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The present study investigated the factors contributing to the loss of upper and lower extremity muscle mass in three elderly stroke patients with right hemiplegia in whom our rehabilitation program could not be performed at １‐２ weeks after onset. The results revealed common factors such as prolonged accurate microinjection of hypotensive agents, severe hemiplegia（Brunnstrom stage I or Ⅱ）, diarrhea and delayed initiation of tube feeding at ３ to ８ days after onset. With regard to individual differences, while all patients were recovering in bed, the degree of decrease in muscle mass varied among patients because they moved their extremities differently.

The present study measured lower extremity muscle mass using DXA （Dual energy X-ray Absorptiometry） in order to verify the effectiveness of intervention with a series of movements, including lying hip raise exercise with bent knees pointing upwards, among bedridden patients with post-stroke hemiplegia in the acute post-stroke period. Subjects in the intervention group were required to perform １０ repetitions of a series of back-lying exercises once a day with researchers, in addition to the exercises performed by those in a control group. The first measurement of muscle mass was conducted at three to five days after onset, and the second measurement was conducted seven days after the first. Muscle mass in the lower extremities was reduced by approximately ６００g （decrease rate ： ９％）on the paralyzed side and by ２８０g on the non-paralyzed side（decrease rate： ５％）in one week in the Brunnstrom stage ≤ II subgroup（site of measurement : lower extremities） （n＝８） of the control group （n＝２３）. The decrease in muscle mass in the Brunnstrom stage ≤ II subgroup （n＝４） of the intervention group （n＝１５） was approximately ２６０g on the paralyzed side （decrease rate ： ５％） and approximately ２８０g （decrease rate ： ５％）on the non-paralyzed side. Thus, muscle mass decreased on both sides, and this occurred regardless of degree of paralysis. Comparison of the Brunnstrom stage ≥ III subgroups between the control and intervention groups also confirmed that the decease in muscle mass was smaller in the latter group. Thus, it was confirmed that back-lying exercises combining lower extremity movements, including hip raises with bent knees pointing upwards, prevented the decrease in lower extremity muscle mass on the paralyzed side in post-stroke patients. The present study also suggests that these exercise movements can be applied to preventive care for bedridden patients with other severe diseases.

The present study analyzed１６patients who were bedridden for one week immediately after onset of post-stroke hemiplegia. We used DXA（dual energy X-ray absorptiometry）to determine changes in muscle mass in the lower extremities on both paralyzed and non-paralyzed sides. The first measurement was conducted ３ to ５ days after the onset, and the second measurement was conducted ７ days after the first. Muscle mass in the lower extremities was reduced by approximately ６００g （９％） on the paralyzed side with and by ２００g on the non-paralyzed side （３％） in the Brunnstrom stage≤II group （n＝５）. Although the decrease of muscle mass in the Brunnstrom stage≥III group（n＝１１, relatively slight degree of functional motion impairment）was not significant, a decrease of approximately ３００g （decrease rate ： ５％）was observed on the paralyzed side and approximately １００g （decrease rate ： １．５％）was seen on the non-paralyzed side. Hence, muscle mass declined on both sides, and this occurred regardless of degree of paralysis. The findings suggested that conventional range of motion exercises, functional position maintenance, and postural changes are inadequate to prevent disuse muscle atrophy in post-stroke patients ; thus, it is necessary to develop a new rehabilitation program which adopts different exercises such as trunk motion, even for patients in the acute stage after stoke onset.

In order to verify the accuracy of the thickness of the rectus femoris muscle and overlying subcutaneous fat as assessed by ultrasound, experiments were conducted on １０ healthy subjects aged over ３０ years to assess the following： １） concordance of measurements made by two different observers； ２） concordance of repeated measurements made by the same observer ; and ３） concordance of repeated measurements made by the same observer with and without an imaging aid（ultrasound gel block）. Between two observers with varying experience in ultrasound, no significant difference in measured muscle thickness was observed ; however, there was a significant difference in subcutaneous fat thickness. When measurements were made by the same observer on two separate days, a significant positive correlation was evident for muscle and subcutaneous fat thickness between the first and second tests. While use of the imaging aid was associated with higher concordance of measurements between the first and second tests, the measurements themselves were affected. Although ultrasonic measurement of tissue thickness requires further investigation to minimize intra-observer error and examine correlations with other imaging techniques, the accuracy of the measurements in the present study suggests that clinical application may be possible.