The purpose of this study was to investigate the relationship between acute somatosensory evoked magnetic fields (SEFs) and early motor recovery in patients with thalamic hemorrhage. Nine patients with thalamic hemorrhage were participated in this study. SEFs. evoked by the electrical stimulation to right and left lower lip, thumb, median nerve, ulnar nerve and posterior tibial nerve, were measured within 72 hours after the onset of thalamic hemorrhage (acute stage). As neurological examinations, the motor paresis of the affected upper extremity (UE), fingers and lower extremity (LE) based on Ueda's 12 grades evaluating method and sensory functions, i.e. two-point discrimination sense, touch sense and joint position sense of affected side, were assessed both at acute stage and one month after the onset of thalamic hemorrhage (subacute stage). Majority of patients who had shown acute median, ulnar and posterior tibial nerve SEFs findings in the affected hemisphere demonstrated good motor recovery of the affected UE, fingers and LE at subacute stage. In contrast, majority of patients who had not shown the acute SEFs findings in the affected hemisphere demonstrated poor motor recovery of all the parts at subacute stage. The similar relationship between the acute SEFs and the motor recovery was also found between the acute SEFs and the sensory function recovery at subacute stage. These results suggest that acute median, ulnar and posterior tibial nerve SEFs findings from the affected hemisphere might indicate not only sensory functions but also the function of corticospinal tract and contribute to the prediction of motor recovery approximately one month after the onset of thalamic hemorrhage.

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The aim of the present study was to investigate the differences in activity among the three parts of the gluteus medius (GMed), tensor fasciae latae (TFL) and the superior part of the gluteus maximus (Gmax) muscles. Seven healthy volunteers participated in this study. The individual EMG activities of the hip abductor muscles, i.e., the anterior part of the GMed, the middle part of the GMed, the posterior part of the GMed, TFL and the superior part of the Gmax muscles, were detected using a bipolar fine wire electrode. And the integrated EMG (IEMG) of each muscle-hip position relationship, the maximum hip abduction torque-hip position relationship and the isometric hip abduction torque-IEMG relationship were analyzed.
As results, during the maximum isometric hip abduction, the IEMG of the anterior part of the GMed muscle and maximum hip abduction torqe decreased significantly as the hip flexion angle increased (p < 0.01). The EMG activities of the hip abduction muscles varied with the change in hip rotation angle except for the superior part of the Gmax muscle under the maximum isometric hip abduction. And the IEMG of the three parts of the GMed and TFL detected at a hip position of external rotation were significantly lower than those at a hip position of neutral and internal rotation. In addition, the maximum hip abduction torque was the largest at a hip neutral position.
The relationship between the isometric hip abduction torque and the IEMG of the three parts of GMed muscle showed a linear relation, and the IEMG of these parts of GMed and TFL muscles increased as the hip abduction torque increased from 0 to 80% maximum voluntary contraction. However, the IEMG of the superior part of the Gmax muscle did not vary as the hip abduction torque increased.
These results were considered to demonstrate a part of functional difference among the three parts of the GMed, TFL and the superior part of the Gmax muscles.

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Pulmonary rehabilitation is one of the most important components of comprehensive care for chronic respiratory disease, but the long-term effectiveness of pulmonary rehabilitation has rarely been reported. The purpose of this study was to evaluate the long-term effectiveness of pulmonary rehabilitation for patients with chronic respiratory disease. Twenty patients with chronic respiratory disease (mean age 69.2 yr) underwent concentrated pulmonary rehabilitation, and continued to practice 2 or 3 times per week for 3 years. They were evaluated using pulmonary function tests, a 6-minute walking distance test and activity of daily living score every year. We examined the changes in each parameter yearly, in addition to differences in symptoms and seriousness of the disease. The patients' FEV_1.0% decreased significantly (p < 0.01), but the other parameters of pulmonary function tests were kept unchanged. The 6-minute walking distance test and activity of daily living score were maintained over the three years. These results indicate that continued practice of the exercises can maintain the effectiveness of pulmonary rehabilitation.

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The purpose of this study was to investigate the influence of seat angle on forward trunk inclination during sit-to-stand (STS). Fifty-two healthy subjects (26 male and 26 female, 20.8 ± 2.9 years old) participated in this study. Seat angles of 5, 10, 0, -5 and -10 degrees were selected. The angle of forward trunk inclination, leg angle and STS time were measured during STS. Data were gathered using a two-dimensional movement analysis system. The results showed that: 1) the angle of forward trunk inclination increased significantly at 5 and 10 degrees, and decreased significantly at -5 and -10 degrees compared with 0 degrees, 2) the leg angle decreased at 5 and 10 degrees, and increased 5 and -10 degrees compared with 0 degrees, and 3) the STS time was prolonged significantly at 10 degrees compared with 0 degree. A significantly negative coefficient of correlation was found between the angle of forward trunk inclination and the leg angle. A significantly positive coefficient of correlation was found between the angle of forward trunk inclination and the STS time. It was clarified that the angle of forward trunk inclination was increased during STS by the backward tilt of the seat angle. The increase in the angle of forward trunk inclination probably limits some of the activities of daily living for the elderly and hemiplegic disabled, which requires STS, such as transferring from a wheelchair to a bed or a toilet. It was suggested that the seat angle must be adjusted to correspond with the purpose of the activity in order to eliminate such difficulties.

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A power-assisted electrical stimulator was developed for motor function improvement of stroke patients, and was clinically evaluated.
The present stimulator can change its stimulation intensity in proportion to the amplitude of voluntary EMG, and give an electrical stimulation of subthreshold intensity during no voluntary contraction. A pair of electrodes were used for both EMG detection and electrical stimulation. Thus, the stimulator can facilitate and amplify weak muscle voluntary contractions of stroke patients. It was expected that the stroke patients might relearn the motor control through the repetitive contraction with the stimulator.
The stimulator was applied to the clinical training for 15 minutes, and its treatment effect was evaluated in comparison with the conventional therapeutic electrical stimulation (TES). The effects were examined in the active range of motion, the muscle strength, and the coordination of the ankle joints. Ten hemiplegic patients (Age: 25-76 years old, SIAS-M foot pat score 2) participated in this study, and were randomly divided into two groups for treating different TES programs.
The treatment improvements were observed in both methods. The power-assisted stimulator group showed greater improvements in dorsiflexion strength, compared with the conventional TES group. There were no significant differences in the active range of motion and coordination between the groups.
The power-assisted stimulator was more effective to facilitate voluntary contraction than the conventional TES in enhancing isometric strength, and was able to assist the patients in the correct recognition and motor learning of the target muscle.

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The objective of study was to determine the restriction of soft tissue and articulation of rat ankle joint mobility following immobilization. Fifty male Wistar rats were divided randomly into experimental (n=25) and control (n=25) groups. In the experimental group, bilateral ankles of each rat were immobilized in full plantar flexion with a plaster cast; immobilization of the ankle joint was maintained for 1, 2, 4, 8 and 12 weeks. After each immobilization period, rats were anesthetized with pentobarbital sodium; subsequently, ROM on dorsiflexion of ankle joints was measured. Similarly, ROM on dorsiflexion of ankle joints was measured following skin incision and myotomy of transarticular triceps muscle of calf. The proportion of the ROM increase after skin incision was approximately 10% for each immobilization period; in contrast, following myotomy, ROM increase was 80.5% at 1 week, 63.8% at 2 weeks, 54.7% at 4 weeks, 35.5% at 8 weeks and 25.4% at 12 weeks after immobilization. The present investigation suggests that the limitation of ROM of joints at 1 month following immobilization may be derived from soft tissular (skin and muscle) changes and arthrogenic limitation may increase at 2-3 months after immobilization.

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We studied life-style, gait ability and QOL of femoral neck fracture cases by mail questionnaires. We sent 170 questionnaires and got 89 answers (52.4%). The cases were 76 females and 13 males with an average age of 77.2 ± 8.7 years old. Twenty-one percent of cases answered that they did not get the same life-style as before the fracture. Fifty percent of cases felt coxalgia, 45% felt worried about hip joint trouble, and 32% experienced reccurrence of fall. Some cases changed the home environment, making floors flatter and installing handrails. Gait abilities were lower at the discharge than at admission, but they became higher 1 year after discharge. The WHO/QOL26 scores of our cases were lower than those of the general elderly population, and were especially lower in the wheelchair cases. Sixty-one percent of cases had been performing self-training after discharge. Recovery of life-style and outdoor leisure activities are important factors of WHO/QOL26 scores, and the fact that the cases of lower gait ability improved after discharge suggests that daily gait exercise after discharge is important for a high QOL.

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In Japan, the public service care system for the elderly began in 2000. In this service the role of welfare equipment has become important both for promoting the independence of disabled people and for reducing the workload of caseworkers. However, there have been an increasing number of small accidents caused by the use of welfare equipment which have been widespread. These are termed “hiyari-hatto” events.
The purpose of this study was to reveal what kinds of hiyari-hatto events have happened in care services for the elderly in Japan.
One hundred and sixteen care service providers in Inba Village (population c. 10,000; over 65's, 18.9%) were registered for this study.
In October 2001, we mailed questionnaires to the care service providers. The questionnaire consisted of 17 questions on hiyari-hatto events. The returned questionnaires were arranged for each item and hiyari-hatto events were classified as “human error”, “equipment risk factor”, and “not adjusted to environment” according to our definitions.
There were 56 valid answers. In these answers we found 28 cases of hiyari-hatto, and 28 cases of injury. Among the 56 cases, 28 cases were related to wheelchairs, 6 cases involved use of a bed, and there were 5 cases of shower to chair. Movement (27 cases) and transfer (23 cases) were the principal factors of accidents, and falls (29 cases) were the major result. The causes of hiyari-hatto events were, human error (75.6%), equipment risk factor (6.7%) and not adjusted to environment (11.9%).
The high risk of potential accident is accepted from there being 28 accidents among the approx. 2,000 elderly of Inba Village (Heinrich's Law). Our results revealed that safety education for care service workers is urgently needed, and also the necessity of safety management of welfare equipment.

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The aim of the present study was to examine the mechanical properties of skeletal muscle during stretching in atrophic muscle. The changes in mechanical properties (passive tension) during stimulation by ramp and hold stretching were studied in the rat soleus muscle with disuse atrophy. Muscular atrophy was induced by hindlimb suspension (HS) or by immobilization with plaster cast (CAST) for two weeks. During stretch condition, passive tensions of skeletal muscles were significantly reduced in HS and increased in CAST. The passive tension was significantly decreased after the continuous stretching exercise (10 minutes) in immobilized hindlimb. On the other hand, monitoring of the continuum for stretch-induced injury allows us to define the threshold of stretch injury. The skeletal muscle was stretched until failure in situ. The passive tension of skeletal muscle was significantly increased by stretching. A threshold for stretch-induced injury does exist.
These results indicate that following muscular atrophy, achieved through two weeks of hindlimb immobilization, the mechanical properties of the skeletal muscle are changed. We suggest that awareness of changes of muscular mechanical properties could provide a useful clue for advancing various therapeutic programs for physical therapy of patients with atrophic muscles.

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It is known that heat stress induces expression of heat shock protein 70 (Hsp 70) in myocytes. Hsp 70 plays an important role in chaperoning nascent peptides during translation, and it has been assumed that the elevation of cellular Hsp 70 levels can serve as a countermeasure to attenuate the disuse-induced reduction in protein synthesis. We therefore investigated the effects of heat stress, prolonged stretching, and heat stress combined with prolonged stretching on prevention of disuse muscle atrophy in rat soleus (SOL) muscle. Thirty Wistar rats were divided randomly into the control (Con, n=5), heat stress (Heat, n=5), hindlimb suspension (HS, n=5), HS and heat stress (HS&Heat, n=6), HS and prolonged stretching (HS&Stretch, n=5), and HS and heat stress combined with prolonged stretching (HS&Heat&Stretch, n=4) groups. Disuse muscle atrophy was induced by hindlimb unweighting for 7 days. Each rat in the Heat, HS&Heat, and HS&Heat&Stretch groups was anesthetized, and bilateral hindlimbs were immersed daily in hot water (42 ℃) for 60 min during HS. In HS&Stretch and HS&Heat&Stretch groups, both soleus muscles underwent prolonged stretching daily for 30 min during HS. At the end of the experimental period, the SOL muscles were extracted and weighed. Frozen sections were stained with myofibrillar adenosin triphosphatase (pH 10.5), and muscle fiber diameters of each fiber type were measured. To determine the levels of Hsp 70 in muscular tissue, we performed an enzyme-linked immunosorbent assay (ELISA) and western blotting methods. The weight of the SOL muscles relative to body weight for the HS&Heat, HS&Stretch, and HS&Heat&Stretch groups increased significantly compared with the HS group. The mean muscle fiber diameter of type I and II for the HS&Heat, HS&Stretch, and HS&Heat&Stretch groups increased significantly compared with the HS group. HSP 70 levels were significantly greater in the Heat, HS&Heat, and HS&Heat&Stretch groups compared with the Con, HS, and HS&Stretch groups. Our results suggest that the progression of disuse muscle atrophy can be attenuated by heat or stretch, and this mechanism is related to the expression of Hsp 70 or mechanical stretch in myocytes.

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Electrical stimulated muscle activity was evaluated using MRI. Two types of electrical stimulation, low and medium frequencies, were used and compared.
Subjects were eleven healthy males. The electrical stimulation was applied to the rectus femoris, vastus medialis, and vastus lateralis muscles. MRI was performed before and immediately after the stimulation. Each muscle was identified, and ROI was determined. T2 value was deduced from each ROI, and increase ratios of T2 value in each ROI were compared between medium and low frequencies.
Increase ratios of T2 value (IRT2) of the surface and the deep layers of rectus femoris, vastus medialis, and vastus lateralis muscles were compared between the two electrical stimulations. IRT2 of the deep layers were decreased in all the muscles, however there were no statistical significances. In addition, no difference was observed between the two stimulations in each muscle.
Threshold of the nerve is much lower than that of the muscle, and the nerve of the motor point is stimulated and activated even by using medium frequency electrical stimulation. Impedance deteriorates with increasing stimulation frequency, and skin discomfort should therefore be decreased by using a medium frequency.

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To obtain the histopathological findings for contracture mechanism and clarify the effect of stretching, we conducted experiments to observe the histopathological changes in joint components after knee joint immobility in rats.
Sixteen adult, nine-week-old male Wistar rats (body weight: 260 g-285 g) were used for this study. The four rats of the control group were raised normally for two weeks. The other 12 rats had their right knee joints immobilized with a cast fixator for two weeks. The four rats of the contracture group were euthanatized immediately after contracture had been achieved. The four rats of the stretch group were subjected to stretching of the immobilized knee for two weeks. The four rats of the non-stretch group were not subjected to stretching. Stretching consisted of five cycles of 50-second stretching and a 10-second rest. The trunk of the rats of the stretch group was immobilized, and the ankle was stretched in the caudal direction. The knee joints excised after sacrifice were fixed in formalin, decalcified and embedded in paraffin. Staining was done with hematoxylin and examination was by a light microscope.
Atrophy of synoviocytes, fibrosis of the layer underlying the synovium, dilatation, proliferation of the synovium at the cartilage-synovium migration area and congestion of the microvasculature were observed in the contracture group. The stretch group returned to almost normal conditions, but the non-stretch group to a lesser extent. The fibroconnective tissue of the contracture group was denser than that of any other group, and the stretch group improved more than the non-stretch group. However, fibrosis of the stretch group was denser than that of the control group. The surface layer of the articular cartilage in the contracture group showed fibrous proliferation in contrast to that of the control group. The contracture group showed thinner connective tissue between the muscle fibers than any other group. The stretch group improved more than the non-stretch group; on the other hand the connective tissue of the stretch group was thinner than that of the control group.
Histopathological changes in the joint components showing contracture were considered to be secondary disorders caused by the cast fixation in this study. However, the stretch group improved more than the non-stretch group, suggesting that stretching has a beneficial effect on joint contracture.

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We describe a method of quantifying the movement of the leg in walking. The purpose of the present investigation was to characterize normal knees and knees affected by osteoarthritis. Nine participants with symptomatic knee OA and 10 asymptomatic controls were studied. Three axis accelerometers were placed on the skin over caput fibulae and malleolus lateralis, and acceleration measurements were obtained during level walking. The magnitude and temporal characteristics of acceleration and velocity were significantly different between the two groups. This study demonstrated differences in the acceleration power spectra of participants with knee OA when compared with control group. These findings sustain a growing belief among health professionals that impairments in movement of leg and motor control have important associations with knee OA. Our results suggest that knee OA may be associated with an alteration in the acceleration product across the leg during walking. Noninvasive acceleration measurements can characterize the normal and knee OA.

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