Ryuji Miyata

Benefits of a Repetitive Facilitative Exercise Program for the Upper Paretic Extremity After Subacute Stroke A Randomized Controlled Trial

Background. Repetitive facilitative exercise (RFE), a combination of high repetition rate and neurofacilitation, is a recently developed approach to the rehabilitation of stroke-related limb impairment. Preliminary investigations have been encouraging, but a randomized controlled evaluation has yet to be performed. Objectives. To compare the efficacy of RFE with that of conventional rehabilitation in adults with subacute stroke. Methods. A total of 52 adults with stroke-related upper-limb impairment (Brunnstrom stage ≥III) of 3 to 13 weeks’ duration participated in this randomized, controlled, observer-blinded trial. Participants were randomized into 2 groups and received treatment on a 4-week, 40 min/d, 5 d/wk schedule. Those assigned to RFE received 100 standardized movements of at least 5 joints of their affected upper extremity, whereas those in the control group participated in a conventional upper-extremity rehabilitation program. Primary and secondary outcomes (improvement in group Action Research Arm Test [ARAT] and Fugl-Meyer Arm [FMA] scores, respectively) were assessed at the end of training. Results. In all, 49 participants (26 receiving RFE) completed the trial. ARAT and FMA scores at baseline were 19 ± 21 and 39 ± 21 (mean ± standard deviation). Evaluation at the trial’s completion revealed significantly larger improvements in the RFE group than in the control group in both ARAT (F = 7.52; P = .009) and FMA (F = 5.98; P = .019) scores. Conclusions. These findings suggest that RFE may be more effective than conventional rehabilitation in lessening impairment and improving upper-limb motor function during the subacute phase of stroke.

Effects of thermal therapy combining sauna therapy and underwater exercise in patients with fibromyalgia

Fibromyalgia syndrome (FMS) is a chronic disorder that is characterized by widespread pain with localized tenderness. We aimed to investigate whether thermal therapy combining sauna therapy and underwater exercise improved pain, symptoms, and quality of life (QOL) in FMS patients. Forty-four female FMS patients who fulfilled the American College of Rheumatology (ACR) criteria received 12-week thermal therapy program comprising sauna therapy once daily for 3 days/week and underwater exercise once daily for 2 days/week. Pain, symptoms, and QOL were assessed using a pain visual analog scale (VAS), a fibromyalgia impact questionnaire (FIQ), and a short form 36-item questionnaire (SF-36), respectively. All of the patients reported significant reductions in pain and symptoms of 31-77% after the 12-week thermal therapy program, which remained relatively stable (28-68%) during the 6-month follow-up period (that is, the thermal therapy program improved both the short-term and the long-term VAS and FIQ scores). Improvements were also observed in the SF-36 score. Thermal therapy combining sauna therapy and underwater exercise improved the QOL as well as the pain and symptoms of FMS patients.

Repetitive facilitative exercise under continuous electrical stimulation for severe arm impairment after sub-acute stroke: A randomized controlled pilot study

Abstract Objective: To investigate the effectiveness of repetitive facilitative exercise (RFE) under surface neuromuscular electrical stimulation (NMES) in patients with post-stroke hemiplegia. Methods: This randomized, controlled, observer-blinded, pilot trial randomized 27 adults with severe arm impairment [Fugl-Meyer Arm scale (FMA) ≤ 20] due to stroke of 3–13 weeks duration into three groups and provided treatment on a 4-week, 40 minutes/day, 5 days/week schedule. The RFE-under-NMES group were given 100–150 repetitions of standardized movements of shoulder, elbow and wrist joints of their affected arm with concurrent low-amplitude NMES for each corresponding musculature. The RFE group was given the same exercise regimen but without NMES. The control group was treated with a conventional arm rehabilitation programme without NMES. FMA was assessed at baseline and 4 weeks. Results: All 27 participants (nine in each group) completed the trial. At 4 weeks, the RFE-under-NMES group evidenced significantly greater improvement compared with the control group on the FMA (p = 0.003), but not with the RFE group (p = 0.092). The RFE group showed improvement compared with the control group, but it was not significant (p = 0.199). Conclusions: RFE under NMES is feasible in clinical settings and may be more effective than conventional rehabilitation in lessening arm impairment after sub-acute stroke.

Effect of Cilostazol Administration on Cerebral Hemodynamics and Rehabilitation Outcomes in Poststroke Patients

ABSTRACT Primary objective: Cilostazol is an antiplatelet agent that inhibits phosphodiesterase III in platelets and the vascular endothelium. We assessed the effects of cilostazol on human cerebral hemodynamics and rehabilitation outcomes. Research design: Prospective, consecutive, observational trial with pretreatment and posttreatment evaluations. Experimental interventions: Cilostazol (200 mg/day) administered for 8 weeks. Methods and procedures: Cerebral blood flow at rest, cerebrovascular reserve capacity, and rehabilitation outcomes (Brunnstrom stage, Barthel index score, modified Rankin Scale score, and Mini-Mental State Examination score) were measured in 104 poststroke patients with an average age ± standard deviation of 60.8 ± 9.2 years. Main outcomes and results: The cerebral blood flow increased by 23.8% on the affected side of the brain and by 16.9% on the nonaffected side. The cerebrovascular reserve capacity increased by 19.0% on the affected side of the brain and by 13.3% on the nonaffected side. Improvements were observed in the Brunnstrom stage, Barthel index score, modified Rankin Scale score, and Mini-Mental State Examination score. Conclusions: Cilostazol appeared to have beneficial effects in poststroke patients with cerebral ischemia and might improve cerebral circulation and rehabilitation outcome.

The Angiotensin II Type 1 Receptor Antagonist Olmesartan Preserves Cerebral Blood Flow and Cerebrovascular Reserve Capacity, and Accelerates Rehabilitative Outcomes in Hypertensive Patients with a History of Stroke

ABSTRACT We aimed to determine the effects of angiotensin II receptor blocker on cerebral hemodynamics and rehabilitative outcome. Sixteen hypertensive patients with a history of stroke received 10–20 mg olmesartan daily for eight weeks. Blood pressure decreased after treatment compared with the baseline, whereas cerebral blood flow (CBF) values of the affected and nonaffected sides increased. The results of the cerebrovascular reserve capacity were also statistically increased in the affected side. Improvements were observed in three rehabilitative outcome parameters. These findings suggest that olmesartan has beneficial effects in hypertensive patients with stroke and impaired CBF autoregulation, and might improve cerebral circulation and rehabilitative outcome.

Benefits of the angiotensin II receptor antagonist olmesartan in controlling hypertension and cerebral hemodynamics after stroke

The purpose of this study was to assess the relative benefits of angiotensin II receptor blockers (ARBs) and calcium channel blockers (CCBs) on cerebral hemodynamics and rehabilitation outcome in hypertensive stroke patients. We randomly assigned 35 patients to either the olmesartan (n=18) or amlodipine (n=17) treatment groups for 8 weeks. Changes in cerebral blood flow (CBF) and cerebrovascular reserve capacity (CRC) were quantified using xenon-CT and rehabilitation parameters were also measured. Over 24 h, olmesartan and amlodipine both reduced blood pressure (BP) to similar levels (systolic BP, −16.1±2.7 mm Hg vs. −15.7±3.1; diastolic BP, −9.2±2.9 vs. −8.6±3.3 mm Hg, respectively). In olmesartan-treated patients, CBF significantly increased in the affected and unaffected hemispheres, and CRC increased significantly in the affected hemisphere. No increases in CBF and CRC were observed in amlodipine-treated patients. Patients treated with olmesartan showed effective rates of improvement in hand (30.0%), upper extremities (40.0%) and lower extremities (100.0%), measured by Brunnstrom stage; these improvements were significantly different from those in amlodipine-treated patients for the total (P<0.02) and lower extremity (P<0.05) scores. There were no significant differences in Barthel indices and Mini-Mental State Examination (MMSE) scores. Olmesartan, but not amlodipine, had beneficial effects on CBF, CRC and rehabilitation outcomes in hypertensive stroke patients, by a mechanism independent of BP reduction and possibly by normalizing CBF autoregulation. Our results suggest that olmesartan may improve cerebral circulation and rehabilitation in hypertensive stroke patients in whom CBF autoregulation is impaired.

Effect of the angiotensin II type 1 receptor antagonist olmesartan on cerebral hemodynamics and rehabilitation outcomes in hypertensive post-stroke patients

Primary objective: In patients with severe hypertension, chronic heart failure or history of stroke, the lower limit of cerebral blood flow (CBF) autoregulation is shifted to a higher blood pressure (BP) than in healthy subjects. This study investigated the effects of the angiotensin II receptor blocker (ARB) olmesartan on human cerebral haemodynamics and rehabilitation outcomes. Research design: Open treatment trial with pre-treatment and post-treatment evaluations. Experimental interventions: Olmesartan (10–20 mg) administered daily for 8 weeks. Methods and procedures: The 24-hour BP, clinical BP, CBF at rest, cerebrovascular reserve capacity (CRC) and rehabilitation outcomes (Brunnstrom stage, Barthel index and Mini-Mental State Examination [MMSE] score) were measured in 44 post-stroke patients with hypertension (62.2 ± 10.7 years). Main outcomes and results: The systemic BP decreased after treatment compared with baseline. The CBF increased by 11.2% on the affected side and by 8.9% on the non-affected side of the brain and the CRC also increased on both sides. Improvements were observed in the Brunnstrom stage, Barthel index and MMSE score. Conclusions: This study suggest that olmesartan has beneficial effects in post-stroke patients with hypertension and impaired CBF autoregulation and provides important information necessary to design future more definitive studies.

Intra-rater and inter-rater reliability of the portable gait rhythmogram in post-stroke patients

[Purpose] Gait analysis, such as portable gait rhythmogram (PGR) provides objective information that helps in the quantitative evaluation of human locomotion. The purpose of this study was to assess the reliability of PGR in post-stroke patients. [Subjects and Methods] Two raters (A and B) examined 44 post-stroke patients. To assess intra-rater reliability, rater A tested subjects on three separate occasions (Days 1, 2, and 3). To assess inter-rater reliability, raters A and B independently tested participants on the same occasion (Day 3). [Results] There was no significant systematic bias between test occasions or raters. Intraclass correlation coefficient values were 0.93−0.97 for intra-rater reliability at both the comfortable speed and maximum speed, and 0.97−0.98 (comfortable speed) and 0.87−0.99 (maximum speed) for inter-rater reliability. The standard error was 1.25−1.49 (comfortable speed) and 1.62−1.77 (maximum speed) for intra-rater investigation, and 1.04−1.32 (comfortable speed) and 0.91−1.26 (maximum speed) for inter-rater investigation. At the 90% confidence level, the minimum detectable change ranged from 2.9−4.1%, and the error of an individual’s score at a given time point ranged from ±2.1−2.9%. [Conclusion] Based on this excellent reliability of the PGR in post-stroke patients, it can be recommended as a simple test of gait analysis in this population.

Effects of Repetitive Facilitative Exercise on Spasticity in the Upper Paretic Limb After Subacute Stroke

BACKGROUND Repetitive facilitative exercise is an effective method for recovery of the affected limb in stroke patients. However, its effects on spasticity are unknown. We aimed to determine the effects of repetitive facilitative exercise on spasticity using the Modified Ashworth Scale (MAS) and the F-wave, and to determine the relationship between the changes in spasticity and functional recovery of the hemiplegic upper limb. METHODS Subacute stroke patients underwent repetitive facilitative exercise (n = 11) or conventional rehabilitation (n = 8) for 4 weeks. We investigated spasticity and functional recovery in a hemiplegic upper limb retrospectively. The MAS, F-wave, Fugl-Meyer Assessment (FMA), and the Action Research Arm Test (ARAT) were assessed immediately before and after the 4-week session. RESULTS Repetitive facilitative exercise did not change the MAS and decreased F persistence and the F amplitude ratio, and improved both the FMA and the ARAT for the affected upper limb. The reduction of F-wave parameters was not correlated with the improvements in the FMA and ARAT in the repetitive facilitative exercise group. Conventional rehabilitation had no effect on the MAS, F-wave parameters, FMA, or the ARAT. CONCLUSIONS Repetitive facilitative exercise decreases spinal motoneuron excitability and promotes functional recovery. However, there was no correlation between the change in spinal motoneuron excitability and the improvement of upper-limb function. The present results suggest that repetitive facilitative exercise is useful for treating spasticity in the subacute phase of stroke.