Glucose Uptake Is Decreased in Affected Lower Leg Muscles of Hemiparetic Persons during Level Walking.

Stroke patients suffer from gait disturbance due to altered leg muscle actions. Many kinesiological studies have investigated muscle actions, but the metabolic activity of muscles in stroke patients remains to be investigated. We therefore evaluated energy consumption in lower extremity muscles during level walking in hemiparetic individuals. Glucose uptake was measured by positron emission tomography (PET) using (18)F-fluorodeoxyglucose ((18)F-FDG) in eight hemiparetic (mean age: 56 years) and 11 healthy (mean age: 26 years) participants. Standardized uptake ratio (SUR) was computed in each muscle to express the (18)F-FDG-uptake level. SUR was compared across gluteal, thigh, and lower leg muscles and across individual muscles within each muscle group. For each muscle, SUR was compared among the paretic limb of hemiparetic participants, the non-paretic limb of hemiparetic participants, and the right limb of healthy participants. In paretic limbs, mean SUR did not differ between the three muscle groups, or between individual muscles within each muscle group. SURs of paretic lower leg muscles and gluteus minimus muscle were significantly smaller than those of non-paretic limb and healthy participants (p < 0.05). In the non-paretic limb of hemiparetic participants, SUR of the lower leg muscles was larger than that of the thigh muscles (p < 0.05). Unexpectedly, SURs of medial hamstring and posterior tibial muscles were larger in the non-paretic limb of hemiparetic participants, compared to the right limb of healthy participants (p < 0.05). (18)F-FDG PET is useful to evaluate energy consumption levels of lower extremity muscles during level walking in hemiparetic individuals.

[The concept of locomotive syndrome and its relationship with frailty and sarcopenia].

Frailty and sarcopenia both contribute to a functional decline among the elderly, and are reportedly reversible with physical exercise. Locomotive syndrome represents the decline in locomotor function as a result of impairments of the locomotor organs. A healthy locomotor organ is essential for locomotor function, as well as daily living and social activities. Hence, elucidating the mechanism underlying locomotive syndrome may help provide physical fitness professionals with insight into the locomotor function in the elderly. Importantly, locomotor organs primarily undergo degenerative changes after middle age. Moreover, overloading may be a risk factor for degenerated cartilages and intervertebral disks, whereas underloading may also predispose bones and muscles to certain risks.

Determination of the optimal cutoff time to use when screening elderly people for locomotive syndrome using the one-leg standing test (with eyes open).

OBJECTIVE: To establish the cutoff time for the one-leg standing (OLS) test (with eyes open) to use when screening elderly people for locomotive syndrome. METHODS: Patients visiting orthopedic clinics and healthy volunteers, all ≥65 years old, were recruited. Participants were asked to complete the 25-question Geriatric Locomotive Function Scale (GLFS-25) and then underwent the OLS test. Using the previously determined GLFS-25 cutoff value, participants were divided into two groups: the locomotive and the non-locomotive syndrome groups (GLFS-25 scores of ≥16 and <16, respectively). Conventional receiver operating characteristic curve (ROC) analysis was used to calculate the optimal cutoff time for the OLS. RESULTS: Data from 880 individuals (261 men, 619 women; mean age (SD), 77 (6) years; range 65-96 years) were analyzed; 497 were in the locomotive syndrome group and 383 were in the non-locomotive syndrome group. A significant difference was seen between each group mean for individual average (IA) OLS times (IA-OLS: the average of the OLS times obtained for both legs of an individual). According to ROC analysis without age adjustment, when the IA-OLS time was ~9 s, the sum of the sensitivity and specificity of the test was highest. However, because of a statistically significant difference in IA-OLS time among the three age groups (aged ≤70, aged >70 and ≤75, and aged >75), we determined the optimal cutoff value for IA-OLS time for each of the three age groups using ROC analysis. According to additional ROC analysis, the optimal cutoff for IA-OLS time was 19 s for individuals aged ≤70, 10 s for individuals aged >70 and ≤75, and 6 s for individuals aged >75 when screening elderly persons for locomotive syndrome. CONCLUSIONS: We propose using a GLFS-25 score of 16 and/or a cutoff for the IA-OLS time of 19 s for individuals aged ≤70, 10 s for individuals aged >70 and ≤75, and 6 s for individuals aged >75 when screening elderly persons to determine who should receive medical intervention or undergoing training programs.

Amount of torque and duration of stretching affects correction of knee contracture in a rat model of spinal cord injury.

BACKGROUND: Joint contractures are a common complication of many neurologic conditions, and stretching often is advocated to prevent and treat these contractures. However, the magnitude and duration of the stretching done in practice usually are guided by subjective clinical impressions. QUESTIONS/PURPOSES: Using an established T8 spinal cord injury rat model of knee contracture, we sought to determine what combination of static or intermittent stretching, varied by magnitude (high or low) and duration (long or short), leads to the best (1) improvement in the limitation in ROM; (2) restoration of the muscular and articular factors leading to contractures; and (3) prevention and treatment of contracture-associated histologic alterations of joint capsule and articular cartilage. METHODS: Using a rat animal model, the spinal cord was transected completely at the level of T8. The rats were randomly assigned to seven treatment groups (n = 4 per group), which were composed of static or intermittent stretching in combination with different amounts of applied torque magnitude and duration. We assessed the effect of stretching by measuring the ROM and evaluating the histologic alteration of the capsule and cartilage. RESULTS: Contractures improved in all treated groups except for the low-torque and short-duration static stretching conditions. High-torque stretching was effective against shortening of the synovial membrane and adhesions in the posterosuperior regions. Collagen Type II and VEGF in the cartilage were increased by stretching. CONCLUSIONS: High-torque and long-duration static stretching led to greater restoration of ROM than the other torque and duration treatment groups. Stretching was more effective in improving articular components of contractures compared with the muscular components. Stretching in this rat model prevented shortening and adhesion of the joint capsule, and affected biochemical composition, but did not change morphologic features of the cartilage. CLINICAL RELEVANCE: This animal study tends to support the ideas that static stretching can influence joint ROM and histologic qualities of joint tissues, and that the way stretching is performed influences its efficacy. However, further studies are warranted to determine if our findings are clinically applicable.

Limb fitting for quadruple amputees: report of two cases of symmetrical peripheral gangrene caused by pneumococcal purpura fulminans.

BACKGROUND: We report our experiences of prosthetic fitting in quadruple amputees. Two patients underwent quadruple amputation after suffering from disseminated intravascular coagulation in conjunction with pneumococcemia with purpura fulminans. CASE DESCRIPTION AND METHODS: The first patient, a 52-year-old man, underwent bilateral transradial, left transtibial, and right transfemoral amputation, and the second patient, a 62-year-old man, underwent bilateral transradial and bilateral transfemoral amputation, both for symmetrical peripheral gangrene subsequent to septic shock. FINDINGS AND OUTCOMES: The amputations were accompanied by skin damage due to ischemic tissue changes both on the stumps and on the nose and/or lips. The combination of the intensive prosthetic rehabilitation program and supportive medical care led to completely independent functioning, including driving a car, with the use of four prosthetic limbs and a wheelchair in both cases. CONCLUSION: Early initiation of a multidisciplinary approach can properly address impairments and minimize future disability.

Development of a screening tool for risk of locomotive syndrome in the elderly: the 25-question Geriatric Locomotive Function Scale.

OBJECTIVE: To evaluate the reliability and validity of a new questionnaire, the 25-question Geriatric Locomotive Function Scale (GLFS-25), for early detection of locomotive syndrome. METHODS: This new screening tool was designed to detect Japanese individuals under high-risk conditions who may soon require care services because of problems of the locomotive organs. Content validity, construct validity, criterion validity, internal-consistency reliability, and reproducibility (test-retest reliability) were examined using psychometric analysis, and a cutoff score to detect locomotive syndrome was determined. To investigate construct validity of the GLFS-25 and determine the cutoff score, the Akaike Information Criteria (AIC) were used. RESULTS: Study 1 analyzed 711 Japanese elderly people ≥65 years old. No floor or ceiling effects were included in the GLFS-25. Internal consistency was confirmed by a Cronbach's α reliability coefficient of 0.961. As for the association between the GLFS-25 and European Quality of Life Scale-5 Dimensions (EQ-5D), Spearman's correlation coefficient was 0.85 (P < 0.001), showing excellent concurrent validity of the GLFS-25. Categorical principal component analysis showed that the construct structure consisted of one item cluster or the GLFS-25 was unifactorial. The AIC showed that one cluster of seven items was located in the center, with significant associations with the other five clusters. In study 2, 205 individuals were analyzed, and the test-retest interclass correlation was satisfactory (range 0.712-0.924). The cutoff score for identifying locomotive syndrome was set at 16. Validity and reliability of this new measurement were psychometrically confirmed as sufficient. CONCLUSIONS: The GLFS-25 offers a valid and reliable questionnaire scale for detecting locomotive syndrome in elderly Japanese individuals.

Effect of long-term, community-based daily exercise on the ability to control the dynamic standing balance of Japanese elderly persons in relation to falls.

It is widely accepted that daily exercise improves the dynamic standing balance of elderly persons. In the current study, 77 community-dwelling Japanese elderly persons (aged 71.1 +/- 0.5 years) participated in a daily exercise program to assess its effect on their dynamic standing balance. The daily exercise consisted of walking, stretching, muscle strengthening, and balance exercises. The program ran for 31 months and the dynamic standing balance was assessed at the start of the program and again at 3, 7, 12, 19, 24, and 31 months. In most of the tests of dynamic standing balance, the measured values improved drastically in the first 7 months; thereafter, they either reached a plateau or continued to improve more slowly. These findings can contribute to the future planning of community-based exercise programs; in particular, the length of the program and the timing of changes to the exercise load.

Monopolar surface electromyography: a better tool to assess motoneuron excitability upon passive muscle stretching.

Bipolar and monopolar surface electromyography (sEMG) are known procedures to measure the H-reflex. However, signal cancellation is a potential experimental problem of bipolar sEMG. The results of our study show that monopolar sEMG was the more sensitive procedure to differentiate motoneuron excitability at different passive muscle stretching speeds as it overcame signal cancellation.

The neural adjustment of postural response through community-based daily exercises in elderly persons.

BACKGROUND: Reflecting the rapidly aging population, community-based interventions in the form of physical exercise have been introduced to promote the health of elderly persons and prevent falls. Postural response is the critical neural response for preventing falls. The objective of this study was to assess the effect of long-term daily exercise on neural adjustment in postural response elucidated by sudden postural perturbation. METHODS: Twenty-six community-based elderly persons (13 men and women; 69.8+/-0.5 years old) participated in this study. Daily exercise was composed of walking for longer than 30 min, stretching, muscle strengthening and balance exercise, and was continued for 3 months. Postural responses were induced by fore or aft horizontal displacement of a platform with a force plate. Center of pressure on the force plate and electromyography of the rectus femoris, tibia anterior, biceps femoris and gastrocnemius were measured in postural response. FINDINGS: Following the 3 months of physical intervention, the amplitude and timing of the center of pressure excursion did not change, whereas the amplitude of muscular activities of the lower leg muscles required for the response significantly decreased. Furthermore, the onset of muscular activation of the lower leg muscles was significantly shortened following the intervention. INTERPRETATION: In conclusion, we showed that a program composed of 3 months of comprehensive exercise modulated the output of the postural response through a neural adjustment in the timing and amplitude of the muscular activation.

Age-related changes in contraction and relaxation of rat diaphragm.

Age-related changes of physiological and biochemical properties were examined in the diaphragm muscle, which has particularly high activation compared to that of other skeletal muscles. The diaphragm from 10-week-, 50-week- and 100-week-old male Wistar rats were used to measure in vitro isometric contractile properties, sarcoplasmic reticulum (SR) Ca2+-ATPase activity, and myosin heavy chain (MHC) isoform composition. Although there were no significant differences in specific twitch tension of the diaphragm among the groups, there was significant reduction in specific tetanic tension in the 50-week to 100-week groups. The contraction time and 1/2 relaxation time of twitch contraction extended with aging, and significant differences were found between 10-week-old and 100-week-old diaphragms. Regarding the activity of SR Ca2+-ATPase, the pattern of age-related change was similar to that in the 1/2 relaxation time and there was a significant difference between 10-week-old and 100-week-old diaphragms. There was a significant increase in the relative composition of the MHC I isoform in 100-week-diaphragms compared to that in 10-week-old diaphragms and a concomitant decrease in the relative composition of fast myosin was noted. These findings demonstrated that older diaphragms have slower contraction and relaxation speeds, and these alterations were attributed to changes in SR Ca2+-ATPase activity and MHC isoform composition.

Efficacy of neurotropin in fibromyalgia: a case report.

Fibromyalgia is a refractory disorder that often necessitates long-term treatment. A 45-year-old woman has suffered from a stiff neck for 27 years and severe widespread pain for 4 years. Her visual analog scale (VAS), global-VAS, self-rating depression scale (SDS), and face scale were 48, 38, 42, and 15, respectively. She met the American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Four tablets of Neurotropin (NT) per day alone were administered, and her pain was gradually alleviated over 3 weeks. Her heavy sensation of the body and morning stiffness had almost disappeared 5 months later. Her VAS was 40 after 6 months, but the subjective pain decreased to half that at the initial visit. Her global-VAS, SDS, and face scale were 0, 35, and 8, respectively. No adverse effects were observed. NT, a nonprotein extract from the inflamed skin of rabbits inoculated with vaccinia virus, is a commonly prescribed analgesic drug for chronic pain in Japan. One of the advantages of NT is its few and slight adverse effects. Because NT does not suppress the synthesis of prostaglandin, NT does not cause digestive ulcers. Recent studies suggest that the analgesic mechanism of NT is due to the activation of a descending pain inhibitory system in the brain. Two open studies have shown the efficacy of NT for fibromyalgia. In order to determine whether NT is effective for fibromyalgia, a rigid clinical study, such as a double-blinded, placebo-controlled study, is needed.

The effects of comprehensive exercise program on the adjustments of standing balance in community-dwelling elderly persons.

The objective of this study was to assess the effect of comprehensive exercise program widely accepted as a community-based physical intervention for the prevention of falling in the elderly persons on their controlling standing balance. Twenty-six community-dwelling elderly persons (13 males and females; 69.8 ± 2.8 years old) participated in this study. Daily exercise was comprised of walking for more than 30 min, stretching, muscle strengthening and balance exercise without exercise equipments. The intervention was continued for three months. Indicators of standing balance related to static balance, dynamic balance and postural response were measured before and after the intervention. As an effect of the intervention on static balance, the sway of center of pressure (COP) in the static stance significantly increased. In the dynamic balance, significant improvements were observed in one leg standing time, the 10-m gait time, functional reach. Additionally, the maximal movable length of COP which subjects can move voluntarily to right and left significantly increased. In the postural response, the integrated electromyography (IEMG) induced by postural response for sudden postural perturbation significantly decreased in the lower leg muscles. Since less muscular activities were sufficient to maintain posture, it was suggested that postural response was elicited more efficiently following the intervention. This study suggested that the comprehensive exercise program, which has been widely introduced as community-based interventions for the prevention of falling, have extensive effects on the control of standing balance covering static balance, dynamic balance and postural response in the elderly persons.

Alteration of knee joint connective tissues during contracture formation in spastic rats after an experimentally induced spinal cord injury.

This study was made to elucidate the changes in the periarticular connective tissue that can underlie the contracture after spasticity development. Sixteen Wistar rats underwent a spinal cord injury and 16 rats were either sham- or nonoperated. The periarticular connective tissue of the knee joint was assessed with histological, histomorphometric, immunohistochemical, and biochemical analyses. Histological results showed a smaller synovial intima, a dense subintimal and posterior joint capsule without fibrosis, and a disarranged posterior capsule in the spinal cord-injured knees with the flexion contracture. The synovial intima length was shortened only at the posterior capsule. Neither the distribution nor expression of type I and III collagen was affected. Contractures after spinal cord injuries are characterized by synovial intima adhesions. A dense and disarranged capsule may lead to joint stiffness. The alteration of periarticular connective tissues exhibits properties characteristic of the contracture after spasticity development.

Neural adjustment in the activation of the lower leg muscles through daily physical exercises in community-based elderly persons.

Reflecting the rapidly aging population, community-based interventions in the form of physical exercise have been introduced to promote the health of elderly persons. Many investigation studies have focused on muscle strength in the lower leg as a potent indicator of the effect of physical exercises. The objective of this study was to assess the effect of long-term daily exercises on neural command in lower leg muscle activations. Twenty-six community-based elderly persons (13 men and 13 women; 69.8 +/- 0.5 years old) participated in this study. Daily exercise was comprised of walking for more than 30 min, stretching, muscle strengthening and balance exercise, and was continued for three months. Muscle strength and surface electromyography of the tibia anterior, rectus femoris, and biceps femoris were measured in maximum isometric voluntary contraction both before and after the intervention. The mean frequency of the firing of motor units was calculated based on fast Fourier transformation of the electromyography. As the results of the intervention, muscle strength increased significantly only in biceps femoris, whereas the mean frequency of motor units decreased significantly in every muscle, indicating that motor unit firing in lower frequency efficiently induces the same or greater strength compared with before the intervention. Thus, synchronization of motor units compensates for the lower frequency of motor unit firing to maintain muscular strength. In conclusion, long-term physical exercises in the elderly can modulate the neural adjustment of lower leg muscles to promote efficient output of muscle strength.

The mRNA expression of neurotrophins in different skeletal muscles of young rats.

Skeletal muscles are a target for motoneurons and synthesize neurotrophins, including nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT-3), and neurotrophin-4/5 (NT-4/5). Both at the embryonic stage and the adult stage, the mRNA expression of neurotrophins in skeletal muscles of rats has been reported. However, little was known about the mRNA expression patterns of neurotrophins in skeletal muscles of rats at the young developmental stage. In this study, we investigated the mRNA expressions of BDNF and NT-3 in three different skeletal muscles in 4- to 8- week-old rats using the reverse transcriptional polymerase chain reaction (RT-PCR) method. The expression of BDNF mRNA in the soleus muscle gradually became higher with age from 5 to 8 weeks. But BDNF mRNA in the tibialis anterior and extensor digitorum longus muscles did not change with growth. The expression of NT-3 mRNA did not show a specific tendency during this period. The differences of muscle fiber types, recruitment patterns of the muscles, and roles of neurotrophins may cause these mRNA expression patterns. Neurotrophins are target-derived, activity-dependent neurotrophic factors and are transported retrogradely. There is a possibility that the different expression patterns of neurotrophins in muscles may be involved in the maturation of neuromuscular function in different muscles during the young developmental period.

Rhythm of daily living and detection of atypical days for elderly people living alone as determined with a monitoring system.

We have developed a system for monitoring the health of elderly people living at home. Infrared and other sensor outputs are collected using a monitoring program installed on a personal computer (PC) in the home at a sampling rate of 1 Hz. Once each day, the data are transferred to a server through the Internet using a cable television (TV) connection. An elderly subject was monitored for a 12-day baseline period and completed a daily questionnaire about her activities. This enabled us to identify the rhythm of daily living (sleeping, 23:00-04:59; getting up/breakfast, 05:00-08:59; indoor activities/going out, 09:00-16:59; and dinner/going to bed, 17:00-22:59) and the average outputs from the sensors in the rooms. The subject was then monitored for a further six months. By identifying sensor output counts outside the limits of mean +/- 3SD, we were able to detect atypical days. During the six-month monitoring period, 29 atypical days were detected. We suggest that the monitoring system may be effective in tele-rehabilitation.

Reliability and validity of the Craig Handicap Assessment and Reporting Technique for Japanese individuals with spinal cord injury.

It is necessary and important to quantify the handicap sustained by individuals with spinal cord injury (SCI); however, few instruments are available to measure the level of the disability. One of the best developed and most often used measures is the Craig Handicap Assessment and Reporting Technique (CHART). Nevertheless, a Japanese version has not yet been developed and tested for SCI individuals. The purpose of this study was to develop a Japanese version of the CHART (CHART-J) and to investigate its test-retest reliability and discriminant validity in SCI in Japan. Fifty-four individuals with SCI participated in the test-retest reliability study and 293 participated in the discriminant validity analysis. We have shown that the test-retest reliability coefficients of the CHART-J range from 0.57 to 1.00. In addition, its discriminant validity is acceptable for individuals with SCI in Japan. Therefore, the CHART-J is useful as a measure of disability for Japanese individuals with SCI.

Progression and direction of contractures of knee joints following spinal cord injury in the rat.

Joint contractures following central nervous system injuries remain a prevalent and significant complication, but no reports are available on evidence of contracture formation over time. The objective of this study was to determine the rate of contracture progression and the direction of loss in joint movement following spinal cord injuries (SCI). Forty-eight female Wistar rats were used. Twenty-four experimental rats underwent a spinal cord transection at the level of T8 and 24 control rats underwent a sham-operation. The animals were studied at each of 5 time points: 2, 4, 8, 12, 16, and 24 weeks after surgical intervention. The degree of contractures was assessed by measuring the femorotibial angle on both hindlimbs with the use of a goniometer. Knee joint motion was measured for flexion and extension direction. Knee flexion contractures developed in all experimental rats. The restriction in motion progressed during the first 12 weeks and plateaued thereafter. The contractures were produced almost exclusively by a loss in the extension range of motion. This study defined the time course that contracture progression was more rapid in the early stage after SCI and stabilized in the later stage of injury. Contractures following SCI occurred in flexion at the knees and resulted from a loss of extension. These findings should help guide timely treatment and provide a better understanding of contracture development.

Analysis of activities of daily living in elderly people living alone: single-subject feasibility study.

We have developed an automatic remote system for use in monitoring the health of independent elderly people living in conventional homes. In this study, a monitoring system was installed and evaluated in the house of one subject to test the feasibility of determining activities from sensor outputs. Over a period of 6 months, it was found that total counts from all sensor outputs matched the concurrently acquired data on physical activity obtained from a pedometer. Performance of each basic activity of daily living could be confirmed from the sensor output records.

Reliability and validity of classification of senile postural deformity in mass examinations.

Nakada (1988) divided senile postural deformities into four types by visual observation: an extended type, an S-shaped type, a flexed type, and a hand-on-the-lap type. The purpose of this study was to investigate the inter-rater reliability and the discriminant validity of assessing the elderly spinal posture using a posture-measuring device developed by us and dividing postural deformities into the four types of Nakada's classification. Seventy-seven elderly persons (52 women and 25 men) who lived independently participated in the study. The average age of the subjects was 73 years (range, 65 to 84 years). The type of the senile postural deformity was determined by three judges using our posture-measuring device in combination with Nakada's classification. The rate of agreement of the classification was 92.2%. This method had a significantly high rate of inter-rater reliability. The thoracic kyphotic angle was larger in the S-shaped type than in the normal, extended type, and flexed type. The lumbar lordotic angle was also larger in the S-shaped type than in the extended type, flexed type, and hand-on-the-lap type. In the hand-on-the-lap type, the mean of the lumbar lordotic angle was much smaller. The lumbosacral angle was smaller in the extended type than in the normal, S-shaped type, and flexed type. With the analysis of x-ray photographs, this method appeared to have discriminant validity as a measure of senile postural deformity. The combination of our posture-measuring device and Nakada's classification would be useful to classify senile postural deformities in mass examinations.