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<b>Objectives: </b>Recently, it has been reported that the effects of artificial high concentration carbon-dioxide (CO<sub>2</sub>) on core temperature, cutaneous blood flow, thermal sensation. However, the effect of artificial high concentration CO<sub>2</sub> water foot baths for spasticity, lower extremity motor function and walking ability was not identified. The purpose of this study was to investigate whether the newly artificial high concentration CO<sub>2</sub> water foot bath inhibits spasticity and improves lower extremity motor function and gait speed in spastic paraplegia patient.<BR><b>Case Presentation: </b>The patient was a 37 years old man with spastic paraplegia of human immunodeficiency virus encephalopathy, without signs of cognitive impairment. The patient was able to walk without assistance using a T-cane or an ankle-foot orthosis. He had no medical condition that limited footbath usage (such as uncontrolled cardiopulmonary disease, severe joint disability and severe sensory disturbance), severe aphasia that made it impossible to follow verbal instructions, and cognitive dysfunction that interfered with outcome assessments. Informed consent was obtained from him according to the ethical guidelines of the hospital, after he fully understood the purpose and methodology of the study. This work was carried out with permission from the Ethical Committee of Kagoshima University.<BR><b>Methods: </b>This case study was before and after intervention trial. Six outcome instruments were used at baseline and after the artificial high concentration CO<sub>2</sub> water foot bath: the modified Ashworth scale (MAS) score for the gastrocnemius muscles as a measure of spasticity, ankle clonus, muscle stiffness at triceps muscle of calf, deep body and surface skin temperature as a monitor for physical condition, the active range of motion as an assessment tool for motor function, and the 10-m walk test as a measure of walking ability. Lower-extremity movement acceleration was also measured using an accelerometer. The subject rested in a chair for 10 min and the above-noted physiological reactions during the last 5 min of the resting period were recorded as baseline values. Next, the subject received a 20-min foot bath in water at 38 °C, with a 10-min recovery period. The artificial high concentration CO<sub>2</sub> water foot bath improved the acceleration of the spastic lower extremities and this improvement in acceleration lasted for 10 min after the footbath usage.<BR><b>Results: </b>The subject experienced no discomfort before, during or after the intervention, and all assessments were completed safely. The deep body temperature and skin temperature increased immediately after and 10 minutes after the artificial high concentration CO<sub>2</sub> water foot baths. The MAS score, ankle clonus and the muscle stiffness for the triceps muscle of calf were decreased. The active range of motion for ankle dorsiflexion and gait speed improved after the 20-min intervention.<BR><b>Conclusion: </b>These findings suggest that artificial high concentration CO<sub>2</sub> water foot bath is an effective method for controlling spasticity, and improves motor function and walking ability in spastic paraplegia patients.
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<b>Objectives:</b> To preliminarily assess the effects of a single warm-water bath (WWB) on the quality of sleep, we measured sleep pattern after WWB in healthy volunteers. The primary objective of the present before-after study was to evaluate whether a single 10-minute WWB at 41°C could modulate sleep pattern in a single group of healthy subjects. In this pilot study, we also assessed the difference in general fatigue and subjects’ satisfaction responses to WWB under two conditions: WWB using tap water (WWB with tap water) and WWB using a bath additive that included inorganic salts and artificial carbon-dioxide (CO<sub>2</sub>) (WWB with ISCO<sub>2</sub>). <BR><b>Methods:</b> Eleven healthy volunteers aged 20 to 48 years (29.8±8.9 years, mean ± SD) participated in this study. Inclusion criteria were as follows: age 20-50 years; free of cardiovascular disease; not taking medications or supplements. In this within-subject, two-way crossover study, all subjects underwent WWB with tap water or WWB with ISCO<sub>2</sub> in random order for two consecutive nights. Objective sleep measures from sleep sensor mat (sleep-scan) and subjective subjects’ reports were collected. This study was approved by the Ethics Committee of Kagoshima University Hospital and written informed consent was obtained from all of the subjects. <BR><b>Results:</b> None of the subjects experienced discomfort before, during or after the study period. The objective sleep measures and subjects’ reports were completed safely in all subjects. WWB with ISCO<sub>2</sub> bathing produced significant improvement in objective and subjective sleep latency compared with WWB with tap water bathing (P<0.05). Sleep-scan-determined wake time after sleep onset (WASO), sleep efficiency, and number of awakenings (NA), and patient-reported measures of WASO, NA, sleep quality, sleep depth, and daytime functioning significantly improved following WWB with ISCO<sub>2</sub> bathing versus WWB with tap water bathing (P<0.05). WWB with ISCO<sub>2</sub> bathing also increased deep sleep time and sleep score (P<0.01 for both comparisons), but did not alter REM or slow-wave sleep. <BR><b>Conclusion: </b>In conclusion, in our group of healthy volunteers, a single warm-water bath was shown to have the potential to modulate the quality of sleep. These findings demonstrate that WWB with ISCO<sub>2</sub> bathing might be effective in improving some domains of sleep quality of healthy volunteers, and the subjects showed acceptance towards the intervention. Strengths and limitations of the present study as well as suggestions for further studies were considered. Further evaluations with larger and longer-term randomized double-blind placebo-controlled trials based on the present study are needed.
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<b>Objectives: </b>The purpose of this study was to investigate whether the whole body vibration (WBV) inhibits spasticity and improves motor function and walking ability in the hemiplegic legs of post-stroke patients.<BR><b>Patients and Methods: </b>This before-and-after intervention trial examined 13 post-stroke patients (11 male and 2 female; mean age, 54.3 ± 13.0 years; range, 24-72 years). The Brunnstrom Recovery Stage of the hemiplegic lower limb was stage 3 in three patients, stage 4 in 7, stage 5 in three. The modified Ashworth scale (MAS) score for the gastrocnemius muscles was 1 in one case, 1+ in 6 cases and 2 in six cases. All patients had increased muscle tonus of the affected lower limb (MAS score ≥1), and were able to walk without assistance using a T-cane or an ankle-foot orthosis. Exclusion criteria were any medical condition preventing vibratory stimulation (such as uncontrolled cardiopulmonary disease, severe joint disability and severe sensory disturbance), severe aphasia that made it impossible to follow verbal instructions, and dementia that interfered with outcome assessments. Each subjects sat on the chair with hip joint angles to approximately 90° of flexion, and with knee joint angles to 0° of extension. WBV was applied at 30 Hz (4-8 mm amplitude) for 5 min on hamstrings, gastrocnemius and soleus muscles (Figure 1). The parameters measured before and after the intervention were the MAS, the F-wave parameters as a measure of motor-neuron excitability, the active and passive range of motion (A-ROM, P-ROM) as a measure of motor function, and the 10-m walk test as a measure of walking ability.<BR><b>Results: </b>None of the subjects experienced discomfort before, during or after the intervention and all assessments were completed safely in all subjects. The MAS and F-wave parameters were significantly decreased (p < 0.05), the A-ROM and P-ROM for ankle dorsiflexion increased (p < 0.01), and the P-ROM for straight leg raising increased (p < 0.01), and walking speed improved (p < 0.01) after the 5-min intervention.<BR><b>Conclusion: </b>These findings suggest that WBV is an effective method for controlling spasticity, and improves motor function and walking ability in post-stroke patients.
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Purpose : To study the effect of repetitive facilitation exercise combined with continuous low-frequency electrical stimulation on upper-extremity motor impairment or hand edema during the acute phase of cerebral infarction. Subjects : Thirty inpatients with both hemiplegia and hand swelling, who were admitted to a hospital from April 2011 to March 2012. Methods : In this randomized, controlled, observer-blinded trial, we randomized the subjects into two groups and provided treatment on a 2-week, 30 minutes/day schedule. Subjects in the intervention group received repetitive facilitation exercise concurrent with continuous low-frequency electrical stimulation, while subjects in the control group were provided passive range-of-motion (ROM) exercise. Upper Limb Fugl-Meyer Assessment (FMA), edema and passive ROM were evaluated at baseline and at two weeks. Results : At two weeks, the intervention group showed significant improvements on all measurements. However, the control group showed significant improvement only in their FMA. The intervention group had significantly greater improvements than the control group on all three measurements. Conclusion : Repetitive facilitation exercise concurrent with continuous low-frequency electrical stimulation therapy is effective not only for recovery from motor impairment but also for reducing swelling of the hand during the acute phase of cerebral infarction.
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Objectives: To preliminarily assess the effects of a single warm-water bath (WWB) on the quality of sleep, we measured sleep pattern after WWB in healthy volunteers. The primary objective of the present before-after study was to evaluate whether a single 10-minute WWB at 41°C could modulate sleep pattern in a single group of healthy subjects. In this pilot study, we also assessed the difference in general fatigue and subjects’ satisfaction responses to WWB under two conditions: WWB using tap water (WWB with tap water) and WWB using a bath additive that included inorganic salts and artificial carbon-dioxide (CO2) (WWB with ISCO2). Methods: Eleven healthy volunteers aged 20 to 48 years (29.8±8.9 years, mean ± SD) participated in this study. Inclusion criteria were as follows: age 20-50 years; free of cardiovascular disease; not taking medications or supplements. In this within-subject, two-way crossover study, all subjects underwent WWB with tap water or WWB with ISCO2 in random order for two consecutive nights. Objective sleep measures from sleep sensor mat (sleep-scan) and subjective subjects’ reports were collected. This study was approved by the Ethics Committee of Kagoshima University Hospital and written informed consent was obtained from all of the subjects. Results: None of the subjects experienced discomfort before, during or after the study period. The objective sleep measures and subjects’ reports were completed safely in all subjects. WWB with ISCO2 bathing produced significant improvement in objective and subjective sleep latency compared with WWB with tap water bathing (P<0.05). Sleep-scan-determined wake time after sleep onset (WASO), sleep efficiency, and number of awakenings (NA), and patient-reported measures of WASO, NA, sleep quality, sleep depth, and daytime functioning significantly improved following WWB with ISCO2 bathing versus WWB with tap water bathing (P<0.05). WWB with ISCO2 bathing also increased deep sleep time and sleep score (P<0.01 for both comparisons), but did not alter REM or slow-wave sleep. Conclusion: In conclusion, in our group of healthy volunteers, a single warm-water bath was shown to have the potential to modulate the quality of sleep. These findings demonstrate that WWB with ISCO2 bathing might be effective in improving some domains of sleep quality of healthy volunteers, and the subjects showed acceptance towards the intervention. Strengths and limitations of the present study as well as suggestions for further studies were considered. Further evaluations with larger and longer-term randomized double-blind placebo-controlled trials based on the present study are needed.
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Objectives: Recently, it has been reported that the effects of artificial high concentration carbon-dioxide (CO2) on core temperature, cutaneous blood flow, thermal sensation. However, the effect of artificial high concentration CO2 water foot baths for spasticity, lower extremity motor function and walking ability was not identified. The purpose of this study was to investigate whether the newly artificial high concentration CO2 water foot bath inhibits spasticity and improves lower extremity motor function and gait speed in spastic paraplegia patient. Case Presentation: The patient was a 37 years old man with spastic paraplegia of human immunodeficiency virus encephalopathy, without signs of cognitive impairment. The patient was able to walk without assistance using a T-cane or an ankle-foot orthosis. He had no medical condition that limited footbath usage (such as uncontrolled cardiopulmonary disease, severe joint disability and severe sensory disturbance), severe aphasia that made it impossible to follow verbal instructions, and cognitive dysfunction that interfered with outcome assessments. Informed consent was obtained from him according to the ethical guidelines of the hospital, after he fully understood the purpose and methodology of the study. This work was carried out with permission from the Ethical Committee of Kagoshima University. Methods: This case study was before and after intervention trial. Six outcome instruments were used at baseline and after the artificial high concentration CO2 water foot bath: the modified Ashworth scale (MAS) score for the gastrocnemius muscles as a measure of spasticity, ankle clonus, muscle stiffness at triceps muscle of calf, deep body and surface skin temperature as a monitor for physical condition, the active range of motion as an assessment tool for motor function, and the 10-m walk test as a measure of walking ability. Lower-extremity movement acceleration was also measured using an accelerometer. The subject rested in a chair for 10 min and the above-noted physiological reactions during the last 5 min of the resting period were recorded as baseline values. Next, the subject received a 20-min foot bath in water at 38 °C, with a 10-min recovery period. The artificial high concentration CO2 water foot bath improved the acceleration of the spastic lower extremities and this improvement in acceleration lasted for 10 min after the footbath usage. Results: The subject experienced no discomfort before, during or after the intervention, and all assessments were completed safely. The deep body temperature and skin temperature increased immediately after and 10 minutes after the artificial high concentration CO2 water foot baths. The MAS score, ankle clonus and the muscle stiffness for the triceps muscle of calf were decreased. The active range of motion for ankle dorsiflexion and gait speed improved after the 20-min intervention. Conclusion: These findings suggest that artificial high concentration CO2 water foot bath is an effective method for controlling spasticity, and improves motor function and walking ability in spastic paraplegia patients.
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Objectives: The purpose of this study was to investigate whether the whole body vibration (WBV) inhibits spasticity and improves motor function and walking ability in the hemiplegic legs of post-stroke patients. Patients and Methods: This before-and-after intervention trial examined 13 post-stroke patients (11 male and 2 female; mean age, 54.3 ± 13.0 years; range, 24-72 years). The Brunnstrom Recovery Stage of the hemiplegic lower limb was stage 3 in three patients, stage 4 in 7, stage 5 in three. The modified Ashworth scale (MAS) score for the gastrocnemius muscles was 1 in one case, 1+ in 6 cases and 2 in six cases. All patients had increased muscle tonus of the affected lower limb (MAS score ≥1), and were able to walk without assistance using a T-cane or an ankle-foot orthosis. Exclusion criteria were any medical condition preventing vibratory stimulation (such as uncontrolled cardiopulmonary disease, severe joint disability and severe sensory disturbance), severe aphasia that made it impossible to follow verbal instructions, and dementia that interfered with outcome assessments. Each subjects sat on the chair with hip joint angles to approximately 90° of flexion, and with knee joint angles to 0° of extension. WBV was applied at 30 Hz (4-8 mm amplitude) for 5 min on hamstrings, gastrocnemius and soleus muscles (Figure 1). The parameters measured before and after the intervention were the MAS, the F-wave parameters as a measure of motor-neuron excitability, the active and passive range of motion (A-ROM, P-ROM) as a measure of motor function, and the 10-m walk test as a measure of walking ability. Results: None of the subjects experienced discomfort before, during or after the intervention and all assessments were completed safely in all subjects. The MAS and F-wave parameters were significantly decreased (p < 0.05), the A-ROM and P-ROM for ankle dorsiflexion increased (p < 0.01), and the P-ROM for straight leg raising increased (p < 0.01), and walking speed improved (p < 0.01) after the 5-min intervention. Conclusion: These findings suggest that WBV is an effective method for controlling spasticity, and improves motor function and walking ability in post-stroke patients.
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<B>Purpose</B><br> The effects of10 min bathing at 41°C and 200 m/1.2min running inducing similar tachycardic response were examined comparatively on cardiovascular functions, blood gas and tissue metabolism, and peripheral blood compositions.<br><B>Subjects and Methods</B><br> The subjects examined were 13 healthy males (28.7±3.6 yrs). They kept rest for 30min before bathing and running study and measurements of blood pressure (BP), heart rate (HR), sublingual temperature and skin blood flow and a indwellng catheter for blood sampling in cubital vein were performed. The subjects had 41°C bathing for 10 min and 200 m running/1.2 min (10km/hr) separately which induced the increase in heart rate by 30bpm in preliminary study. Measurements and blood sampling were done just after the loading (bathing or running) and 15min after the loading.<br><B>Results and Discussion</B><br> The increase in HR just after bathing and running were nearly the same level, 27 and 25 bpm, respectively. The increase in systolic BP after running was greater than that after bathing, and diastolic BP was significantly reduced after bathing from resting level. Sublingual temperature and skin blood flow were increased only after bathing suggesting the marked thermal vasodilation.<br> After bathing, venous pO<SUB>2</SUB> was significantly increased and pCO<SUB>2</SUB> was significantly decreased, and there were no significant changes in lactate and pyruvate level. On the contrary, after 200 m running, venous pO<SUB>2</SUB> was decreased and pCO<SUB>2</SUB> was increased, and blood lactate, pyruvate and P/L ratio were significantly increased. These changes show that bathing provides tissue full oxygenation and washout of CO<SUB>2</SUB> by increased blood supply without metabolic activation. After running, increased glycolysis in muscle and delayed oxidation by TCA cycle were suggested.<br> As the increase in WBC after bathing (+6%) and exercise (+22%) subsided very shortly., these changes might be explained by mixing perivascular flow enriched with leucocytes and central flow enriched with plasma due to increased circulation. Previous reports on the change of lymphocyte subsets after bathing and exercise should be examined from this viewpoint. The role of plasma concentration estimated from the changes in RBC and plasma protein was relatively low, around 2% by bathing and 4% by running.<br><B>Conclusion</B><br> Health promotion by bathing seems to be conducted through sufficient O<SUB>2</SUB> supply and washout of CO<SUB>2</SUB> by thermal vasodilation without metabolic activation. Health promotion by exercise is induced by strong activation of cardiovascular and muscle metabolic function. Combination of passive effects by bathing and active exercise will be favorable for balanced health promotion.
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The effects of bathing in a solution of artificial bath additive including inorganic salts and carbon dioxide (CO<SUB>2</SUB>-bathing: 41°C, 10 minutes; the concentration of carbon dioxide was 160-180 ppm, and that of inorganic salts was about 64 ppm) on the cardiovascular system, body flexibility, muscle stiffness and the subjective feeling of bathing were compared with those of no bathing and plain water bathing in the healthy subjects.<br> The deep body temperature and skin blood flow increased after bathing, and the increases after CO<SUB>2</SUB>-bathing were significantly greater than those after plain water bathing.<br>Body flexibility after CO<SUB>2</SUB>-bathing was similar to that of no bathing and plain water bathing.<br> Stiffness of the trapezius muscle was decreased at both 15 min and 30 min after CO<SUB>2</SUB>-bathing and plain water bathing, with no change in no bathing. The changes at 15 min after CO<SUB>2</SUB>-bathing and plain water bathing were statistically significant. Stiffness in the latissimus dorsi muscle decreased at both 15 min and 30 min after CO<SUB>2</SUB>-bathing and plain water bathing, with no change in no bathing. However, only these changes at 15 min and 30 min after CO<SUB>2</SUB>-bathing were statistically significant.<br> A large decrease in the stiffness of the trapezius muscle by its isometric contraction was observed during both CO<SUB>2</SUB>-bathing and plain water bathing, and the decrease after CO<SUB>2</SUB>-bathing was greater than that after plain water bathing. These changes did not reach statistical significance.<br> Improvements in subjective feeling of bathing were observed after both plain water bathing and CO<SUB>2</SUB>-bathing. Improvements after CO<SUB>2</SUB>-bathing in stiffness of muscle, ease of movements and mental relaxation were statistically greater than those after plain water bathing.<br> Compared with plain water bathing, CO<SUB>2</SUB>-bathing showed additional effects on muscle stiffness and subjective feeling of bathing. Further research is needed to confirm the effectiveness of the CO<SUB>2</SUB>-bathing alone and combined with isometric movements on muscle stiffness.
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Purpose The effects of 10 min bathing at 41°C and 200 m/1.2min running inducing similar tachycardic response were examined comparatively on cardiovascular functions, blood gas and tissue metabolism, and peripheral blood compositions. Subjects and Methods The subjects examined were 13 healthy males (28.7±3.6 yrs). They kept rest for 30min before bathing and running study and measurements of blood pressure (BP), heart rate (HR), sublingual temperature and skin blood flow and a indwellng catheter for blood sampling in cubital vein were performed. The subjects had 41°C bathing for 10 min and 200 m running/1.2 min (10km/hr) separately which induced the increase in heart rate by 30bpm in preliminary study. Measurements and blood sampling were done just after the loading (bathing or running) and 15min after the loading. Results and Discussion The increase in HR just after bathing and running were nearly the same level, 27 and 25 bpm, respectively. The increase in systolic BP after running was greater than that after bathing, and diastolic BP was significantly reduced after bathing from resting level. Sublingual temperature and skin blood flow were increased only after bathing suggesting the marked thermal vasodilation. After bathing, venous pO2 was significantly increased and pCO2 was significantly decreased, and there were no significant changes in lactate and pyruvate level. On the contrary, after 200 m running, venous pO2 was decreased and pCO2 was increased, and blood lactate, pyruvate and P/L ratio were significantly increased. These changes show that bathing provides tissue full oxygenation and washout of CO2 by increased blood supply without metabolic activation. After running, increased glycolysis in muscle and delayed oxidation by TCA cycle were suggested. As the increase in WBC after bathing (+6%) and exercise (+22%) subsided very shortly., these changes might be explained by mixing perivascular flow enriched with leucocytes and central flow enriched with plasma due to increased circulation. Previous reports on the change of lymphocyte subsets after bathing and exercise should be examined from this viewpoint. The role of plasma concentration estimated from the changes in RBC and plasma protein was relatively low, around 2% by bathing and 4% by running. Conclusion Health promotion by bathing seems to be conducted through sufficient O2 supply and washout of CO2 by thermal vasodilation without metabolic activation. Health promotion by exercise is induced by strong activation of cardiovascular and muscle metabolic function. Combination of passive effects by bathing and active exercise will be favorable for balanced health promotion.
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The effects of bathing in a solution of artificial bath additive including inorganic salts and carbon dioxide (CO2-bathing: 41°C, 10 minutes; the concentration of carbon dioxide was 160-180 ppm, and that of inorganic salts was about 64 ppm) on the cardiovascular system, body flexibility, muscle stiffness and the subjective feeling of bathing were compared with those of no bathing and plain water bathing in the healthy subjects. The deep body temperature and skin blood flow increased after bathing, and the increases after CO2-bathing were significantly greater than those after plain water bathing. Body flexibility after CO2-bathing was similar to that of no bathing and plain water bathing. Stiffness of the trapezius muscle was decreased at both 15 min and 30 min after CO2-bathing and plain water bathing, with no change in no bathing. The changes at 15 min after CO2-bathing and plain water bathing were statistically significant. Stiffness in the latissimus dorsi muscle decreased at both 15 min and 30 min after CO2-bathing and plain water bathing, with no change in no bathing. However, only these changes at 15 min and 30 min after CO2-bathing were statistically significant. A large decrease in the stiffness of the trapezius muscle by its isometric contraction was observed during both CO2-bathing and plain water bathing, and the decrease after CO2-bathing was greater than that after plain water bathing. These changes did not reach statistical significance. Improvements in subjective feeling of bathing were observed after both plain water bathing and CO2-bathing. Improvements after CO2-bathing in stiffness of muscle, ease of movements and mental relaxation were statistically greater than those after plain water bathing. Compared with plain water bathing, CO2-bathing showed additional effects on muscle stiffness and subjective feeling of bathing. Further research is needed to confirm the effectiveness of the CO2-bathing alone and combined with isometric movements on muscle stiffness.
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<b>Purpose</b><br> Forearm bathing is considered beneficial for the hands of patients with spastic hemiplegia, but the effect has not been investigated comprehensively. This study investigated the effectiveness of forearm bathing for patients with hemiplegic hands. <br><b>Subjects and Methods</b><br> In total, nine hemiplegic patients participated in the study (mean±standard deviation age=56.9±16.6 years; mean±standard deviation period from onset=21.1±21.2 months). Participants sat in a relaxed position on a chair, and dipped the affected forearms into 40°C warm water for 15 mins. The Simple Test for Evaluating Hand Function (STEF) score was evaluated before and after forearm bathing as an indicator of hemiplegic hand function. The Modified Ashworth Scale (MAS) score for the biceps brachii muscle, and both the resistance power of elbow extension and the F/M ratio (F-wave amplitudes/ M wave amplitudes) for the abductor pollicis brevis muscle, were evaluated as indicators of hemiplegic hand spasticity. The device used to measure the resistance power of elbow extension comprised a motor, cuffs to fix the hemiplegic arm and forearm in place, and a control system. The axis of rotation of the device was positioned over the axis of rotation of the elbow joint. The device induced passive elbow flexion and extension movements at an angular velocity of 60°/sec or 90°/sec.<br><b>Results</b><br> After forearm bathing, the STEF score increased significantly (<i>p</i><0.05) from 42.9±28.0 to 47.8±28.4 (<i>n</i>=9), the resistance power of elbow extension at 90°/min decreased significantly (<i>p</i><0.01) from 4.0±1.8 N to 3.0±1.9 N, and the MAS score and F/M ratio were unchanged (<i>n</i>=6).<br><b>Conclusions</b><br> Forearm bathing appeared to improve function and decrease spasticity in hemiplegic hands. This treatment might facilitate hand rehabilitation.
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Blood glucose disposition rate after intravenous glucose infusion is considered to reflect mainly the rate of cellular glucose uptake, the rate of glucose degradation process and gluconeogenesis. excluding the influense of glucose absorption. <br> When it is hypothesized that the elevated blood glucose is disposed by constant rate (one-compartment theory), the following formula will be realized.<br> Ct = A (1— k)<sup>t</sup> Ct = blood glucose level at t-minutes after infusion<br> A = initial glucose level after infusion<br> k = constant glucose disposition index / min<br> log Ct = log A (1—k) <sup>t</sup>= log A + t log (1 — k)<br> This formula demonstrates that logarithm of blood glucose concentration (Ct) is a one-dimensional (linear) function of time t with a slope log (1 — k), and blood glucose disposition index k can be calculated from this slope.<br> To examine the validity of this hypothesis, 1.5 ml / kg of 20% glucose (0.3g / kg) was infused at rest within 3 minutes into an antecubital vein and plasma glucose was determinned at 1, 3, 5, 10, 15, 20, 30 and 40 min after the cessation of infusion.<br> In 10 healthy subjects, linear regression coefficient between logarithm of plasma glucose and time t was significantly higher (r= 0.992 ± 0.006, p<0.001) during 5 to 40 min. Calculated k index ranged from 0.78 to 4.54% / min and the correlation between the 1st and the 2nd measurements (n=5) within a week was also significantly high (0.92±0.06, p<0.01). These results highly support the validity of basic formula (one-compartment theory) and practical procedure to measure k index.<br> The effects of warm water bathing (42 C, 10min) was examined in 7 subjects keeping warmth by blankets. After bathing, k value remained in nearly the same in 4 subjects, decreased in 2 and increased in 1. Although more detailed studies are needed, the effect of single bathing on glucose disposition seems to be not so significant.
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Genetic polymorphisms in the cytochrome P450 family are widely known to contribute to inter-individual differences in drug pharmacokinetics. In this study we report a case of a patient with cytochrome P450 2C19 polymorphism. A 57-year-old woman presented with right cerebral hemorrhage and left hemiplegia. She was administrated phenytoin (200 mg/day)and phenobarbital (60 mg/day) to prevent convulsions. After a change in phenytoin dosage (97% grains to 10% grains), she developed ataxia and experienced a disturbance in her activities of daily living. She was admitted to our hospital. Her serum concentration of phenytoin was found to be at a toxic level (45.9μg/ml) and serum phenobarbital was relatively high (19.1μg/ml). She showed an extremely low clearance of phenytoin, so we checked the genotype of her P450 2C9 and P450 2C19 cytochromes, which are metabolic enzymes of phenytoin. For cytochrome P450 2C9, the patient was a homozygous extensive metabolizer (wild type, *1/*1), but for cytochrome P450 2C19, she was a poor metabolizer (*3/*3). Her phenytoin dosage was reduced, and her ataxia, activities of daily living, left hemiplegia, and cerebral blood flow in Xe-CT improved.
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<b>Objective</b>: Exercise baths are generally considered to be one of the most appropriate and advantageous rehabilitative therapies, yet their effects have not been comprehensively investigated. The aim of this study is to assess the efficacy of exercise baths on quality of life (QOL).<br><b>Methods</b>: The 49 subjects consisted of 20 patients with brain disease, 21 patients with orthopaedic disease, and 8 patients with other diseases (i.e., 7 life-style related diseases and one heat burn). In the present study, all patients were first treated by conventional rehabilitation comprising physical therapy and occupational therapy for 4.2±1.4 weeks. Exercise baths were then added to the rehabilitation program for a further 4.4±1.2 weeks. The subjects were immersed in water at 38°C for 30-60min, twice a week. QOL was evaluated by alterations in the MOS Short-Form 36-item Health Survey (SF-36). We defined the period from admission to exercise bath start as Treatment I, and the period from exercise bath start to discharge (exercise bath finish) as Treatment II. On admission, before and after exercise bath, QOL was evaluated using the SF-36 scores.<br><b>Results</b>: We found that the increase of all eight subscales of the SF-36 was smaller in Treatment I period than in Treatment II period. Increases in SF-36 scores were observed in all patients, in all eight domains. Specifically, after exercise baths, increased scores of Physical functioning (PF), Role physical (RP), General health (GH), Vitality (VT), Role emotional (RE) and Mental health (MH) subscales of the SF-36 were observed in the patients with brain disease. Further, after exercise baths, increased scores of PF, RP, Bodily pain (BP), GH, VT, RE and MH subscales of the SF-36 were observed in the patients with orthopedic disease.<br><b>Conclusions</b>: It was concluded that exercise baths are an effective non-pharmacological treatment that might facilitate rehabilitation programs.
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Although visual field defects are common disorders in stroke patients, rehabilitation treatments have developed slowly. In this study, we report a case of a 35-year-old man with quadranopsia and visual agnosia due to right occipital hemorrhage. He had no upper limb motor impairments and began to work as a dental mechanic one month after the stroke, but had to retire because of difficulty in making dental implants. He failed to find things in his lower left visual field, and could not perceive fine differences in slope and depth. He was admitted 2 months after the onset and received occupational therapy for visual agnosia, and treatment for quadranopsia one month after admission. The treatment for quadranopsia was performed using a newly designed computerized visual field training machine consisting of a personal computer system which displayed a fixing point for the eyes at the center of the computer display, and a visual stimulation point at areas between residual vision and quadranopsia on the computer display accompanied by a response warning sound after the patient indicated using a switch when he found the visual stimulation. The visual stimulations contained 20% placebo (no visual stimulation). The computer also calculated the percent of correct responses. After one month of continuous occupational therapy only, his visual agnosia improved but his quadranopsia did not. However, his quadranopsia did improve after repetitive visual stimulation using the computerized visual field training machine. In conclusion, quadranopsia might be improved by repetitive visual stimulation.
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Treadmill exercise tolerance test(Modified Bruce Method) was performed with and without warm water bathing (WWB, 41°C, 10min) in 14 healthy aged men and women over 65y. o. (68.6±6.0y.o).<br>Increase in HR, BP and PRP during exercise was reduced after WWB. Duration of exercise and ST depression and occurrence of arrythmia during treadmill exerecise were significantly improved after WWB. Fatigability of the legs and Borg's index were also decreased aftr WWB. These results indicated the improvement of exercise tolerance after WWB was probably due to the increase in cardiac functions and collagenous viscosity (extensivility) of the musculoskeletal system.
