Training effect of repeated rolling motions on boccia players with severe cerebral palsy: comparison with the effect of conventional upper-limb training using a crossover test.

[Purpose] The present study aimed to establish evidence regarding comparisons between training methods for boccia players with severe cerebral palsy. [Participants and Methods] Ten boccia players with severe cerebral palsy were enrolled in this study. This intervention had a cross-over design. Participants were divided into two groups based on the training method applied. The study period was divided into an upper extremity training period and an interval rolling training period, which lasted 4 weeks each. Each was separated by a 4-week training detraining period. Joint range of motion and throwing distance were measured before and after the interventions and the effects were compared and verified. [Results] Compared to upper extremity training, interval rolling training significantly expanded the range of motion and improved throwing distance in bocce players with severe cerebral palsy. [Conclusion] Collectively, interval rolling training is more effective than upper limb training in improving the physical function and throwing distance of boccia players with severe cerebral palsy.

A proper sequence of dynamic alignment in transtibial prosthesis: insight through socket reaction moments.

Dynamic alignment in prosthetic fitting is important because it affects the user's stability, kinematics, and kinetics such as socket reaction moments. It is performed by tuning the spatial relationship between the transtibial prosthetic socket and the foot following sequential observational gait analysis in the three anatomical planes. However, the order of planes in which the adjustment should be performed is still unclear. To investigate the appropriate sequence of dynamic alignment adjustment, ten participants with transtibial amputation were asked to walk in different alignment conditions (flexion, extension, adduction, abduction; lateral, medial, anterior, and posterior translation of the socket, and plantarflexion, dorsiflexion, inversion, and eversion of the foot) to measure socket reaction moments in the out-of-planes (e.g., the effect of sagittal alignment on the coronal moment). A significant difference was found only among socket posterior translation, socket flexion, and baseline alignment in the coronal moment (P = 0.02). The results of the current and previous studies suggest that moments in the coronal plane are affected by alignment changes in all three planes, whereas moments in the sagittal plane are affected only by sagittal alignment changes. It is suggested that the procedure of alignment adjustments should be finalized in the coronal plane.

Long-term body-weight-supported treadmill training for incomplete cervical spinal cord injury: a case report.

[Purpose] To investigate the effects of long-term body-weight-supported treadmill training on walking ability and physical function in an elderly individual with incomplete cervical spinal cord injury. [Participant and Methods] The patient was a 68 year-old male with an incomplete spinal cord injury at the C3/C4 level, incurred when he was 56 years old. He initiated home-based body-weight-supported treadmill training using a body-weight-supported treadmill installed at his home. His walking ability was measured as the percentage of body weight load reduction, and his physical function was evaluated using manual muscle testing and measuement of the range of motion of his lower limbs. [Results] The physical function of the lower limbs was improved, maintained, or showed delayed decline until 9.5 years post-injury. [Conclusion] Long-term body-weight-supported treadmill training may improve, maintain, or at least delay the decline of the physical function of participants for several years, without causing any remarkable complications.

Angulation vs translation of transtibial prosthetic socket: their difference analyzed by socket reaction moments.

BACKGROUND: Previous studies investigated the effects of alignment changes in transtibial prostheses on socket reaction moments. However, the effects of angular and translational alignment changes with equal displacement between the foot and the socket were not directly compared. RESEARCH QUESTIONS: What are the different effects of angular and translational alignment changes in transtibial prostheses? METHODS: Ten individuals with transtibial prostheses participated in the measurement of temporo-spatial parameters, socket reaction moments, and their timings under nine alignment conditions (3° flexion/extension, anterior/posterior translation, 6° adduction/abduction, medial/lateral translation, and baseline). The displacement of the prosthetic feet was set to be equal between the angular and translational changes. RESULTS: No significant changes in walking speed were found. Similar effects were observed in the magnitudes, but not in timing, of the moments under angular and translational changes in the sagittal plane (p < 0.01 for the differences in peak extension moment among anterior translation, baseline, and extension conditions, and in peak flexion moment among anterior translation, baseline, and extension conditions). In the coronal plane, similar effects were found in the magnitudes of the moments in the early stance (p < 0.01 at 5 %, 20 %, and 75 % stance). A significant difference in magnitude was observed in the late stance (p < 0.01 between adduction and medial translation conditions). SIGNIFICANCE: The timing of the socket reaction moment may be different in the sagittal plane, while the magnitudes of the socket reaction moment in the late stance may be different in the coronal plane between the angular and translational alignment changes.

Influence of coronal and sagittal prosthetic foot alignment on socket reaction moments in transtibial prostheses during walking.

BACKGROUND: The socket reaction moment (SRM) has been reported to change because of alignment changes in transtibial prosthetic sockets. However, the influence of prosthetic foot alignment on SRM remains unclear. RESEARCH QUESTION: Are SRMs predictable from alignment changes of prosthetic feet? METHODS: Ten users of transtibial prostheses participated in this study. Under five alignment conditions (3 ° plantarflexion and dorsiflexion, 6 ° inversion and eversion, and baseline alignment), temporal-spatial parameters and sagittal and coronal SRMs were measured during walking. Cadence, walking speed, step time, single support time, and step length were compared. The maximum/minimum SRM, % stance (timing) of the maximum/minimum SRM, Zero-cross, and SRMs at 5 %, 20 %, and 75 % stance were extracted and compared. Repeated measures analysis of variance or Friedman tests, and linear regression analyses were conducted for statistical analyses (i.e., alignment conditions as independent variables and SRM parameters as dependent variables). RESULTS: The SRMs at 5%, 20 %, and 75 % stance showed significant differences under coronal angular changes. The minimum SRM, % stance of the minimum/maximum SRM, and Zero-cross showed significant differences under sagittal alignment changes. In linear regression analysis, the minimum SRM, % stance of the minimum/maximum SRM, SRM at 20 % stance, and Zero-cross were significant dependent variables in the sagittal plane. The maximum/minimum SRM, SRM at 20 % and 75 % stance, and % stance of the minimum SRM were significant dependent variables in the coronal plane. SIGNIFICANCE: The results indicated that the changes in prosthetic feet angles may predict the magnitude of SRM (maximum/minimum SRM, SRM at 20 % and 75 % stance) in the coronal plane, and the timing of SRM (Zero-cross, % stance of the maximum/minimum SRM) in the sagittal plane. These findings suggest that the SRM may be useful for evaluating foot alignment in transtibial prostheses.

Throwing distance and competitive performance of Boccia players.

[Purpose] This study aimed to clarify the relationship between throwing distance and competitive performance in Boccia players in order to establish a training program based on this evidence. [Participants and Methods] In total, 40 athletes, who competed in the Japan Boccia Championships and are certified players of the Japan Boccia Association, participated in the study. Participants threw the Boccia ball as far as possible, and throwing distances were compared between certified players (Group I, n=8), those who participated in the final round (Group II, n=9), and those who lost in the preliminary round (Group III, n=23). [Results] The maximum throwing distances were 16.38 ± 5.17 m (Group I), 10.67 ± 2.66 m (Group II), and 8.34 ± 2.73 m (Group III). Group I threw the ball significantly farther than Groups II and III. [Conclusion] Boccia is a target sport and throwing farther distances requires more effort. In addition, being able to throw at a longer distance means that Boccia players can throw a stronger ball and use this for various tactics. The results of this study suggest that long-distance throwing training would be effective in improving the competitive performance of Boccia players.

Relationship between pulmonary function, throw distance, and psychological competitive ability of elite highly trained Japanese boccia players via correlation analysis.

BACKGROUND: Boccia players have severe quadriplegia; nonetheless, detailed aspects of the physical function of individual players have not been evaluated. AIMS: This study aimed to detetmine the relationship between pulmonary function, pitching distance, and psychological competitive ability of Japanese boccia players. METHODS: Participants were athletes from the Japan Boccia Association (10 males, 3 females; average age, 32.9 ± 12.0 years) who could independently perform pitching motions. We measured pulmonary function, respiratory muscle force, and diaphragm movement using ultrasonography, pitching distance, and psychological competitive ability. OUTCOMES AND RESULTS: In all participants, pulmonary function, respiratory muscle force, and diaphragm displacement were low, whereas respiratory function was very low compared to the normal range (i.e., the value calculated from the subjects' height, weight, and age). However, boccia players with high level of competitive ability performed well. CONCLUSIONS AND IMPLICATIONS: The results raise the question as to whether focusing on the development of boccia players' competitive ability and physical function will improve their overall performance. This question warrants future investigation.

Preliminary study on the effects of movement velocity training of the upper limbs on gait ability in older adults: a nonrandomized controlled trial.

Purpose: Movement velocity of the limbs or trunk plays an important determinant of gait speed in older adults. Movement velocity-focused training of the lower limbs or trunk has recently been shown to be an effective intervention to improve gait ability. Because movement velocities of various body regions are significantly correlated, movement velocity training of the upper limbs may also be effective for improving gait speed. Therefore, the purpose of this study was to investigate whether movement velocity training of the upper limbs in a seated position is effective for improving gait ability. Patients and methods: This study was a nonrandomized controlled trial. The participants were older adults residing in geriatric health service facilities. They were assigned to the movement velocity training of the upper limbs group (n=26) or control group (n=15). The participants in the training group performed exercises (three times per week for 10 weeks) to move the upper limbs as quickly as possible. The outcomes were gait speed, movement velocity, and quadriceps strength. These measurements were performed preintervention and 4, 8, and 10 weeks after intervention. Results: A significant time-group interaction was found for maximum gait speed and movement velocity of the upper limbs. Bonferroni post-hoc test showed significant improvement in gait speed between preintervention and 10 weeks after intervention in the training group. The movement velocity of the upper limbs was significantly improved between preintervention and 4, 8, and 10 weeks after intervention. Conclusion: Movement velocity training of the upper limbs showed significant and clinically relevant improvements in maximum gait speed at 10 weeks after intervention. This training is a potentially useful intervention and can be safely performed.

The effect of transverse prosthetic alignment changes on socket reaction moments during gait in individuals with transtibial amputation.

BACKGROUND: Alignment affects gait of individuals with transtibial prostheses. Sagittal and coronal alignment changes of the transtibial prostheses were demonstrated to affect socket reaction moments. However, the effects of transverse alignment changes on the socket reaction moments are not known. RESEARCH QUESTION: The aim of this study was to investigate the effects of transverse alignment changes on the socket reaction moments and temporal-spatial parameters of gait in transtibial prostheses. METHODS: The effects of transverse prosthetic alignment changes (i.e. 10° and 5° of internal and external rotations: toe-in and toe-out of the foot relative to the socket from a baseline alignment) on the sagittal and coronal socket reaction moments and temporal-spatial parameters (gait speed, cadence and step width) while walking in 9 individuals with transtibial amputation were investigated using an instrumented prosthetic pyramid adaptor and a three-dimentional (3D) motion capture system. RESULTS: The transverse alignment changes demonstrated significant effects on the socket reaction moments in the coronal plane at 5% (P =  0.04), 20% (P =  0.04) and 75% (P =  0.0001) of stance phase. No significant effects were found in the socket reaction moments in the sagittal plane and the temporal-spatial parameters. The internal and external rotations of the prosthetic feet may have opposite effect in early and mid- to late-stance potentially due to changes in the spatial position of the heel (rearfoot) and toe (forefoot) of the prosthetic foot relative to the socket. SIGNIFICANCE: Transverse alignment of the transtibial prostheses should be tuned not only considering the symmetry in toe-out angles of the feet, but also considering the potential effects of transverse alignment changes that may affect the coronal socket reaction moments.

The effect of coronal prosthetic alignment changes on socket reaction moments, spatiotemporal parameters, and perception of alignment during gait in individuals with transtibial amputation.

INTRODUCTION: The alignment of a prosthesis is clinically determined based on observations by clinicians and the subjective perception of amputees during gait. However, this process has been reported to be unreliable. Socket reaction moment has been reported to be significantly impacted by alignment changes, but the impact of these alignment changes on other gait parameters is unclear. The aim of this study was to investigate the effects of coronal alignment changes of a transtibial prosthesis on socket reaction moment, spatiotemporal parameters, and perceptions of alignment during gait in amputees. METHODS: Nine individuals with transtibial amputation participated in this study. Socket reaction moment and spatiotemporal parameters (step time, step length, step width, single limb support time, cadence, and gait speed) were measured under nine coronal alignment conditions (angulation: ±3°, ±6°, translation: ±5 mm, ±10 mm, and baseline) using a three-dimensional motion capture system (Vicon) and an embedded load-cell system (Europa™). In addition, subjective perceptions of alignment were examined. RESULTS: Coronal alignment changes of the transtibial prostheses demonstrated significant changes in socket reaction moment; however, no significant changes were found with spatiotemporal parameters or the amputee's perception. CONCLUSION: Measurement of socket reaction moment, along with the embedded load-cell system, may be a better metric for tuning the coronal alignment of transtibial prostheses compared to spatiotemporal parameters and amputee's perceptions.

Relationship between the duration and trunk inclination and hip angle during car transfer in individuals with tetraplegia.

[Purpose] The purpose of the present study was to investigate the relationship between the duration of the car transfer (CT) movement and trunk inclination and hip angles during this movement in individuals with tetraplegia. [Subjects and Methods] Eleven adult males with C6 tetraplegia participated in this study. The CT movement was recorded from the passenger side of the car using a digital video camera. From the video, the duration and trunk inclination and hip joint angle were recorded, and correlation coefficients were calculated. [Results] No correlation was found between the trunk inclination angle and the duration of the CT movement. However, a significant correlation was found between the hip angle and the duration of the CT movement: when the duration was short, the hip flexion angle was substantial. [Conclusion] The trunk inclination angle probably showed no effect on the duration of the CT movement because the movement was performed in a limited space and because the trunk muscles of the subjects were paralyzed. In contrast, C6 tetraplegia enabled smooth CT by allowing for control of trunk inclination, such as placing the lower extremities in the car, whereby the pelvis backward tilt angle increased.

Muscle activity and mood state during simulated plant factory work in individuals with cervical spinal cord injury.

[Purpose] The present study investigated the physical and mental effects of plant factory work in individuals with cervical spinal cord injury and the use of a newly developed agricultural working environment. [Subjects] Six males with C5-C8 spinal cord injuries and 10 healthy volunteers participated. [Methods] Plant factory work involved three simulated repetitive tasks: sowing, transplantation, and harvesting. Surface electromyography was performed in the dominant upper arm, upper trapezius, anterior deltoid, and biceps brachii muscles. Subjects' moods were monitored using the Profile of Mood States. [Results] Five males with C6-C8 injuries performed the same tasks as healthy persons; a male with a C5 injury performed fewer repetitions of tasks because it took longer. Regarding muscle activity during transplantation and harvesting, subjects with spinal cord injury had higher values for the upper trapezius and anterior deltoid muscles compared with healthy persons. The Profile of Mood States vigor scores were significantly higher after tasks in subjects with spinal cord injury. [Conclusion] Individuals with cervical spinal cord injury completed the plant factory work, though it required increased time and muscle activity. For individuals with C5-C8 injuries, it is necessary to develop an appropriate environment and assistive devices to facilitate their work.

Quickness of trunk movements in a seated position, regardless of the direction, is more important to determine the mobility in the elderly than the range of the trunk movement.

Although trunk function is known to be critical for maintaining balance during gait, a detailed evaluation regarding the relationship between trunk function and mobility has not been performed. We previously reported that the ability of quick lateral trunk movements in a seated position reflects mobility in elderly people. In this study, we further examined whether trunk movement in the anterior-posterior direction is also a determinant of mobility. In addition, the correlation between range of lateral trunk movement and mobility was also examined. One hundred and forty community-dwelling elderly participants (73.3±6.2 years) were enrolled in this study. We performed various trunk movement tests in a seated position, such as the seated side tapping test (SST), the seated anterior-posterior tapping test (APT), and the lateral sitting functional reach test (sitting reach test). Maximum gait speed and the timed up and go test (TUG) were performed to determine mobility. Parameters of trunk movement were compared. SST and APT showed moderate significant correlations with both maximum gate speed and TUG, while the sitting reach test weakly correlated (SST r=-0.58, p<0.01, APT r=-0.63, p<0.01, sitting reach test r=0.30, p<0.01). Moreover, multiple regression analysis revealed that SST and APT were independent indicators of both maximum gate speed and TUG, while the sitting reach test was not. These findings indicate that quickness, regardless of the direction of the movement, is more important than range in determining mobility in the elderly.

Maximum movement velocity of the upper limbs reflects maximum gait speed in community-dwelling adults aged older than 60 years.

AIM: A number of studies have shown that the maximum movement velocity of the lower limbs is a critical determinant of gait speed in elderly adults. However, it is still unclear whether gait speed is associated with the movement velocity of the lower limbs or the movement velocity itself. Therefore, we measured the movement velocity of upper limbs that would not have a direct effect on gait, and examined the relationship between the movement velocity and gait speed. METHODS: A total of 76 community-dwelling adults aged older than 60 years (mean age 73.3 years) participated in the study. We measured the movement velocity of the upper limbs, maximum gait speed, quadriceps strength, trunk muscle endurance and skeletal muscle mass index. RESULTS: A significant correlation was found between the movement velocity of the upper limbs and maximum gait speed (r=0.47; P<0.01). In a stepwise multiple regression analysis using maximum gait speed as a dependent variable, age, movement velocity of the upper limbs, body mass index and quadriceps strength were selected as independent variables (R(2)=0.55, P<0.001). CONCLUSIONS: The movement velocity of the upper limbs is a significant determinant of maximum gait speed, suggesting that the ability to move any region rapidly might be a critical factor in maximum gait speed.

Carbon Dioxide Water Bathing Enhances Myogenin but Not MyoD Protein Expression after Skeletal Muscle Injury.

[Purpose] We reported that carbon dioxide (CO2) water bathing accelerates skeletal muscle regeneration; however, the underlying mechanism was unclear. MyoD and myogenin play roles in muscle regeneration, and the purpose of this study was to determine changes in MyoD and myogenin caused by CO2 water bathing after injury. [Subjects] Sixteen female Wistar rats (n = 4 per group) were used. [Methods] The rats were divided into four groups: no-injury (NI), injury (IC), injury + tap water bathing (ITW), and injury + CO2 water bathing (ICO2). Muscle injury was induced by injection of bupivacaine hydrochloride into the left tibial anterior (TA) muscles. Tap water and CO2 (1,000 ppm) water bathing were performed at 37 °C for 30 minutes once a day. The left TA muscles were removed 4 days after injury, and the expressions of MyoD and myogenin were measured. [Results] MyoD and myogenin were increased in the IC, ITW, and ICO2 groups compared with the NI group. Although the MyoD level was similar in the IC, ITW, and ICO2 groups, myogenin increased more in the ICO2 group than in the IC and ITW groups. [Conclusion] CO2 water bathing after muscle injury appears to induce an increase in the expression of myogenin.