We use the “Nasent Self-supporting Table (NST)” which is developed as the device for adjustment of abnormal sitting posture and tapping stimulation on the sole using the sole tapping stimulator (STS), named “Kyusokubi” which generates rhythmic percussion on the surface of the sole for patients with cerebral vascular disorders (CVD). Functional states of the patients were measured by Barthel Index (BI), Maximum Walking Speed (MWS) and Movement Time (MT) which required by the task, which has come to be known as the Fitts' tapping task, before, 3 days after applied NST alone and 14 days after the training using NST and STS. After 14 days, BI score and MWS were significantly increased (p<0.05), and MT was shortened (p<0.05). The present results proved that NST and STS are useful tools for the medical rehabilitation to the patients with CVD.

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It is well known that the patients with Parkinson's disease (PD) tend to fall backward due to the disorder of equilibrium function. There have been no quantitative methods for measuring the disorder of equilibrium function, and the risk factor of fall has only been judged according to the experiences of medical doctors and/or therapists. We have therefore developed a new method to measure the stability of the standing position (the ability to keep the standing position) against the tilting stimulation. This method was expected to reflect the risk factor of falls among the patients with PD. Subjects were 14 patients with PD (7 men and 7 women). In Yahr's classification, three were grade 11, eight were grade III, and three were grade IV. Seven healthy elderly subjects without neurological disturbances served as control group. Subjects were instructed to stand on a tilt table, the foot plate of the table was then inclined backward, and the maximum angle at which the subject could keep standing position was measured. With a videotaping from the side, the change of the ROM of the hip joint was recorded at the straight standing position and leaning to the back. Results indicated that the maximum angle of PD patients was significantly smaller than that of controls. Among PD patients, the grade IV group exhibited the tendency to fall backward at the smaller tilting angle compared with the grade II and III groups. Those subjects whose maximum angle was less than 6 degrees had all experienced backward falls. The grade IV group of PD patients showed forward flexion of the body at the straight standing position, and fell backward in the similar position to the straight standing with a small change in ROM of the hip joint. These results suggested usefulness of our new method to predict the risk factor of falls of PD patients.

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In order to examine the relationship between gait ability and sensory disturbance (SD), the maximum walking speed, walking rate, repeated walk distance, and standing balance were compared between hemiparetic patients with and without SD. Significant differences in maximum walking speed and walking rate were observed between patients with and without SD. No significant difference in repeated walk distance was, however, found between them. Patients with SD indicated significantly shorter standing time on an affected leg compared with patients without SD. No such difference was observed in case of standing on an unaffected leg. The present findings suggest that SD may induce a decrease in walking rate, thereby potentially decreasing the maximum walking speed. It was also clarified that walking rate was highly influenced by the state of standing balance, and that the static standing balance could reflect the dynamic standing balance in hemiparetic patients. These imply that the standing balance test on a single leg may be useful for evaluating gait ability of hemiparetic patients. It remains to be seen whether the test will also be applicable to patients with severe hemiplegia.

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For the purpose of investigating a difference in muscle fiber composition and bone marrow between the affected and unaffected sides, the relaxation times of Magnetic Resonance Imaging (MRI) were measured in lower thigh muscles of hemiplegic stroke patients. Results obtained were as follows: 1) Of soleus muscle, both TI and T2 values were larger in the affected side than in the unaffected side, which implies that the fast twitch fiber may be contained more in the muscle of the affected side than in the unaffected side. 2) No significant difference in T1 and T2 values of anterior tibial muscle was observed between the sides, which suggests that relatively active muscle fiber may be decreased in the muscles of both sides. 3) Of upper part of the bone marrow, both T1 and T2 values were larger in the unaffected side compared with the affected side. This suggests that fat bone marrow may be contained more in the affected side than in the unaffected side.

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The purpose of this study was to obtain the histological and histochemical findings regarding skeletal muscle of elderly patients. The subjects were I male and 9 female patients with fracture of the neck of the femur, aged 80-90 years, who had received operations at the Ohashi Hospital of Toho University. Muscle biopsies were taken from the vastus lateralis muscle by the open biopsy technique. Serial transverse frozen sections (10 μm thick) were cut on a cryotome at -20°C. The myofibrillar ATPase method was used for muscle fiber classification into slow twitch (type 1) and fast twitch (type 2) fibers. The reactions were carried out at pH 9.4 followed by alkaline preincubation (pH 10.3). Various changes observed in skeletal muscles and the results were summarized as follows: 1) Atrophy of type 2 fiber was seen in all patients, and that of type I fibers (postural slow fibers) was smaller compared with type 2 fibers. 2) Neuropathic changes: Small angulated fibers were seen in 5 of 10 patients. Small group atrophy and type 2 fiber predominance were present in 3 of 10 patients. 3) Myopathic changes: Variation in muscle fiber size was seen in 3 of 10 patients. Interstitial fibrosis was also observed in 3 patients, and opaque fibers and cetnral nucleis were seen in I patient each. In the present findings, myopathic as well as neuropathic changes were observed in skeletal muscles of elderly patients, and neuropathic changes were more prominent. The patients with neither neuropathic nor myophathic changes exhibited good prognosis of gait ability.

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In order to confirm the reliability of evalution of exercise capacity by analyzing expired gas, 17 healthy university students performed the cardiopulmonary exercise testing. Followed by a 2-min rest and 2-min warm-up (30 watt/min), subjects underwent the bicycle ergometer exercise with ramp loading of 15 watt/min. During the exercise, oxygen uptake (VO₂), carbon dioxide production (VCO₂) and minute ventilation (VE) breath by breath were continously measured. Anaerobic threshold (AT) was also determined by the Wasserman's V-slope method during the exercise. There was a significant correlation between VO2max and AT, and between HR_max and HR_AT. AT was found 56.2% of VO_2max. These results suggest that evaluation of exercise capacity by expired gas during cardiopulmonary exercise testing is useful.

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We measured lumbar vertebral bone density of patients with spinal cord injury by the Dualenergy X-ray absorptiometry (DEXA) in order to examine the effect of wheelchair sports on their bone density. Thirty-two male patients with spinal cord injury (2 with C level, 25 with T level, 5 with L level), all used wheelchair daily, were divided into two groups; those who played some wheelchair sports, and those who did not. The relationship between lumbar vertebral bone density and body weight, lean body mass, and the period from injury was investigated. There was no correlation between the bone density and the period from injury in subjects who played wheelchair sports. Subjects who played wheelchair sports exhibited higher mean lumbar vertebral bone density compared with subjects and controls who did not play sports. No significant difference in the bone density was observed between subjects who played wheelchair sports and controls who played sports. These results indicate that a decrease in lumbar vertebral bone density of patients with spinal cord injury is preventable if the patients play sports customarily.

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The purpose of this study was to introduce the full-time exercise program performed on acute hemiplegic patients by physical, occupational, and speech therapists of our hospital, and its effects and defects examined. Of 433 inpatients after stroke who had received rehabilitation in our hospital during 5-year period from 1985 to 1989, 195 patients after initial attack served as subjects. Despite a long hospitalization (3 months in average), approximately 80% of the subjects showed independent gait and ADL at discharge, and 80% and more could return their homes. There were several cases of fractures by falling, orthostatic hypotension, etc. during the exercise, which was fewer than we had expected, and no recurrence of stroke was observed. Although further investigation need to prevent accidents during the exercise program, it is our conclusion that this full-time exercise program is effective for acute hemiplegic patients after stroke.

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Pain caused by functional disorders of cervical spine can be devided into two types; somatic pain and radicular pain. The former is derived from the cervical musculoskeletal structure mechanical or chemical stimulus received by a nociceptor in cervical region is introduced by way of concentric nerve and perceived as pain. The latter is caused by mechanical or chemical stimulus on spinal nerve or spinal nerve root; perception of the pain results from ectopic impluse in the concentric nerve. The ingravescent potential of the condition is in general high in case the patient complain of radicular pain. It is important to distinguish between somatic pain and radicular pain not only for risk management of the patient but also for application of appropriate treatment.

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