Using an electromyogram, specificity of muscle fatigue was investigated in 6 healthy subjects and 6 hemiplegic patients. Subjects positioned themselves in supine position with the knees slightly flexed and the ankle wearing a weight of 5% body weight, and performed knee extension once per 2 sec for 5 min. Electromyographic data were obtained from vastus medialis muscle before exercise and during 5-sec knee flexion at every 1 min of exercise. The data were processed using Fast Fourier Transform (FFT), and compared by the change rate of Median Frequency (MF). A statistically significant difference in electromyographic data was observed between hemiplegic patients and healthy subjects. In hemiplegic patients, a significant difference in electromyographic data was observed between before exercise and 2 min after the initiation of the exercise; the frequency became lower. The change conformed to the change of secondary function. In healthy subjects, the frequency also became lower, but not statistically significant.

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Physiological Cost Index (PCI) of 20 stroke patients was measured for 3 consecutive days in order to clarify the reproducibility of the variants for PCI as well as PCI itself. The subjects were ordered to “walk comfortably” and “walk as fast as you can”. From the viewpoint of reproducibility, the types of patients who could be assessed by PCI were also examined. The analysis of variance revealed no significant difference in PCI among measurement days, and the reproducibility of PCI was confirmed. Intraclass correlation coefficients were 0.90 and 0.89 during comfortable and maximum walkings, respectively, which suggests high reproducibility of PCI. Coefficient of variation were 11.3% and 7.6% in average during comfortable and maximum walkings, respectively. This variation was considered to be caused by heart rate at rest, changes in heart rate before and after walking, and the velocity of comfortable walking. Although the profiles of the subjects such as age, period from the onset, physical structure, Brunnstrom stage, maximum velocity of 10 m walking, and Barthel Index, varied considerably, the applicability of PCI to stroke patients was confirmed in the present study.

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The release of soft tissues of lower extremities was performed in 6 spastic diplegic patients with cerebral palsy who could walk independently with crouch gait, being aimed at improving gait in terms of both pattern and function. On the basis of long-term follow-up of the patients, the operative methods and gait before and after surgery were studied. Although all patients showed improvement in gait after surgery, those who had only soft tissue release revealed gait with internal rotation of hip joint and required additional osteotomy to reduce internal torsion. Following the fractional lengthening of the gastrocnemius muscle, gait with mild equinus deformity and excessive contraction still persisted at the time of toeoff. The lengthening of Achilles tendon using the triple cut was more effective to improve gait in terms of both pattern and function in the patients with equinus deformity. Since shortening of iliopsoas and hamstrings tended to recur, the procedure to diminish the strength of psoas muscle is therefore desirable. The procedure should be determined by dynamic assessment, and be performed on multi-joint muscles simultaneously to adjust multi-joint alignment, taking patient's age into consideration. Postoperative care such as exercise and orthoses is important.

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In our hospital, simulataneous bilateral total knee arthroplasty (TKA) has positively been performed on a patient with knee osteoarthritis, in whom the operation is indicated. We have then undertaken the postoperative physical therapy (PT) progam same as that for unilateral TKA, and have so far obtained satisfactory results; no patient has complained of loosening. In the present report, the postoperarive PT for patients receiving simultaneous bilateral TKA is introduced, and the PT method is examined from the functional viewpoint. Forty outpatients who had already showed functional stability (20 received simultaneous bilateral TKA, and 20 received bilateral TKA) participated in the study, and their knee ROM and walking velocity were measured. No differences in both knee ROM and walking velocity were observed between patients receiving bilateral TKA and those receiving unilateral TKA. The result suggests that PT program for unilateral TKA may be applicable to that for bilateral TKA without any modification.

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Ninety-six patients with femoral neck fracture were studied by clinical recordings to investigate the factors which affect gait performance at discharge from hospital. The items investigated were age, sex, type of fracture operation, complications, gait performance before injury and at discharge, physical therapy achievements in hospital, etc. The patients who could walk independently using T cane at discharge, those who could not showed higher rate of complications before injury and senile dementia, lower physical therapy achievements, and gait performance before injury. These differences were all significant. The results suggest the necessity of team approach consisting of doctors, nurses, and physical therapists for the patients with femoral neck fracture, especially those who are expected to have poor gait performance at discharging from hospital.

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Hip joint disorder in adults is an osteopathic disease, characterized by deformity and contracture of joint tissues, and the patients exhibit gait pain, restricted motility of legs, and limping gait accompanied by the leg length inequality. Patients with hip joint disorder further show equilibrium dysfunction, and have considerable problems in maintaining balance of center of gravity. In the present study, we measured equilibrium function of 4 adult female patients with hip joint disorder (average age, 51 years), and performed Pelvis Adjusting Method (PAM) on them in order to examine the effectiveness of PAM. Compared with healthy subjects, the patients revealed no significant difference in body sway during standing with both legs or one leg, but could not show a smooth locus of Center of Gravity Rotation (CGR), exhibiting approximately one half of vertical and horizontal lengths. This suggests that restricted motility of hip joint may limit the movement of whole body. After receiving PAM, the patients showed changes in leg length inequility, and longitudinal point of center of gravity, and improvements in body sway and CGR (horizontal length). The results suggest that sacroiliac joint may play a pivotal role in the vital mechanism, and relate closely to motility of hip joint. It is also suggested that the repetition of CGR exercise and PAM may be effective for the improvement in equilibrium function of patients with hip joint disorder.

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The purpose of this article is to describe the neuroanatomy of a headache. Although many factors can cause headaches and the clinical manifestations vary greatly, a common neuroanatomical basis exists. The trigeminocervical nucleus receives afferent fibers from the spinal tract of the trigeminal nerve and the C1 to C3 spinal nerves, and mediates the information from nociceptors. The activation of the neuron in the trigeminocervical nucleus conducts impulse to a higher center to perceive the headache. Besides the trigeminal nerve and the upper cervical nerves, the glossopharygeal and the vagal afferents terminate in the trigeminocervical nucleus. Convergence of these afferents causes a referred pain.

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Cardiac muscles cannot be nourished in case a marked constriction or occlusion occurs in coronary arteries, and result in necrosis, in other words, myocardial infarction. Accompanied by cardiac necrosis, characteristic changes appear in the results of electrocardiogram, echocardiogram, cardiac scintigram, and biochemical examination of blood. This article describes the clinical examination methods of myocardial infarction, focusing on important methods for the diagnosis.

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