Katsuhiko Takatori

Abnormalities of the First Three Steps of Gait Initiation in Patients with Parkinson's Disease with Freezing of Gait

The purpose of this study was to investigate abnormalities of the first three steps of gait initiation in patients with Parkinsons disease (PD) with freezing of gait (FOG). Ten PD patients with FOG and 10 age-matched healthy controls performed self-generated gait initiation. The center of pressure (COP), heel contact positions, and spatiotemporal parameters were estimated from the vertical pressures on the surface of the force platform. The initial swing side of gait initiation was consistent among the trials in healthy controls but not among the trials in PD patients. The COP and the heel contact position deviated to the initial swing side during the first step, and the COP passed medial to each heel contact position during the first two steps in PD patients. Medial deviation of the COP from the first heel contact position had significant correlation with FOG questionnaire item 5. These findings indicate that weight shifting between the legs is abnormal and that medial deviation of the COP from the first heel contact position sensitively reflects the severity of FOG during the first three steps of gait initiation in PD patients with FOG.

Does assessing error in perceiving postural limits by testing functional reach predict likelihood of falls in hospitalized stroke patients

Objective: To investigate the relationship between errors in perceiving postural limits and falls in hospitalized hemiplegic patients and to determine whether this relationship is useful for identifying patients at high risk of falls. Design: Observational study. Subjects: Seventy-six hemiplegic patients who were admitted to a rehabilitation hospital. Methods: Error in perceiving postural limits was defined as the difference between the estimated maximum reach and actual reach distances, and its relationship to falls during hospitalization was investigated. Other measurements included Functional Ambulation Category, Brunnstroms recovery stage, sensory disturbance, fear of falling and the Japanese version of the Montgomery-Åsberg Depression Rating Scale (MADRS-J). Results: For the multiple fall group, the error in estimated distance (EED) was significantly greater than that for the zero/single fall group (P<0.01). Stepwise logistic regression analysis showed that EED (odds ratio 1.2, 95% confidence interval (CI) 1.1—1.4, P<0.01) and MADRS-J scores (odds ratio 1.1, 95% CI 1.0—1.3, P<0.05) were correlated with multiple falls. According to the receiver operating characteristic curve for EED, the cut-off value for discriminating multiple fallers was 6.3cm (sensitivity 81.0%, specificity 78.2%, area under the curve 0.8). Conclusions: The results suggest that assessing error in perceiving postural limits by measuring the maximum reach of the non-affected side of hemiplegic patients is one way to identify those who are at high risk for falling.

Effects of Ultrasound Therapy on Calcificated Tendinitis of the Shoulder

In general, surgery is recommended for calcificated tendinitis of the shoulder if the patients have symptoms after conservative treatments, including needle aspiration and physical therapy. Many researchers agree about the need for adequate physical therapy consisting of range of motion exercise, muscle strengthening exercises and electrophysical agents. Some researchers report that ultrasound (u/s) promotes angiogenesis and calcium uptake to fibroblasts, but there are few studies about u/s effects on calcificated tendinitis of the shoulder. The purpose of this study was to evaluate the u/s therapy effect on calcification, pain during active movement, and to identify factors related to improvement in a randomized controlled fashion. We used the stratified random allocation method to assign 40 consecutive patients to experimental and control groups, so each group consisted of 20 patients. The experimental group was treated by u/s therapy and therapeutic exercises, and the control group was treated with therapeutic exercises only. All patients in both groups came to our department 3 times per week and u/s therapy was performed 3 times per week until the end of the study. First, we classified the calcifications as type I (clearly circumscribed and with dense appearance on radiography), type II (dense or clearly circumscribed appearance) and type III (translucent or cloudy appearance without clear circumscription) according to the classification of Gartner and Heyer. Radiography was performed every one month, and the main outcome measure was the change from the base-line of the calcification on radiography at the end of the treatment. The three point scale of Gartner and Heyer was used, in which a score of 1 indicates no change or a worsening of the condition, a score of 2 a decrease of at least 50 percent in the area and density of the calcification, and a score of 3 a complete resolution of the calcification. We also examined the affected shoulders for presence or absence of pain in active movement at the start and at the end of the study. The calcifications improved significantly and fewer patients had pain during active movement in the experimental group. There was a statistical significant disease duration difference from the first clinical presentation between scores 2 and 3 in the experimental group. The results of this study suggest that u/s therapy helps to resolve calcifications of shorter disease duration. Calcifications of longer disease duration tended to persist in spite of u/s therapy, but we thought treatment of 27-38 times (95% CI), until score 2 was attained, was a desirable strategy.

Effect of a cognitive task during obstacle crossing in hemiparetic stroke patients

Stroke patients are at a higher risk of falling than the community-dwelling elderly, and many falls are due to contact with an obstacle. This study compared the effects of the simultaneous addition of a cognitive task during obstacle crossing between stroke patients and community-dwelling older adults (control subjects). Participants comprised 20 stroke patients who could walk with or without supervision and 20 control subjects matched for age and height with the stroke patients. Participants were asked to cross a 4-cm-high obstacle while walking at a self-selected speed. The number of failures and the spatial and temporal parameters were compared between a single-task condition (i.e., crossing task only) and a dual-task condition (i.e., verbal fluency task: listing vegetables or animals). Under the dual-task condition, six stroke patients (30%) and three community-dwelling elderly individuals (15%) failed to complete the motor task. Task failure was only due to heel-obstacle contact after toe clearance. In both groups, obstacle-heel distance after clearance was reduced, and the time from heel contact to toe clearance and stride time were significantly increased under dual-task condition versus single-task condition. In addition, group-task interaction for the time from heel contact to toe clearance of the obstacle was significant; this increase in time was significantly greater under dual-task condition in stroke patients than in control subjects. Obstacle crossing in stroke patients involved an increase in crossing performance time and a risk of heel-obstacle contact after crossing. These tendencies appeared stronger under the dual-task condition.

Perception of postural limits and falls in community-dwelling elderly people

An important prerequisite in performing diverse movements safely and without falling in daily life is postural limits. Postural limits decreases with age. The accurate perception of postural limits is interpreted as a potential safety factor to prevent the planning of movements that create loss of balance. The main purpose of this study was to investigate the relation between perception of postural limits and falls in 163 community-dwelling elderly people. The experimental protocol required subjects first to estimate the maximum-distance forward reach and then execute that. The error in estimated reach distance(ED) was defined as the difference between actual and estimated forward reaches, with positive values of error representing underestimates and negative value representing overestimates. The ED was interpreted to reflect perception of postural limits. Other assessments included incidence of falls in the previous year, Functional Reach Test (FRT), Falls Efficacy scale (FES). Then we explored whether ED, FRT, and FES are associated with falls in older adults. The mean value of ED in multiple-fallers was negative and significantly smaller than that in non-fallers. In logistic regression analysis, ED and FES were detected as risk factors for multiple falls. The results suggested that perception of postural limits was one of the important risk factors for falls in community-dwelling elderly people.

Relationships Between Simple Toe Elevation Angle in the Standing Position and Dynamic Balance and Fall Risk Among Community-Dwelling Older Adults

To investigate the relationships between toe elevation ability in the standing position and dynamic balance and fall risk among community‐dwelling older adults.