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<b>Objectives: </b>The purpose of this study was to investigate whether the whole body vibration (WBV) inhibits spasticity and improves motor function and walking ability in the hemiplegic legs of post-stroke patients.<BR><b>Patients and Methods: </b>This before-and-after intervention trial examined 13 post-stroke patients (11 male and 2 female; mean age, 54.3 ± 13.0 years; range, 24-72 years). The Brunnstrom Recovery Stage of the hemiplegic lower limb was stage 3 in three patients, stage 4 in 7, stage 5 in three. The modified Ashworth scale (MAS) score for the gastrocnemius muscles was 1 in one case, 1+ in 6 cases and 2 in six cases. All patients had increased muscle tonus of the affected lower limb (MAS score ≥1), and were able to walk without assistance using a T-cane or an ankle-foot orthosis. Exclusion criteria were any medical condition preventing vibratory stimulation (such as uncontrolled cardiopulmonary disease, severe joint disability and severe sensory disturbance), severe aphasia that made it impossible to follow verbal instructions, and dementia that interfered with outcome assessments. Each subjects sat on the chair with hip joint angles to approximately 90° of flexion, and with knee joint angles to 0° of extension. WBV was applied at 30 Hz (4-8 mm amplitude) for 5 min on hamstrings, gastrocnemius and soleus muscles (Figure 1). The parameters measured before and after the intervention were the MAS, the F-wave parameters as a measure of motor-neuron excitability, the active and passive range of motion (A-ROM, P-ROM) as a measure of motor function, and the 10-m walk test as a measure of walking ability.<BR><b>Results: </b>None of the subjects experienced discomfort before, during or after the intervention and all assessments were completed safely in all subjects. The MAS and F-wave parameters were significantly decreased (p < 0.05), the A-ROM and P-ROM for ankle dorsiflexion increased (p < 0.01), and the P-ROM for straight leg raising increased (p < 0.01), and walking speed improved (p < 0.01) after the 5-min intervention.<BR><b>Conclusion: </b>These findings suggest that WBV is an effective method for controlling spasticity, and improves motor function and walking ability in post-stroke patients.
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Purpose : To study the effect of repetitive facilitation exercise combined with continuous low-frequency electrical stimulation on upper-extremity motor impairment or hand edema during the acute phase of cerebral infarction. Subjects : Thirty inpatients with both hemiplegia and hand swelling, who were admitted to a hospital from April 2011 to March 2012. Methods : In this randomized, controlled, observer-blinded trial, we randomized the subjects into two groups and provided treatment on a 2-week, 30 minutes/day schedule. Subjects in the intervention group received repetitive facilitation exercise concurrent with continuous low-frequency electrical stimulation, while subjects in the control group were provided passive range-of-motion (ROM) exercise. Upper Limb Fugl-Meyer Assessment (FMA), edema and passive ROM were evaluated at baseline and at two weeks. Results : At two weeks, the intervention group showed significant improvements on all measurements. However, the control group showed significant improvement only in their FMA. The intervention group had significantly greater improvements than the control group on all three measurements. Conclusion : Repetitive facilitation exercise concurrent with continuous low-frequency electrical stimulation therapy is effective not only for recovery from motor impairment but also for reducing swelling of the hand during the acute phase of cerebral infarction.
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Objectives: The purpose of this study was to investigate whether the whole body vibration (WBV) inhibits spasticity and improves motor function and walking ability in the hemiplegic legs of post-stroke patients. Patients and Methods: This before-and-after intervention trial examined 13 post-stroke patients (11 male and 2 female; mean age, 54.3 ± 13.0 years; range, 24-72 years). The Brunnstrom Recovery Stage of the hemiplegic lower limb was stage 3 in three patients, stage 4 in 7, stage 5 in three. The modified Ashworth scale (MAS) score for the gastrocnemius muscles was 1 in one case, 1+ in 6 cases and 2 in six cases. All patients had increased muscle tonus of the affected lower limb (MAS score ≥1), and were able to walk without assistance using a T-cane or an ankle-foot orthosis. Exclusion criteria were any medical condition preventing vibratory stimulation (such as uncontrolled cardiopulmonary disease, severe joint disability and severe sensory disturbance), severe aphasia that made it impossible to follow verbal instructions, and dementia that interfered with outcome assessments. Each subjects sat on the chair with hip joint angles to approximately 90° of flexion, and with knee joint angles to 0° of extension. WBV was applied at 30 Hz (4-8 mm amplitude) for 5 min on hamstrings, gastrocnemius and soleus muscles (Figure 1). The parameters measured before and after the intervention were the MAS, the F-wave parameters as a measure of motor-neuron excitability, the active and passive range of motion (A-ROM, P-ROM) as a measure of motor function, and the 10-m walk test as a measure of walking ability. Results: None of the subjects experienced discomfort before, during or after the intervention and all assessments were completed safely in all subjects. The MAS and F-wave parameters were significantly decreased (p < 0.05), the A-ROM and P-ROM for ankle dorsiflexion increased (p < 0.01), and the P-ROM for straight leg raising increased (p < 0.01), and walking speed improved (p < 0.01) after the 5-min intervention. Conclusion: These findings suggest that WBV is an effective method for controlling spasticity, and improves motor function and walking ability in post-stroke patients.
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Various approaches to stroke rehabilitation, such as facilitation techniques including proprioceptive neuromuscural facilitation techniques (PNF), Brunnstrom's approach, and Bobath's approach, have been studied to improve the functional recovery of hemiplegia due to brain damage. However, there is some controversy surrounding these facilitation techniques with regard to their efficacy in stroke rehabilitation. Specifically, there is insufficient evidence that these techniques are superior to conventional exercise therapies.<BR>Recent studies have shown that brain plasticity results in functional recovery in humans. Recovery depends on the plasticity of the synapse, and changes in the strength of a synapse are controlled by a basic mechanism:An increase in synaptic efficacy arises from the repeated stimulation of the postsynaptic cell by the presynaptic cell. The basic theory of repetitive facilitation exercises (RFE) using novel facilitation methods for the hemiplegic limb mainly aim to strengthen the neuronal circuits through the injured descending motor tracts by repetition of the movements that are to be recovered. The patient's intentions to move the hemiplegic limb are realized by using multiple sensory stimulations to target the neural circuits related to each movement. The effects of RFE on the functional recovery of hemiplegic limbs have been confirmed by scientific studies. <BR>Combined therapy using vibratory or electrical stimulation might promote efficacy of RFEs for patients with hemiplegia.
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We had designed Repetitive facilitation exercises (RFEs) using a novel facilitation technique and showen its promoting effects on the functional recovery of the hemiplegica. Balneotherapy (or spa therapy) for patients with disabilities is one of the most familiar forms of rehabilitative therapy. We applied balneotherapy or heat, vibratory sutimuli, Transcranial Magnetic Stimulation (TMS) in new manner or in combination with RFEs for patients with hemiplegia. We observed beneficial effects of balneotherapy on controlling the spasticity of hemiparetic limb, and on the quality of life in patients with disability stroke and orthopedic disease, in addition to beneficial effects on Adipo-cytokines. These studies will develop new effective neuro-rehabilitation and contribute to welfares of the people.
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The effects of bathing in a solution of artificial bath additive including inorganic salts and carbon dioxide (CO<SUB>2</SUB>-bathing: 41°C, 10 minutes; the concentration of carbon dioxide was 160-180 ppm, and that of inorganic salts was about 64 ppm) on the cardiovascular system, body flexibility, muscle stiffness and the subjective feeling of bathing were compared with those of no bathing and plain water bathing in the healthy subjects.<br> The deep body temperature and skin blood flow increased after bathing, and the increases after CO<SUB>2</SUB>-bathing were significantly greater than those after plain water bathing.<br>Body flexibility after CO<SUB>2</SUB>-bathing was similar to that of no bathing and plain water bathing.<br> Stiffness of the trapezius muscle was decreased at both 15 min and 30 min after CO<SUB>2</SUB>-bathing and plain water bathing, with no change in no bathing. The changes at 15 min after CO<SUB>2</SUB>-bathing and plain water bathing were statistically significant. Stiffness in the latissimus dorsi muscle decreased at both 15 min and 30 min after CO<SUB>2</SUB>-bathing and plain water bathing, with no change in no bathing. However, only these changes at 15 min and 30 min after CO<SUB>2</SUB>-bathing were statistically significant.<br> A large decrease in the stiffness of the trapezius muscle by its isometric contraction was observed during both CO<SUB>2</SUB>-bathing and plain water bathing, and the decrease after CO<SUB>2</SUB>-bathing was greater than that after plain water bathing. These changes did not reach statistical significance.<br> Improvements in subjective feeling of bathing were observed after both plain water bathing and CO<SUB>2</SUB>-bathing. Improvements after CO<SUB>2</SUB>-bathing in stiffness of muscle, ease of movements and mental relaxation were statistically greater than those after plain water bathing.<br> Compared with plain water bathing, CO<SUB>2</SUB>-bathing showed additional effects on muscle stiffness and subjective feeling of bathing. Further research is needed to confirm the effectiveness of the CO<SUB>2</SUB>-bathing alone and combined with isometric movements on muscle stiffness.
RESUMEN
We had designed Repetitive facilitation exercises (RFEs) using a novel facilitation technique and showen its promoting effects on the functional recovery of the hemiplegica. Balneotherapy (or spa therapy) for patients with disabilities is one of the most familiar forms of rehabilitative therapy. We applied balneotherapy or heat, vibratory sutimuli, Transcranial Magnetic Stimulation (TMS) in new manner or in combination with RFEs for patients with hemiplegia. We observed beneficial effects of balneotherapy on controlling the spasticity of hemiparetic limb, and on the quality of life in patients with disability stroke and orthopedic disease, in addition to beneficial effects on Adipo-cytokines. These studies will develop new effective neuro-rehabilitation and contribute to welfares of the people.
RESUMEN
The effects of bathing in a solution of artificial bath additive including inorganic salts and carbon dioxide (CO2-bathing: 41°C, 10 minutes; the concentration of carbon dioxide was 160-180 ppm, and that of inorganic salts was about 64 ppm) on the cardiovascular system, body flexibility, muscle stiffness and the subjective feeling of bathing were compared with those of no bathing and plain water bathing in the healthy subjects. The deep body temperature and skin blood flow increased after bathing, and the increases after CO2-bathing were significantly greater than those after plain water bathing. Body flexibility after CO2-bathing was similar to that of no bathing and plain water bathing. Stiffness of the trapezius muscle was decreased at both 15 min and 30 min after CO2-bathing and plain water bathing, with no change in no bathing. The changes at 15 min after CO2-bathing and plain water bathing were statistically significant. Stiffness in the latissimus dorsi muscle decreased at both 15 min and 30 min after CO2-bathing and plain water bathing, with no change in no bathing. However, only these changes at 15 min and 30 min after CO2-bathing were statistically significant. A large decrease in the stiffness of the trapezius muscle by its isometric contraction was observed during both CO2-bathing and plain water bathing, and the decrease after CO2-bathing was greater than that after plain water bathing. These changes did not reach statistical significance. Improvements in subjective feeling of bathing were observed after both plain water bathing and CO2-bathing. Improvements after CO2-bathing in stiffness of muscle, ease of movements and mental relaxation were statistically greater than those after plain water bathing. Compared with plain water bathing, CO2-bathing showed additional effects on muscle stiffness and subjective feeling of bathing. Further research is needed to confirm the effectiveness of the CO2-bathing alone and combined with isometric movements on muscle stiffness.
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<b>Purpose</b><br> Forearm bathing is considered beneficial for the hands of patients with spastic hemiplegia, but the effect has not been investigated comprehensively. This study investigated the effectiveness of forearm bathing for patients with hemiplegic hands. <br><b>Subjects and Methods</b><br> In total, nine hemiplegic patients participated in the study (mean±standard deviation age=56.9±16.6 years; mean±standard deviation period from onset=21.1±21.2 months). Participants sat in a relaxed position on a chair, and dipped the affected forearms into 40°C warm water for 15 mins. The Simple Test for Evaluating Hand Function (STEF) score was evaluated before and after forearm bathing as an indicator of hemiplegic hand function. The Modified Ashworth Scale (MAS) score for the biceps brachii muscle, and both the resistance power of elbow extension and the F/M ratio (F-wave amplitudes/ M wave amplitudes) for the abductor pollicis brevis muscle, were evaluated as indicators of hemiplegic hand spasticity. The device used to measure the resistance power of elbow extension comprised a motor, cuffs to fix the hemiplegic arm and forearm in place, and a control system. The axis of rotation of the device was positioned over the axis of rotation of the elbow joint. The device induced passive elbow flexion and extension movements at an angular velocity of 60°/sec or 90°/sec.<br><b>Results</b><br> After forearm bathing, the STEF score increased significantly (<i>p</i><0.05) from 42.9±28.0 to 47.8±28.4 (<i>n</i>=9), the resistance power of elbow extension at 90°/min decreased significantly (<i>p</i><0.01) from 4.0±1.8 N to 3.0±1.9 N, and the MAS score and F/M ratio were unchanged (<i>n</i>=6).<br><b>Conclusions</b><br> Forearm bathing appeared to improve function and decrease spasticity in hemiplegic hands. This treatment might facilitate hand rehabilitation.
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Blood glucose disposition rate after intravenous glucose infusion is considered to reflect mainly the rate of cellular glucose uptake, the rate of glucose degradation process and gluconeogenesis. excluding the influense of glucose absorption. <br> When it is hypothesized that the elevated blood glucose is disposed by constant rate (one-compartment theory), the following formula will be realized.<br> Ct = A (1— k)<sup>t</sup> Ct = blood glucose level at t-minutes after infusion<br> A = initial glucose level after infusion<br> k = constant glucose disposition index / min<br> log Ct = log A (1—k) <sup>t</sup>= log A + t log (1 — k)<br> This formula demonstrates that logarithm of blood glucose concentration (Ct) is a one-dimensional (linear) function of time t with a slope log (1 — k), and blood glucose disposition index k can be calculated from this slope.<br> To examine the validity of this hypothesis, 1.5 ml / kg of 20% glucose (0.3g / kg) was infused at rest within 3 minutes into an antecubital vein and plasma glucose was determinned at 1, 3, 5, 10, 15, 20, 30 and 40 min after the cessation of infusion.<br> In 10 healthy subjects, linear regression coefficient between logarithm of plasma glucose and time t was significantly higher (r= 0.992 ± 0.006, p<0.001) during 5 to 40 min. Calculated k index ranged from 0.78 to 4.54% / min and the correlation between the 1st and the 2nd measurements (n=5) within a week was also significantly high (0.92±0.06, p<0.01). These results highly support the validity of basic formula (one-compartment theory) and practical procedure to measure k index.<br> The effects of warm water bathing (42 C, 10min) was examined in 7 subjects keeping warmth by blankets. After bathing, k value remained in nearly the same in 4 subjects, decreased in 2 and increased in 1. Although more detailed studies are needed, the effect of single bathing on glucose disposition seems to be not so significant.
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Genetic polymorphisms in the cytochrome P450 family are widely known to contribute to inter-individual differences in drug pharmacokinetics. In this study we report a case of a patient with cytochrome P450 2C19 polymorphism. A 57-year-old woman presented with right cerebral hemorrhage and left hemiplegia. She was administrated phenytoin (200 mg/day)and phenobarbital (60 mg/day) to prevent convulsions. After a change in phenytoin dosage (97% grains to 10% grains), she developed ataxia and experienced a disturbance in her activities of daily living. She was admitted to our hospital. Her serum concentration of phenytoin was found to be at a toxic level (45.9μg/ml) and serum phenobarbital was relatively high (19.1μg/ml). She showed an extremely low clearance of phenytoin, so we checked the genotype of her P450 2C9 and P450 2C19 cytochromes, which are metabolic enzymes of phenytoin. For cytochrome P450 2C9, the patient was a homozygous extensive metabolizer (wild type, *1/*1), but for cytochrome P450 2C19, she was a poor metabolizer (*3/*3). Her phenytoin dosage was reduced, and her ataxia, activities of daily living, left hemiplegia, and cerebral blood flow in Xe-CT improved.
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Dry skin causes many skin disorders such as dry dermatitis. It requires a lot of time and medication to treat patients with skin disorder that cover a vast skin area. Although glycerin is a component of many skin care creams and cosmetics, there is no report regarding the effects of glycerin alone as a bathwater additive. We investigated the effects of bathing in warm water with added glycerin on skin conditions and the prevention of skin disorders in patients with severe motor and intellectual disabilities.<br>Two studies were conducted to analyze the effects of a glycerin+warm water bath (GWWB). In study 1, the skin conditions in a total of 18 subjects were compared between the glycerin group (G) and nonglycerin group (NG). In the G group, skin moisture, skin pH, and skin sebum were measured with a skin analyzer noninvasively at the forehead and precordial and lateral forearm after GWWB for approximately 6 months. Subjects in the 2 groups had bathed 2 times per week and were immersed in warm water at 40 to 41°C for 2 to 3min. In the G group, 250ml glycerin was added in a 14001 bathtub. In study 2, a total of 78 subjects were examined retrospectively; their medical records after GWWB for approximately 6 months were investigated to gain information regarding cutaneous diseases (number of diagnosis, drugs, areas affected with cutaneous diseases, and days of treatment) in order to compare the G and NG groups.<br>Skin moisture levels at forearm improved significantly (p<0.05) in the G group. The average skin moisture level in other areas was higher in the G group than in the NG group but without sig nificance. Skin sebum levels at the forehead improved significantly (p<0.05) in the G group. The number of diagnosis, drugs, and areas with cutaneous disease were significantly lower in the G group than in the NG group. Further, the average number of treatment days was lower in case of the G group than in case of the NG group but without significance.<br>The moisturizing effects are produced due to a thin film formed by glycerin after GWWB, especially in an area where there is friction between the skin and clothes. Skin sebum is also maintained due to glycerin-film formation.<br>It is possible that maintenance of skin moisture protects the skin from cutaneous diseases due to xerosis. In conclusion, these results indicate that GWWB maintains skin moisture and sebum and prevents skin disorders.
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Although visual field defects are common disorders in stroke patients, rehabilitation treatments have developed slowly. In this study, we report a case of a 35-year-old man with quadranopsia and visual agnosia due to right occipital hemorrhage. He had no upper limb motor impairments and began to work as a dental mechanic one month after the stroke, but had to retire because of difficulty in making dental implants. He failed to find things in his lower left visual field, and could not perceive fine differences in slope and depth. He was admitted 2 months after the onset and received occupational therapy for visual agnosia, and treatment for quadranopsia one month after admission. The treatment for quadranopsia was performed using a newly designed computerized visual field training machine consisting of a personal computer system which displayed a fixing point for the eyes at the center of the computer display, and a visual stimulation point at areas between residual vision and quadranopsia on the computer display accompanied by a response warning sound after the patient indicated using a switch when he found the visual stimulation. The visual stimulations contained 20% placebo (no visual stimulation). The computer also calculated the percent of correct responses. After one month of continuous occupational therapy only, his visual agnosia improved but his quadranopsia did not. However, his quadranopsia did improve after repetitive visual stimulation using the computerized visual field training machine. In conclusion, quadranopsia might be improved by repetitive visual stimulation.
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Objective: Warm water immeresion (WWI) has been customary in Japan as useful thermal therapy. However, a comprehensive investigation of the effects of WWI on internal organs has never been undertaken. The purpose of this study was to examine the effects of single WWI on indocyanine green (ICG) excretion in healthy humans. Subjects: 23 healthy males. (32.6±1.9 [mean±SEM] years) Methods: 1CG was administered intravenously (0.5mg/kg) to calculate excretion rate (ER). ICG injection was given before and after WWI (10min at 41°C). Sublingual temperature (ST), blood pressure (BP), heart rate (HR), and cardiac output (CO) were simultaneously measured by noninvasive methods. Results: Significant changes were observed after WWI. These included an increase in ST, HR, and CO and a decrease in systolic BP (p<0.01). ER significantly decreased from 0.210±0.015 to 0.168±0.009 (p<0.01). Front-back ratio of ICG-ER which was calculated in order to evaluate the effect of aging increased significantly with age (R=0.582, p<0.0001). Conclusion: These results indicate that although CO increased due to the vasodilating effects of WWI, hepatic blood flow decreased after WWI and its response reduced with age even in before middle age.
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<b>Objective</b>: Exercise baths are generally considered to be one of the most appropriate and advantageous rehabilitative therapies, yet their effects have not been comprehensively investigated. The aim of this study is to assess the efficacy of exercise baths on quality of life (QOL).<br><b>Methods</b>: The 49 subjects consisted of 20 patients with brain disease, 21 patients with orthopaedic disease, and 8 patients with other diseases (i.e., 7 life-style related diseases and one heat burn). In the present study, all patients were first treated by conventional rehabilitation comprising physical therapy and occupational therapy for 4.2±1.4 weeks. Exercise baths were then added to the rehabilitation program for a further 4.4±1.2 weeks. The subjects were immersed in water at 38°C for 30-60min, twice a week. QOL was evaluated by alterations in the MOS Short-Form 36-item Health Survey (SF-36). We defined the period from admission to exercise bath start as Treatment I, and the period from exercise bath start to discharge (exercise bath finish) as Treatment II. On admission, before and after exercise bath, QOL was evaluated using the SF-36 scores.<br><b>Results</b>: We found that the increase of all eight subscales of the SF-36 was smaller in Treatment I period than in Treatment II period. Increases in SF-36 scores were observed in all patients, in all eight domains. Specifically, after exercise baths, increased scores of Physical functioning (PF), Role physical (RP), General health (GH), Vitality (VT), Role emotional (RE) and Mental health (MH) subscales of the SF-36 were observed in the patients with brain disease. Further, after exercise baths, increased scores of PF, RP, Bodily pain (BP), GH, VT, RE and MH subscales of the SF-36 were observed in the patients with orthopedic disease.<br><b>Conclusions</b>: It was concluded that exercise baths are an effective non-pharmacological treatment that might facilitate rehabilitation programs.
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The effects of bathing with inorganic salts and carbon dioxide (ISCD) on body temperature, systemic circulation, food ingestion and absorption have been studied in healthy volunteers. The peripheral blood flow in the forearm was found to increase in and after immersion of the forearm into a 25<i>l</i> bathing receptacle containing ISCD, as compared with plain water. The peripheral blood flow tended to increase in a dose-dependent manner with ISCD bathing. The skin core temperature, the skin surface temperature and the peripheral blood flow were significantly higher after ISCD bathing than after plain water bathing. The influences of ISCD bathing on food ingestion and absorption were also studied in healthy volunteers. Blood glucose and insulin levels after food ingestion tended to be suppressed by ISCD bathing as compared with plain water bathing. There was no difference between ISCD and plain water bathing in total protein, total cholesterol, triglyceride, HDL cholesterol, and uric acid levels in the blood. These results suggest that ISCD bathing may contribute to the promotion of human health.
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The effects of the bathing on renal function were studied in 12 healthy men (32.3±7.7y. o.). The subjects took 41°C, 10min bathing and kept warm by a blanket for 30min, and then a mixture of 10% para-aminohippurate (PAH, 0.3<i>ml</i>/kg) and 10% sodium thiosulfate (NTS, 80<i>ml</i>) was infused intravenously. Clearance of PAH and NTS was calculated as the index of renal plasma flow (RPF) and glomerular filtration rate (GFR). PAH and NTS clearance test was also done at rest without bathing in another day. Blood Pressure (BP), Heart rate (HR), cardiac output (CO), sublingual temperature by electric thermista as deep body temperature were measured during the experiment. 30min after bathing, sublingual temperature was significantly increased by 0.9°C, and CO by +40%. After bathing, renal plasma flow (PAH clearance) significantly increased from 388.5±158.9<i>ml</i>/min to 572±170.7<i>ml</i>/min. Glomerular filtration rate (NTS clearance) was, however, unchanged from 115.6±37.3<i>ml</i>/min to 119.3±51.3<i>ml</i>/min. Filtration fraction (GFR/RPF) was significantly decreased. These results indicated that GFR was not improved by bathing although CO and RPF was increased by thermal vasodilation effect. The mechanism of unchanged GFR, despite of increased RPF, is probably that glomerular filtration pressure unchanged by thermal vasodilation of glomerular efferent and afferent arterioles.
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Phthalides and ligustilide in Senkyu extract and limonene and fravonoids in Chimpi extract have been reported to have strong vasodilation effects.<br>In the present study the circulatory effects of Senkyu and Chimpi extract (crude drug extract) were studied as bath agent in 40.0°C bath water (Senkyu ext. 224mg and Chimpi ext. 272mg/2001). Thirteen healthy men (36.2±5.8 years old) took a bath at 40.0°C for 10 min with and without (only with flavor and dye) crude drug extract and the circulatory effects were followed for 30 min after bathing.<br>Heart rate and cardiac output were increased equally by 10 min bathing either with or without crude drug extract. Although systolic blood pressure was slightly increased during bathing, diastolic blood pressure and total peripheral resistance were significantly decreased during and after bathing with and without crude drug extract. Forehead skin blood flow and sublingual temperature were significantly increased during bathing, and remained at higher level for 10-30 min after bathing with crude drug extract. Venous blood pO<sub>2</sub> and pH were significantly increased and pCO<sub>2</sub> was decreased equally with and without crude drug extract. Plasma NE was significantly increased by bathing with crude drug extract.<br>Bath agent with Senkyu and Chimpi extract are considered favorable as bath agent to keep high skin blood flow and sublingual temperature probably due to its vasodilating effects.
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Effects of cold and warm water bathing of hemiplegic lower limb on its isokinetic muscle strength were studied in 12 chronic stroke patients (9 males and 3 females, 53.3±14.2 yo, Ueda's grading 8.5±1.6 Grade).<br>Measurements of the isokinetic muscle strength of the knee flexion/extension were repeated three times; 1) after sitting for 10min at room temperature (21-22°C) as a control, 2) after cold water bathing (18°C) of hemiplegic lower limb for 5min, 3) after warm water bathing (41°C, 700ppm artificial CO<sub>2</sub> bath) of hemiplegic lower limb for 10min. The measurements were performed, using Cybex 6000 (Cybex international Co) at velocities of 60, 120, 180 and 240°/sec. Artificial CO<sub>2</sub> bath was prepared by dissolving Kao Babu (Kao Co) in 41°C warm water.<br>Peak torque of the knee flexions at any velocity decreased significantly after cold water bathing and imcreased after warm water bathing. Change in the maximum power and total work were similar to that of the peak torque. The muscle strength of the knee extension were not changed by neither cold nor warm water bathing.<br>The correlation coefficient between Ueda's Grade and its isokinetic muscle strength ranged from 0.3 to 0.6 and significantly improved after warm water bathing at velocity of 120 (°/second) in flexion. Warm water bathing might make it easy to exert their muscle strength at 120°/sec in flexion corresponding to their severity of their hemiplegia.<br>Regarding to the influence of spasticity, patients with no ankle clonus or pseudoclonus showed a tendency to increase in muscle strength of flexion and extension after warm water bathing. In patients with evident clonus, a tendency to decrease on extension and increase on flexion was seen after warm water bathing.<br>Further studies on the effects of warm water bathing of partial and full immersion in the treatment for spasticity of hemiplegic limb would contribute to stroke rehabilitation.
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The effects of single bathing of the artificial mineral spring (Basukurin: Tsumura Juntendo Inc. Japan), equivalent mixture of sodium sulfate and sodium bicarbonate, were studied in 13 normal and 22 hypertensive subjects comparing with natural simple hot spring (Kirisima spa).<br>Blood pressure (BP: automatic sphygmomanometer), heart rate (HR), cardiac output (CO: earpiece type dye-dilution densisometer), total peripheral resistance (TPR: mean BP/cardiac index), forehead deep body temperature (DBT: Core Temp CTM 204) plasma renin activity (PRA: RIA by Habar's method), plasma norepinephrine (NE) and blood gas partial pressure (pO<sub>2</sub> and pCO<sub>2</sub>) and pH were measured before and after bathing. Mineral concentration of simple hot spring and Basukurin bath (120g powder/360l simple hot spring) were 0.019% and 0.052%, respectively. The temperature and duration of bathing were both 41°C for 10min.<br>In normotensives, only systolic BP and TPR were significantly decreased 30min after the simple and Basukurin bathing by the same degree. HR was significantly increased throughout 30min after both bathing. CO was increased only after 10min of Basuku rin bathing. In hypertensives, systolic and diastolic BP and TPR were significantly decreased throughout 30min after simple and Basukurin bathing. The decrement in BP and TPR, however were significantly greater in Basukurin bathing. HR and CO were significantly increased after both bathing. Forehead DBT was significantly elevated after both bathing and gradually decreased throughout 30min of observation. In Basukurin bathing, although the increment in DBT was greater than simple hot spring bathing, the decrease was slower than simple hot spring bathing suggsting the protection from heat radiation by Basukurin bathing. PRA and plasma NE concentration examined in hypertensive subjects after 30min of bathing were significantly elevated only in Basukurin bathing. Although arterial gas concentration and pH were not changed after bathing, venous blood pO<sub>2</sub> and pH were significantly increased and pCO<sub>2</sub> was significantly decreased after 10min of Basukurin bathing.<br>These data indicates that single Basukurin bathing has more potent hypotensive effect due to vasodilation than simple hot spring. Enhanced vasodilation by Basukurin bathing is probably derived from the protection of heat radiation from the skin by the formtion of thin mineral film on the skin. Increased venous blood pO<sub>2</sub> and pH and decreased pCO<sub>2</sub> represents also the improvement of peripheral circulation assisted by vasodilation and elevated CO.