Lower limb joint moment during walking in water

Purpose: Walking in water is a widely used rehabilitation method for patients with orthopedic disorders or arthritis, based on the belief that the reduction of weight in water makes it a safer medium and prevents secondary injuries of the lower-limb joints. To our knowledge, however, no experimental data on lower-limb joint moment during walking in water is available. The aim of this study was to quantify the joint moments of the ankle, knee, and hip during walking in water in comparison with those on land.

Method: Eight healthy volunteers walked on land and in water at a speed comfortable for them. A video-motion analysis system and waterproof force platform were used to obtain kinematic data and to calculate the joint moments.

Results: The hip joint moment was shown to be an extension moment almost throughout the stance phase during walking in water, while it changed from an extension- to flexion-direction during walking on land. The knee joint moment had two extension peaks during walking on land, whereas it had only one extension peak, a late one, during walking in water. The ankle joint moment during walking in water was considerably reduced but in the same direction, plantarflexion, as that during walking on land.

Conclusions: The joint moments of the hip, knee, and ankle were not merely reduced during walking in water; rather, inter-joint coordination was totally changed.     

Study of nasopharyngeal bacterial flora. Variations in nasopharyngeal bacterial flora in schoolchildren and adults when administered antimicrobial agents

Changes in nasopharyngeal bacterial flora in adults with acute upper respiratory tract infection on administration of antimicrobial agents were investigated, and how these changes contrasted with those in children. Many patients with acute sinusitis due to allergies, and patients with malignancy and diabetes mellitus were included in the investigation. The detection rates of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, the major bacteria of acute otitis media (AOM), were 22%, 10%, and 7% respectively, which were significantly lower than those for children. Gram stain examination of nasopharyngeal swab samples showed a significant relation between leukocyte infiltration and the detection amount of S. pneumoniae (P = 0.0086). A significant relation (P = 0.0134) was also observed when H. influenzae was simultaneously detected. No significant change in the three major AOM bacteria present in nasopharyngeal bacterial flora after administration of antimicrobial agents was observed. However, all S. pneumoniae and H. influenzae detected after antimicrobial agent administration had the β-lactam-resistance gene. It was observed that a significant improvement in leukocyte infiltration occurred 6 to 10 days after antimicrobial agent administration. In contrast, a significant improvement in children was observed at 2 to 5 days. In the adult subjects, this improvement was probably due to spontaneous remission rather than the effect of the antimicrobial agents. Although investigation of the long-term administration of antimicrobial agents was also conducted, its benefits for the patients were not elucidated.     

Long-term effects of combined botulinum toxin treatment and rehabilitation on upper limb muscle spasms: a case report

[Purpose] We report our experience with a patient with a central spinal cord injury who showed improved finger and upper limb functions after long-term treatment with a combination of rehabilitation and botulinum toxin type A. [Participants and Methods] The patient had spasms and pain that gradually became more profound and was given botulinum toxin type A at 1 year 3 months after sustaining a spinal cord injury. We administered 14 botulinum toxin type A injections periodically for 7 years 4 months after the injury. We administered the injections at an average interval of 5.6 months. Splints that allowed extension and improved finger muscle tone and contracture were made for the patient. [Results] The patient experienced gradual alleviation of the spasms in the proximal upper limb muscles and improved range of motion after receiving five doses of botulinum toxin type A. The spasms and range of motion in the fingers gradually improved around 4 years after the injury through splint therapy and a combination of botulinum toxin type A administration and rehabilitation. [Conclusion] The combination of botulinum toxin type A, splint, and rehabilitation therapies can lead to positive improvements in finger spasticity and range of motion and is recommended for hypertonia cases with severe contractures.Key words: Carry-over effect, Concomitant use of splint, Restoration of hand function     

Robotic-assisted stepping modulates monosynaptic reflexes in forearm muscles in the human

Although the amplitude of the Hoffmann (H)-reflex in the forelimb muscles is known to be suppressed during rhythmic leg movement, it is unknown which factor plays a more important role in generating this suppression-movement-related afferent feedback or feedback related to body loading. To specifically explore the movement- and load-related afferent feedback, we investigated the modulation of the H-reflex in the flexor carpi radialis (FCR) muscle during robotic-assisted passive leg stepping. Passive stepping and standing were performed using a robotic gait-trainer system (Lokomat). The H-reflex in the FCR, elicited by electrical stimulation to the median nerve, was recorded at 10 different phases of the stepping cycle, as well as during quiet standing. We confirmed that the magnitude of the FCR H-reflex was suppressed significantly during passive stepping compared with during standing. The suppressive effect on the FCR H-reflex amplitude was seen at all phases of stepping, irrespective of whether the stepping was conducted with body weight loaded or unloaded. These results suggest that movement-related afferent feedback, rather than load-related afferent feedback, plays an important role in suppressing the FCR H-reflex amplitude.     

Evaluation of postural control in quiet standing using center of mass acceleration: comparison among the young, the elderly, and people with stroke

Yu E, Abe M, Masani K, Kawashima N, Eto F, Haga N, Nakazawa K. Evaluation of postural control in quiet standing using center of mass acceleration: comparison among the young, the elderly, and people with stroke.

Objective

To determine center of mass (COM) acceleration usefulness in the evaluation of postural control during quiet standing.

Design

Three-group comparison design.

Setting

A research laboratory.

Participants

Poststroke subjects (n=12), healthy elderly subjects (n=22), and healthy young subjects (n=25).

Interventions

Not applicable.

Main Outcome Measures

With a force platform, postural sway was evaluated by using the standard deviations of COM acceleration and center of pressure (COP) and COM (COP-COM) in which COP-COM represents the distance between the COP and the COM.

Results

COM acceleration and COP-COM variables were greater in the poststroke group than in the healthy groups (elderly and young) in the mediolateral (ML) direction. Both variables in the anteroposterior (AP) direction were greater in the poststroke group and the elderly group than in the young group. Furthermore, the correlations between COM acceleration and COP-COM in each group in each direction were shown to be significantly high (r range, .906-.979; P<.001).

Conclusions

COM acceleration was useful in the evaluation of postural control during quiet standing when comparing the young, the elderly, and poststroke patients. Additionally, COM acceleration and COP-COM in both the AP and ML directions during quiet standing were significantly and highly correlated. Thus, we proposed that COM acceleration can be an alternative and convenient measure instead of COP-COM in the evaluation of postural control.     

Usefulness of high-concentration calcium chloride solution for correction of activated partial thromboplastin time (APTT) in patients with high-hematocrit value

INTRODUCTION: Pseudoprolongation of activated partial thromboplastin time (APTT) is a serious problem in anticoagulation therapy for patients with high hematocrit, such as cyanotic congenital heart diseases. APTT pseudoprolongation occurs when APTT assay is performed using routinely used vacuum sampling tubes containing citrate. Because the plasma fraction is small in high-hematocrit blood, the prescribed volume of citrate would be excessive for APTT assay, resulting in prolongation of clotting or APTT pseudoprolongation. CLSI--The Clinical and Laboratory Standards Institute (formerly NCCLS) method is the established method to correct the pseudoprolongation. However, the CLSI method needs repeated blood drawings and time-consuming, complicate procedures. Thus, alternative simple method is desired. METHOD: We examined whether APTT pseudoprolongation would be prevented by the increase in free calcium ion concentration by using high-concentration calcium chloride solution for the assay. Blood samples were obtained from 15 patients with high hematocrit (65+/-6%) who had cyanotic congenital heart disease. RESULT: Conventional APTT assay using 0.025 mol/L calcium chloride solution gave greater APTT compared with the CLSI method (51.7+/-11.8 vs. 34.6+/-4.7 s, p<0.001). However, when 0.035 mol/L calcium chloride solution was used, APTT (36.6+/-5.8 s) was similar to that obtained from the CLSI method. There was a good correlation in APTT values between high-calcium chloride solution method and the CLSI method (the slope=0.57, r2=0.49). CONCLUSION: High-calcium chloride solution method is useful to correct APTT pseudoprolongation. Because of the simplicity and the need of a single blood drawing, this method would reduce the burdens of not only patients but also clinical laboratory.     

Influence of aging over 10 years on auditory and vestibular functions in three patients with auditory neuropathy

The influence of aging on hearing and vestibular function in patients with auditory neuropathy has not been investigated. The purpose of this study was to investigate how hearing and vestibular function in this disease change with aging. The subjects were three female patients with auditory neuropathy. We checked their hearing and vestibular function by speech discrimination tests, ABR, ECochG, DPOAE, caloric test, damped-rotational chair test, and VEMPs. In all three patients, speech discrimination ability and vestibular function markedly declined with aging. However, speech language understanding and higher brain function were less affected by aging.     

Auditory agnosia due to long-term severe hydrocephalus caused by spina bifida - specific auditory pathway versus nonspecific auditory pathway

A 27-year-old female showed auditory agnosia after long-term severe hydrocephalus due to congenital spina bifida. After years of hydrocephalus, she gradually suffered from hearing loss in her right ear at 19 years of age, followed by her left ear. During the time when she retained some ability to hear, she experienced severe difficulty in distinguishing verbal, environmental, and musical instrumental sounds. However, her auditory brainstem response and distortion product otoacoustic emissions were largely intact in the left ear. Her bilateral auditory cortices were preserved, as shown by neuroimaging, whereas her auditory radiations were severely damaged owing to progressive hydrocephalus. Although she had a complete bilateral hearing loss, she felt great pleasure when exposed to music. After years of self-training to read lips, she regained fluent ability to communicate. Clinical manifestations of this patient indicate that auditory agnosia can occur after long-term hydrocephalus due to spina bifida; the secondary auditory pathway may play a role in both auditory perception and hearing rehabilitation.     

Dysphagia in patients with Duchenne muscular dystrophy evaluated with a questionnaire and videofluorography

Purpose. To investigate swallowing problems in patients with Duchenne muscular dystrophy (DMD) using a questionnaire and videofluorography (VF).

Method. A questionnaire survey was performed of swallowing-related symptoms and VF in 31 male patients with DMD (mean age 19.9 years, range 9 - 26 years). The relationships among age, frequency of symptoms and VF abnormalities were analysed using Spearman's rank correlation. The differences in VF abnormalities among different food textures were analysed with the Kruskal - Wallis test.

Results. Symptoms related to pharyngeal phase dysfunction were more frequent than those related to oral and oesophageal phases. Coughing while eating was seen in 71% of the patients, choking while eating in 32% and the need to clear the throat in 26%. VF abnormalities were observed in 30 patients (96.8%). Common VF abnormalities included pooling in the valleculae (90.3%) and in the pyriform sinus (90.3%). Pharyngo-oral regurgitation was seen in 35.5% of the patients. Pooling in the pyriform sinus after repeated swallowing seen in VF correlated significantly with symptoms related to the pharyngeal phase (Spearman's rho 0.356 - 0.544).

Conclusion. Because oropharyngeal dysphagia in DMD was evident in teenage patients as well as those without clinical symptoms, VF is recommended in patients with DMD.