Takahiko Fukumoto

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.

Clinical Phenotype Classifications Based on Static Varus Alignment and Varus Thrust in Japanese Patients With Medial Knee Osteoarthritis.

To investigate the association between knee pain during gait and 4 clinical phenotypes based on static varus alignment and varus thrust in patients with medial knee osteoarthritis (OA).

Variable Initial Swing Side and Prolonged Double Limb Support Represent Abnormalities of the First Three Steps of Gait Initiation in Patients with Parkinson’s Disease with Freezing of Gait

This study investigated abnormalities of the first three steps of gait initiation in patients with Parkinson’s disease without freezing of gait (PD − FOG) and investigated which abnormalities are related to FOG. Seven PD − FOG and seven age-matched healthy controls performed self-generated or cue-triggered gait initiation. Data for PD patients with FOG (PD + FOG) were cited from a previous study using a procedure similar to that used in the present study. Gait initiation was abnormal, and external cue normalized some abnormalities in PD − FOG. The initial swing side was fairly consistent among the trials in both PD − FOG and in healthy controls, although the initial swing side was inconsistent in PD + FOG. The duration of the first double limb support (DLS) was the only parameter that depends on FOG severity and that was abnormal in PD + FOG but was not abnormal in PD − FOG. The variability of the initial swing side and prolonged first DLS are abnormalities specifically related to FOG.

Reference values for toe grip strength among Japanese adults aged 20 to 79 years: a cross-sectional study

BackgroundNo standardised method has been adopted for measuring toe-grip strength (TGS), and no reference values have been established for evaluating it. The present study investigated age-related changes in TGS and the association of TGS with various descriptive characteristics.MethodsTGS was measured in both feet of 1842 community-dwelling individuals aged 20–79 years using a toe-grip dynamometer. The participants were classified by decade into six age groups: 20–29, 30–39, 40–49, 50–59, 60–69, and 70–79 years. Correlations for TGS between the dominant and non-dominant sides were analysed according to decade and sex using Pearson’s correlation coefficient. The mean TGS and TGS-to-weight ratio (TGS/Wt%) were compared between sexes by each decade and among all decades by sex using two-way analysis of variance with post-hoc tests. To assess relationships between mean TGS and various descriptive characteristics, we determined Pearson’s correlation coefficient by sex and performed a stepwise multiple-regression analysis. Significance was set at 5%.ResultsCorrelations for TGS between the dominant and non-dominant sides were significant in all decades by sex, ranging from 0.73 for men in their 70s to 0.91 for women in their 50s. Mean TGS and TGS/Wt% significantly differed between the sexes in all decades and in all decades except the 40s, respectively. In men, the mean TGS and TGS/Wt% significantly decreased with aging after the 50s and 60s, respectively. In women, both the mean TGS and TGS/Wt% significantly decreased between the 40s and 50s and between the 60s and 70s. TGS significantly correlated with age, height, and weight in both sexes. The stepwise multiple-regression analysis revealed TGS was significantly associated with sex, age, height, and weight (adjusted R2 = 0.31).ConclusionsTGS was closely correlated between the dominant and non-dominant sides. TGS and TGS/Wt were significantly reduced with aging after the 50s in men and significantly reduced between the 40s and 50s and between the 60s and 70s in women. Age, sex, height, and weight accounted for only 30.8% of the variance in TGS. Therefore, other factors (e.g. toe flexibility, structural characteristics) should be considered for improving the accuracy of predicting TGS.

Association of Varus Thrust With Pain and Stiffness and Activities of Daily Living in Patients With Medial Knee Osteoarthritis

Background Increasing evidence highlights potential associations between varus thrust and health domains associated with knee osteoarthritis (OA). Objective The aim of this study was to investigate the association between varus thrust and 2 subcategories—“pain and stiffness” and “activities of daily living (ADL)”—of the Japanese Knee Osteoarthritis Measure (JKOM). Design This was a cross-sectional study. Methods In total, 296 outpatients with knee OA visiting orthopedic clinics were enrolled. The inclusion criteria were age ≥50 years, medial knee OA and Kellgren-Lawrence (K/L) grade ≥1 in one or both knees, and the ability to walk independently. Standard posterior-anterior knee radiographs were measured for varus alignment. Participants were video recorded while walking and were evaluated for the presence or absence of varus thrust. Pain and stiffness of the knee joint and ADL were evaluated using the JKOM. Multivariate regressions (outcomes: pain and stiffness and ADL; predictor variable: varus thrust) were performed. Results Varus thrust was present in 46 (16.2%) of 284 patients. Multivariate regression analyses demonstrated that varus thrust is independently associated with pain and stiffness, adjusted for age, sex, body mass index, K/L grade, and varus alignment (β=.17, P=.005). However, the association between varus thrust and ADL was not significant (β=.11, P=.058). Based on sensitivity analyses, including participants of K/L grade 1 had little influence on this analysis. Limitations Only 16.2% of participants had a varus thrust. Moreover, a cause-effect relationship between varus thrust and pain and stiffness remains unknown due to the cross-sectional design of this study. Conclusions Varus thrust was associated with pain and stiffness in patients with medial knee OA. However, the association between varus thrust and ADL did not reach significance.

Clinical Impact of Coexisting Patellofemoral Osteoarthritis in Japanese Patients With Medial Knee Osteoarthritis

To evaluate the clinical impact in knee osteoarthritis (OA) of coexisting patellofemoral (PF) joint OA (PFOA) in Japanese patients with medial tibiofemoral (TF) joint OA (TFOA).

Associations between toe grip strength and hallux valgus, toe curl ability, and foot arch height in Japanese adults aged 20 to 79 years: a cross-sectional study

BackgroundThe associations between toe grip strength (TGS) and foot structure are not well known, although foot structure is inferred to affect TGS. This study investigated the associations between TGS and hallux valgus angle (HVA), toe curl ability, and foot arch height (FAH).MethodsThis study analysed 227, 20 to 79-year-old, community-dwelling participants. TGS, HVA formed by the first metatarsal bone and the proximal phalanx of the hallux, toe curl ability (percentage) calculated as (foot length–flexed foot length)/foot length, and FAH (percentage) calculated as navicular height/truncated foot length were measured. To elucidate associations between TGS and foot structure, a correlation analysis and stepwise multivariate linear regression analyses were performed, based on the participant’s sex. Pearson’s correlation coefficients for TGS with age, height, weight, HVA, toe curl ability, and FAH were also calculated. In the stepwise, multivariate linear regression analyses, the independent variable was TGS and the dependent variables were those that significantly correlated with TGS, as shown by the Pearson’s correlation coefficients. The significance level was set at 5%.ResultsAccording to the Pearson’s correlation coefficients, in men, TGS was significantly correlated with age, height, toe curl ability, and FAH. According to the stepwise multiple regression analysis, TGS correlated with age and toe curl ability (adjusted R2=0.22). In women, TGS was significantly correlated with age, height, and toe curl ability (adjusted R2=0.40).ConclusionsTGS was associated with toe curl ability in both men and women. However, TGS was not associated with HVA and FAH in men or women. The results of this study may lead to the development of effective interventions to improve TGS. However, factors other than structure of the foot require more detailed investigation to clarify the factors contributing to TGS.

The relationship between skeletal muscle oxygenation and systemic oxygen uptake during exercise in subjects with COPD: a preliminary study.

BACKGROUND: Muscle oxygenation correlates with systemic oxygen uptake (V̇O2) in normal subjects; however, whether this relationship exists in COPD patients remains unclear. The purpose of this study was to investigate the influence of skeletal muscle oxygenation on V̇O2 during exercise in patients with COPD. METHODS: Eight subjects performed an incremental cycle ergometer exercise test. We measured ventilation and pulmonary gas exchange with a metabolic measurement system. We also continuously monitored SpO2, and measured tissue oxygen saturation (StO2) in the vastus lateralis with continuous-wave near-infrared spectroscopy. We calculated the muscle oxygen extraction rate (MOER) based on SpO2 and StO2. In addition, we calculated Pearson correlation coefficients to examine the relationships between the V̇O2 obtained during exercise testing and the mean values of SpO2, StO2, heart rate (HR), and MOER for each 30-second interval of the tests. Finally, we analyzed the relationships between the peak V̇O2 and the slopes of HR/V̇O2, SpO2/V̇O2, StO2/V̇O2, and MOER/V̇O2. RESULTS: With the increasing exercise intensity, many subjects showed a gradual decrease in StO2 and SpO2, but a gradual increase in HR and MOER. V̇O2 was negatively correlated with StO2 and SpO2, and was positively correlated with HR and MOER. However, peak V̇O2 was not correlated with any of the slopes. CONCLUSIONS: V̇O2 is highly influenced by oxygen utilization in exercising muscles, as well as by blood oxygenation levels and cardiac function. However, the impact of skeletal muscle utilization during exercise on peak V̇O2 varied greatly among the subjects.

The Relationship Between Toe Grip Strength and Dynamic Balance or Functional Mobility Among Community-Dwelling Japanese Older Adults: A Cross-Sectional Study

Evaluating toe flexor strength may be an important method for predicting and preventing walking dysfunction and falls, particularly among older adults. In this study, toe grip strength (TGS), the functional reach (FR, a measure of dynamic balance) test, the timed up and go (TUG) test (a measure of functional ability), isometric knee extension strength (IKES), sex, age, weight, and height were analyzed among 665 healthy Japanese older adults. Statistical analyses were used to assess the relationships between TGS and FR or TUG and to investigate whether TGS was independently associated with FR or TUG. Our results indicate that, among both men and women, TGS was associated with TUG, independent of age, height, weight, and IKES, but TGS was not associated with FR. These results may facilitate the development of strategies for improving functional mobility through physical therapy.

Children with flat feet have weaker toe grip strength than those having a normal arch.

[Purpose] This study investigated the relationship between toe grip strength and foot posture in children. [Subjects and Methods] A total of 619 children participated in this study. The foot posture of the participants was measured using a foot printer and toe grip strength was measured using a toe grip dynamometer. Children were classified into 3 groups; flatfoot, normal, and high arch, according to Staheli’s arch index. The differences in demographic data and toe grip strength among each foot posture group were analyzed by analysis of variance. Additionally, toe grip strength differences were analyzed by analysis of covariance, adjusted to body mass index, age, and gender. [Results] The number of participants classified as flatfoot, normal, and high arch were 110 (17.8%), 468 (75.6%), and 41 (6.6%), respectively. The toe grip strength of flatfoot children was significantly lower than in normal children, as shown by both analysis of variance and analysis of covariance. [Conclusion] A significant difference was detected in toe grip strength between the low arch and normal foot groups. Therefore, it is suggested that training to increase toe grip strength during childhood may prevent the formation of flat feet or help in the development of arch.