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.

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.

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.

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.