Fumio Eto

Toward the realization of a better aged society: Messages from gerontology and geriatrics

1. Background:  Recent medical advancements, and improvements in hygiene and food supply have led to Japan having the longest life expectancy in the world. Over the past 50 years, the percentage of the elderly population has increased fourfold from 5.7% in 1960 to 23.1% in 2010. This change has occurred at the fastest rate in the world. Compared with France, where the percentage of the elderly population has increased just twofold in the past 100 years, Japanese society is aging at an unprecedented rate. In addition, the percentage of the very elderly (aged 75 years and over), comprising more frail people, exceeded 10% of the nations population in 2008. In such a situation, many elderly Japanese wish to spend their later years healthy, and wish to achieve great accomplishments in their lives. To achieve that, rather than considering an aging population as a negative social phenomenon, we should create a society where elderly people can enjoy a healthy, prosperous life through social participation and contribution.

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.

Posthemiplegic Shoulder-Hand Syndrome, with Special Reference to Related Cerebral Localization

Seven autopsy cases of shoulder‐hand syndrome following hemiplegia were studied with regard to cerebral localization. One of them showed an isolated brain lesion in the premotor area due to a metastasis from malignant melanoma. Four other cases with cerebral infarction and one with glioblastoma multiforme showed massive brain lesions involving the frontal and parietal lobe cortex in the area supplied by the middle cerebral artery. The seventh case showed a hemorrhagic cerebral lesion in the lentiform nucleus. The most common overlap area in 6 of the 7 cases was located in the premotor region including the anterior part of the motor region. The shoulder‐hand syndrome following hemiplegia always develops on the side contralateral to the brain lesion which might cause a unilateral longstanding autonomic dysfunction. As corroborated in a review of the relevant literature, a lesion in the premotor area appears chiefly responsible for the primary mechanism of the shoulder‐hand syndrome in post‐stroke hemiplegia.

Assessment of sensory neglect: A study using moving images

A novel modified passive line-bisection test was performed using a computer display with a moving image. In the test, the subjects were required to give verbal responses instead of limb movements. The test, consisting of two subtasks, left-to-right and right-to-left tasks, was applied to patients with unilateral neglect and controls. The patient group showed an obvious mean deviation in both tasks, and showed greater rightward deviation in the right-to-left task than in the left-to-right task. The control group showed little differences between the two tasks. This paper discusses the results obtained from the two different conditions and their correlations. This method provides useful data for the assessment of unilateral neglect.

Effects of Passive Leg Movement on the Oxygenation Level of Lower Limb Muscle in Chronic Stroke Patients

Objective. To evaluate the effects of passive leg movements on the muscle oxygenation level and electromyographic (EMG) activity in the lower limbs in chronic stroke patients. Methods. With a gait training apparatus, passive movements were imposed on the lower limbs of 15 chronic stroke patients at a frequency of 0.8 Hz for 10 minutes. During the passive leg movements, muscle oxygenation level and muscular EMG activity of the paretic and nonparetic calf muscles were assessed. Results. The passive leg movements caused increases in the EMG activity and muscle oxygenation level in both paretic and nonparetic lower limbs. Although a significant difference was found in the concentration changes of the oxygenated hemoglobin (Oxy-Hb), both paretic and nonparetic sides of the muscle showed enhancement of the tissue oxygenation level (TOI). The degree of the changes of the Oxy-Hb depended on the level of motor recovery after stroke; subjects with good motor recovery showed less difference in the Oxy-Hb level between the paretic and nonparetic sides of the muscle. Conclusion. Passive leg movements have the capacity to induce muscular activity and enhance oxygen metabolism, even in the paretic lower limb muscle of chronic stroke patients. This type of exercise might be a useful and efficient method for the prevention of metabolic deterioration in the lower limb paretic muscles of chronic stroke patients.

Source modeling of the P300 event-related response using magnetoencephalography and electroencephalography measurements

This study aimed to measure the event-related potential P300 with electroencephalography (EEG) and the event-related field P300m with magnetoencephalography (MEG), and to locate the equivalent current sources related to attentional brain function. Multiple equivalent current dipoles were estimated from the P300 and P300m waveforms obtained from visual and somatosensory oddball paradigm tasks. Estimated sources from P300m were located on both sides of the occipito-temporal gyrus for visual stimuli and on the post central gyrus for somatosensory stimuli. The sources of P300m were modality specific. The equivalent current dipoles of P300 were located on the cingulate gyrus and the thalamus in addition to the locations estimated from P300m. However, the dipoles of P300m in MEG were not located on the cingulate gyrus and the thalamus. The discrepancy between EEG and MEG was due to the difficulty to measure radially oriented dipoles in MEG.

Health-related quality of life foctor in chronic hemodialysis patients

目的: 腎疾患特異的QOL尺度であるKDQOL-SFTM version1.3 (日本版) を用い, 慢性透析患者における健康関連QOL (HRQOL) に関連する要因について検討し, その要因, 特に透析リハビリテーションでの有益な要因を明らかにする. 方法: 横断研究で無記名自記式質問票を協力の得られた適格対象者 (102名) に配布し, 有効回答が得られた慢性血液透析患者67名 (回収率65.7%) を分析対象とした.「腎疾患による負担, 腎疾患の日常生活への影響, 症状, 透析ケアに対する満足度透析スタッフからの励まし, 原疾患, 標準化透析量 (Kt/Vurea), 透析クール, 透析継続期間, 透析関連血液生化学検査値」などの疾病や透析関連要因,「認知機能, 人との付き合い, ソーシャルサポート, 勤労状況, 睡眠身体活動度, 社会復帰状況, 自主運動状況, 自主運動有効性の認識」などのリハビリテーション関連要因及び「年齢, 性別, 学歴, 配偶者有無, 同居状況」などの基本属性要因の三つの側面より分析を行った. HRQOLは身体的側面スコア(PCS)と精神的側面スコア (MCS) に分けて算出したものを独立変数とした. 結果: PCSに関連する独立要因として症状改善度 (β=0.47, 95%CI: 0.23 to 0.61, P<0.001), 透析満足度(β=0.23, 95%CI:0.12 to 0.46, P<0.05), 血清アルブミン (β=0.30, 95%CI:0.10 to 0.46, P<0.005) や勤労状況 (β=0.32, 95% CI:0.11 to 0.50, P<0.05)が有意であった (調整済みR2=0.60). MCSに関連する独立要因として人との付き合い (β=0.36, 95% CI: 0.08to 0.57, P<0.05) や自主運動有効性に対する認識 (β=0.27, 95% CI: 0.04 to 0.50, P<0.05) が有意であった (調整済みR2=0.22). 結論: 透析患者の健康関連QOL低下を向上させるためさらに取り組むべき課題として, より満足度の高い透析治療症状及び栄養管理に加えて, リハビリテーションにおいては, 自主運動に対する積極的な態度, 社会参加と対人関係改善などを促進することが大切と考えられた.

Laryngeal Phonation after Tracheoesophageal Diversion

When tracheoesophageal diversion is performed, laryngeal phonation is usually impossible. We, however, experienced the case of a 65 year-old female patient, who was able to do so. Fluoroscopic and Videoendoscopic examinations elucidated her mechanism of phonation. This is the first detailed report describing the mechanism of laryngeal phonation after the procedure. Our case is compared with a few other similar cases found in available literature.

New reliable and valid motor assessment scale for stroke patients: Hemiplegic motor behavior tests

Various motor function tests have been reported and applied for the assessment of impairment and disability in stroke patients with hemiplegia. However, those staging criteria are ambiguous and show little evidence of reliability and validity. New criteria have therefore been designed that allow practical use of staging; namely, a well‐defined set of hemiplegic motor behavior tests (HMBT) based on simplified staging criteria. The purpose of the present paper was to assess the reliability and validity of this method as applied to hemiplegic stroke patients.

The current source estimation of the event related field derived from visual attention to the hemi-space

This study aimed to measure the event related field P2m using magnetoencephalogaphy (MEG), and to locate the equivalent current sources related to visual attention to the hemi-space. The current distributions were estimated from the P2m waveforms obtained from visual oddball paradigm tasks. The event related field P2m was observed around 200 msec after the onset of the target stimuli. Estimated sources from P2m were located on the both side of the occipto-temporal region and on the calcarine sulcus. The amplitude of the sources of the occipto-temporal region was different between the target condition and the control condition. A multiple dipole fitting indicated that the activity of the occipital cortex at P2m changed according to visual attention to the hemi-visual field.