No Impact of Stochastic Galvanic Vestibular Stimulation on Arterial Pressure and Heart Rate Variability in the Elderly Population.

OBJECTIVE: Noisy galvanic vestibular stimulation (nGVS) is often used to improve postural stability in disorders, such as neurorehabilitation montage. For the safe use of nGVS, we investigated whether arterial pressure (AP) and heart rate vary during static supine and slow whole-body tilt with random nGVS (0.4 mA, 0.1-640 Hz, gaussian distribution) in a healthy elderly population. METHODS: This study was conducted with a double-blind, sham-controlled, cross-over design. Seventeen healthy older adults were recruited. They were asked to maintain a static supine position on a bed for 10 min, and the bed was tilted up (TU) to 70 degrees within 30 s. After maintaining this position for 3 min, the bed was passively tilted down (TD) within 30 s. Real-nGVS or sham-nGVS was applied from 4 to 15 min. The time course of mean arterial pressure (MAP) and RR interval variability (RRIV) were analyzed to estimate the autonomic nervous activity. RESULT: nGVS and/or time, including pre-/post-event (nGVS-start, TU, and TD), had no impact on MAP and RRIV-related parameters. Further, there was no evidence supporting the argument that nGVS induces pain, vertigo/dizziness, and uncomfortable feeling. CONCLUSION: nGVS may not affect the AP and RRIV during static position and whole-body tilting or cause pain, vertigo/dizziness, and discomfort in the elderly.

Prediction of destination at discharge from a comprehensive rehabilitation hospital using the home care score.

[Purpose] This study investigated whether it is possible to predict return to home at discharge from a rehabilitation hospital in Japan using the home care score of patients with cerebrovascular or osteoarticular disease and low activities of daily living at admission. [Subjects and Methods] The home care score and functional independent measurement were determined for 226 patients at admission and at discharge from five hospitals, and receiver operating characteristic analyses were conducted. [Results] The home care score cutoff point for the prediction of return to home at admission and at discharge was 11, and the area under the curve was more than 0.8. The area under the curve of the home care score was 0.77 for patients with low activities of daily living and within this group, the probability of return to home was approximately 50%, as predicted by the functional independent measurement. The home care score increased after receiving intervention at a rehabilitation hospital. [Conclusion] The home care score is useful for the prediction of return to home from a rehabilitation hospital, although prediction using the functional independent measurement is difficult for patients with low activities of daily living. Moreover, comprehensive interventions provided by the rehabilitation hospitals improve the ability to provide home care of the patient's family, which is assessed by the home care score.

Prediction of Advisability of Returning Home Using the Home Care Score.

Purpose. The aim of this study was to assess whether the home care score (HCS), which was developed by the Ministry of Health and Welfare in Japan in 1992, is useful for the prediction of advisability of home care. Methods. Subjects living at home and in assisted-living facilities were analyzed. Binominal logistic regression analyses, using age, sex, the functional independence measure score, and the HCS, along with receiver operating characteristic curve analyses, were conducted. Findings/Conclusions. Only HCS was selected for the regression equation. Receiver operating characteristic curve analysis revealed that the area under the curve (0.9), sensitivity (0.82), specificity (0.83), and positive predictive value (0.84) for HCS were higher than those for the functional independence measure, indicating that the HCS is a powerful predictor for advisability of home care. Clinical Relevance. Comprehensive measurements of the condition of provided care and the activities of daily living of the subjects, which are included in the HCS, are required for the prediction of advisability of home care.

Effect of cerebellar transcranial magnetic stimulation on soleus Ia presynaptic and reciprocal inhibition.

Previously, we reported that cerebellar transcranial magnetic stimulation (C-TMS) facilitates spinal motoneuronal excitability in resting humans. In this study, we aimed to characterize the descending pathway that is responsible for the C-TMS-associated cerebellar spinal facilitation. We evaluated the effect of C-TMS on ipsilateral soleus Ia presynaptic inhibition (PSI) and reciprocal inhibition (RI) because the vestibulospinal and reticulospinal tracts project from the cerebellum to mediate spinal motoneurons via interneurons associated with PSI. PSI and RI were measured with a soleus H-reflex test following operant conditioning using electrical stimulation of the common peroneal nerve. C-TMS was delivered before test tibial nerve stimulation with conditioning-test interstimulus intervals of 110 ms. C-TMS did not generate motor-evoked potentials, and it did not increase electromyography activity in the ipsilateral soleus muscle, indicating that C-TMS does not directly activate the corticospinal tract and motoneurons. However, C-TMS facilitated the ipsilateral soleus H-reflex and reduced the amount of soleus Ia PSI, but not RI. These findings indicate that C-TMS may facilitate the excitability of the spinal motoneuron pool via the vestibulospinal or reticulospinal tracts associated with PSI. Cerebellar spinal facilitation may be useful for assessing the functional connectivity of the cerebellum and vestibular nuclei or reticular formation.

Task dependency of the long-latency facilitatory effect on the soleus H-reflex by cerebellar transcranial magnetic stimulation.

We investigated whether cerebellar transcranial magnetic stimulation (C-TMS) facilitates the excitability of the ipsilateral soleus motoneuron pool in resting humans, and whether the facilitation is modulated by a task that promotes cerebellar activity. A test tibial nerve stimulus evoking the H-reflex from the right soleus muscle was delivered before or after conditioning C-TMS in prone individuals. The amplitude of the H-reflex was significantly increased at conditioning-test interstimulus intervals of 110, 120, and 130 ms. Furthermore, we revealed that this facilitation effect was inhibited while the individuals tapped their right index finger. These findings indicate that C-TMS facilitates spinal motoneuronal excitability with an ∼100 ms latency in resting humans, and that this cerebellar spinal facilitation is modulated by a task that might increase cerebellar activity. Cerebellar spinal facilitation could thus be useful for assessing the excitability of the cerebellum, or the cerebellar output to spinal motoneurons.

Revision of the predictive method improves precision in the prediction of stroke outcomes for patients admitted to rehabilitation hospitals.

[Purpose] The purpose of this study was to confirm the accuracy of a revised method for predicting the Functional Independence Measure (FIM) at discharge when stroke patients are first admitted to a rehabilitation hospital. [Subjects and Methods] The predictive equation with logarithmic trend line was calculated based on the total score of the FIM at admission and discharge in 93 patients with cerebral infarction (CI) and 60 patients with intracerebral hemorrhage (ICH). In other patients with CI or ICH (validation group), the differences between the actual FIM and the predicted FIM at discharge calculated by the CI or ICH equation and the combined (CI + ICH) equation, as well as by the CI or ICH equation and combined equation used in a previous study, were calculated. [Results] The multiple correlation coefficients of the CI equation, ICH equation, and combined equation were 0.87, 0.71, and 0.8. The residual of the actual FIM and predicted FIM at discharge calculated by the CI equation was the smallest in the CI validation group. In the ICH validation group, the residual calculated for ICH patients alone was smaller than that calculated by the previous ICH equation. [Conclusion] This easy-to-use method using a new equation for prediction was more precise than the previous equation. Therefore, we should revise the equation for predicting stroke patient outcome strata according to data from within the governing medical administration system.

The development of a Tai Chi exercise regimen for the prevention of conditions requiring long-term care in Japan.

This study was to examine an effect of such an exercise program on preventing conditions requiring long-term care in the Japanese frail elderly who participated in a Tai Chi Yuttari-exercise program. The first-intervention group underwent an intervention program by participating in a Tai Chi Yuttari-exercise session once a week for 3 months. Each session lasted 90 min including a break time. Moreover, the subjects received a video recording of the exercise, and instructions to carry out the exercise at home. The same program was administered to the second-intervention group. Physical function improved significantly in the first-intervention group, with single-leg balance (SLB) increasing, and trunk anteflexion increasing after the intervention program. Furthermore, the total score of the Motor Fitness Scale (MFS) improved significantly. On the other hand, mono- and multi-variate analyses showed no significant differences observed in the second-intervention group during the study period. A careful interpretation of the results suggests that Tai Chi Yuttari-exercise improves physical function and ability for frail elderly individuals and could reduce the need for long-term care.

A nine-year clinical case study of a resin-bonded fixed partial denture seated on the maxillary anterior teeth.

PATIENT: This report describes the longevity of a resin-bonded fixed partial denture (RBFPD). This denture was seated on the maxillary anterior teeth with minimal tooth preparation. The RBFPD was cast from a silver-palladium alloy (Castwell M.C. 12), and the pontic was veneered with an indirect composite material (Estenia). The retainers were primed with a metal conditioner (V-Primer) and seated with a tri-n-butylborane initiated adhesive resin (Super-Bond C&B). After an observation period of eight years, a fracture occurred in the incisal edge of the central incisor abutment. The fractured area was restored with light-polymerizing composite resin and the anterior guidance was re-adjusted. DISCUSSION: RBFPD abutment teeth with deep vertical overlap should be carefully prepared to avoid abutment tooth fracture. CONCLUSION: The clinical performance of the RBFPD made from a silver-palladium-copper-gold alloy was sufficient when seated with tri-n-butylborane initiated adhesive resin after surface modification using vinyl-thiol primer. CLINICAL SIGNIFICANCE: The use of vinyl-thiol primer and tri-n-butylborane initiated adhesive resin is a clinically reliable bonding system for seating resin-bonded fixed partial denture (RBFPD) made from a silver-palladium-copper-gold alloy. The RBFPD, based on a reliable bonding system, can clinically function for a long time, even if the vertical overlap of the abutment teeth is excessive.

Comparative evaluation of the breaking strength of a simple mobile mandibular advancement splint.

Mandibular advancement splints (MASs) are used to advance the mandible forward in patients with sleep-disordered breathing. The conventional rigid MAS restricts the movement of the mandible, and this immobility sometimes produces discomfort, including temporomandibular disorders. A simple method for fabricating a mobile MAS was devised, using a connector made from a polyethylene toothed belt, with the intention of making the MAS more comfortable. The experimental connector is easily constructed, inexpensive, and small enough for use as an intraoral MAS. To evaluate durability, the axial and diagonal tensile breaking strengths of the MAS, using high- or low-density polyethylene (HDPE or LDPE) lateral toothed belts, were compared with those of a conventional mobile MAS (Silensor). The values were compared by factorial analysis of variances and post hoc Scheffe's S multiple comparison intervals, with the value of statistical significance set at alpha = 0.05. In addition, the experimental LDPE connectors were clinically tested in 30 patients (23 males and 7 females aged 19-71 years) and evaluated. Compared with the Silensor, the experimental MAS exhibited sufficient breaking strength, especially when a diagonal tensile load was applied to mimic mandibular lateral translation. When examining the clinical evaluation between 3 and 4 months after insertion, no damage or failure was observed. The experimental connecting system may have clinical applications. To make the connector stronger for clinical use, HDPE should be used.

Application of a pre-impregnated fiber-reinforced composite in the fabrication of an indirect dowel-core.

The root canal space prepared for a foundation restoration is often elliptic or too large, and an unintentionally prepared undercut is sometimes detected. This article presents a dental laboratory technique to reconstruct an endodontically treated tooth using a pre-impregnated fiber-reinforced composite (FRC) system instead of a conventional fiber post. Particular attention was paid to increase the volume of the fiber in the root canal, and care was taken to achieve adequate primary laboratory polymerization of the matrix monomer. This simple technique is useful in the fabrication of an FRC dowel core with increased fiber content.

International telephone code used for citizenship identification in a denture.

This case report describes a simple method for identifying the citizenship of a denture wearer by marking the telephone country code number inside the denture base. A wax pattern for the denture framework was prepared on the refractory cast. A piece of embossing tape, containing the country code (81, Japan), Japanese prefectural code, and abbreviation of the dental clinic where the denture was fabricated, was placed on the metal framework. A titanium-aluminum-niobium (Ti-6Al-7Nb) alloy was cast in the mold, and the denture was then fabricated by the conventional method. The casting satisfactorily reproduced the embossed letters, and the plate was identifiable through the gingiva-colored acrylic denture base resin. Since an embossed metal plate integrated with the skeleton is embedded in the denture base resin material, the current denture marking technique serves as a simple procedure for insertion of an undegradable denture identification mark which makes it possible to identify the nationality of the denture wearer.

[Team communication needed in treatment for fixed prosthesis. 2) Opinion from dental technician's standpoint].

The fabrication of a fixed prosthesis is influenced by the communication between the dentist and the laboratory technician. Especially for tooth-colored restoration of anterior teeth, the laboratory technician has the difficult task of understanding the shade selected by the dentist and reproducing it in the final restoration. Conventional shade analysis techniques using the Vita shade guide often result in subjective analysis and a resultant miscommunication of color. Over the years, many different techniques including picture-taking, drawing of diagrams, and using multiple shade guides have been formulated to help overcome this problem. Recently, digital shade analysis systems have been designed to eliminate the subjectivity of color analysis and provide precise information for laboratory buildup and fabrication. However, even these techniques have not completely erased the difficulties involved in communicating the choice of the proper shade for tooth-colored restoration. Many dentists are only familiar with techniques they were taught in dental school and/or their residency program, and they are unaware of other, superior methods that can be used. This review introduces various shade analysis systems that can be performed in dental clinical practice. Further, it highlights the importance of communication between the dentist, technician, and patient for the fabrication and delivery of aesthetic restorations.

Use of a light-polymerized composite removable partial denture base for a patient hypersensitive to poly(methyl methacrylate), polysulfone, and polycarbonate: a clinical report.

This article describes a light-polymerized composite denture base used for a patient with hypersensitivity to poly(methyl methacrylate) (PMMA), polysulfone (PSF), and polycarbonate (PC). A urethane-dimethacrylate (UDMA) composite was used as an alternative to fabricate both the denture base and the custom artificial teeth. Immediately after placing the new prosthesis, allergic symptoms disappeared from the patient's mucous membrane. The denture has functioned satisfactorily for more than 2.5 years without recurrence of the hypersensitivity.

Effect of noble metal adhesive systems on bonding between an indirect composite material and a gold alloy.

In this study, the bond strength between an indirect composite and a gold alloy was determined for the purpose of evaluating noble metal bonding systems. A single liquid primer designed for conditioning noble metal alloys (Infis Opaque Primer) and tri-n-butylborane-initiated adhesive resins (Super-Bond C & B), with or without the powder component, were assessed. Cast gold alloy disks (Casting Gold type IV) were air-abraded with alumina, followed by six surface preparations, and were then bonded with a light-activated composite material (New Metacolor Infis). Shear testing was performed both before and after thermocycling for evaluation of bond durability. The results showed that three primed groups improved post-thermocycling bond strengths compared to each of the corresponding unprimed groups (P < 0.01). The bond strength was reduced for all six groups by the application of thermocycling (P < 0.01). After thermocycling, the group primed with the Infis Opaque Primer material and bonded with the Super-Bond C & B resin exhibited the greatest bond strength (23.4 MPa). The Infis Opaque Primer and Super-Bond bonding system increased the post-thermocycling bond strength of the control group by a factor of approximately ten. This simple technique is applicable in the fabrication of composite veneered restorations and cone-telescope dentures.

[Appropriate outcome measures for evaluating change in activities of daily living of elderly residents].

PURPOSE: To identify functional dimensions related to changes in activities of daily living (ADL) and appropriate outcome measures for evaluating change in ADL of residents in a health care home for the elderly. SUBJECTS AND METHODS: The subjects were 123 residents living for three months or more in a health care home for the elderly in Osaka Prefecture. ADL on admission and three months these after were evaluated using four standardized outcome measures: ADL criteria for disabled elderly people developed by the Ministry of Health and Welfare (ADL criteria), the Barthel Index (BI), the Functional Independence Measure (FIM), and the Office of Population Censuses and Surveys (OPCS) scale. ResponsivenesS was also determined with the same four measures. The subjects were divided into two groups according to the frequency of functional training: twice or more and once or less per week. Appropriateness of the outcome measures was determined by examining score distributions and floor and ceiling effects, and by correlating changes in scores with frequency of functional training. RESULTS: The floor effect of the FIM was the smallest among the four outcome measures. The average FIM score on admission was significantly higher than that three months these after (70.7 +/- 30.8 and 71.6 +/- 30.6, respectively P < .05). In terms of funcTional dimensions of the BI, FIM and OPCS measures, the average FIM scores for transfer, walking, and stairs on admission were significantly higher than three months after admission (4.6 +/- 1.8 and 4.8 +/- 1.7 for transfer, 3.8 +/- 2.3 and 4.0 +/- 2.2 for walking, 3.0 +/- 2.1 and 3.2 +/- 2.1 for stairs, respectively, P < .05). Total FIM scores for the same three dimensions were the most responsive among the four outcome measures. Furthermore, when improvement in ADL was evaluated in terms of changes in total scores for the three FIM functional dimensions, those who received functional training twice or more per week showed a significantly higher rate of improvement in ADL than those who received functional training less frequently. CONCLUSION: FIM was found to be the most appropriate ADL measurement for evaluating changes in ADL of elderly residents. Regarding functional dimensions, locomotion in terms of transfer, walking and stairs was the most responsive. These findings indicate that the FIM functional dimension of locomotion is the most suitable for evaluating changes in ADL of elderly residents.