Futoshi Wada

Oxygen consumption, oxygen cost and physiological cost index in polio survivors: a comparison of walking without orthosis, with an ordinary or a carbon-fibre reinforced plastic knee-ankle-foot orthosis.

OBJECTIVE To examine, for polio survivors, whether walking with a carbon-fibre reinforced plastic knee-ankle-foot orthosis (carbon KAFO) is more efficient than walking with an ordinary KAFO or without an orthosis. DESIGN Consecutive sample. SETTING Post-polio clinic, University Hospital of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan. PARTICIPANTS Eleven polio survivors who had a carbon KAFO prescribed at the post-polio clinic. INTERVENTIONS A carbon KAFO was prescribed, fabricated and inspected. MAIN OUTCOME MEASURES Oxygen consumption, oxygen cost and physiological cost index. RESULTS An ordinary KAFO weighed 1403 g (standard deviation(SD) 157 g), whereas a carbon KAFO weighed 992 g (SD 168 g). Subjects walking with a carbon KAFO showed a tendency to increase step length, and to increase speed significantly compared with walking without an orthosis and with an ordinary KAFO (paired t-test, p < 0.05). Oxygen consumption per body weight, oxygen cost (O2 consumption for 1-m walk divided by body weight) and physiological cost index ((heart rate at 3-min walk - heart rate at rest) /speed) were significantly lower than those walking without an orthosis (-16%, -35%, -33%; paired t-test, p < 0.05) and were lower than those walking with an ordinary KAFO (-9%, -14%, -15%; paired t-test, p < 0.05). CONCLUSION The gait efficiency of polio survivors with a carbon KAFO was objectively better than those without an orthosis or with an ordinary KAFO.

Gait training in subacute non-ambulatory stroke patients using a full weight-bearing gait-assistance robot: A prospective, randomized, open, blinded-endpoint trial

BACKGROUND This study was a prospective, randomized, open, blinded-endpoint trial with the aim of examining whether gait training with a gait-assistance robot (GAR) improves gait disturbances in subacute non-ambulatory hemiplegic stroke patients more than overground conventional gait training. The GAR adopts a robot arm control system with full weight bearing and foot pressure visual biofeedback. METHODS Twenty-six hemiplegic patients were randomly assigned to either the GAR-assisted gait training (GAGT) group or the overground conventional gait training (OCGT) group. Both groups underwent 60 min of standard physical therapy and 20 min of GAGT or OCGT 5 days a week for 4 weeks. The primary outcome measure was the Functional Ambulation Classification (FAC). The secondary outcome measures were the peak torque of the extensor muscles in the lower extremities and a 10-m walking test. The lower extremity function was evaluated using the Fugl-Meyer Assessment, and activities of daily living were assessed using the Functional Independence Measure. RESULTS The GAGT group demonstrated significantly greater improvements in FAC and peak torque on the unaffected side (p=0.02) than the OCGT group. Additionally, gait speed tended to be faster (p=0.07) in the GAGT group. CONCLUSIONS GAGT combined with standard physical therapy in subacute non-ambulatory hemiplegic patients led to significant improvements in gait and peak torque on the unaffected side compared to OCGT.

SPEED AND PHYSIOLOGICAL COST INDEX OF HEMIPLEGIC PATIENTS PEDALLING A WHEELCHAIR WITH BOTH LEGS

OBJECTIVE To determine whether hemiplegic patients can propel a leg-pedalling wheelchair and whether it is easier and faster for them to pedal the wheelchair using both legs alternately than to propel an ordinary wheelchair with their unaffected hand and leg. DESIGN Within-subject comparison. SUBJECTS Subjects comprised 10 hemiplegic in-patients (8 males, 2 females), aged 63.7 (SD 12.7) years with severe or moderate gait disturbance due to stroke. METHODS Subjects were asked to practice propelling the leg-pedalling wheelchair and ordinary wheelchair on both slalom and rectangular courses for a period of 7-10 days. Once they had become skilled in this, the wheelchair speed and patients heart rate were measured, and a physiological cost index was calculated. RESULTS Subjects could pedal the leg-pedalling wheelchair using both legs alternately. The speed of this wheelchair was faster than that of the ordinary wheelchair, and the physiological cost index for pedalling it was lower than that for propelling the ordinary wheelchair. However, subjects needed some help in transferring to the leg-pedalling wheelchair. CONCLUSION The hemiplegic patients could pedal the leg-pedalling wheelchair using both legs alternately faster and more effectively with regard to speed and physiological cost index.

Research and Development of Compact Wrist Rehabilitation Robot System

Compact rehabilitation robot system which can support movement of the wrist of patients has been developed. The robot system can detect and analyze the patients intention to move the wrist by such a biological signal as muscle potential, then, assist the wrist exercise of patients. Also, both-wrist rehabilitation robot system by mirror effect has been successfully developed for practical use in the hospital and at home.

Dynamics of capsule swallowing by healthy young men and capsule transit time from the mouth to the stomach.

We examined the dynamics of capsule swallowing by healthy young men using the anterior-posterior view of videofluoroscopy as a first step in a study on capsule swallowing by dysphagic patients. The subjects were 14 healthy men who did not have any complaint of dysphagia. They were asked to swallow a #4 hard gelatin capsule filled with barium sulfate with 15 ml of water during the videofluoroscopic examination. This examination was repeated three times for each subject (total of 42 trials). In four of the 14 subjects, a swallowed capsule was retained at the upper esophageal sphincter, or the broncho-aortic constriction of the esophagus, or the lower esophageal sphincter. Except where retention occurred, the average capsule transit time from the mouth to the stomach was 6.0 ± 2.4 s. Three of the four subjects who had capsule retention did not realize that the swallowed capsule was retained en route to the stomach. By considering the dynamics of swallowing a capsule with 15 ml of water in healthy men, we should be able to reveal the dynamics of capsule swallowing in dysphagic patients, and the capsule transit time from the mouth to the stomach.

Improvement study for measurement accuracy on wireless shoe-type measurement device to support walking rehabilitation

We have developed a shoe-type measurement device which is able to measure gait information such as step length, width and pressure distribution while daily living. We hypothesized that a walking rehabilitation system could be realized by combining shoe-type device and comprehensively display which showed analytical results for gait with real time operation. From evaluation to first trial manufacture, it was found that our system was effective to let the patients, physicians and physical therapists know quantitative gait information. However, it was also found that there were some problems such as insufficient measurement area. Then, hardware of device was redesigned to enlarge measurement area but measurement accuracy decreased. Therefore, improvement method which could decrease measurement error was proposed and the efficacy of proposition was revealed by experimental results.

Development of a shoe-type device for collecting gait information

We are developing a measurement device by means of which gait information can be obtained that cannot be obtained by existent devices. We are also evaluating the effectiveness of the device in rehabilitation programs. The final goal of our work is to realize a space where patients can exe- cute their rehabilitation routines at any time. In this paper, we report the outline of our novel measurement device. That is to say, we describe our real-time measurement technique for measuring the position and angle of the feet to obtain the gait information, as well as our method of presenting the gait in- formation.

Fatigue evaluation for work load of Visual Display Terminals (VDT) operation

A method for the analysis of fatigue parameters has been rarely researched in VDT operation. Up to now, fatigue was evaluated by changing of biological information. If signals regarding fatigue are detected, fatigue can be measured. This study proposes an experiment and analysis method to extract parameters related to fatigue from the biological information during VDT operation using the independent component analysis (ICA). An experiment had 11 subjects. As for the experiment were light loaded VDT operation and heavy loaded VDT operation. A measurement item were amount of work, a mistake number, subjective symptom, surface skin temperature (forehead and apex nasi), heart rate, skin blood flow of forearm and respiratory rate. In the heavy loaded operation group, mistake number and subjective symptom score were increased to compare with the other. And Two-factor ANOVA was used for analysis. The result of mistake number was confirmed that heavy loaded. After the moving averages of waveshapes were calculated, it was made to extract independent components by using the ICA. The results of the ICA suggest that the independent components increase according to accumulation of fatigue. Thus, the independent components would be a possible parameter of fatigue.

Effects of gait-related imagery and mirror visual feedback on cortical activation during robot-assisted gait training

Robot-aided gait training is expected to facilitate the recovery of lower limb functions in spinal cord injury (SCI) patients. This study determined whether gait-related imagery and visual feedback affects a cortical activation pattern during robot-aided gait of healthy subjects and SCI patients. Five healthy volunteers and four patients with chronic SCI (two completely paraplegic and two partially quadriplegic) participated in this study. We measured the cortical activation of the motor area during robot-aided gait by a near-infrared spectroscopic imaging system. After a 60 s resting stage, each subject walked on the treadmill with robotic assistance (GAR: Gait-Assistance Robot) for 1 min. The subjects performed actual and imaginary movements of their lower extremities in several ways: active assisted movement, passive movement, imaginary leg movement without actual movement, imagined leg movement with passive movement, and active assisted movement with mirror visual feedback. All gait patterns except passive movement showed cortical activation in the healthy subjects and partially quadriplegic SCI patients. The cortical activation of gait-related motor imagery was higher in the partially quadriplegic SCI patients compared with the healthy subjects. For the completely paraplegic SCI patients, it was difficult to induce cortical activation during the robot-assisted gait; however, only the mirror visual feedback effectively induced cortical activation. Our results indicate that partially quadriplegic SCI patients have not lost the motor imagery of their lower extremities. Motor imagery is an effective means to evoke cortical activation of the motor area during robot-aided gait training in such cases. Chronic completely paraplegic SCI patients could not induce cortical activation during robot-aided gait. Visual feedback is considered important for inducing cortical activation of the motor area during a robot-aided gait.

Peripheral Neuropathies in Nonparetic Upper Extremities of Stroke Patients Induced by Excessive Use of a Walking Device

BACKGROUND Poststroke patients reportedly experience entrapment neuropathies in the nonparetic upper extremities, and the use of an assistive device for long periods may increase this risk. We examined nerve conduction velocities in hemiparetic patients and investigated the relationship between abnormal measurements and duration of walking. METHODS Twenty-eight male hemiparetic outpatients who used a cane or a crutch participated in this study. Clinical characteristics such as age, period of time from stroke onset, side and severity of paresis, activities of daily living, and basic ability to walk, as well as each patients approximate number of hours walking per day, were collected. Electrophysiological evaluation was performed via nerve conduction studies of the median, ulnar, and radial nerves. The clinical features were compared between patients with and without peripheral neuropathies. RESULTS Twelve patients (43%) had peripheral neuropathies involving a total of 15 nerves. There was no difference in age, duration of hemiparesis, side and severity of paresis, Barthel index, and Functional Ambulation Classification between the 2 groups. Abnormalities were absent in the patients who walked at or less than an hour but were present in 50% and 63.4% of patients with walking times of 1-2 hours and more than 2 hours, respectively. CONCLUSIONS Excessive use of a T-cane or a Lofstrand crutch was hypothesized to induce entrapment neuropathies in the nonparetic upper extremity. To prevent these injuries, a well-balanced gait should be established to reduce the load on the walking device.