Izumi Kondo

Amelioration of osteoporosis by menatetrenone in elderly female Parkinson's disease patients with vitamin D deficiency.

Significant reduction in bone mineral density (BMD) occurs in patients with Parkinsons disease (PD), correlating with immobilization and with vitamin D deficiency, and increasing the risk of hip fracture, especially in elderly women. As a biological indicator of compromised vitamin K status, an increased serum concentration of undercarboxylated osteocalcin (Oc) has been associated with reduced BMD in the hip and an increased risk of fracture in otherwise healthy elderly women. We evaluated treatment with vitamin K(2) (menatetrenone; MK-4) in maintaining BMD and reducing the incidence of nonvertebral fractures in elderly female patients with PD. In a random and prospective study of PD patients, 60 received 45 mg of MK-4 daily for 12 months, and the remaining 60 (untreated group) did not. At baseline, patients of both groups showed vitamin D and K(1) deficiencies, high serum levels of ionized calcium, and glutaminic residue (Glu) Oc, and low levels of parathyroid hormone (PTH) and 1,25-dihydroxyvitamin D [1,25-(OH)(2)D], indicating that immobilization-induced hypercalcemia inhibits renal synthesis of 1,25-(OH)(2)D and compensatory PTH secretion. BMD in the second metacarpals increased by 0.9% in the treated group and decreased by 4.3% in the untreated group (p < 0.0001). Vitamin K(2) level increased by 259.8% in the treated group. Correspondingly, significant decreases in Glu Oc and calcium were observed in the treated group, in association with an increase in both PTH and 1,25-(OH)(2)D. Ten patients sustained fractures (eight at the hip and two at other sites) in the untreated group, and one hip fracture occurred among treated patients (p = 0.0082; odds ratio = 11.5). The treatment with MK-4 can increase the BMD of vitamin D- and K-deficient bone by increasing vitamin K concentration, and it can also decrease calcium levels through inhibition of bone resorption, resulting in an increase in 1,25-(OH)(2)D concentration.

Vitamin D Deficiency and Risk of Hip Fractures Among Disabled Elderly Stroke Patients

Background and Purpose— Risk of hip fracture after stroke is 2 to 4 times that in a reference population. Osteomalacia is present in some patients with hip fractures in the absence of stroke, while disabled elderly stroke patients occasionally have severe deficiency in serum concentrations of 25-hydroxyvitamin D (25-OHD) (≤5 ng/mL). To determine the effects of vitamin D status on hip fracture risk, we prospectively studied a cohort of patients with hemiplegia after stroke who were aged at least 65 years. Methods— We compared baseline serum indices of bone metabolism, bone mineral density, and hip fracture occurrence in stroke patients with serum 25-OHDH25 nmol/L (≤10 ng/mL; deficient group, n=88) with findings in patients from the same cohort who had 25-OHD levels 26 to 50 nmol/L (10 to 20 ng/mL; insufficient group, n=76) or ≥51 nmol/L (≥21 ng/mL; sufficient group, n=72). Results— Over a 2-year follow-up interval, hip fractures on the paretic side occurred in 7 patients in the deficient group and 1 patient in the insufficient group (P <0.05; hazard ratio=6.5), while no hip fractures occurred in the sufficient group. The 7 hip fracture patients in the deficient group had an osteomalacic 25-OHD level of <5 ng/mL. Higher age and severe immobilization were noted in the deficient group. Serum 25-OHD levels correlated positively with age, Barthel Index, and serum parathyroid hormone. Conclusions— Elderly disabled stroke patients with serum 25-OHD concentrations ≤12 nmol/L (≤5 ng/mL) have an increased risk of hip fracture. Immobilization and advanced age cause severe 25-OHD deficiency and consequent reduction of BMD.

Validity of the Kihon Checklist for assessing frailty status

The Kihon Checklist is extensively used in Japan to identify elderly persons who are at risk of requiring support/care. We aimed to determine whether or not the Kihon Checklist can estimate frailty status defined by the Cardiovascular Health Study criteria.

An ankle-foot orthosis with inhibitor bar: effect on hemiplegic gait.

OBJECTIVE To test whether an inhibitor bar attached to an ankle-foot orthosis (AFO) improves walking ability in hemiplegic stroke patients with tonic toe flexion reflex (TTFR). DESIGN Before-after trial. SETTING Rehabilitation hospital in Japan. PARTICIPANTS Nine patients with TTFR were assigned to the TTFR group, and 8 patients without TTFR were assigned to the control group. INTERVENTION Inhibitor bar attached to an AFO. MAIN OUTCOME MEASURE Gait was analyzed by measuring the number of steps and the time required to walk 10m at a maximal walking speed. RESULTS In the TTFR group, use of an inhibitor bar for 2 weeks significantly increased the maximal walking speed, stride length, and cadence by 13.8% (P=.0045), 8.0% (P=.0398), and 6.1% (P=.0056), respectively. There were no significant changes in the control group. CONCLUSION An inhibitor bar improved walking ability of hemiplegic patients with TTFR, and its use with an AFO is recommended.

Effectiveness of selective muscle‐release surgery for children with cerebral palsy: longitudinal and stratified analysis

The purpose of this study was to determine the effectiveness of muscle‐release surgery for children with cerebral palsy (CP) using longitudinal and stratified analysis. Twenty‐five children with CP (15 females, 10 males; age range 4 to 16 years; mean age 8 years 2 months, SD 3 years 2 months) were selected from five treatment centres in Japan. Twenty‐two children had spastic diplegia, two had spastic quadriplegia, and one had athetospastic quadriplegia. Motor function for each child was assessed using the Gross Motor Function Measure (GMFM). Assessment was conducted on eight separate occasions: 1 month and 1 week before surgery, and 1,2,4,6,9, and 12 months after surgery. Participants’motor function before surgery was classified using the Gross Motor Function Classification System (GMFCS). Six children were classified at level I, three at level II, six at level III, and 10 at level IV. A significant difference was found after surgery in the GMFCS levels III and IV groups (p<0.05). Improvement in GMFM scores between 1 week before surgery and 12 months after surgery were 1,5,8.5, and 8.5 for GMFCS levels I to IV respectively. Results indicate that this treatment is advantageous for improving motor function in children within GMFCS levels III and IV.

Hyperhomocysteinemia in Japanese patients with convalescent stage ischemic stroke: Effect of combined therapy with folic acid and mecobalamine

Hyperhomocysteinemia is considered to be a risk factor for vascular diseases including ischemic stroke. It has been shown that plasma homocysteine level can be lowered by folic acid supplementation. Vitamin B(12) may be also beneficial when included in the supplement regimen with folic acid. We have examined in Japanese patients with ischemic stroke the homocysteine-lowering potential of a combination therapy with folic acid and vitamin B(12). Patients with ischemic stroke were randomized into three groups and each group received vitamin B(12) (1500 microg/day, n = 63), folic acid (5 mg/day, n = 64), or both vitamin B(12) and folic acid (n = 64) for 8 weeks. Plasma levels of homocysteine and these vitamins were followed. Significant reduction in plasma homocysteine was observed in all three groups, and the combination therapy yielded the most remarkable result, i.e., plasma total homocysteine was reduced by 38.5% and this was significantly larger than the reduction in other two groups (22.4% and 10.9% in the groups received folic acid and vitamin B(12), respectively). Vitamin B(12) synergizes with folic acid in reducing plasma homocysteine in Japanese patients with ischemic stroke and the combined therapy may be particularly effective in the secondary prevention.

Validity study of the standing test for imbalance and disequilibrium (SIDE): Is the amount of body sway in adopted postures consistent with item order?

The standing test for imbalance and disequilibrium (SIDE) is a discriminative measure developed for the purpose of identifying balance deficits that may cause falls. The purpose of the present study was to determine the validity of the sequence of postures used in SIDE. Subjects comprised 30 men with a mean (±standard deviation) age of 21.9±3.11 years (range 19-32 years) and 30 women with a mean age of 20.7±1.24 years (range 19-23 years). Center of pressure (COP) was measured using a stabilometer recording for 30s with a 20-Hz sampling frequency. The measurement postures that were similar to postures adopted in the SIDE were: standing with feet 20cm apart; standing with legs close and the insides of both feet touching; two tandem standing positions (with the dominant foot forward and with the non-dominant foot forward); and two single-leg standing positions (on the dominant foot and on the non-dominant foot). We calculated total path length and envelopment area of sway from the COP data. Statistical differences in means were determined using the Tukey-Kramer multiple comparison test. Results indicate that the orders of total path length and envelopment areas of sway in each posture were consistent with the item order of SIDE. Significant differences existed between the means of total path length and envelopment areas of sway in each posture (p<0.05), with the exception of both tandem standing positions and both one-leg standing positions. The item order of SIDE appears to show concurrent validity in terms of the amount of body sway in the adopted postures.

Preliminary Trial of Postural Strategy Training Using a Personal Transport Assistance Robot for Patients With Central Nervous System Disorder

OBJECTIVE To examine the efficacy of postural strategy training using a personal transport assistance robot (PTAR) for patients with central nervous system disorders. DESIGN Single-group intervention trial. SETTING Rehabilitation center at a university hospital. PARTICIPANTS Outpatients (N=8; 5 men, 3 women; mean age, 50±13y) with a gait disturbance (mean time after onset, 34±29mo) as a result of central nervous system disorders were selected from a volunteer sample. INTERVENTIONS Two methods of balance exercise using a PTAR were devised: exercise against perturbation and exercise moving the center of gravity. The exercises were performed twice a week for 4 weeks. MAIN OUTCOME MEASURES Preferred and tandem gait speeds, Functional Reach Test, functional base of support, center of pressure (COP), muscle strength of lower extremities, and grip strength were assessed before and after the completion of the exercise program. After the exercise program, enjoyment of exercise was investigated via a visual analog scale questionnaire. RESULTS After the program, statistically significant improvements were noted for tandem gait speeds (P=.009), Functional Reach Test (P=.003), functional base of support (P=.014), and lower extremity muscle strength (P<.001-.042). On the other hand, preferred gait speeds (P=.151), COP (P=.446-.714), and grip power (P=.584) did not change. Finally, subjects rated that this exercise was more enjoyable than traditional balance exercises. CONCLUSIONS Dynamic balance and lower extremity muscle strength were significantly improved in response to postural strategy training with the PTAR. These results suggest that postural strategy training with the PTAR may contribute to fall prevention of patients with a balance disorder.

Change in thigh muscle cross-sectional area through administration of an anabolic steroid during routine stroke rehabilitation in hemiplegic patients.

Objective:The aim of this study was to clarify the effect of administration of an anabolic steroid (AS) without the addition of specific training in stroke patients by measuring the cross-sectional area (CSA) of the thigh. Design:Twenty-six hemiplegic stroke patients during subacute rehabilitation were randomly assigned to a metenolone enanthate (ME) administration group or a control group (CT group). In the ME group, ME (100 mg) was injected intramuscularly weekly for 6 wks in the ME group. The CSA of the bilateral thigh muscles was measured using computed tomography. Motor subscore of the Functional Independence Measure (FIM-M) was assessed before the experimental period. Results:At the end of 6 wks, the CSA increase in the ME group (13.4%, affected side; 14.5%, unaffected side) was significantly larger than that in the CT group (3.3%, affected side; 5.2%, unaffected side). Correlation coefficients between the initial FIM-M score and the CSA increase at 6 wks were −0.754 for the affected side and −0.567 for the unaffected side in the ME group and 0.199 for the affected side and 0.431 for the unaffected side in the CT group. Conclusions:ME administration is effective for improving muscle CSA and, thus, muscle strengthening in stroke rehabilitation. The CSA increase in the ME group was most prominent in patients with a low initial FIM-M score.

Training with a balance exercise assist robot is more effective than conventional training for frail older adults

To examine the efficacy of postural strategy training using a balance exercise assist robot (BEAR) as compared with conventional balance training for frail older adults.