Kenji Hachisuka

Disuse muscle atrophy of lower limbs in hemiplegic patients

OBJECTIVEnTo clarify the histopathologic findings from lower limb muscles in hemiplegic patients and determine whether the findings are related to the severity of paralysis or daily physical activity.nnnDESIGNnNonrandomized control trial.nnnSETTINGnReferral center.nnnPATIENTSnEight patients were selected from 21 hemiplegic persons who underwent a muscle biopsy, and the controls were four men who had no abnormal findings in their histopathology.nnnMAIN OUTCOME MEASURESnMorphometric evaluations of bilateral vastus lateralis muscles on the involved (I-VL) and non-involved (N-VL) sides in eight hemiplegic subjects, five flexor hallucis longus muscles on the involved side (I-FHL), and vastus lateralis muscles of four controls (C-VL) were performed. Muscle fiber diameters were measured with an image analyzer, and atrophy factors, hypertrophy factors, and fiber type proportions were calculated based on the data.nnnRESULTSnThe morphometric measurements revealed that the hemiplegic patients had type 2 fiber atrophy, type 2B fiber atrophy, and type 2 fiber atrophy with type 1 fiber hypertrophy in the I-VL, N-VL, and I-FHL, respectively, and that the controls had no muscle fiber atrophy or hypertrophy. The muscle fiber atrophy in the hemiplegic patients was not related to the period after the onset, the severity of paralysis, or activities of daily living score but was related to daily physical activity.nnnCONCLUSIONSnAlthough the hemiplegic patients had undergone rehabilitative treatments, which did not include muscle strengthening exercises, in a hospital without a board-certified doctor of rehabilitation medicine, a considerable amount of muscle atrophy was found characteristic of changes seen in disuse.

Muscle strength of trunk flexion-extension in post-stroke hemiplegic patients

This study was undertaken to determine muscle strength of trunk flexion-extension in hemiplegic patients after stroke compared with that of normal controls. The design consisted of a nonrandomized control trial in a secondary care setting (a rehabilitation unit at a hospital facility). The subjects included 25 post-stroke male hemiplegic patients and 25 male healthy controls. The maximal peak torques of trunk flexion-extension at angular velocities of 0 degrees (isometric contraction), 60 degrees, 120 degrees, and 150 degrees/s were measured by using an isokinetic dynamometer (Cybex Trunk Extension-Flexion Unit, Cybex, Ronkonkoma, NY). Peak torque of trunk flexion and extension in hemiplegic patients was significantly smaller than that of healthy controls (P < 0.05), except isometric trunk flexion (P > 0.05). The weakness of trunk flexion-extension muscles in hemiplegic patients might be accounted for by the bilateral innervation from the motor cortex, the insufficient use of high threshold motor units, and disuse atrophy.

Sound lateralisation in patients with left or right cerebral hemispheric lesions: relation with unilateral visuospatial neglect

OBJECTIVES To localise the brain lesion that causes disturbances of sound lateralisation and to examine the correlation between such deficit and unilateral visuospatial neglect. METHOD There were 29 patients with right brain damage, 15 patients with left brain damage, and 22 healthy controls, who had normal auditory and binaural thresholds. A device was used that delivered sound to the left and right ears with an interaural time difference using headphones. The amplitude (an index of ability to detect sound image shifts from the centre) and midpoint (an index of deviation of the interaural time difference range perceived as the centre) parameters of interaural time difference were analysed in each subject using 10 consecutive stable saw toothed waves. RESULTS The amplitude of interaural time difference was significantly higher in patients with right brain damage than in controls. The midpoint of the interaural time difference was significantly more deviated in patients with right brain damage than in those with left brain damage and controls (p<0.05). Patients with right brain damage with lesions affecting both the parietal lobe and auditory pathway showed a significantly higher amplitude and deviated midpoint than the controls, whereas right brain damage with involvement of only the parietal lobe showed a midpoint significantly deviated from the controls (p<0.05). Abnormal sound lateralisation correlated with unilateral visuospatial neglect (p<0.05). CONCLUSIONS The right parietal lobe plays an important part in sound lateralisation. Sound lateralisation is also influenced by lesions of the right auditory pathway, although the effect of such lesions is less than that of the right parietal lobe. Disturbances of sound lateralisation correlate with unilateral visuospatial neglect.

Trunk rotatory muscle performance in post-stroke hemiplegic patients.

This study was undertaken to determine whether the direction of trunk rotation would have any effect on trunk muscle performance of post-stroke hemiplegic patients. The design consisted of a nonrandomized control trial in a setting of secondary care (rehabilitation unit at hospital facility). The subjects included 65 hemiplegic patients (50 males) and age-matched 80 healthy controls (38 females). Isokinetic trunk rotatory muscle performance at angular velocities of 60, 120, and 150 degrees per second was measured by using an isokinetic dynamometer (Cybex Torso Rotation Unit). There were no significant differences in the peak torque and best work between the right and left directions of the trunk rotation in the hemiplegic patients or in healthy controls, regardless of the gender of the subjects (paired t test, P > 0.05). The muscle performance of the hemiplegic patients was significantly lower than that of the controls for both genders (t test, P < 0.05). In the hemiplegic patients, the direction of trunk rotation does not affect the trunk rotatory muscle performance, although the performance itself was slightly decreased.

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

OBJECTIVEnTo 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.nnnDESIGNnCase-comparison study.nnnMATERIAL AND METHODSnSixty-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.nnnRESULTSnAmong 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).nnnCONCLUSIONnAmong 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.

Association between location of the lesion and discharge status of ADL in first stroke patients

We investigated the relationship between the location of the lesion in the brain and discharge status of activities of daily living measured by Barthel index in 112 first-stroke patients who had survived to discharge. Physiatrists and radiologists determined the location of the lesion based on neuroanatomic classification of findings detected by head-computed tomography (CT) of the patients. A stepwise regression analysis showed that only one selected location, the right parietal lobe lesion, was negatively associated with discharge Barthel index (R2 = 0.04). However, low R2 indicated that factors other than CT findings could also influence discharge Barthel index, and thus location of the lesion detected by head CT should be considered as adjunctive on prediction of discharge status.

Effect of activities of daily living on fiber type atrophy of the vastus lateralis muscle in patients with joint disorders

Tanaka S, Hachisuka K, Nara S, Ogata H, Kobayashi Y, and Tanaka H: Effect of activities of daily living on fiber type atrophy of the vastus lateralis muscle in patients with joint disorders. Am J Phys Med Rehabil 1998;77:122–127 The histopathologic study was performed to elucidate whether the fiber type atrophy of the vastus lateralis muscle in patients with hip or knee joint disorders is related to the activities of daily living (ADL) or habitual physical activity. Subjects were 16 female patients, 52.4 pm 16.0 yr of age (mean pm standard deviation), who underwent a vastus lateralis muscle biopsy at the time of total hip or knee replacement. At the time of referral to the rehabilitation center, the Functional Independence Measure (FIMTM) motor score and habitual physical activity at home were evaluated, and the diameter and atrophy factor for each muscle fiber type were measured on the histopathologic preparations of the biopsied muscles. The data were analyzed using t test, one-way analysis of variance (ANOVA), Kruskal-Wallis one-way ANOVA, Spearmans correlation coefficient, and partial correlation coefficient. The patients showed muscle fiber atrophy and small angular fibers, and the atrophy factor was significantly increased in type 1, 2A, and 2B fibers, in that order (one-way ANOVA, P < 0.05). The patterns of the fiber type atrophy, consisting of normal, type 2B atrophy, type 2AB atrophy, and type 1 and 2AB atrophy, had a significant relationship with the fiber type atrophy (Spearmans correlation coefficient; rho = 0.834, P < 0.001). The FIMTM motor score showed a significant correlation with the atrophy factor (r = −0.584, P < 0.05), and significant differences were recognized among the four patterns of the fiber type atrophy (Kruskal-Wallis one-way ANOVA, P < 0.05). In conclusion, the muscle atrophy and patterns of the fiber type atrophy of the vastus lateralis muscle in patients with joint disorders may be related to changes in the FIMTM motor score.

Gerstmann's syndrome and ideational apraxia with a right cerebral hemispheric lesion: A case report

Abstract We report an ambidextrous patient with a right parieto-occipital subcortical haemorrhage who exhibited Gerstmanns syndrome, ideational apraxia, constructional apraxia, dressing apraxia, and left hemispatial neglect. Though Gerstmanns syndrome and ideational apraxia are generally caused by a left cerebral hemispheric lesion, we thought the right cerebral hemispheric lesion to be responsible for these symptoms. The features of the case provide important information regarding the laterality and localization of Gerstmanns syndrome and ideational apraxia, especially in this ambidextrous patient.

The role of weakness of triceps surae muscles in astasia without abasia

OBJECTIVE: To investigate the role of weakness of the bilateral triceps surae muscles-the gastrocnemius and soleus muscles-in astasia without abasia and whether compensating for muscle weakness with ankle-foot orthoses improves this disability. DESIGN: Case-control study of clinical findings and before and after trial of ankle-foot orthoses. SETTING: Clinics of the departments of rehabilitation medicine of two university hospitals. PATIENTS: A stilts group consisting of 23 patients with astasia without abasia, and a non-stilts group without this phenomenon consisting of 12 patients with hereditary motor sensory neuropathy, 15 patients with lumbosacral spondylotic radiculopathy or spondylolisthesis, and 20 healthy volunteers. MAIN OUTCOME MEASURE: Clinical findings of the stilts and non-stilts groups were compared and the sensitivity and specificity of each clinical finding was calculated. The length of the centre of foot pressure (COP) while standing was measured in a bilateral below knee amputee and 16 consecutive patients in the stilts group with and without ankle-foot orthoses. RESULTS: Weakness of the triceps surae muscles was the only finding that differed significantly between the two groups and was both sensitive and specific. The amputee was unable to stand in place without dorsiflexion bumpers, which functioned similarly to the triceps surae muscle. Bilateral ankle-foot orthoses improved the COPs of 14 out of 16 patients. CONCLUSION: The main cause of astasia without abasia is weakness of the triceps surae muscles, and this disability is improved by bilateral ankle-foot orthoses.

Prestatie van de romprotatiemusculatuur bij hemiplegiepatiënten

Dit onderzoek werd verricht om vast te stellen of de richting van de romprotatie effect heeft op de prestatie van de rompmusculatuur bij hemiplegiepatienten na een beroerte. Het ontwerp bestond uit een niet–willekeurige gecontroleerde proefneming in een tweedelijns zorglocatie (revalidatieafdeling binnen een ziekenhuis). De proefpersonen waren 65 hemiplegiepatienten (50 mannen, 15 vrouwen) en 80 in leeftijd overeenkomende gezonde controlepersonen (42 mannen, 38 vrouwen).