[Quantification of gait using insole type foot pressure monitor : clinical application for chronic hemiplegia].

Home-based stroke hemiplegia patients tend to fall easily. Poor toe clearance is reported to be one of the causes of falling, although there are many other related factors. We developed a low-priced insole type portable foot pressure measurement device, and measured the foot pressure distribution and the foot pressure-time curve of 20 chronic hemiplegia patients and compared them with 36 healthy controls. We also analyzed the outdoor gait of a chronic hemiplegia patient on flat ground, on rough terrain, walking up stairs and on a downward slope. The result was that the load rate of the unaffected heel was significantly increased in hemiplegic gait, and there was a significant negative correlation between the affected side stance phase rate and gait time for 10 m distance (r = -0.73, P < 0.01). The primary role of the unaffected side and the poor toe clearance on the affected side were assured in the uneven ground gait, and it was suggested that chronic hemiplegia patients tend to be highly dependent on their unaffected side during indoor and outdoor gait.

Differences in the peak cough flow among stroke patients with and without dysphagia.

Coughing is an important protective mechanism for keeping the airway clear, and adequate voluntary coughing reduces the risk of aspiration in patients with deglutition disorders. The purpose of this study was to compare the peak cough flow (PCF) of stroke patients with and without dysphagia and to identify the physical and respiratory determinants of PCF.Using a spirometer, we measured and compared the PCFs of 10 stroke patients with dysphagia (SPD), 20 stroke patients without dysphagia (SP) and 10 gender and age matched healthy controls (HC) recruited by using a notice at a clinic and in newspapers. The PCF of the SPD (mean ± SD, 160.1 ± 68.7 l/min) was significantly lower than that of the SP and HC (297.2 ± 114.2 l/min and 462.0 ± 84.4 l/min, respectively; one-way ANOVA, Scheffe's test, P < 0.05). The vital capacity (VC) and inspiratory reserve volume (IRV) of the SPD were lower than those of the HC. Stepwise multivariate regression analysis revealed that IRV and ambulation function (Functional Ambulation Categories, FAC) contributed 50% and 17% to the variance of PCF (P < 0.05), respectively. It is suggested that respiratory function, especially IRV, is important for maintaining PCF in SPD.

Community-based survey of amputation derived from the physically disabled person's certification in Kitakyushu City, Japan.

BACKGROUND: There were no recent reports of community-based surveys on the incidence, level and causes of amputation in Japan. OBJECTIVES: To identify any changes in the incidence, level, causes of amputation and gender distribution. STUDY DESIGN: A community-based survey. METHODS: The subjects were Kitakyushu-citizens amputated between 2001 and 2005 and selected based on medical certificates for the physically disabled person's certificate. RESULTS: The incidence of amputation (/100,000 population per year) was 6.9 overall, 1.4 for upper limbs and 5.8 for lower limbs. The average age at amputation was 63.5 ± 20.1 years and the male:female ratio was 1.9:1. The most frequent levels of amputations were partial hand amputation (84.4%) for upper limbs, and transtibial amputation (42.3%) and transfemoral amputation (36.8%) for lower limbs. The major causes were injuries (54.3%) for upper limbs, and peripheral vascular disorder (49.0%) and diabetes mellitus with peripheral circulatory complications (28.6%) for lower limbs. CONCLUSIONS: The incidence of amputation was 6.9 overall, 1.4 for upper limbs and 5.8 for lower limbs, and the male:female ratio was 1.9:1. In comparison to a previous survey the percentages of amputation due to peripheral circulatory disorders and injuries increased and decreased, respectively, and the rate of female amputations increased. CLINICAL RELEVANCE: This study provides useful data about change of the recent epidemiology of amputation in Kitakyushu, Japan. These data are essential to perform clinical practices in amputation rehabilitation, including prescription of prosthesis, general fatigue for aged amputees, and complication of peripheral circulatory disorders.

[Effect of an increase in numbers of physical therapists on dynamic situation of inpatients in an acute hospital].

To determine the effects of an increase of four physical therapists in an acute hospital, we compared the number and outcomes of inpatients for whom rehabilitation doctors newly prescribed physical therapy between two periods (from October 1, 2008 to September 30, 2009 and from October 1, 2009 to September 30, 2010). The number of new inpatients and the total number of inpatients who underwent physical therapy significantly increased by 317 and 4,536, respectively (Wilcoxon test, P < 0.05), and the total number of inpatients who performed training in their own room in a ward also significantly increased by 3,341 (Wilcoxon test, P < 0.05). The mean length of hospital stay of the inpatients who were transferred to other hospitals decreased by 5.9 days after the increase in the staff(t-test, P < 0.05). These changes suggest that the increase in the physical therapists contributed to the increases of the new inpatients and total number of inpatients who underwent rehabilitation, and possibly to the decrease in the length of hospital stay for the transferred inpatients by effectively providing a sufficient amount of physical therapy.

Intragastric administration of capsiate, a transient receptor potential channel agonist, triggers thermogenic sympathetic responses.

The sympathetic thermoregulatory system controls the magnitude of adaptive thermogenesis in correspondence with the environmental temperature or the state of energy intake and plays a key role in determining the resultant energy storage. However, the nature of the trigger initiating this reflex arc remains to be determined. Here, using capsiate, a digestion-vulnerable capsaicin analog, we examined the involvement of specific activation of transient receptor potential (TRP) channels within the gastrointestinal tract in the thermogenic sympathetic system by measuring the efferent activity of the postganglionic sympathetic nerve innervating brown adipose tissue (BAT) in anesthetized rats. Intragastric administration of capsiate resulted in a time- and dose-dependent increase in integrated BAT sympathetic nerve activity (SNA) over 180 min, which was characterized by an emergence of sporadic high-activity phases composed of low-frequency bursts. This increase in BAT SNA was abolished by blockade of TRP channels as well as of sympathetic ganglionic transmission and was inhibited by ablation of the gastrointestinal vagus nerve. The activation of SNA was delimited to BAT and did not occur in the heart or pancreas. These results point to a neural pathway enabling the selective activation of the central network regulating the BAT SNA in response to a specific stimulation of gastrointestinal TRP channels and offer important implications for understanding the dietary-dependent regulation of energy metabolism and control of obesity.

Ketogenic essential amino acids modulate lipid synthetic pathways and prevent hepatic steatosis in mice.

BACKGROUND: Although dietary ketogenic essential amino acid (KAA) content modifies accumulation of hepatic lipids, the molecular interactions between KAAs and lipid metabolism are yet to be fully elucidated. METHODOLOGY/PRINCIPAL FINDINGS: We designed a diet with a high ratio (E/N) of essential amino acids (EAAs) to non-EAAs by partially replacing dietary protein with 5 major free KAAs (Leu, Ile, Val, Lys and Thr) without altering carbohydrate and fat content. This high-KAA diet was assessed for its preventive effects on diet-induced hepatic steatosis and whole-animal insulin resistance. C57B6 mice were fed with a high-fat diet, and hyperinsulinemic ob/ob mice were fed with a high-fat or high-sucrose diet. The high-KAA diet improved hepatic steatosis with decreased de novo lipogenesis (DNL) fluxes as well as reduced expressions of lipogenic genes. In C57B6 mice, the high-KAA diet lowered postprandial insulin secretion and improved glucose tolerance, in association with restored expression of muscle insulin signaling proteins repressed by the high-fat diet. Lipotoxic metabolites and their synthetic fluxes were also evaluated with reference to insulin resistance. The high-KAA diet lowered muscle and liver ceramides, both by reducing dietary lipid incorporation into muscular ceramides and preventing incorporation of DNL-derived fatty acids into hepatic ceramides. CONCLUSION: Our results indicate that dietary KAA intake improves hepatic steatosis and insulin resistance by modulating lipid synthetic pathways.

[Walking assist robot and its clinical application].

The walking assist robot was developed to improve gait disturbance in patients with severe disabilities. The robot had a trunk supporter, power generator and operating arms which held patient's lower extremities and simulated walking, a control unit, biofeedback system, and a treadmill. We applied the robot-aided gait training to three patients with severe gait disturbance induced by stroke, axonal Guillan-Barré syndrome or spinal cord injury, and the walking assist robot turned out to be effective in improving the gait disturbance.

[Physical therapy for four patients with severe axonal Guillain-Barré syndrome in acute stage].

We describe four male patients suffering from quadriplegia caused by axonal Guillain-Barré syndrome. They were diagnosed with axonal Guillain-Barré syndrome based on their clinical course and electrophysiological findings. Three patients had severe pain, two had marked elevation of serum creatine kinase, one had finger contracture, and two required mechanical ventilation. Two of the patients recovered during the period from nadir to discharge in the Hughes functional grading scale and Barthel index. A physical therapist should understand the characteristics of severe axonal Guillain-Barré syndrome in an acute stage, and consider the psychological status of the patients.

Influence of moderate smoking on physical fitness and local muscle oxygenation profile during incremental exercise.

To reveal the influence of chronic moderate smoking on physical fitness and local muscle oxygenation profile, we compared the oxygen uptake (VO2), CO2 output, respiratory rate, minute ventilation and blood lactate accumulation between six moderate smokers and ten non-smokers during incremental exercise. In order to know the difference of the peripheral oxygen supply to the muscles between the two groups, oxygenation profiles based on the changes of oxygenated hemoglobin (O2Hb) in the right vastus lateralis muscles were observed using near-infrared spectroscopy (NIRS). The intensity of incremental exercise using a bicycle ergometer was from 10 W to 80% of the maximum heart rate (80% HR(max)) of each subject. There were no significant differences between the two groups in VO2 and work rate at the level of 2 mmol/ l lactate or 80%HR(max) (P < 0.05). However, as to the local muscle oxygenation profile during exercise, 5 out of the 6 smokers showed a decrease of O2Hb throughout the incremental exercise, but 8 out of the 10 non-smokers showed a gradual increase of O2Hb throughout the exercise. In conclusion, our results suggest that chronic moderate smoking might cause a change of local muscle oxygenation profile during incremental exercise, even if the smokers have shown no decrease in physical fitness.