Crossing Obstacles of Different Heights in Hemiplegic Stroke Patients

OBJECTIVE: To evaluate the changes of gait patterns during crossing obstacles of different heights in hemiplegic stroke patients and to compare gait characteristics with those of healthy control subjects. METHOD: Subjects were 13 hemiplegic stroke patients and 9 age-matched healthy adults. Subjects stepped over obstacles with each height of 3, 8 and 13 cm. The three- dimensional gait analysis was performed. Temporospatial, kinematic and kinetic parameters were measured in both lead and trail limb. The pre- and post-obstacle distance, pre- and post-obstacle swing time and toe clearance were also measured. RESULTS: With increase in height of obstacles, ratio of single limb support time, angle of hip, knee flexion in swing phase and hip extensor moment increased in both lead and trail limbs. In the lead limb, post-obstacle distance and toe clearance also increased (p<0.05). Compared with control groups, the angle of knee flexion, hip extensor and hip flexor moment and pre- and post-obstacle distance decreased significantly in the lead limb of hemiplegic patients (p<0.05). In the trail limb of hemiplegic patients, the angle of hip flexion, hip flexor moment and post-obstacle distance decreased (p<0.05). CONCLUSION: Understanding strategies for adequate control and coordination of the swing limb during crossing obstacles may be the basis for the safe training of obstacle crossing in hemiplegic stroke patients.

Usefulness of the Oxygen Uptake Efficiency Slope in the Evaluation of Cardiorespiratory Fitness of the Stroke Patients

OBJECTIVE: To investigate the usefulness of the oxygen uptake efficiency slope (OUES) in the evaluation of cardiorespiratory fitness of the stroke patients. METHOD: 25 stroke patients who could walk independently were included in this syudy. The symptom-limited graded treadmill test was performed to assess cardiovascular fitness. During the test, minute ventilation (VE), oxygen consumption (VO2), carbon dioxide production (VCO2), respiratory exchange ratio (RER) and anaerobic threshold (AT) were measured through respiratory gas analysis. A linear relationship was established between the oxygen consumption and the logarithmic transformation of minute ventilation. From this linear relationship, we obtained a slope that represented the OUES. OUES values were obtained from data corresponding to 75% (OUES75), 90% (OUES90) and 100% (OUES100) of the exercise duration. RESULTS: The differences among OUES75, OUES90 and OUES100 groups were not statistically significant and these three groups were highly correlated to each other. Maximal oxygen consumption (VO2max) was positively correlated with OUES75 (r=0.723), OUES90 (r=0.762), OUES100 (r=0.809) and AT (r=0.696), respectively (p<0.01). CONCLUSION: OUES is considered to be the valuable submaximal index to evaluate the cardiorespiratory fitness of stroke patients who can not reach maximal exercise.

Bone Mineral Density in Men with Type 2 Diabetes Mellitus

OBJECTIVE: To investigate the association between type 2 diabetes mellitus and bone mineral density (BMD), the relationship between the duration of type 2 diabetes and BMD, and the effect of diabetic microangiopathies on BMD. METHOD: 52 men, aged 55~65 years, with type 2 diabetes and 52 men without diabetes were studied and matched by age and body mass index (BMI). The slit-lamp examinations and the nerve conduction studies were used for diagnosing diabetic retinopathies and diabetic peripheral polyneuropathies, respectively. The densitometric studies were carried out in the L1, L2, L3, L4 and total lumbar vertebra, the femoral necks, the trochanters, and total hips using a DEXA densitometer. RESULTS: Diabetic men had BMDs similar to those of the control group. There is no relationship between the duration of diabetes and BMD. BMDs at the trochanters in subjects with diabetic microangiopathies were reduced in comparison with those without diabetic microangiopathies (p<0.05). CONCLUSION: The densitometric studies may be helpful to diabetic men with microangiopathies, especially with other osteoporotic risks.