Differences in the Kinematic and Kinetic Characteristics between Successful and Failed Sit-to-stand Trials in Patients with Stroke / The Japanese Journal of Rehabilitation Medicine

Objects：Sit-to-stand (STS) interventions are frequently used as part of stroke rehabilitation. This study aimed to clarify the kinematic and kinetic characteristics of patients recovering from stroke, who have difficulties with STS movement.Method：The participants included 26 stroke patients who struggled to complete the STS maneuver. Using a 3D motion analysis system, the kinematic and kinetic parameters during STS were retrospectively analyzed and compared between failed and successful trials. The kinematic parameters of the trunk and lower limbs were obtained within the seat-off phases, and the kinetic indices of the lower limbs were obtained from measurements taken before and after the seat-off phase. The weight-bearing ratio on the unaffected side was calculated from the vertical ground reaction forces.Results：In the successful trials, analyses of the parameters revealed more forward tilting of the pelvic and thoracic regions, a further forward and downward shift of the center of mass, and larger hip and knee extension moments than those of the failed trials. However, there was no difference in the weight-bearing ratio on the non-paralyzed side.Conclusion：This study revealed that the kinematic and kinetic properties of the STS maneuver differed between successful and failed trials among patients with stroke. The study therefore provides useful information for clinical evaluation and rehabilitation.

Differences in the Kinematic and Kinetic Characteristics between Successful and Failed Sit-to-stand Trials in Patients with Stroke / The Japanese Journal of Rehabilitation Medicine

Objects：Sit-to-stand (STS) interventions are frequently used as part of stroke rehabilitation. This study aimed to clarify the kinematic and kinetic characteristics of patients recovering from stroke, who have difficulties with STS movement.Method：The participants included 26 stroke patients who struggled to complete the STS maneuver. Using a 3D motion analysis system, the kinematic and kinetic parameters during STS were retrospectively analyzed and compared between failed and successful trials. The kinematic parameters of the trunk and lower limbs were obtained within the seat-off phases, and the kinetic indices of the lower limbs were obtained from measurements taken before and after the seat-off phase. The weight-bearing ratio on the unaffected side was calculated from the vertical ground reaction forces.Results：In the successful trials, analyses of the parameters revealed more forward tilting of the pelvic and thoracic regions, a further forward and downward shift of the center of mass, and larger hip and knee extension moments than those of the failed trials. However, there was no difference in the weight-bearing ratio on the non-paralyzed side.Conclusion：This study revealed that the kinematic and kinetic properties of the STS maneuver differed between successful and failed trials among patients with stroke. The study therefore provides useful information for clinical evaluation and rehabilitation.

Improving Community-based Health Care through Active Admission of Patients with Vertebral Compression Fracture for Recovery Phase Rehabilitation, and Statistical Analysis of the Backgrounds / The Japanese Journal of Rehabilitation Medicine

Objective：Patients with vertebral compression fracture first visit the acute care hospital for a diagnosis, but cannot be admitted and return home with a corset and analgesics. Because of severe lower back pain, they stay in bed for a significant period of time, and their skeletal muscles suffer from disuse atrophy. We aimed to actively admit these patients for recovery phase rehabilitation by setting up a hotline.Methods：The backgrounds of each case including the major laboratory findings were investigated for 1 year. Health professionals were able to use the hotline to request admission for the patients.Results：One hundred twenty-seven patients (38 males and 89 females, aged 84±7.5 years) were admitted. The percentages of phone calls from acute-care hospitals, clinics, and regional care managers were 46%, 31%, and 20%, respectively. With regard to degree of disability 36％ of the patients were at C1, 31% were at B2, and 20% were at C2 indicating that they needed almost complete assistance. Fifty one percent of the patients lived alone, and 20% were couples without assistance from others. Because they were elderly patients with many complications, more than six agents had been prescribed on average. However, osteoporosis medication had been prescribed to only 23%. The prognosis was favorable with ratio of returned home being 91%, even though the outcome of rehabilitation is limited by ageing and deteriorated cardiac and renal functions in these patients.Conclusion：Services to support these patients during the recovery phase of rehabilitation is crucial, in order to improve community-based health care.

Improving Community-based Health Care through Active Admission of Patients with Vertebral Compression Fracture for Recovery Phase Rehabilitation, and Statistical Analysis of the Backgrounds / The Japanese Journal of Rehabilitation Medicine

Objective：Patients with vertebral compression fracture first visit the acute care hospital for a diagnosis, but cannot be admitted and return home with a corset and analgesics. Because of severe lower back pain, they stay in bed for a significant period of time, and their skeletal muscles suffer from disuse atrophy. We aimed to actively admit these patients for recovery phase rehabilitation by setting up a hotline.Methods：The backgrounds of each case including the major laboratory findings were investigated for 1 year. Health professionals were able to use the hotline to request admission for the patients.Results：One hundred twenty-seven patients (38 males and 89 females, aged 84±7.5 years) were admitted. The percentages of phone calls from acute-care hospitals, clinics, and regional care managers were 46%, 31%, and 20%, respectively. With regard to degree of disability 36％ of the patients were at C1, 31% were at B2, and 20% were at C2 indicating that they needed almost complete assistance. Fifty one percent of the patients lived alone, and 20% were couples without assistance from others. Because they were elderly patients with many complications, more than six agents had been prescribed on average. However, osteoporosis medication had been prescribed to only 23%. The prognosis was favorable with ratio of returned home being 91%, even though the outcome of rehabilitation is limited by ageing and deteriorated cardiac and renal functions in these patients,Conclusion：Services to support these patients during the recovery phase of rehabilitation is crucial, in order to improve community-based health care.

Application of quality control circle program in post stroke depression at the recovery phase / 中国基层医药

Objective To explore the effect of Quality Control Circle(QCC) on patients in the recovery phase with post stroke depression at rehabilitation therapy.Methods 80 patients in the recovery phase with post stroke depression were collected.According to the digital table, they were randomly divided into control group and QCC group,40 cases in each group.All the patients got treatment as rehabilitation medical care routine, rehabilitation exercise and medical treatement.And patients of QCC group received extra QCC management.The activities of daily living(Barthel Index Scale),severity of depression(Hamilton Depression Scale HAMD),rehabilitation exercises compliance were evaluated in the two groups.Results After intervention, the scores of ADL,HAMD and rehabilitation exercises compliance in the control group were (33.50±6.22)points,(22.23±3.30)points,(2.70±1.32)points,respectively,which in the QCC group were (54.13±8.84)points,(14.75±4.14)points,(4.45±0.90)points,respectively.The scores of activities of daily living(ADL)(t=15.06,26.03,all P<0.01) and rehabilitation exercises compliance(t=1.78,12.2,all P<0.01) had been improved, which in the QCC group was more obvious(t=12.10,6.90,all P<0.01)).The depression scores in both two groups were decreased(t=13.35,25.78,all P<0.01),and the decrease in the QCC group was significantly higher than that in the control group(t=8.93,P<0.01).Conclusion QCC application in post stroke depression at the recovery phase can effectively reduce the degree of depression, improve patients' ADL and rehabilitation exercise compliance.

Efficacy of Ginkgo laminae on blood lipid, homocysteine and intimamedia thickness in recovery phase of cerebral infarction / 中国生化药物杂志

Objective To observe the influence of Ginkgo laminae on serum lipid, serum level of homocysteine (HCY) and carotid intima-media thickness (IMT) of patients in recovery phase of cerebral infarction. Methods 100 patients in recovery phase of cerebral infarction were randomly divided into treatment group and control group, with 50 cases in each group. The control group were given aspirin enteric coated tablets 0.1g qn po., atorvastatin calcium capsule 20mg qn po.; the treatment group on the basis of the control group were added Ginkgo laminae, 1 tablet per time, three times daily. The blood liqid and HCY levels pre-treatment and 1, 3 and 6 months post-treatment and IMT value pre-treatment and 6 months post-treatment were collected. Results The triglyceride level had no significantly change in two groups. The high density lipoprotein cholesterol 3, 6 months post-treatment in treatment group was significantly higher than control group(P<0.05). The cholesterol and low density lipoprotein cholesterin 1 ,3, 6 months post-treatment in two groups significantly decreased compared with pre-treatment(P<0.05), while there was no significant difference between two groups at each time point. The cholesterol in treatment group had a smooth decreasing, while it had an increasing trend in control group 3 months post-treatment. The HCY 3 months post-treatment in treatment group was significantly lower than pre-treatment and control group 1, 3 and 6 months post-treatment (P<0.05). The IMT 6 months post-treatment in treatment group was significantly lower than control gorup(P<0.05). Conclusion Ginkgo laminae combined with atorvastatin for reducing lipid, which could raise high density lipoprotein cholesterol and reduce cholesterol smoothly and lower IMT, with the effective protection on vessel. The blood homocysteine level decreases after taking Ginkgo laminae for three months, which also could improve impaired endothelial function induced by high level of HCY and slow down the process of atherosclerotic plaque.

Effect of Acupunctures Variable with Stages on Lumbar Intervertebral Dise Protrusion / 中国康复理论与实践

Objective To investigate the effect of acupunctures variable with stages on lumbar intervertebral dise protrusion (LIDP). Methods 98 LIDP patients in our hospital from October, 2014 to July, 2015 were randomly divided into control group (n=49) and observa-tion group (n=49) according to the sequence of first diagnosis time. The control group received routine acupuncture, and the observation group acupunctured at Ouch point and Huantiao point (GB30) with different acupuncture according to manifestations and courses. Modified Yang acupuncture was adopted in acute phase, triple acupuncture was used in remittent phase, and lateral needling was used in the recovery phase. They were both treated once a day, 7 days as a course for 3 courses with 2 days of interval. Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and clinical effects were assessed before and 1, 2, 3 courses after treatment. Results Both VAS and ODI scores im-proved after treatment (F>7.12, P4.43, P<0.05). The efficiency was higher in the observation group than in the control group (χ2=5.594, P<0.05). Conclusion Compared with normal acupuncture, the acupunctures variable with stages is more effective on LIDP than routine.

El infradesnivel del segmento ST que se presenta o se profundiza durante la fase de recuperación: su aporte a la utilidad clínica de la ergometría / Clinical Usefulness of Exercise-Induced ST-Segment Depression Occurring or Increasing during the Recovery Phase / Clinical Usefulness of Exercise-Induced ST-Segment Depression Occurring or Increasing during the Recovery Phase

Introducción No obstante la disponibilidad actual de estudios por imágenes que brindan una muy buena capacidad diagnóstica y de evaluación, la prueba ergométrica graduada (PEG) está reconocida como un estudio importante y continúa siendo el procedimiento más utilizado para la evaluación, el diagnóstico y la estratificación de riesgo de los pacientes con enfermedad arterial coronaria (EAC). Objetivos 1) Investigar el valor clínico de la presencia durante una ergometría del infradesnivel del segmento ST (infra-ST) significativo que aparece sólo durante la fase de recuperación o del que es dudoso durante la fase de ejercicio pero que se profundiza tornándose positivo durante la fase de recuperación de la PEG y compararlos con el infra-ST significativo que se presenta durante la fase activa de ejercicio. 2) Evaluar los datos clínicos, ergométricos y de la angiografía coronaria de los pacientes. Material y métodos Se analizaron los datos clínicos y ergométricos de 147 pacientes con PEG positiva por infra-ST significativo, que en 94 pacientes (GI) se presentó durante la fase de ejercicio, en 29 (GII) sólo en la fase de recuperación y en 24 (GIII) fue dudoso durante el ejercicio, pero se profundizó tornándose significativo en la fase de recuperación. En cada grupo se realizó una correlación entre los resultados de la PEG y los hallazgos de la coronariografía. Resultados Se diagnosticó EAC significativa en 78 pacientes del GI (82,9%), 22 del GII (75,8%) y 21 del GIII (87,5%) (p = 0,52). El GIII reunió los pacientes de edad más avanzada y con alta prevalencia de dislipidemia, antecedente de infarto previo y lesión de tres vasos y/o del tronco de la coronaria izquierda. El GII presentó el mayor número de pacientes asintomáticos, con lesión de un vaso y alta prevalencia de historia familiar de EAC. Conclusiones No se observaron diferencias estadísticas en el porcentaje de pacientes con EAC significativa entre los grupos. Los pacientes del GIII mostraron alta prevalencia de enfermedad coronaria extensa y grave. La evaluación correcta del infra-ST que aparece o se profundiza durante la fase de recuperación aumentó la información clínica que aporta una ergometría.

Background Despite the current availability of diagnostic image tests with excellent diagnostic and prognostic accuracy, exercise stress testing (EST) remains as the procedure most commonly used for the evaluation, diagnosis and risk stratification of patients with coronary artery disease (CAD). Objectives 1) To investigate the clinical usefulness of significant exercise-induced ST-segment depression (ST-d) occurring or increasing during the recovery phase of exercise stress test and to compare it with significant ST-segment depression presenting during the active phase of exercise; 2) to evaluate the clinical data and the information provided by EST and coronary angiography. Material and Methods Clinical and EST data from 147 patients with positive stress test were analyzed. All patients had significant ST-segment depression and were divided into three groups: GI, 94 patients with ST-d during exercise; GII, 29 patients with ST-d only during the recovery phase; and GIII, 24 patients with borderline ST-d during exercise which became significant during the recovery phase. The results of the EST were correlated with the coronary angiography findings in each group. Results A diagnosis of significant CAD was made in 78 patients in GI (82.9%), in 22 in GII (75.8%) and in 21 in GIII (87.5%),(p = 0.52). Patients in GIII were older, with high prevalence of dyslipemia, history of previous infarction and three-vessel and/or left main coronary artery disease. GII presented the higher number of asymptomatic patients with one-vessel disease and high prevalence of CAD. Conclusions There were no statistical differences in the percentage of patients with significant CAD among the groups. Patients in GIII had high prevalence of significant and severe CAD. A proper evaluation of ST-d occurring or becoming significant during the recovery phase provided additional clinical information to the results of the EST.

Executive dysfunction and influencing factors in convalescent patients with traumatic brain injury / 中华行为医学与脑科学杂志

Objective To explore and analyze the executive function of patients with traumatic brain injury in recovery phase and reveal its influential factors.Methods Behavioral Assessment of Dysexecutive Syndrome (BADS) was conducted in 104 patients with brain injury at 5 ～ 6 months after discharging and matched healthy comparison subjects in this study.Basic information in patients with the clinical data were collected by self-designed questionnaire to analyze the relevant factors.Results BADS findings showed that the individual scores and total standard scores of brain injury patients( 12.05 ± 2.54 ) were significantly lower than those of health population ( 19.02 ± 3.77 ) (P ＜ 0.05 ).Action program test, temporal judgment test, modified six elements test and total sub-standard scores ( 14.83 ±3.86)in junior high school education level and below group were significantly lower than that in high school and higher education group ( 17.67 ± 4.10 ).The individual scores and total standard scores ( 10.13 ± 3.86 )in heavier group were significantly lower than that in the lighter group ( 15.68 ± 4.10 ).The group without complication' action program test, key search test, zoo map test, modified six elements test were significantly lower than the group with complication.The BADS scores were related to education, illness condition,and complication (hypertension, hyperglykemia, hyperlipemia) (P＜0.05).Conclusion There is executive dysfunction in traumatic brain injury patients.The executive dysfunction is mainly correlated with education, illnesscondition and complication.Medical staff should provide pertinent intervention and treatment according to the above aspects, in order to obtain better effects of rehabilitation therapy .

Medical support in Recovery phase after an earthquake in Bam / 国際保健医療

A major earthquake in Bam, Iran, which occurred on 26th of December,2003, claimed more than 26,000 deaths and most of the medical facilities were destroyed or left inoperative.<br>Although many relief organizations left Bam after the initial stage of the disaster, the necessity of medical support continued with the condition of many victims still desperate. Therefore, medical assistance was provided by HuMA in the recovery phase, and four prefabricated buildings were donated to an Urban Health Center (UHC) for use as a clinic. Essential medical equipment was provided to emergency centers in Bam. In addition, surveillance study was conducted to investigate how environmental health conditions could be improved and effective assistance be given during the recovery phase of the disaster. From monitoring of onsite disaster relief in Bam, it is concluded that the donor agencies should make efforts to continue their activities not only in the acute phase but also in sub-acute and recovery phase and if necessary to cooperate among different agencies according to their capability. Furthermore, it is suggested that close cooperation between NGOs and government agencies would lead to much faster and much more effective disaster relief for victims.

Characteristics of QT Dispersion during Recovery Phase after Treadmill Exercise in Airlines Pilots

BACKGROUND: QT dispersion (QTD) represents the inhomogeneity of ventricular repolarization and has been suggested to predict ventricular arrhythmia in patients with coronary artery disease. The purpose of this article is to study the characteristics of QTD during recovery phase after maximal treadmill exercise in airlines pilots. METHODS: The study population included 45 healthy airlines pilots. QTpeak D (QTpD) was defined as the difference between maximum and minimum QTp interval measured on 12 lead ECG at single cardiac beat. Paired t test was used between QTpD at rest and QTpD during recovery phase after maximal treadmill exercise. RESULTS: The QTpD at early recovery phase (1 minute) after maxial treadmill exercise was significantly decreased compared to QTpD at rest (22+/-11 msec. vs 27+/-12 msec., P<0.05), but there was no significant difference between QTpD at rest and QTpD at late recovery phases (3 minutes, 5 minutes and 7 minutes). CONCLUSION: This finding suggests that antiarrhythmogenic effect is present at early recovery phase (1 minute) after maxial treadmill exercise in healthy airlines pilots.

Relationships between oxygen Uptake kinetics on recovery from maximal exercise and blood lactate, glucose and alanine metabolism / 体力科学

A study was performed to clarify the relationships between oxygen uptake (VO<SUB>2</SUB>) kinetics on recovery from incremental maximal exercise and blood lactate, glucose and alanine metabolism. Eight healthy males aged 21.6±3.3 years were studied. The incremental exercise test was performed using a modified version of Bruce's protocol until 30 min after exhaustion. The VO<SUB>2</SUB> responses on recovery were fitted by a two-component exponential model. Blood lactate concentration in the recovery phase was fitted by a bi-exponential time function to assess the velocity constant of the slowly decreasing component (γ2) expressing the rate of blood lactate removal. Both blood lactate and plasma alanine concentration were significantly increased from rest to maximal exercise, and were significantly decreased thereafter, but remained above resting values for 30 min after the maximal stage. Blood glucose concentration was significantly decreased following maximal exercise and returned to the pre-exercise value by 30 min after the maximal stage. Concentrations of plasma branched-chain amino acids (valine, leucine and isoleucine) were significantly decreased from the maximal stage until 30 min after exhaustion. The time constant of the slow component on recovery VO<SUB>2</SUB> [τVO<SUB>2</SUB> (s) ] was correlated with neither γ2 nor the degree of change in blood lactate from the maximal stage until 30 min after exhaustion (Δlactate) . However, τVO<SUB>2</SUB> (s) was significantly correlated with both Δ blood glucose and Δ alanine. In addition, Δ alanine was significantly correlated with Δ blood glucose. From these results, we conclude that oxygen uptake kinetics after exhaustive maximal exercise is related to glucose resynthesis through alanine metabolism, as compared with that from lactate metabolism.

Effects of degree of revascularization and graft patency on training ability in recovery phase after coronary artery bypass graft surgery / 体力科学

A study was conducted to clarify training ability in the recovery phase after coronary artery bypass graft surgery (CABG) . Thirty-one patients who underwent CABG were divided into four groups according to the degree of revascularization and graft patency: complete revascularization with graft patency (group A), complete revascularization without graft patency (group B), incomplete revascularization with graft patency (group C) and incomplete revascularization without graft patency (group D) . In all patients, exercise training was started one month after CABG and continued for one month. Treadmill exercise testing was performed at three points during the clinical course (one month before CABG, one month after CABG and at the end of exercise training) . Functional aerobic impairment (FAT), myocardial aerobic impairment (MAT), peripheral circulatory impairment (PCI) and electrocardiogram were measured at these points. The results obtained were as follows:<BR>1) FAI was improved significantly after CABG as compared with before CABG in groups A and C, and was also improved significantly after exercise training as compared with before training in groups A and C. The degree of improvement in FAI in group A was larger than in group C.<BR>2) Althought MAT was improved significantly after CABG as compared with before CABG in groups A and C, it was improved significantly after exercise training as compared with before training only in group A.<BR>3) PCI remained unchanged before and after CABG in all groups. However, it was improved significantly after training as compared with before training in groups A and C.<BR>4) The number of patients with a positive finding in the exercise test was reduced by CABG in all groups, and was decreased by training only in group A. However, CABG produced a significant decrease in groups A, B and C.<BR>In conclusion, the present findings suggest that while graft patency is probably a major factor, the degree of revascularization may play only a subsidiary role in determining trainability soon after CABG.