Izumi Machida

Inhibiting bacteria and skin pH in hemiplegia: effects of washing hands with acidic mineral water.

Kurabayashi H, Tamura K, Machida I, Kubota K: Inhibiting bacteria and skin pH in hemiplegia: effects of washing hands with acidic mineral water. Am J Phys Med Rehabil 2002;81:40–46. ObjectiveTo evaluate bacterial flora in hemiplegic hands as a possible pathogen of endogenous infection in a rehabilitation unit and to examine the effect of cleansing hands with acidic mineral water on the flora. DesignCase-control study in a university affiliated hospital. Seventy-two patients with hemiplegia caused by cerebrovascular diseases were included in this study. Bacterial flora by the swab method, bacterial frequency on the palm by the stamp method, and skin surface pH were examined before and after single cleansing by immersion in plain or acidic mineral water. ResultsThe bacterial frequencies of patients with hemiplegia and diabetes were higher than those of normal healthy subjects. After cleansing with acidic mineral water, skin surface pH was decreased and bacterial frequency was markedly decreased. A prolonged decrease in skin surface pH was observed in patients with hemiplegia in contrast to normal healthy subjects who presented a short-term decrease. ConclusionIncreased bacterial frequencies were associated with a high skin surface pH caused by disordered skin systems in patients with hemiplegia. Acidic mineral water may be useful for inhibiting bacterial growth in patients with hemiplegia.

Effective physical therapy for chronic obstructive pulmonary disease : Pilot study of exercise in hot spring water

Respiratory function and arterial blood gas were examined before and after a two-month exercise program performed in a pool filled with hot spring water in 22 patients (70.9 +/- 9.1 years of age) with stable chronic obstructive pulmonary disease (12 cases of bronchial asthma and 10 cases of pulmonary emphysema) treated at our hospital between 1991 and 1994. The ratio of forced expired volume in one second to forced vital capacity (FEV1%) was significantly increased after the exercise program (P < 0.05), whereas the ratio of forced vital capacity to predicted normal value (%FVC) did not change. In addition, a tendency toward an increase in peak flow without an increase in maximum expiratory flow at 25 and 50% (V25 and V50) was observed. Although PaO2 was not increased, PaCO2 was selectively decreased by the exercise program (P < 0.05). The changes in respiratory function and arterial blood gas were considered attributable to respiratory muscle training and small airway clearance. Exercise in a pool filled with hot spring water may be useful in treating chronic obstructive pulmonary disease.

Breathing out into water during subtotal immersion: a therapy for chronic pulmonary emphysema.

OBJECTIVE To determine the importance of a breathing out into water exercise during subtotal immersion for emphysematous patients. DESIGN Results of a respiratory function test and arterial blood gas analysis were examined to compare the programs of breathing exercise with and without the breathing out into water exercise. The breathing exercises in a pool filled with 38 degrees C water were performed 30 min/day, 5 days/wk, for 2 mo in 17 patients with stable chronic emphysema. Patients were randomly assigned to breathing exercise programs including subtotal water immersion with the nose and mouth either immersed (9 patients) or out of the water (8 patients) during exhalation. RESULTS The ratio of %forced expired volume in 1 sec to forced vital capacity and %forced vital capacity at rest were significantly increased in the program with the breathing out into water exercise, but they did not change in the program without the breathing out into water exercise. A significant increase in peak flow was observed in the former program, although it did not change in the latter program. The maximal expiratory flow at 25% did not change in either program. Pao2 was significantly increased and Paco2 was significantly decreased in the former program, although a trend for a decrease in Paco2 was observed in the latter program. CONCLUSIONS These results suggest that the breathing out into water exercise enhances the effects of a breathing exercise during immersion and is useful in rehabilitation for chronic pulmonary emphysema.

Comparison of three protocols for breathing exercises during immersion in 38°C water for chronic obstructive pulmonary disease

Kurabayashi H, Machida I, Handa H, Akiba T, Kubota K: Comparison of three protocols for breathing exercises during immersion in 38°C water for chronic obstructive pulmonary disease. Am J Phys Med Rehabil 1998;77:145–148 Respiratory function test, arterial blood gas analysis, and ejection fraction were used to compare three protocols of breathing exercises during immersion in 38°C water. Therapy was given for 2 mo to patients with stable chronic obstructive pulmonary disease. Protocol A consisted of a total exercise period of 20 min/wk (10 min/day, 2 days/wk) and was performed by 7 patients (5 cases of asthma and 2 cases of emphysema). Protocol B consisted of a total exercise period of 120 min/wk (20 min x2 per day at 10:00 am and 3:00 pm, 3 days/wk) and was performed by 9 patients (6 asthmas and 3 emphysemas). Protocol C consisted of a total exercise period of 120 min/wk (20 min/day, 6 days/wk) and was performed by 8 patients (4 asthmas and 4 emphysemas). The ratio of forced expired volume in one second to forced vital capacity (FEV10%) was significantly increased in protocols B and C (P < 0.01). The ratio of forced vital capacity to the predicted normal value (%FVC) was not changed in any of the three protocols. A significant increase in peak flow was observed in protocols B and C (P < 0.05). The maximal expiratory flow at 25% (V25) was not changed in any of the three protocols. Pao2 was significantly increased and Paco2 was significantly decreased in protocol B (P < 0.01 and P < 0.05, respectively), whereas only Paco2 was significantly decreased in protocol C (P < 0.05). Ejection fraction was increased in protocols B and C. These results suggest that exercise for a total period of 120 min/wk is preferable to that of 20 min/wk in COPD.

Assessment of upper limb function in hemiplegia by measuring transcutaneous oxygen tension

To investigate whether the noninvasive determination of transcutaneous oxygen tension (TcO2) can be used to evaluate the degree of hemiplegia, we measured TcO2 before and after a 2-mo rehabilitation course in 12 patients with hemiplegia caused by cerebrovascular diseases. All patients with no evidence of heart failure (ejection fraction evaluated by echocardiogram: 68.7 +/- 6.4%) began to receive conventional physical therapy a few days after the onset of stroke. The measurement of TcO2 was performed at 9:00 a.m. with an electrode placed on the skin surface of the flexion side of the forearm 5 cm distal to the elbow. Before rehabilitation, the difference in TcO2 between the paralyzed and healthy upper limbs ((delta)TcO2) in patients at Brunnstroms stage V was significantly lower than that in patients at stages II, III, and IV (P < 0.05, P <0.01, and P < 0.01, respectively). After rehabilitation, (delta)TcO2 in patients at Brunnstroms stage V was significantly lower than that in patients at stage III(P < 0.05). The (delta)TcO2 in the patients with severe hemiplegia was larger than that in patients with slight hemiplegia. In addition, TcO2 at the paralyzed upper limb increased significantly after rehabilitation (before 62.7 +/- 10.5 mm Hg; after 71.9 +/- 9.0 mm Hg; P < 0.05), although arterial blood oxygen tension (PaO2) did not. Therefore, the TcO2 determination may be useful in assessing the degree of hemiplegia in upper limbs.

Rehabilitation for Chronic Obstructive Pulnlonary Disease. 4. Clinical Effects of Breathing Exereise by Head-Out Water Immersion on Cardiac Function in Patients with Emphysema.

1996年から1998年までに草津分院内科及びリハビリテーション部に入院した慢性肺気腫患者10例 (男性8例, 女性2例;年齢72.7±5.6歳) を対象に, 運動浴を用いた呼吸訓練 (1日30分, 週5日間, 60日間) を行った.全例とも5年以上前に診断を受け病状安定し, 本研究期間中に内服薬の変更はなかった.本訓練施行前, 開始後30日, 60日で心エコー法により心拍出分画, 左室収縮期径及び左室拡張期径を測定した.60日間の運動浴呼吸訓練により心拍出分画は有意に増加し, 左室収縮期径及び左室拡張期径は有意に減少した.1秒率は有意に増加し, PaCO2は有意に減少した.全例とも自覚症状の悪化はみられなかった.運動浴は, 静水圧による呼吸筋群強化, 横隔膜挙上による死腔減少, 水中呼気法による気道内圧上昇のため慢性閉塞性肺疾患のリハビリテーションに有用であり, さらに心拍出量を増加させ拡張期左室径を減少させ, 慢性肺気腫に伴う心不全の治療にも有用であることが示唆された.

Problems of Rehabilitation: 1. A Clinical Analysis of Elderly Patients Hospitalized in the Division of Rehabilitation of the Kusatsu Branch Hospital over the Last 10 Years.

1987-1996年の10年間に群馬大学草津分院に入院しリハビリテーションを受けた70歳以上の患者222例について, 年齢, 住所, 疾患名, 合併症, 障害期間, 入院期間, 入院理由, 介護者, 家族数を検討した.年齢は70歳代が多く, 患者は地元草津町が45%を占めた.疾患別では脳疾患が最多 (38%) で, 患者の70%が合併症を持っていた.平均入院期間は82日であった.高齢ながら温泉を利用したリハビリを希望して遠方より来院する患者が多いが, 本人の意志による入院が多く, 医師の紹介による入院はわずかであった.介護者は女性が81%を占めた.介護者が妻, 夫, 娘, 息子, 嫁 (息子または兄弟の妻), 無しの症例の平均入院期間はそれぞれ58, 71, 75,114, 86,124日であった.家族数は1, 2人がそれぞれ16, 31%で, 独居老人や老夫婦2人暮らしがほぼ半数を占めた.80歳以上の患者についてみると4人以上の家族が多かった.高齢者のリハビリの動機と目標は漠然としていて, 入院は長期化した.温泉療法を活用することでリハビリの意欲は増加しQOLの向上に寄与したと思われるが, 高齢者のリハビリ適応については慎重な検討を要すると思われた.

Rehabilitation for Chronic Obstructive Pulmonary Disease. 3. A Comparison of Breathing Exercise among the Patients with Bronchial Asthma, Chronic Pulmonary Emphysema and Constrictive Pulmonary Disease.

1990年から1995年までに草津分院リハビリテーション部に入院した呼吸気疾患 (気管支喘息7例, 慢性肺気腫7例, 拘束性肺疾患5例) を対象に草津温泉を用いた運動浴 {1日2回, 1回20分, 週3日, 2月間} の効果を比較した.全例とも病状安定し本研究期間中に内服薬の変更はなかった.2ヵ月間の運動浴の前後で呼吸機能と動脈血液ガス分析を行った.%肺活量 (%VC), 25%の努力肺活量時の気流速度 (V25) は喘息, 肺気腫, 拘束性肺疾患ともに有意な変化はみられなかった.1秒率 (FEV1.0%) は拘束性肺疾患では有意な変化はなかったが, 喘息と肺気腫では有意に増加した (p<0.05).肺気腫ではPaO2は有意に増加し (p<0.01), 喘息と肺気腫ではPaCO2は有意に減少したが (p<0.05), 拘束性肺疾患ではPaO2およびPaCO2に変化はみられなかった.本運動浴法は喘息と肺気腫の理学療法として極めて有用であり, また拘束性肺疾患においても有用と思われた.