Yoshiko Tobimatsu

Time-Course Action Analysis of Daily Life Investigations in the Welfare Techno House in Mizusawa

In this study, we have examined the possibility of non-intrusive monitoring at home. We describe the experimental results of the relation between an individuals recorded behavior and the actions detected by the sensors during the course of the subjects daily life. Infrared sensors and the opening of doors and windows and the use of appliances were used. In this paper, it is assumed that the subjects were sleeping when there were no responses by the infrared sensors or when only the bedroom sensor was responding. The sensors were able to detect excretion by using the outputs of the infrared sensor and the water valve of the lavatory, even if a subject did not record it in the time-course of daily life during the investigation. Our findings show that the actions of subjects who stayed at Welfare Techno House (WTH) in Mizusawa could be estimated from outside the house, especially for sleeping and excretion.

Cardiorespiratory endurance in people with cerebral palsy measured using an arm ergometer

OBJECTIVE To determine whether cardiorespiratory endurance, a component of physical fitness, in people with cerebral palsy (CP) is lower than that in able-bodied people, and whether the difference in locomotion of CP patients affects their cardiorespiratory endurance. DESIGN Nonrandomized control trial. SETTING Referred care center. SUBJECTS Twelve men with CP who were independent in daily life and 7 able-bodied control volunteers. INTERVENTION Cardiorespiratory endurance of the subjects was measured with an arm ergometer. MAIN OUTCOME MEASURES Oxygen consumption (VO2), heart rate (HR), and physical working capacity (PWC) measured during arm ergometer rotation. RESULTS The 75%VO2max and 75%HRmax did not differ significantly between CP subjects and control subjects, or between ambulatory CP subjects and wheelchair-bound CP subjects. However, the PWC at 75%HRmax of the CP subjects was significantly lower than that of the control subjects. CONCLUSION Cardiorespiratory endurance does not differ significantly between people with CP and able-bodied people. Type of locomotion does not affect cardiorespiratory endurance. However, the highest PWC performed by the CP subjects was significantly lower than that of the control subjects.

Rhythm of daily living and detection of atypical days for elderly people living alone as determined with a monitoring system

We have developed a system for monitoring the health of elderly people living at home. Infrared and other sensor outputs are collected using a monitoring program installed on a personal computer (PC) in the home at a sampling rate of 1 Hz. Once each day, the data are transferred to a server through the Internet using a cable television (TV) connection. An elderly subject was monitored for a 12-day baseline period and completed a daily questionnaire about her activities. This enabled us to identify the rhythm of daily living (sleeping, 23:00–04:59; getting up/breakfast, 05:00–08:59; indoor activities/going out, 09:00–16:59; and dinner/going to bed, 17:00–22:59) and the average outputs from the sensors in the rooms. The subject was then monitored for a further six months. By identifying sensor output counts outside the limits of mean ±3SD, we were able to detect atypical days. During the six-month monitoring period, 29 atypical days were detected. We suggest that the monitoring system may be effective in tele-rehabilitation.

Alteration of Knee Joint Connective Tissues during Contracture Formation in Spastic Rats after an Experimentally Induced Spinal Cord Injury

This study was made to elucidate the changes in the periarticular connective tissue that can underlie the contracture after spasticity development. Sixteen Wistar rats underwent a spinal cord injury and 16 rats were either sham- or nonoperated. The periarticular connective tissue of the knee joint was assessed with histological, histomorphometric, immunohistochemical, and biochemical analyses. Histological results showed a smaller synovial intima, a dense subintima and posterior joint capsule without fibrosis, and a disarranged posterior capsule in the spinal cord-injured knees with the flexion contracture. The synovial intima length was shortened only at the posterior capsule. Neither the distribution nor expression of type I and III collagen was affected. Contractures after spinal cord injuries are characterized by synovial intima adhesions. A dense and disarranged capsule may lead to joint stiffness. The alteration of periarticular connective tissues exhibits properties characteristic of the contracture after spasticity development.

Monopolar surface electromyography: a better tool to assess motoneuron excitability upon passive muscle stretching

Bipolar and monopolar surface electromyography (sEMG) are known procedures to measure the H-reflex. However, signal cancellation is a potential experimental problem of bipolar sEMG. The results of our study show that monopolar sEMG was the more sensitive procedure to differentiate motoneuron excitability at different passive muscle stretching speeds as it overcame signal cancellation.

Effect of long‐term, community‐based daily exercise on the ability to control the dynamic standing balance of Japanese elderly persons in relation to falls

It is widely accepted that daily exercise improves the dynamic standing balance of elderly persons. In the current study, 77 community-dwelling Japanese elderly persons (aged 71.1 +/- 0.5 years) participated in a daily exercise program to assess its effect on their dynamic standing balance. The daily exercise consisted of walking, stretching, muscle strengthening, and balance exercises. The program ran for 31 months and the dynamic standing balance was assessed at the start of the program and again at 3, 7, 12, 19, 24, and 31 months. In most of the tests of dynamic standing balance, the measured values improved drastically in the first 7 months; thereafter, they either reached a plateau or continued to improve more slowly. These findings can contribute to the future planning of community-based exercise programs; in particular, the length of the program and the timing of changes to the exercise load.

The effects of comprehensive exercise program on the adjustments of standing balance in community-dwelling elderly persons.

The objective of this study was to assess the effect of comprehensive exercise program widely accepted as a community-based physical intervention for the prevention of falling in the elderly persons on their controlling standing balance. Twenty-six community-dwelling elderly persons (13 males and females; 69.8 ± 2.8 years old) participated in this study. Daily exercise was comprised of walking for more than 30 min, stretching, muscle strengthening and balance exercise without exercise equipments. The intervention was continued for three months. Indicators of standing balance related to static balance, dynamic balance and postural response were measured before and after the intervention. As an effect of the intervention on static balance, the sway of center of pressure (COP) in the static stance significantly increased. In the dynamic balance, significant improvements were observed in one leg standing time, the 10-m gait time, functional reach. Additionally, the maximal movable length of COP which subjects can move voluntarily to right and left significantly increased. In the postural response, the integrated electromyography (IEMG) induced by postural response for sudden postural perturbation significantly decreased in the lower leg muscles. Since less muscular activities were sufficient to maintain posture, it was suggested that postural response was elicited more efficiently following the intervention. This study suggested that the comprehensive exercise program, which has been widely introduced as community-based interventions for the prevention of falling, have extensive effects on the control of standing balance covering static balance, dynamic balance and postural response in the elderly persons.

The neural adjustment of postural response through community-based daily exercises in elderly persons

BACKGROUND Reflecting the rapidly aging population, community-based interventions in the form of physical exercise have been introduced to promote the health of elderly persons and prevent falls. Postural response is the critical neural response for preventing falls. The objective of this study was to assess the effect of long-term daily exercise on neural adjustment in postural response elucidated by sudden postural perturbation. METHODS Twenty-six community-based elderly persons (13 men and women; 69.8+/-0.5 years old) participated in this study. Daily exercise was composed of walking for longer than 30 min, stretching, muscle strengthening and balance exercise, and was continued for 3 months. Postural responses were induced by fore or aft horizontal displacement of a platform with a force plate. Center of pressure on the force plate and electromyography of the rectus femoris, tibia anterior, biceps femoris and gastrocnemius were measured in postural response. FINDINGS Following the 3 months of physical intervention, the amplitude and timing of the center of pressure excursion did not change, whereas the amplitude of muscular activities of the lower leg muscles required for the response significantly decreased. Furthermore, the onset of muscular activation of the lower leg muscles was significantly shortened following the intervention. INTERPRETATION In conclusion, we showed that a program composed of 3 months of comprehensive exercise modulated the output of the postural response through a neural adjustment in the timing and amplitude of the muscular activation.

Efficacy of Neurotropin in Fibromyalgia: A Case Report

Fibromyalgia is a refractory disorder that often necessitates long-term treatment. A 45-year-old woman has suffered from a stiff neck for 27 years and severe widespread pain for 4 years. Her visual analog scale (VAS), global-VAS, self-rating depression scale (SDS), and face scale were 48, 38, 42, and 15, respectively. She met the American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Four tablets of Neurotropin (NT) per day alone were administered, and her pain was gradually alleviated over 3 weeks. Her heavy sensation of the body and morning stiffness had almost disappeared 5 months later. Her VAS was 40 after 6 months, but the subjective pain decreased to half that at the initial visit. Her global-VAS, SDS, and face scale were 0, 35, and 8, respectively. No adverse effects were observed. NT, a nonprotein extract from the inflamed skin of rabbits inoculated with vaccinia virus, is a commonly prescribed analgesic drug for chronic pain in Japan. One of the advantages of NT is its few and slight adverse effects. Because NT does not suppress the synthesis of prostaglandin, NT does not cause digestive ulcers. Recent studies suggest that the analgesic mechanism of NT is due to the activation of a descending pain inhibitory system in the brain. Two open studies have shown the efficacy of NT for fibromyalgia. In order to determine whether NT is effective for fibromyalgia, a rigid clinical study, such as a double-blinded, placebo-controlled study, is needed.

Limb fitting for quadruple amputees: Report of two cases of symmetrical peripheral gangrene caused by pneumococcal purpura fulminans

Background: We report our experiences of prosthetic fitting in quadruple amputees. Two patients underwent quadruple amputation after suffering from disseminated intravascular coagulation in conjunction with pneumococcemia with purpura fulminans. Case Description and Methods: The first patient, a 52-year-old man, underwent bilateral transradial, left transtibial, and right transfemoral amputation, and the second patient, a 62-year-old man, underwent bilateral transradial and bilateral transfemoral amputation, both for symmetrical peripheral gangrene subsequent to septic shock. Findings and Outcomes: The amputations were accompanied by skin damage due to ischemic tissue changes both on the stumps and on the nose and/or lips. The combination of the intensive prosthetic rehabilitation program and supportive medical care led to completely independent functioning, including driving a car, with the use of four prosthetic limbs and a wheelchair in both cases. Conclusion: Early initiation of a multidisciplinary approach can properly address impairments and minimize future disability. Clinical relevance We have reported our experience of limb fitting in two patients who had undergone quadruple amputation after suffering peripheral gangrene. Appropriate limb fitting that provides support in daily activities can address impairments and minimize disability.