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The reaching motion to the back of the head with the hand is an important movement for daily living. The scores of upper limb function tests used in clinical practice alone are difficult to use as a reference when planning exercises for movement improvements. This cross-sectional study aimed to clarify in patients with mild hemiplegia the kinematic characteristics of paralyzed and non-paralyzed upper limbs reaching the occiput. Ten patients with post-stroke hemiplegia who attended the Department of Rehabilitation Medicine of the Jikei University Hospital and met the eligibility criteria were included. Reaching motion to the back of the head by the participants' paralyzed and non-paralyzed upper limbs was measured using three-dimensional motion analysis, and the motor time, joint angles, and angular velocities were calculated. Repeated measures multivariate analysis of covariance was performed on these data. After confirming the fit to the binomial logistic regression model, the cutoff values were calculated using receiver operating characteristic curves. Pattern identification using random forest clustering was performed to analyze the pattern of motor time and joint angles. The cutoff values for the movement until the hand reached the back of the head were 1.6 s for the motor time, 55° for the maximum shoulder joint flexion angle, and 145° for the maximum elbow joint flexion angle. The cutoff values for the movement from the back of the head to the hand being returned to its original position were 1.6 s for the motor time, 145° for the maximum elbow joint flexion angle, 53°/s for the maximum angular velocity of shoulder joint abduction, and 62°/s for the maximum angular velocity of elbow joint flexion. The numbers of clusters were three, four, and four for the outward non-paralyzed side, outward and return paralyzed side, and return non-paralyzed side, respectively. The findings obtained by this study can be used for practice planning in patients with mild hemiplegia who aim to improve the reaching motion to the occiput.

Abstract We investigated the coordinated activity patterns of muscles based on cosine tuning in the elderly during an isometric force exertion task. We also clarified whether these coordinated activity patterns contribute to the control of hip and knee joint torque and endpoint force as co-activation. Preferred direction (PD) of activity for each muscle in 10 young and 8 older males was calculated from the lower limb muscle activity during isometric force exertion task in various directions. The covariance of endpoint force (η) was calculated from the exerted force data using a force sensor. Relationship between PD and η was used to examine the effect of muscle co-activation on the control of endpoint force. Co-activation between rectus femoris and semitendinosus/biceps femoris increased with changes in muscle PD. Additionally, the η values were significantly low, suggesting that co-activation of multiple muscles may contribute to endpoint force exertion. The mechanism for cooperative muscle activity is determined by the cosine tuning of the PD of each muscle, which affects the generation of hip and knee joint torque and endpoint force exertion. Co-activation of each muscle’s PD changes with age, causing increased muscle co-activation to control torque and force. We demonstrated that co-activation in the elderly is a stabilizer of unsteady joints and a muscle control strategy for cooperative muscle activity.

Abstract Background Although the importance of kinematic evaluation of the sit-to-stand (STS) test of total knee arthroplasty (TKA) patients is clear, there have been no reports analyzing STS during the 30-s chair sit-up test (30 s-CST) with a focus on kinematic characteristics. This study aimed to demonstrate the clinical utility of kinematic analysis of STS during the 30 s-CST by classifying STS into subgroups based on kinematic parameters, and to determine whether differences in movement strategies are expressed as differences in clinical outcomes. Methods The subjects were all patients who underwent unilateral TKA due to osteoarthritis of the knee and were followed up for one year postoperatively. Forty-eight kinematic parameters were calculated using markerless motion capture by cutting STS in the 30 s-CST. The principal components of the kinematic parameters were extracted and grouped by kinematic characteristics based on the principal component scores. Clinical significance was examined by testing whether differences in patient-reported outcome measures (PROMs) were observed. Results Five principal components were extracted from the 48 kinematic parameters of STS and classified into three subgroups (SGs) according to their kinematic characteristics. It was suggested that SG2, using a kinematic strategy similar to the momentum transfer strategy shown in previous studies, performed better in PROMs and, in particular, may be associated with achieving a “forgotten joint”, which is considered the ultimate goal after TKA. Conclusions Clinical outcomes differed according to kinematic strategies used STS, suggesting that kinematic analysis of STS in 30 s-CST may be useful in clinical practice. Trial registration This study was approved by the Medical Ethical Committee of the Tokyo Women’s Medical University (approval number: 5628 on May 21, 2021).

For clinicians to provide more efficient early mobilization in patients with acute stroke, they must quantitatively evaluate the motion characteristics of the patients. To measure the motion in the acute phase, it is necessary to prevent physical interference between the measurement and medical equipment. This study classified abnormal muscle synergies during sit-to-stand motion in patients with acute stroke by using small, wirelessly operable, noninvasive surface electromyography devices. Four patients with acute stroke and four healthy adults performed a six-directional isometric contraction task and a sit-to-stand motion task. A nonnegative matrix factorization algorithm was applied to the muscle activity data to extract the muscle synergies. Hierarchical cluster analysis was used to classify these synergies. The results suggest that sit-to-stand motion characteristics according to the severity of effects in patients with acute stroke can be quantitatively classified by muscle synergy analysis. The spatial structure of muscle synergies of patients was classified into different clusters from that of the healthy adults. The abnormal muscle synergy in patients with severe paresis is considered severe in that it cannot be modulated according to the task. The muscle synergies in patients with moderate paresis were modulated in the sit-to-stand motion to compensate for extensor muscle weakness. Such abnormal muscle synergy in the sit-to-stand motion is useful as a reference for motion practice, especially for early mobilization after the onset of a stroke. In addition, the results verify that the early to late stages of recovery can be consistently evaluated with this small, wireless noninvasive electromyography device.

Summary: Objective: Abnormal load stress caused by joint instability has been reported to be one of the factors responsible for the development of osteoarthritis (OA). However, few studies have investigated the efficacy of exercise therapy for patients with knee instability-induced OA, and there are no specific treatment guidelines or effects for this form of OA. Therefore, the purpose of this study was to examine the effect of exercise treatments for joint instability in patients with knee OA by a systematic review. Design: Systematic review. Results: Searches in three databases, PubMed, Cochrane, and the Physiotherapy Evidence Database, yielded 14 articles that were scrutinized, and 6 articles that met the inclusion criteria were selected. Conclusions: Exercise therapy focusing on joint instability, including muscle maintenance and strength training, and specific training targeting knee instability have no additional beneficial effects on knee joint instability. However, because of the benefits of treatment protocols based on patient attributes in exercise treatment focused on joint instability, it is necessary to investigate the effects in more detail in the future.

The purpose of this study was to determine the clinical effects of a training robot that induced eccentric tibialis anterior muscle contraction by controlling the strength and speed. The speed and the strength are controlled simultaneously by introducing robot training with two different feedbacks: velocity feedback in the robot controller and force bio-feedback based on force visualization. By performing quantitative eccentric contraction training, it is expected that the fall risk reduces owing to the improved muscle function. Evaluation of 11 elderly participants with months training period was conducted through a cross-over comparison test. The results of timed up and go (TUG) tests and 5 m walking tests were compared. The intergroup comparison was done using the Kruskal-Wallis test. The results of cross-over test indicated no significant difference between the 5-m walking time measured after the training and control phases. However, there was a trend toward improvement, and a significant difference was observed between the training and control phases in all subjects.

Gastric neuroendocrine carcinomas are rare and have a poor prognosis, and the diagnostic criteria for this disease have recently changed. We herein report a case of sporadic gastric neuroendocrine carcinoma. A 75-year-old man was referred to our hospital with epigastric pain. Endoscopic examination revealed a localized ulcerative lesion (diameter, 4 cm) at the upper stomach. The diagnosis on biopsy was neuroendocrine carcinoma. Total gastrectomy with D2 lymphadenectomy, splenectomy, and cholecystectomy was performed. Pathologically, the tumor infiltrated the subserosal layer, and 6/49 lymph nodes were involved. The tumor was uniform in shape and arranged in a rosette-like structure to form solid nests, with medium-sized, round-to-cuboid-shaped tumor cells and intense mitosis 46/10 HPF. It was positive for synaptophysin and chromogranin A, and the Ki-67 labeling index was 70–80%. The diagnosis of neuroendocrine carcinoma was made according to the WHO 2010 criteria. The patient was followed up for three years without recurrence.