training period, CPK did not increase. These results indicate that isokinetic muscle strengthening and aerobic training are applicable for patients with polymyositis under the condition that clinical symptoms are carefully observed.

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In a series of movements in having a bath, getting in and out of the bath is one of the most difficult movements not only for hemiplegic patients but also for care givers. The present study was designed to compare physical load of care movements using different assistive equipments; a ceiling lifter and a shower carry, and bathtub; 30 and 60 cm deep. Physical load was evaluated by care giving postures and subjective reports from care givers. It was found that physical load was lowest in the care using the lifter and a bathtub 30 cm deep, from the results of care giving postures and subjective reports. On the other hand, the results of physical regions loaded and required time suggested that physical load may be highest using the shower carry and bathtub 30 cm deep.

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We simulatively prepared voluntary movements based on the movements of isokinetic measurement of trunk extension torque in order to esitimate the axis of the movement. By Kin-Com 500H, 25 healthy female subjects performed voluntary movements at trunk flexion of 40 degrees and extension of 20 degrees. The difference between the 4th spine of thoracic vertebrae and a measurement arm was recorded, and the axis of the movement was obtained from the equation, assuming that the movement is a circular motion. From the results, the mean X axis was supposed 1-2 cm posterior to the middle point between anterior and posterior superior iliac spines, ranged longitudinally from 2 to 5 cm. The mean Y axis was considered 2-5 cm lower than the middle point between anterior and posterior superior iliac spines with a vertical range of 2 to 9 cm. There were considerably big differences in the axis among the subjects.

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Ten healthy adult subjects performed standing-up movements from a chair with the aid of handrails of six different heights, and the moments of hip, knee, and ankle joints were measured. There was no significant difference in the peak moments of knee and ankle joints between the 6 handrails. The peak moment of hip joint indicated three patterns according to changes in height of handrails. This is considered to be reflected by different ways to use handrails.

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Aiming at improving gait performance of hemiplegic patients after stroke, we have been performing newly-developed training method, called “calf triceps muscle suppression method”. In the present study, the effectiveness of this method was compared with that of continuous expansion method, in regard to changes in maximum walking speed and step length. Thirteen hemiplegic patients who could walk independently in the hospital partipated in the study. They were instucted to walk 10 m at maximum speed, and thier maximum walking speed and step length were obtained from the required time and steps. After the training of calf triceps muscle suppression method, all the subjects showed improvements in maximum walking speed and step length, with a significant difference between before and after training (p<0.01). However, they indicated no such improvements after the training of continous expansion method. This may be because the newly-developed method induces coordinated movements among lower extremity joints at the standing phase, thereby resulting in smooth forward transfer of center of gravity.

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Chest physical therapy plays an essential role in respiratory care. Since April, 1993, two physical therapists have regularly been assigned in the Department of Respiratory Medicine of our hospital to respiratory care. They are expected to participate in the total care of patients in collaboration with nurses by performing chest physical therapy. Although some problems are to be solved, the benefits of chest physical therapy that have been obtained are the improvement in quality and duration of the therapy. To be concrete, chest physical therapy can intensively be performed on patients with acute respiratory disease, and well-controlled physical therapy service can be extended to patients with chronic respiratory disease both to hospital and at home treatments.

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