Journal of Physical Therapy Science Vol. 13(2001) No. 1

This study was conducted to determine if any one strength measure or combination of strength measures provided an explanation of ambulatory independence among 107 acute rehabilitation patients. This was a retrospective, descriptive, and correlational study where ambulatory function was quantified using the Functional Independence Measure (FIM). Lower extremity strength was quantified by sit to stand performance, and knee extension force measured by manual muscle testing and hand held dynamometry. Descriptive, correlational, and multiple regression statistical analysis were used. Correlation coefficients between ambulatory independence and the different strength measures ranged from .414 to .585. Sit to stand had the highest correlation coefficient with ambulatory independence (r=.585). However a combination of sit to stand performance and total knee extension force offered the best explanation of ambulatory independence (r=.617). A combination of functional and instrumental strength testing is therefore indicated in the prediction of ambulatory performance of patients in acute rehabilitation.

The present study examined the effect of rehabilitation upon improving upper extremity function in post-stroke patients. A meta-analysis combined the results reported in the literature concerning this issue. Fourteen citations met our inclusion criteria, of which the overall effect value was 0.33. However, the reported effects varied considerably. Subgroup analysis revealed the following effect values without significant heterogeneity: the effect value of neurodevelopmental treatment (NDT) compared with conventional physical therapy was -0.01; that of conventional physical therapy compared with no treatment was 0.51; that of EMG biofeedback compared with conventional physical therapy was 0.85 and that of EMG biofeedback compared with no treatment was 0.75. Therefore, it was concluded that the effects of NDT and conventional physical therapy are similar, in that conventional physical therapy has a medium effect and EMG biofeedback has a large effect on improving upper extremity function in post-stroke patients.

Using a measuring caliper, 30 persons with residual hemiplegia and 30 healthy aged persons underwent measurement of antero-posterior excursion of the right and left hemithoraces during volitional deep breathing. There was no difference in the antero-posterior excursion of the sound hemithorax of the persons with hemiplegia, but the affected hemithorax showed significantly smaller excursions with crosswise differences in a range of 0 to 2.5 cm. In one third of the healthy aged persons the crosswise differences of antero-posterior excursion of the hemithoraces ranged from 0 to 1.0 cm. These findings suggest that the movement of the hemiplegic hemithorax becomes restricted following a cerebrovascular accident, and physiotherapists should be aware of the possibility of compromised respiratory function and postural disturbance when treating such persons.

We examined the changes of biting force after the application of deep friction massage on the masticatory muscles of CVA subjects. The subjects were ten CVA patients (five males, five females, average age 66 ± 3), eight healthy young persons (four males, four females, average age 20 ± 1) and eight healthy elderly persons (three males, five females, average age 65 ± 8), all of whom did not use dentures on molars and could bite at the molars of both sides. The biting force was determined by three times measurements each for the left and right molars before and after the deep friction massage, using a biting force meter, and the maximum value was adopted. The results were as follows: 1) In the CVA group of both sexes, there was no difference between the unaffected side and the affected side, but both groups showed an approximate 20~30% decrease in biting force, compared with the healthy elderly group; 2) An approximate 10% increase of biting force was observed after therapy of deep friction massage to the CVA subjects of both sexes. The mechanism of increased biting force due to deep friction massage was attribute to facilitation of muscle tonus manifestation of the masticatory muscles group and relief of hypertonus of peripheral muscles in the neck.

Objective: To examine the effects of muscle trauma and cold application on indicators of oxygen free radical (OFR) and protein levels in exercise trained rat skeletal muscle. Design: Randomized intervention study following an exercise training program. Skeletal muscle tissue analysis 72 hours after trauma and cold treatments. Setting: University animal research laboratory. Subjects: 70 female Sprague-Dawley rats weighing 200-250 grams, housed in wire cages, provided with rat food and water ad libitum. Interventions: 35 rats took part in a daily running program for 8 weeks. After the training program, 28 rats were randomly assigned to one of four groups to study indices of OFR levels after trauma and cold treatments. Further, 28 rats were randomly assigned to one of four groups to study muscle protein content after trauma and cold treatment. A sedentary group (N=7) was included in each analysis as a control group. Groups that received trauma were subjected to a single impact blunt trauma to the medial aspect of the gastrocnemius muscle of the left leg. Following the trauma procedure, groups that received cold treatment had 6 cold applications for 10 minutes, twice per day over a 72 hour period with a 3 × 2 inch gel cold pack, stored at -4°C. Main outcome measures: Medial gastrocnemius muscles were analyzed at 72 hours post-trauma for citrate synthase, indicators of OFR (malonaldehyde and lipofuscin) and protein content. Results: After the endurance training program, significant increases (p<0.05) in citrate synthase activity and protein levels were elicited, but the indices of lipid peroxidation (OFR indicators) were unaltered when compared to sedentary and exercise groups. Following trauma, the net loss of pre-existing protein was statistically significant (p<0.05) and lipid peroxidation activity increased slightly, but not significantly. Further, modulations in lipid peroxidation and protein content were induced in muscle by cold treatment followed by trauma (p<0.05) as the application of cold prevented or delayed indicators of OFR activity and protein loss in the medial gastrocnemius muscle. Conclusions: Cold treatment applied to traumatized muscle significantly decreased lipofuscin content (indices of OFR) and offset the catabolic response in protein content during the inflammatory phase. The early application of cold immediately after trauma is recommended within the protocol guidelines.

Eighteen healthy women (mean ± standard deviation, 20.6 ± 0.9 years old) were examined to determine the possibility of predicting muscle strength from the length and width of the bones. Estimating muscle strength by the variable reduction method of multiple regression analysis, a multiple correlation coefficient of 0.90 (p<0.01) was obtained for grip strength in relation to three independent variables of height, distance between the medial and lateral epicondyle of the humerus, and distance between the medial malleolus of the tibia and lateral malleolus of the fibula. A multiple correlation coefficient of 0.84 (p<0.01) was obtained for knee joint extension muscle strength in relation to three independent factors of distance between the medial and lateral epicondyle of the femur, distance between the medial malleolus of tibia and lateral malleolus of the fibula, and distance between the styloid process of the ulna and radius. Individual grip strength and the isometric knee extension muscle strength could be predicted from the length and width of bones in the present study.

In this study, subjective well-being of 81 adult cerebral palsy (CP) patients who had been discharged from our hospital was evaluated using the Philadelphia Geriatric Center Morale Scale. They were questioned about their life and physical condition. The results were as follows: 1) The subjective well-being of CP patients in their late 30 years to early 40 years was lower than that of these in their early 30 years. 2) The subjective well-being of CP patients whose physical health was deteriorating, due to falling stamina, appearance of pains and gait disturbance, was lower. 3) Subjective well-being was determined by the convenience of social environment and job integration. These results suggest that age and progression of disability are important factors for life satisfaction in middle-aged and elderly out-patients with CP.

In this study we try to clarify sequential changes in Meissner corpuscles after transection of the spinal cord. Meissner corpuscles stained with cholinesterase in the experimental group were already significantly fewer one week after spinal cord transection. The condition of rats in the first week after the operation was regarded as a spinal shock period. Denervation caused a decrease in the number of stained Meissner corpuscles in the shock period. In the experimental group at 7 weeks after the operation, atrophy of these corpuscles was statistically significant. These rats could not carry their weight on their hind limbs, and this change was regarded as the effect of disuse. The results of this study suggest the possibility of human sensory organs' atrophy after spinal cord injury.

This study investigated the necessity and importance of rehabilitational education for nursing students by questionnaire. Forty-three nursing students who have practical nurse licenses in a certain vocational school were given a lecture on rehabilitation. Before and after this lecture, they filled out questionnaires about the lecture contents. The rate of valid answers was 95.3%. The students were significantly more interested in rehabilitation after the lecture. Also, although they felt the necessity for the knowledge and technique of rehabilitation, they answered that it was not very necessary to learn these before the lecture. However their opinion significantly changed after the lecture and learning the knowledge and techniques of rehabilitation become more important to them. They were interested in rehabilitation and realized again the importance of education profoundly compared with before the lecture. It was considered that creating interest was necessary first and that this would lead to the understanding of rehabilitation.

The physical fitness of people with cerebral palsy (CP) was measured during continuous incremental exercises (ramp method) until exhaustion on an arm crank ergometer, and muscular efficiency was calculated. Subjects were eleven ADL-independent men with CP and nine male able-bodied control volunteers. Heart rate (HR, beats/min), minute ventilation (VE, liter/min), oxygen consumption (VO₂, ml/kg/min) and physical work capacity (PWC, watt) as cardiorespiratory endurance were measured continuously. After that, VO₂-100, VO₂max at age-predicted maximal HR, and anaerobic threshold (AT) were calculated based on the aforementioned data. We found that the cardiorespiratory endurance of CP subjects indicated in peak VO₂, VO₂-100, VO_2max, and AT were not significantly different from those of the able-bodied subjects, but peak PWC of CP subjects was significantly lower than that of the able-bodied subjects and work efficiency, which was about 50% of that of able-bodied subjects, was poor.

A method for determining a ten-repetition-maximum (10 RM) for the gluteus medius muscle (GM) was developed with the participation of 14 healthy college students. First, a one-repetition-maximum (1 RM) was obtained with the participants in a sidelying position. Specifically, this was achieved by a tensiometer reading taken when the participant performed maximum isometric contraction of GM with the hip in 0°, 15°, and 30° of abduction. Next, determination of 10 RM was carried out by having the participant perform an isotonic GM contraction with two thirds of the 1 RM. The load was either decreased or increased depending on whether or not the participant was capable of carrying out this manoeuvre 10 times. The results showed that correlation coefficients were largest for 0° of hip abduction in comparison to those for 15° and 30° of hip abduction. For all the participants with the hip in 0° of abduction the mean proportion of the load for 10 RM to that for 1 RM was 45.9%. Also this position of 0° abduction showed the smallest dispersion of the three angles in hip abduction. It was concluded from this study that, for progressive resistance exercise for GM, 40 to 45% of 1 RM obtained in 0° of hip abduction can be used for calculation of 10 RM.

When patients with chronic spinal cord injuries have pain as an accessory symptom, ADL training is delayed, and it is often difficult to take measures to cope with this situation. There have been very few reports on pain experienced by patients with spinal cord injuries in the world literature to date, and medical science today still does not know how to treat patients with spinal cord injuries accompanied by pain systematically. Against this background, to clarify the actual state of pain in chronic spinal cord injury patients, we investigated the severity of impairment due to the pain and patients' independence when they underwent rehabilitation training. 1) Out of patients with chronic spinal cord injuries, 43 that had pain (incidence, 51.2%) were enrolled in this study. 2) Many patients in the vertebral fused group had pain in the back, and the pain was likely to disappear following removal of internal fixation. 3) Pain in the non-surgery group frequently occurred in a sensory extinction area and was intractable. 4) The period until independence in ADL was achieved was 5.6 ± 1.71 months for the complete paraplegia group with no pain, 7.5 ± 3.34 months for the group with disappearance of previous tentative pain, and 11.6 ± 4.89 months for the group with remaining pain. These findings indicate that pain associated with spinal cord injury is a factor that interferes with rehabilitation.

We recommend the following movements for low back pain patients dependent on their stage of impairment. In the early stage of exercise, the pull-down exercise in a sitting position with handgrip width adjustments for exercise of the front muscles. With advance of stage, the handgrip width can be narrowed and the exercise can start in the standing position. For the back muscles, pull-up movement can be performed in a sitting position in the early stage, and pull-up movement in a standing position can be performed in subsequent stage. The handgrip width does not influence the pull-up exercises.

The relationship between bilateral transfer and the effect of motor learning schedule was investigated using a palm force-retaining task. Thirty-three study subjects, all of whom were right-handed, were randomly divided into 2 groups, and each group was subjected to a separate practice schedule. The task was to generate and retain a force of 400 g using the right index finger for pressure. One session of practice consisted of 5 trials, and a total of 5 sessions (25 trials) were carried out exclusively with the right hand. Of the two groups, one group was set as a massed practice group (MP Group), and the other was a distributed practice group (DP Group). The former underwent an intensive practice schedule by carrying out 5 sessions of practice a day with a 1-minute recess every session, and the latter underwent a 5-day consecutive practice schedule by carrying out 1 session of practice a day. In the practice phase, visual feedback (VF) was given following the end of each trial. All of the study subjects underwent the initial test prior to the practice and retention tests at 5 minutes, 1 day and 4 days after the end of the final session of practice, without receiving VF. The data analysis was carried out by calculating the root mean squared error (RMSE). In the practice phase of the right hand, a decrease in RMSE was observed in both groups. In the retention tests of the right hand, there was a difference between these groups. The DP Group showed higher learning-retention ability, demonstrating the effect of the practice schedule. Regarding the left hand, the RMSE values in the retention tests were lower than the value observed in the initial test. This demonstrates that practice of the right hand gives a positive effect on the left hand. In addition, although no significant difference in the retention tests of the left hand was observed between these groups, the DP Group showed a tendency of higher learning-retention ability. This suggests that the practice schedule affects the effect on the non-practiced side as well.