Kazunari Furusawa

Gender Differences in Disability and Lifestyle Among Community-Dwelling Elderly Stroke Patients in Kitakyushu, Japan

OBJECTIVE To examine whether there were differences in lifestyle and performance of activities of daily living (ADL) between men and women in a population of elderly stroke patients. DESIGN Case-comparison study. MATERIAL AND METHODS Sixty-eight men and 34 women who were elderly stroke patients living in the community with a spouse or family members were evaluated with the self-rating Barthel Index (SRBI), Frenchay Activities Index (FAI), Stroke Impairment Assessment Set (SIAS), Functional Independence Measure (FIM), and a pedometer for physical activity. Control subjects, 30 men and 30 women, were assessed with the FAI. RESULTS Among the stroke subjects, there were no significant differences in age, SRBI, motor score of the SIAS, or physical activity between men and women; however, men had significantly lower values than did women for three FIM items and the total FIM score and for 6 FAI items and the total FAI score. Among control subjects, men had significantly lower values than did women for 7 FAI items and the total FAI score (Tukeys test, p < .05). CONCLUSION Among elderly stroke patients, men received more support from family members in ADL performance and had less active lifestyles than did women, possibly because of cultural gender roles.

Assessment of autonomic function in myotonic dystrophy by spectral analysis of heart-rate variability

We analyzed by means of autoregressive spectral analysis the spontaneous beat-to-beat heart-rate variability (HRV) of 10 myotonic dystrophy (MD) patients (4 men and 6 women, aged 37-53 years) and 10 age- and sex-matched healthy, sedentary humans (control) at rest in the supine position. All MD patients had no cardiac conduction disturbances (i.e., atrioventricular or intraventricular conduction defects) on 12-lead electrocardiogram and were able to walk and perform daily activities. In the MD group, the total power, the power of the low-frequency component (a marker of sympathetic and vagal modulation of heart rate) and that of the high-frequency component (a marker of vagal modulation of heart rate) were smaller than those in the control group (P < 0.01, P < 0.05 and P < 0.05, respectively). The results of this study suggest that the cardiovascular autonomic nervous system contributing to the HRV may be disturbed even in the MD patients who can walk and perform daily activities. Therefore, one must give careful consideration to the cardiovascular autonomic dysfunction, as well as the cardiac conduction disturbance in the MD patients.

The Effect of Service Dogs on the Improvement of Health-Related Quality of Life

To assess the effects of service dogs on health-related quality of life (HRQOL), we conducted a survey of 10 service dog owners using SF-36v2 (Medical Outcomes Study 36 Item Short-Form Health Survey Version 2.0) and compared it with a matched control group of people with physical disabilities who did not have service dogs but were eligible for one. The scores for mental health and role emotional of service dog owners were relatively high, and their mental component summary was higher than the general population norm. These results indicate that service dogs affect the mentality of their owners. The comparison with the control group indicated that service dogs alleviate the mental burden of daily activities, and subjectively improved the physical functioning of their owners. This study showed that service dogs have positive functional and mental effects on their disabled owners.

Activation of natural killer cell function in recreational athletes with paraplegia during a wheelchair half-marathon race.

OBJECTIVE To investigate a part of the immune homeostasis in recreational athletes with spinal cord injury (SCI) during and after a wheelchair half-marathon race. DESIGN Case-control study in an actual race. SETTING The half-marathon division of an international wheelchair marathon race in Japan. PARTICIPANTS Seven male wheelchair racers with SCI between T7 and L1. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Changes in the number and function of natural killer (NK) cells and the endocrine effects, including plasma catecholamines and cortisol in blood samples obtained the day before the race, immediately after it, and 1 day after the race. RESULTS Both the percentage and absolute number of peripheral NK cells did not change significantly throughout the experiment. Mean NK cell cytotoxic activity +/- standard deviation increased significantly, from 45.5%+/-7.5% to 56.1%+/-5.1% (P<.01) immediately after the race and remained increased until the next day. Plasma adrenaline levels were increased (P<.05) immediately after the race and recovered 1 day later; the plasma concentration of cortisol did not change throughout the experiment. CONCLUSIONS The wheelchair half-marathon race induced activation of NK cell function in recreational athletes with SCI between T7 and L1.

Short-term attenuation of natural killer cell cytotoxic activity in wheelchair marathoners with paraplegia

OBJECTIVE To investigate homeostasis of the immune system in athletes with spinal cord injuries during and after racing a wheelchair marathon. DESIGN The study examined changes in the number and function of natural killer (NK) cells in nine male wheelchair marathon athletes (spinal cord injuries between T5 and T12) who completed the 15th Oita International Wheelchair Marathon Race. Blood samples were obtained the day before, immediately after, and 1 day after the race. Blood samples were also obtained from seven age-matched control subjects with spinal cord injuries but who did not exercise regularly. RESULTS The number of peripheral leukocytes increased (p < .01) immediately after the race. In contrast, the number of peripheral NK cells and NK cell cytotoxic activity significantly decreased from 310+/-130/microL to 133 +/-61/microL and from 42.6%+/-3.0% to 38.2%+/-3.2%, respectively (mean+/-SD), immediately after the race. Plasma cortisol levels were increased after the race. However, all parameters returned to control levels within 24 hours. Measurements in control subjects did not change throughout the experiment. CONCLUSION These findings suggest that racing a marathon suppressed peripheral NK cell number as well as NK cell cytotoxic activity in wheelchair athletes and that this was probably mediated by increased postrace cortisol levels. Wheelchair marathon athletes are advised to take extra precaution to avoid infection within 24 hours after racing because of the transient suppression of NK cell cytotoxic activity during this period.

Wheelchair marathon racing causes striated muscle distress in individuals with spinal cord injury

OBJECTIVE To assess the effects of wheelchair marathon racing in individuals with spinal cord injury (SCI) on circulating muscle enzymes and myoglobin. SUBJECTS Thirty-one men with SCI, including 25 wheelchair marathon athletes and 6 sedentary men. DESIGN Serum myoglobin (Mb), creatine kinase (CK) activity, and lactate dehydrogenase (LDH) were measured in participants of the 1995 Oita International Wheelchair Marathon Race (42.195 km). Blood samples were obtained 24 hours before, immediately after, 24 hours after, and 7 days after the race. RESULTS Marathon racing resulted in significant increases in serum Mb, total CK activity, and LDH (p<.01) after the race. The peak Mb and LDH levels occurred immediately after the race; total CK activity peaked 24 hours after the race. Evaluation of cardiac muscle enzymes showed no significant changes in two CK isoenzymes (CK-MM and CK-MB). CONCLUSIONS Propulsion of the wheelchair in a marathon race induced muscle stress in athletes with SCI. Completion of the marathon race did not cause cardiac muscle damage, however. Elevated muscle enzyme levels likely resulted from muscle distress rather than from dehydration.

Development of computer input device for patients with tetraplegia

We describe a measurement and evaluation methods of a computer input ability of patients with tetraplegia. We measure the position locus of the mouse cursor when a patient operates the computer using a computer input device such as a ball mouse, a trackball, and a touch pad. We analyze the position locus of mouse cursor in order to analyze the computer input ability of patients. Using this system, we can measure and evaluate the computer input ability of patients using various kinds of computer input devices. Based on the experiment result using this system, we developed a new computer input device for the patient with tetraplegia. It makes clear that the new computer input device is useful for the patient with tetraplegia

Wheelchair marathon creates a systemic anti-inflammatory environment in persons with spinal cord injury.

Objective:To investigate interleukin (IL)-6 and other inflammation markers in athletes with spinal cord injury (SCI) during a wheelchair marathon race. Design:Nonrandomized study in an actual race. Setting:The 28th Oita International Wheelchair Marathon Race, Japan. Participants:Twenty-eight men with SCI between T7 and L2 (16 full-marathon racers, full-group; and 12 half-marathon racers, half-group). Main Outcome Measures:Plasma IL-6, tumor necrosis factor (TNF)-&agr;, and high-sensitivity C-reactive protein (hsCRP) were measured the day before, immediately after the race, and 2 hours after the race. Results:Plasma IL-6 concentrations increased by 18.4-fold and by 9.4-fold (P < 0.05) in the full- and half-groups immediately after the race (P < 0.05), respectively, but returned to baseline at 2 hours of recovery. In contrast, plasma TNF-&agr; and hsCRP did not change throughout the race in both groups. The fold change in plasma IL-6 immediately after the race relative to the prerace was significantly higher in the full-group than the half-group (P < 0.05). In both groups, plasma IL-6 immediately after the race did not correlate with the average wheelchair speed. Interestingly, plasma IL-6 and hsCRP before the race in the full-group, but not in half-group, correlated negatively with the average wheelchair speed (P < 0.05). Conclusions:The study demonstrated that half- and full-marathon wheelchair races increased plasma IL-6, but not TNF-&agr; and hsCRP. Furthermore, the top athletes of the full-group had low plasma IL-6 and hsCRP at baseline. Wheelchair marathon competition, especially full-marathon, and daily training seem to have beneficial effects on SCI through the plasma IL-6 response.

Evaluation System of Suitable Computer Input Device for Patients

In rehabilitation medicine, it is necessary for medical staff members to recommend the suitable computer input device for each patient with spinal cord injury. This paper describes the recommendation and the adjustment of a computer input device for each patient. We propose the device parameter to characterize the computer input device. We measure the moving distance of a mouse cursor in browsing of the Internet to estimate the necessity moving distance in operating the computer. Moreover, we measure the patients moving distance of his hand. Using these measurement results and the proposed equation, medical staffs can adjust the suitable computer input device for each patient.

Small device for counting the number of manual wheelchair strokes

The goal of our study is to provide wheelchair users with the novel device that can easily acquire the amount of activity for prevention of metabolic syndrome. In this paper, we proposed a small device which can count the number of the wheelchair strokes when wheelchair users drive their manual wheelchair. The device counts the number of the wheelchair strokes by detecting the peak of the forward and backward acceleration signal acquired by an acceleration sensor. We defined a peak acceleration value as a high (more than 1.0m/sec2), a middle (form 0.5 m/sec2 to 1.0 m/sec2), and a low acceleration (from 0.2 m/sec2 to 0.5 m/sec2) and then the device counted the number of peaks by three levels of stroke intensity. The device eliminated the acceleration due to gravity, detected using 0.1 Hz low-pass filter, from the forward and backward acceleration. Moreover, we evaluated the accuracy of this device using the images measured by a small video camera when able-bodied persons drove the wheelchairs.