Carbon fibre reinforced plastic knee-ankle-foot orthosis with a partially flexible thigh cuff: a modification for comfort while sitting on a toilet seat.

At the request of a polio survivor, a partially flexible thigh cuff made of leather and canvas for a carbon KAFO was devised to allow the wearer to feel more comfortable while sitting on a toilet seat. The original, acrylic resin, thigh cuff was partially excised to make an opening (15x10 cm), which was stuffed with rubber sponge, and was sealed with leather and canvas. The opening's surround was vertically and horizontally reinforced with carbon fibres. This modification provided relief to the polio survivor from the discomfort previously experienced while sitting on a toilet seat, and satisfied her needs in daily life.

Clinical application of carbon fibre reinforced plastic leg orthosis for polio survivors and its advantages and disadvantages.

A prospective study was carried out on the clinical application and features of a carbon fibre reinforced plastic leg orthosis (carbon orthosis) for polio survivors. The subjects comprised 9 polio survivors, and 11 carbon knee-ankle-foot orthoses (KAFOs) were prescribed, fabricated, and checked out at the authors' post-polio clinic. Walking was classified based on the functional ambulatory category, and the features of walking with a carbon orthosis were self-evaluated by using a visual analogue scale. The period from modelling a cast to completion was 55 +/- 25 days; the weight of a carbon KAFO was 27.8% lighter than that of the ordinary KAFO; the standard carbon KAFO was 50% more expensive than the ordinary KAFO. The carbon KAFO remained undamaged for at least 2 years. It improved the scores in the functional ambulation categories, but there was no difference between walking with an ordinary and with a carbon KAFO. The self-evaluation of walking with a carbon KAFO revealed that the subjects using a carbon KAFO were satisfied with their carbon KAFO. The carbon KAFO is lightweight, durable, slim and smart, and is positively indicated for polio survivors.

Disorganization of honey-comb immunoreactive pattern of desmin and plectin in rat atrophic soleus muscle fiber induced by hindlimb suspension.

Immunoreactivity for desmin, plectin and alpha-actinin was investigated in rat atrophic soleus muscle fibers induced by hindlimb suspension between 1 and 4 weeks (hindlimb suspension group, HSG), and compared with that of the control group (CG). Some of the HSG for 4 weeks were allowed unrestricted cage activity for 2 weeks as the recovery group (RG). In the cross-sectioned muscle fibers of the CG, desmin and plectin showed honey-comb immunoreactive patterns extending throughout the sarcoplasm. Superimposed images by double immunofluorescence labeling showed overlapping of both immunoreactivities. In the longitudinally sectioned profiles, superimposed images of alpha-actinin and desmin were overlapped at the level of Z-discs. The focal disorganization of the above honeycomb immunoreactive patterns, followed by the reduction of the cross-sectional area (CSA) of atrophic soleus muscle fibers and the appearance of Z-streaming, uniquely arose in the HSG from the first week and extended throughout the sarcoplasm in proportion to the suspension period. Such honey-comb patterns of both desmin and plectin were already restored in the RG at 2 weeks, followed by the disappearance of Z-streaming, prior to the recovery of the CSA. These findings indicate that the disorganization of topological and structural relationships of desmin and plectin with Z-discs surrounding individual myofibrils is primarily evoked, which leads to Z-streaming of atrophic soleus muscle fibers, and that the restoration of the muscle activity results in an early arrangement recovery of desmin and plectin around myofibrils.

Hygiene problems of residual limb and silicone liners in transtibial amputees wearing the total surface bearing socket.

OBJECTIVE: To determine whether washing the residual limb and silicone liner reduces the associated skin problems in transtibial amputees who wear a total surface bearing (TSB) socket. DESIGN: Case series. SETTING: General community. PATIENTS: Eighty-three transtibial amputees (65 men, 18 women; mean age, 53.4 yr) in western Japan who used or had used a TSB socket with a silicone liner in the previous 5 years. INTERVENTION: Participants took a self-administered questionnaire that included items concerning their personal profile, daily life activities, period of TSB use (yr), hours of TSB use daily, washing frequency of the residual limb and silicone liner, the method of washing, and any associated hygiene problems. MAIN OUTCOME MEASURES: Logistic regression analysis was applied to examine factors related to hygiene problems. Predicted values include hygiene problems (perspiration, eruptions, itching, odor) and explanatory values include TSB use, daily life activity, and washing of limb and prosthetic. RESULTS: Fifty-five subjects washed the residual limb, and 44 subjects washed the silicone liner every day. Itching, perspiration, eruption, and odor were frequent hygiene problems. Perspiration was noted less by women, eruption more by older subjects, and itching and odor more by younger subjects. Washing the silicone liner every day was associated with fewer reports of skin eruption. CONCLUSION: Keeping the residual limb and silicone liner clean is important to reduce skin problems, but hygiene problems of the residual limb and silicone liner still remain to be resolved.

Moisture permeability of the total surface bearing prosthetic socket with a silicone liner: is it superior to the patella-tendon bearing prosthetic socket?

The purpose of this study was to examine the moisture permeability properties of materials used for total surface bearing (TSB) socket with a silicone liner, a combination of Silicone Suction Socket or Icelandic Roll-On Silicone Socket (ICEROSS) and an acrylic plastic sheet (Degaplast), patella-tendon bearing (PTB) socket, a combination of Pe-Lite and Degaplast, and wooden socket made of poplar. Moisture permeability of the socket materials was measured as the diminution of water in a container after 12 hours in a climatic chamber. Eight containers with their open, top side were uncovered (no material) or sealed with one of the socket materials; the experiment was repeated four times. One-way analysis of variance followed by Bonferroni's test was applied to examine the differences in moisture permeability. Moisture permeability levels were as follows: no material, 85.9 +/- 1.3 g; poplar, 4.3 +/- 0.4 g; Silicone Suction Socket, 1.1 +/- 0.2 g; ICEROSS, 1.0 +/- 0.2 g; Pe-Lite, 0.8 +/- 0.1 g; 3S + Degaplast, 0.8 +/- 0.1 g; ICEROSS + Degaplast, 0.8 +/- 0.2 g; and Pe-Lite + Degaplast, 0.8 +/- 0.1 g. There were significant differences between the uncovered container and the others, and between poplar and the others (P < 0.05). We concluded that the TSB socket with a silicone liner is not superior to the PTB socket with regard to moisture permeability, and that it is necessary to develop a new prosthetic socket that allows heat release and drainage of sweat.

Items regarded as important for satisfaction in daily life by elderly residents in Kitakyushu, Japan.

The objective of this study was to determine what items were important for satisfaction in the daily life of elderly Japanese people living at home. The subjects consisted of 996 persons living in Yahatanishi Ward, Kitakyushu City, Japan, two percent of residents aged 60 years or over, who were randomly selected from the official register of voters. A questionnaire was sent to the subjects to determine their profiles and asking them to select the five items they considered most important for satisfaction in daily life from 35 predetermined items. The items with a significant difference using a chi 2 test between age groups, gender, place of residence, living conditions and level of disability were analyzed by logistic regression analysis. The top five items selected were "good health" (86%), "social security and pension" (47%), "self-care independence" (45%), "marital satisfaction" (34%), and a "good relationship with relatives" (33%). Logistic regression analysis showed gender, age group, living conditions, and level of disability significantly affected the preference for selection of 12 items. Men or younger persons regarded "health" and a "good relationship with a spouse" as very important, whereas women, older persons, or persons with a disability considered "self-care independence" and the "ability to walk" as important. The items selected for satisfaction in daily life and the order of preference yield important information about rehabilitative and social welfare services for elderly persons living at home.

Workplace disability management in postpolio syndrome.

Postpolio syndrome (PPS) is generally defined as a clinical syndrome of new weakness, fatigue, and pain in individuals who have previously recovered from acute paralytic poliomyelitis. These new problems may lead to loss of employment as well as new deficits in instrumental activities in daily living (cleaning, washing, shopping, transportation, etc.), walking, climbing stairs, and personal assistance. We presented three cases of PPS with working disabilities in Japan, and stated the issues confronted with. Particularly at the workplace, PPS individuals need special supports from both rehabilitation medicine and occupational health services, including improved nutrition, achieving ideal body weight, regular and sensible exercise, frequent checkups, and modifying working conditions.

[Outcome of rehabilitation for traumatic brain injury in the UOEH Hospital].

We investigated the outcome after patients with traumatic brain injury (TBI) were treated in our hospital. Subjects were 51 patients with TBI (43 men, 8 women; mean age 34.9 +/- 20.3 yr), who had been admitted to the department of rehabilitation in our hospital between 1980 and 2000. Data were collected retrospectively from the medical records. Most injuries were due to motor vehicle accidents. The percentage of patients who suffered impaired cognitive and behavioral functions was 86.3%. The percentage of patients who were discharged to their homes was 70.6%, but none of them could return to work. Patients who were severely disabled in their daily activities or had cognitive and behavioral disturbances were difficult to discharge. We need to establish a comprehensive rehabilitation approach to cognitive and behavioral disturbances for patients with TBI.

A phase III randomized study comparing doxifluridine and 5-fluorouracil as supportive chemotherapy in advanced and recurrent gastric cancer.

We conducted a phase III randomized study to investigate effects of supportive chemotherapy with oral doxifluridine (group A, 75 patients) or 5-fluorouracil (group B, 75 patients) in advanced gastric cancer when intensive chemotherapy was not an option. Although there were no significant differences between the groups with regard to survival, hospital-free survival and time to progression, median values of 3 endpoints were superior in group A. Secondary analysis showed that group A patients with prior chemotherapy tended to have longer survival and hospital-free survival and significantly longer time to progression.

Factor structure of satisfaction in daily life of elderly residents in Kitakyushu.

The purpose of this study was to investigate what items elderly persons living at home consider important for satisfaction in daily life and what factor structure is obtained by a principal components analysis. Two percent of the residents 60 years old or over of Yahatanishi Ward, Kitakyushu, were randomly sampled as subjects. A questionnaire asking residents to select items considered important in daily life was sent by mail, and 722 responses (72.5%) were eligible for analysis. "Health", "social security and pension" and "self-care" were considered important in daily life with the highest selection rates. A five-factor solution for 25 items with a selection rate greater than 4.5% was obtained by an oblique rotated principal components analysis: "health and disability", "social environment and activity", "socio-economic condition", "emotional stability in marital and family life" and "social intercourse and companionship". These factors appeared to be the fundamental framework of the subjective domain of health-related quality of life of elderly persons living at home.

Gender-related differences in scores of the Barthel Index and Frenchay activities index in randomly sampled elderly persons living at home in Japan.

The purpose of this study was to examine for gender-related differences in activities of daily living (ADL) and lifestyle of elderly persons living at home, and to support our hypothesis that the gender-related difference in lifestyle of stroke patients derives from their lifestyle prior to the stroke. Participants were randomly sampled elderly persons living at home. Questionnaire sheets including subject profile, Self-Rating Barthel Index (disability index), and Self-Rating Frenchay Activities Index (activity index) were mailed and collected, and the data were analyzed with the t-test and General Linear Model (factorial model with interaction). A total of 752 subjects were recruited, and their average age was 67.1 years. No significant gender-related differences were evident in the disability index including self-care and mobility domains (t-test, P > 0.05). In contrast gender-related differences in the activity index were significant (t-test, P < 0.05) for three factors; gender, age group, and living conditions, and in a covariate disability index (GLM, P < 0.05). Because randomly selected elderly persons in this study exhibited a prominent gender-related difference in lifestyle, we believe the lifestyle difference in stroke patients that we have previously described derives primarily from their premorbid attitude to daily life.

Primary progressive aphasia presenting as conduction aphasia.

We report a case of a woman with primary progressive aphasia (PPA) who presented with conduction aphasia. A 60-year-old, right-handed, Japanese female suffering from progressive aphasia had difficulty in repeating words and phrases. She displayed phonemic paraphasias but had preserved comprehension and had no cognitive or behavior disorder for more than 6 years after the onset of the condition. She was able to continue to work successfully and to perform all her normal daily activities. T1-weighted magnetic resonance imaging revealed minute dilatation of the left inferior horn and sulci in the left hemisphere, and positron emission tomography revealed mild hypometabolism in the left supramarginal gyrus and its surrounding areas. Therefore, she was diagnosed as suffering from PPA presenting as conduction aphasia. We believe that the progressive conduction aphasia of the patient belongs to one of the fluent forms of PPA, and the ability to continue normal work along with the clinical portrayal of preserved memory and cognition skills may be features of a form of PPA presenting as conduction aphasia.

Sound lateralisation in patients with left or right cerebral hemispheric lesions: relation with unilateral visuospatial neglect.

OBJECTIVES: To localise the brain lesion that causes disturbances of sound lateralisation and to examine the correlation between such deficit and unilateral visuospatial neglect. METHOD: There were 29 patients with right brain damage, 15 patients with left brain damage, and 22 healthy controls, who had normal auditory and binaural thresholds. A device was used that delivered sound to the left and right ears with an interaural time difference using headphones. The amplitude (an index of ability to detect sound image shifts from the centre) and midpoint (an index of deviation of the interaural time difference range perceived as the centre) parameters of interaural time difference were analysed in each subject using 10 consecutive stable saw toothed waves. RESULTS: The amplitude of interaural time difference was significantly higher in patients with right brain damage than in controls. The midpoint of the interaural time difference was significantly more deviated in patients with right brain damage than in those with left brain damage and controls (p<0. 05). Patients with right brain damage with lesions affecting both the parietal lobe and auditory pathway showed a significantly higher amplitude and deviated midpoint than the controls, whereas right brain damage with involvement of only the parietal lobe showed a midpoint significantly deviated from the controls (p<0.05). Abnormal sound lateralisation correlated with unilateral visuospatial neglect (p<0.05). CONCLUSIONS: The right parietal lobe plays an important part in sound lateralisation. Sound lateralisation is also influenced by lesions of the right auditory pathway, although the effect of such lesions is less than that of the right parietal lobe. Disturbances of sound lateralisation correlate with unilateral visuospatial neglect.

Subjective evaluations and objective measurements of the ischial-ramal containment prosthesis.

We examined 12 transfemoral amputees, 6 using the IRC socket and 6 the QL socket, to confirm whether the ischial-ramal containment (IRC) socket is truly superior to the quadrilateral (QL) socket. In subjective evaluation, the IRC group was significantly better in the total score and in items of comfort, that is, to sit on a chair and lumbar lordosis at heel off (Mann-Whitney test, P < 0.05), better but not significant in the items of comfortable to wear, comfortable to go up and down stairs, and truncal sway during stance phase. By computed tomography, the femur of the IRC group was kept in a position significantly more medial than that of the QL group (Mann-Whitney test, P < 0.05); but no significant difference in gluteal medial muscle atrophy ratios between the two groups was found (Mann-Whitney test, P > 0.05). By X-ray, the stump of the IRC group was maintained significantly more adducted during one foot standing on the prosthesis (Mann-Whitney test, P < 0.05), but the lateral force ratio during mid-stance of the IRC group was smaller, but not significantly, than that of the QL group. Physiological cost index (PCI), an indirect simple method for evaluating oxygen consumption of gait, had no significant difference between the two groups (Mann-Whitney test, P > 0.05), and a multiple regression analysis revealed that the stump length ratio and lateral force ratio during mid-stance were significant explanatory variables for predicting PCI (adjusted R square: 0.87, F-value: 11.85, P < 0.05). The results of this study have revealed that the advantage of the IRC socket is a tender feeling of the stump, but that the metabolic efficiency is not superior to the QL socket at the most comfortable speed.

Health status and satisfaction of asymptomatic HIV-positive haemophiliacs in Kyushu, Japan.

The purpose of this study was to elucidate the effects of human immunodeficiency virus (HIV) on haemophiliacs with physical functional disabilities induced by haemophilia in Kyushu, Japan. The subjects were 38 adult haemophiliacs who were selected from 129 patients registered with the North Kyushu Haemophilia Centre. They were divided into 21 asymptomatic HIV-positive and 17 HIV-negative adult haemophiliacs. Coagulation factor levels, modified DePalma classification, Arthritis Impact Measurement Scale 2 (AIMS 2), and a satisfaction in daily life (SDL) questionnaire were used to investigate the clinical severity of their haemophilia and arthropathy, physical functional disabilities, and satisfaction. Although there were no significant differences in the objective assessments of health status between the HIV-positive and -negative haemophiliacs, the HIV-positive haemophiliacs were significantly more dissatisfied with their social activities and mood, according to AIMS 2, and with social intercourse, job, self-development, and social security and pension according to SDL assessment. These dissatisfactions were due to the effects of HIV, in addition to the physical functional disabilities that were caused by haemophilia. Dissatisfaction with social security and pension may be a specific feature in HIV-positive haemophiliacs in Japan resulting from the origin of HIV infection.

Gender differences in disability and lifestyle among community-dwelling elderly stroke patients in Kitakyushu, Japan.

OBJECTIVE: To examine whether there were differences in lifestyle and performance of activities of daily living (ADL) between men and women in a population of elderly stroke patients. DESIGN: Case-comparison study. MATERIAL AND METHODS: Sixty-eight men and 34 women who were elderly stroke patients living in the community with a spouse or family members were evaluated with the self-rating Barthel Index (SRBI), Frenchay Activities Index (FAI), Stroke Impairment Assessment Set (SIAS), Functional Independence Measure (FIM), and a pedometer for physical activity. Control subjects, 30 men and 30 women, were assessed with the FAI. RESULTS: Among the stroke subjects, there were no significant differences in age, SRBI, motor score of the SIAS, or physical activity between men and women; however, men had significantly lower values than did women for three FIM items and the total FIM score and for 6 FAI items and the total FAI score. Among control subjects, men had significantly lower values than did women for 7 FAI items and the total FAI score (Tukey's test, p < .05). CONCLUSION: Among elderly stroke patients, men received more support from family members in ADL performance and had less active lifestyles than did women, possibly because of cultural gender roles.

Muscle strength of trunk flexion-extension in post-stroke hemiplegic patients.

This study was undertaken to determine muscle strength of trunk flexion-extension in hemiplegic patients after stroke compared with that of normal controls. The design consisted of a nonrandomized control trial in a secondary care setting (a rehabilitation unit at a hospital facility). The subjects included 25 post-stroke male hemiplegic patients and 25 male healthy controls. The maximal peak torques of trunk flexion-extension at angular velocities of 0 degrees (isometric contraction), 60 degrees, 120 degrees, and 150 degrees/s were measured by using an isokinetic dynamometer (Cybex Trunk Extension-Flexion Unit, Cybex, Ronkonkoma, NY). Peak torque of trunk flexion and extension in hemiplegic patients was significantly smaller than that of healthy controls (P < 0.05), except isometric trunk flexion (P > 0.05). The weakness of trunk flexion-extension muscles in hemiplegic patients might be accounted for by the bilateral innervation from the motor cortex, the insufficient use of high threshold motor units, and disuse atrophy.

Total surface bearing below-knee prosthesis: advantages, disadvantages, and clinical implications.

OBJECTIVE: To investigate the total surface bearing (TSB) prosthesis for below-knee amputee patients and to determine its clinical indications. DESIGN: Case series. SETTING: University hospital and the Welfare Center for the Disabled. PATIENTS: Thirty-two subjects who could walk with the TSB prosthesis and had already used the patellar-tendon bearing (or Kondylen-Bettung Münster) socket. MAIN OUTCOME MEASURE: Subjective assessment of the TSB socket, consisting of an overall rating and ratings of 13 individual items, was performed, and results were analyzed with Fisher's exact test. RESULTS: Seventy-five percent of the subjects were satisfied overall with the TSB socket. Of the 13 items, comfort, ease to swing, pain, piston movement, tightness, skin irritation, appearance, and durability were regarded as good by more than 75% of the patients. Donning, perspiration, odor, and staining were regarded as poor by more than 20%. Items that were significantly related with overall satisfaction with the TSB socket were comfort, ease to swing, and piston movement, while donning was significantly related to dissatisfaction. CONCLUSION: The TSB socket is suitable for and preferred by many amputee subjects, but some problems remain to be solved.

Clinical evaluations of dorsiflexion assist controlled by spring ankle-foot orthosis for hemiplegic patients.

To examine the usefulness of Dorsiflexion Assist Controlled by Spring Ankle-Foot Orthoses (DACS-AFO), 5 hemiplegic patients in Brunnstrom's recovery stage IV were prescribed the DACS-AFO, after which their gait with the DACS-AFO was clinically evaluated. Clinical observation did not reveal that their gait with the DACS-AFO was better than that with an AFO which the patients usually used, except when one patient walked on a slope. No significant difference in 10 m walking time was found between when the DACS-AFO and shoehorn type AFO were used. Subjective evaluations by the patients indicated that the DACS-AFO was as good as a shoehorn type AFO in walking on flat and sloped surfaces, though its weight, noise, and appearance caused by the cylinder of the DACS-AFO were regarded as poor. In spite of the excellent biomechanical characteristics of the DACS-AFO, the patients did not adopt it. The subjects in this study had already walked well with their own shoehorn type AFO, and their selection may have been biased toward poor results. However, we did not conclude that the DACS-AFO is superior to the shoehorn type AFO for hemiplegic patients in the stage IV.

Effect of activities of daily living on fiber type atrophy of the vastus lateralis muscle in patients with joint disorders.

The histopathologic study was performed to elucidate whether the fiber type atrophy of the vastus lateralis muscle in patients with hip or knee joint disorders is related to the activities of daily living (ADL) or habitual physical activity. Subjects were 16 female patients, 52.4 +/- 16.0 yr of age (mean +/- standard deviation), who underwent a vastus lateralis muscle biopsy at the time of total hip or knee replacement. At the time of referral to the rehabilitation center, the Functional Independence Measure (FIM) motor score and habitual physical activity at home were evaluated, and the diameter and atrophy factor for each muscle fiber type were measured on the histopathologic preparations of the biopsied muscles. The data were analyzed using ttest, one-way analysis of variance (ANOVA), Kruskal-Wallis one-way ANOVA, Spearman's correlation coefficient, and partial correlation coefficient. The patients showed muscle fiber atrophy and small angular fibers, and the atrophy factor was significantly increased in type 1, 2A, and 2B fibers, in that order (one-way ANOVA, P < 0.05). The patterns of the fiber type atrophy, consisting of normal, type 2B atrophy, type 2AB atrophy, and type 1 and 2AB atrophy, had a significant relationship with the fiber type atrophy (Spearman's correlation coefficient; rho = 0.834, P < 0.001). The FIM motor score showed a significant correlation with the atrophy factor (r = -0.584, P < 0.05), and significant differences were recognized among the four patterns of the fiber type atrophy (Kruskal-Wallis one-way ANOVA, P < 0.05). In conclusion, the muscle atrophy and patterns of the fiber type atrophy of the vastus lateralis muscle in patients with joint disorders may be related to changes in the FIM motor score.