Kyoshi Mase

Changes in quadriceps muscle thickness in acute non-ambulatory stroke survivors

Background:Loss of skeletal muscle mass is one of the main reasons for disability in patients with stroke. However, lower leg muscle wasting has not been studied in acute stroke patients. Objective:To investigate the changes in quadriceps muscle thickness in acute non-ambulatory stroke survivors. Methods:A total of 16 consecutive acute non-ambulatory stroke survivors who were in acute inpatient rehabilitation, with a mean age of 72.1 years, were included in the study. Quadriceps muscle thickness was examined in their paretic and non-paretic limbs within the first week from admission (first week), 1 week after the first examination (second week), and 1 week after the second week examination (third week) using ultrasonography. Results:Quadriceps muscle thickness in the paretic limb decreased every week (mean% difference between the first and second weeks, 12.8, 95% confidence interval (CI) 5.3–20.2%; mean% difference between the second and third weeks, 10.1, 95% CI 5.2–14.9%). Quadriceps muscle thickness in the non-paretic limb was lower in the second and third weeks than the first week, but there was no difference between the second and third weeks (mean% difference between the first and second weeks, 9.3, 95% CI 2.5–16.1%; mean% difference between the second and third weeks, 5.3, 95% CI − 1.6 to 12.1%). Conclusion:Quadriceps muscle thickness decreased in acute non-ambulatory stroke survivors not only in the paretic limb but also in the non-paretic limb, particularly during the period from admission to the second week.

Relationship Between Spontaneous Expiratory Flow-Volume Curve Pattern and Air-Flow Obstruction in Elderly COPD Patients

BACKGROUND: Assessment of the degree of air-flow obstruction is important for determining the treatment strategy in COPD patients. However, in some elderly COPD patients, measuring FVC is impossible because of cognitive dysfunction or severe dyspnea. In such patients a simple test of airways obstruction requiring only a short run of tidal breathing would be useful. We studied whether the spontaneous expiratory flow-volume (SEFV) curve pattern reflects the degree of air-flow obstruction in elderly COPD patients. METHODS: In 34 elderly subjects (mean ± SD age 80 ± 7 y) with stable COPD (percent-of-predicted FEV1 39.0 ± 18.5%), and 12 age-matched healthy subjects, we measured FVC and recorded flow-volume curves during quiet breathing. We studied the SEFV curve patterns (concavity/convexity), spirometry results, breathing patterns, and demographics. The SEFV curve concavity/convexity prediction accuracy was examined by calculating the receiver operating characteristic curves, cutoff values, area under the curve, sensitivity, and specificity. RESULTS: Fourteen subjects with COPD had a concave SEFV curve. All the healthy subjects had convex SEFV curves. The COPD subjects who had concave SEFV curves often had very severe airway obstruction. The percent-of-predicted FEV1% (32.4%) was the most powerful SEFV curve concavity predictor (area under the curve 0.92, 95% CI 0.83–1.00), and had the highest sensitivity (0.93) and specificity (0.88). CONCLUSIONS: Concavity of the SEFV curve obtained during tidal breathing may be a useful test for determining the presence of very severe obstruction in elderly patients unable to perform a satisfactory FVC maneuver.

Promoting physical activity in hospitalized patients with mild ischemic stroke: a pilot study

Abstract Background: Patients with acute stroke spend most of their hospital day inactive. However, a method to promote physical activity (PA) in stroke has not been established. Objective: To evaluate the effectiveness of promoting PA by enhancing self-efficacy in hospitalized patients with mild ischemic stroke. Design: Pre–post interventional study. Methods: Hospitalized patients with mild ischemic stroke who could walk without assistance were recruited. We measured the daily number of steps taken as the index of daily hospitalized PA using an accelerometer. At the baseline measurement, patients did not receive accelerometer-based feedback. To promote hospitalized PA, a physical therapist provided instruction on the self-monitoring approach and discussed PA targets, encouraged the patients to walk more, and instructed them on the importance of PA after stroke. We also measured self-efficacy for PA using an assessment tool at the baseline and during the intervention. Results: Twenty-two patients (62.5 years old, 68.2% men) were included. PA during the intervention was higher than that at the baseline measurement (5709.4 ± 2236.1 vs. 2813.9 ± 1511.9 steps/day, p < 0.001). Self-efficacy for PA during the intervention was also higher than that at the baseline measurement (76.4 ± 18.8 vs. 58.9 ± 29.0 points, p < 0.001). Conclusions: Promoting PA by enhancing self-efficacy may increase PA and self-efficacy for PA in hospitalized patients with mild ischemic stroke. The present results might provide new strategies of PA promotion in these hospitalized patients.

Changes in Quadriceps Muscle Thickness, Disease Severity, Nutritional Status, and C-Reactive Protein after Acute Stroke

BACKGROUND Lower leg muscle wasting is common in stroke patients; however, patient characteristics in the acute phase are rarely studied. This study aimed to examine the relationship between changes in quadriceps muscle thickness and disease severity, nutritional status, and C-reactive protein (CRP) levels after acute stroke. METHODS Thirty-one consecutive patients with acute intracerebral hemorrhage or ischemic stroke had quadriceps muscle thickness measured in the paretic and nonparetic limbs within 1 week after admission (first week) and 2 weeks after the first examination (last week) using ultrasonography. We also determined the relationship between the percentage change in muscle thickness and disease severity, nutritional status, and CRP levels on admission. RESULTS There was a significant correlation between changes in muscle thickness for both paretic and nonparetic sides and National Institutes of Health Stroke Scale (NIHSS) scores (paretic limb: r = -.46, P = .01; nonparetic limb: r = -.54, P = .002, respectively); however, there was no significant correlation with nutritional status on admission. Quadriceps muscle thickness was reduced more in the CRP-positive (≥.3 mg/dL) patients than in the CRP-negative (<.3 mg/dL) patients in the nonparetic limb (positive: -21.4 ± 12.1, negative: -11.4 ± 16.4%; P = .039), but not in the paretic limb (positive: -23.4 ± 9.0, negative: -19.1 ± 15.7; P = .27). CONCLUSIONS A high NIHSS score and a positive CRP on admission were both significantly correlated with decreased quadriceps muscle thickness after acute stroke. Nutritional status on admission was not correlated with changes in quadriceps muscle thickness for these patients.

Effect of accelerometer-based feedback on physical activity in hospitalized patients with ischemic stroke: a randomized controlled trial:

Objective: To evaluate the effect of accelerometer-based feedback on physical activity in hospitalized patients with ischemic stroke. Design: Randomized controlled trial. Setting: Acute care hospital. Subjects: A total of 55 patients with ischemic stroke who could walk without assistance were randomly assigned to the intervention group (n = 27) or the control group (n = 28). Interventions: At the baseline measurement, patients did not receive accelerometer-based feedback. At follow-up, a physical therapist provided instruction on accelerometer-based feedback, discussed physical activity targets and encouraged the patients to walk more until discharge. Main measures: The average daily number of steps taken was used as the index of daily hospitalized physical activity. Results: The study sample consisted of 48 patients, of whom 23 patients comprised the intervention group and 25 patients comprised the control group. Although there were no significant differences in physical activity values between the two groups at the baseline measurement, the values in the intervention group at follow-up were significantly higher than those in the control group (5180.5 ± 2314.9 vs. 3113.6 ± 1150.9 steps/day, P = 0.0003). The effect size of physical activity values (Cohen’s d = 1.15) at follow-up was large between the two groups. Conclusion: Exercise training combined with accelerometer-based feedback effectively increased physical activity in hospitalized patients with ischemic stroke.

Effects of Arm Bracing on Expiratory Flow Limitation and Lung Volume in Elderly COPD Subjects.

BACKGROUND: Although it is useful for COPD patients to relieve their dyspnea by bracing their arms, the relationships between the arm bracing posture and expiratory flow limitation (EFL) and lung volume are unknown. Whether arm bracing affects dyspnea, EFL, and lung volume in elderly COPD patients was investigated. METHODS: Sixteen elderly subjects (median [interquartile range] age 81 [77–85] y) with stable COPD (percent-of-predicted FEV1 50.9 [31.3–64.9] %) and 16 age-matched healthy subjects were studied. Breathing patterns, EFL, lung volume, SpO2, and heart rate during quiet breathing were randomly evaluated in 3 standing postures: erect, leaning forward, and arm bracing. Dyspnea was also assessed for each posture with a Borg dyspnea score at the end of the test. RESULTS: Lung volume was significantly higher with arm bracing than with the other postures in both groups (P < .05). Breathing patterns, SpO2, and pulse rate were not significantly different among the 3 postures in both groups. However, EFL and Borg dyspnea scores were significantly lower with arm bracing than with the other postures in COPD subjects (P < .01). CONCLUSIONS: The decreased EFL in the arm bracing position may be caused by breathing at a higher lung volume than in the erect position, which may be one of the factors relieving dyspnea in elderly COPD patients.

Measurements of chest wall volume variation during tidal breathing in the supine and lateral positions in healthy subjects.

PURPOSE To study the feasibility and the laterality of measurements of chest wall volume variation during tidal breathing in the lateral position in healthy subjects. METHODS Eighteen normal subjects were studied. Chest wall volume changes were measured by optoelectronic plethysmography in the supine and right and left lateral positions during quiet breathing. The accuracy of measuring lung volume was also examined using hot wire spirometry in 10 of the subjects. RESULTS The measurement errors between lung volume changes and chest wall volume changes were not significantly different in all positions. There was no significant difference between right and left compartmental volume changes in the supine position. However, chest wall volume changes were lower on the dependent side in the lateral position than on the non-dependent side because of the decrease in abdominal rib cage and abdomen volume changes. CONCLUSION Chest wall volume measurements during quiet breathing in the lateral position have high measuring accuracy and show laterality.

Regional Chest Wall Volume Changes During Various Breathing Maneuvers in Normal Men

PURPOSE The purpose of this study is to investigate the regional chest wall volume changes during various breathing maneuvers in normal men with an optical reflectance system (OR), which tracks reflective markers in three dimensions. METHODS Chest wall volume was measured by the OR system [VL(CW)], and lung volume was measured by hot wire spirometry [VL(SP)] in 15 healthy men during quiet breathing (QB), during breathing at a rate of 50 tidal breaths/min paced using a metronome (MT: metronome-paced tachypnea), and during a maximal forced inspiratory and expiratory maneuver (MFIE maneuver). RESULTS There were few discrepancies between VL(CW) and VL(SP) for QB and MT. In the MFIE maneuver, however VL(CW) was often underestimated compared with VL(SP), particularly during forced maximal expiration, because of pulmonary rib cage volume changes. Furthermore, the regional chest wall volume changes were affected by breathing maneuver alternation. In the pulmonary and abdominal rib cage, inspiratory reserve volume was larger than expiratory reserve volume, respectively, and in the abdomen, expiratory reserve volume was larger than inspiratory reserve volume. CONCLUSION Alternation of breathing maneuvers affects regional chest wall volume changes.

Efficacy of neuromuscular electrical stimulation for preventing quadriceps muscle wasting in patients with moderate or severe acute stroke: A pilot study

BACKGROUND Stroke-related muscle wasting is one of the factors leading to long-term disability and functional dependency. No study has reported an effective therapeutic intervention for such muscle wasting. OBJECTIVE The purpose of this study was to investigate the effects of neuromuscular electrical stimulation (NMES) on quadriceps muscle mass preservation in patients with acute moderate or severe stroke by using ultrasonography (US). METHODS Twenty patients with acute, moderate, or severe stroke (age: 68±11 years) were divided into usual care group (control group) and intervention groups (NMES group), respectively. Patients in the NMES group underwent NMES treatment for bilateral quadriceps muscles for 2 weeks in addition to the usual care. Quadriceps muscle thickness was measured on admission and 2 weeks after the first measurement. RESULTS The quadriceps muscle thickness on the paretic and non-paretic sides in the NMES group (-12.4% ±12.7%, -5.5% ±15.3%, respectively) significantly decreased to a lesser degree than that in the control group (-29.5% ±12.1%, P = 0.004; and -22.0% ±16.8%, P = 0.04, respectively). CONCLUSIONS NEMS seemed to have preserved the quadriceps muscle mass in patients with moderate or severe acute stroke.

Effects of posture on chest-wall configuration and motion during tidal breathing in normal men

[Purpose] The purpose of this study was to clarify the impact of postural changes during tidal breathing on the configuration and motion of chest-wall in order to further breathing motion evaluation. [Subjects and Methods] Chest-wall configuration and motion in the supine, right lateral, and sitting positions were measured using optoelectronic plethysmography in 15 healthy adult men. [Results] The anteroposterior diameters of the chest wall were significantly lower in the supine position for the pulmonary and abdominal rib cages, whereas the mediolateral diameters in the lateral position were lowest for the abdominal rib cage. Regarding chest-wall motion, both craniocaudal and anteroposterior motions of the anterior surface of the pulmonary and abdominal rib cages were significantly greater in the sitting position. Regarding motion of the left lateral abdominal rib cage, lateral motion was greatest in the lateral position. [Conclusion] Chest-wall configuration and motion changed according to posture in healthy men, particularly in the pulmonary and abdominal rib cages.