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[Purpose] To evaluate the effect of bilateral lower limb strengthening designed to improve balance and walking in stroke patients. [Subjects and Methods] Twenty hemiparetic stroke patients were divided into two groups: a unilateral therapy group (UTG) (n=10) and a bilateral therapy group (BTG) (n=10). The UTG completed strength training only in the paretic lower limb. The BTG completed strength training in the paretic and non-paretic lower limbs. Assessment tools included the functional reach test (FRT), the Berg balance scale (BBS), the timed up and go (TUG) test, and a 10-meter walk test (10MWT). [Results] In both groups, the lower limb strengthening exercise for balance and walking significantly improved the FRT, BBS, TUG, and 10MWT scores. Compared with UTG, the BTG attained significantly improved FRT and BBS scores. [Conclusion] Bilateral therapy using this lower limb strengthening exercise effectively promotes balance in hemiparetic stroke patients.

Neural reorganization for movement therapy after a stroke is thought to be an important mechanism that facilitates motor recovery. However, there is a lack of evidence for the effectiveness of exercise programs in improving the lower limbs.We investigated the immediate effect of isolating the paretic limb using different foot positions ((i) foot parallel; both feet parallel, (ii) foot asymmetry; paretic foot backward by 10 cm, and (iii) foot lifting; nonparetic foot lifting by normalization to 25% of knee height) on weight-bearing distribution and electromyography (EMG) of the thigh muscle during squats.In total, 20 patients with hemiplegia and 16 healthy subjects randomly performed three squat conditions in which the knee joint was flexed to 30°. Weight distribution was measured using the BioRescue system. Muscle activity was measured using a surface EMG system.Patients with hemiplegia exhibited significantly decreased weight bearing on the paretic foot at 0° and 30° knee flexion compared with the nondominant foot of a healthy subject. The muscle activity of the quadriceps was significantly lower in patients with hemiplegia compared to healthy subjects. Weight bearing and EMG activity of the quadriceps femoris on the paretic or nondominant side significantly increased during a knee flexion of 30° with under the foot asymmetry and foot lifting positions compared with the parallel foot position.Isolating the paretic limb using the asymmetric foot positions and lifting of the foot during squats might help patients with hemiplegia to improve weight-bearing and achieve greater activation of the quadriceps muscle in the paretic limb.

Spasticity is an important barrier that can hinder the restoration of function in stroke patients. Although several studies have attempted to elucidate the relationship between brain lesions and spasticity, the effects of specific brain lesions on the development of spasticity remain unclear. Thus, the present study investigated the effects of stroke lesions on spasticity in stroke patients. The present retrospective longitudinal observational study assessed 45 stroke patients using the modified Ashworth Scale to measure muscle spasticity. Each patient was assessed four times: initially (within 2 weeks of stroke) and at 1, 3, and 6 months after the onset of stroke. Brain lesions were analyzed using voxel-based lesion symptom mapping (VLSM) with magnetic resonance imaging images. Spasticity developed to a certain degree within 3 months in most stroke patients with spasticity. The VLSM method with non-parametric mapping revealed that lesions in the superior corona radiata, posterior limb of the internal capsule, posterior corona radiata, thalamus, putamen, premotor cortex, and insula were associated with the development of upper-limb spasticity. Additionally, lesions of the superior corona radiata, posterior limb of the internal capsule, caudate nucleus, posterior corona radiata, thalamus, putamen, and external capsule were associated with the development of lower-limb spasticity. The present study identified several brain lesions that contributed to post-stroke spasticity. Specifically, the involvement of white matter tracts and the striatum influenced the development of spasticity in the upper and lower limbs of stroke patients. These results may be useful for planning rehabilitation strategies and for understanding the pathophysiology of spasticity in stroke patients.

[Purpose] This study aimed to examine the effect of upper extremity training in the standing position on trunk alignment of patients with stroke. [Subjects and Methods] Twelve stroke patients were enrolled in the study and divided into two groups: a group of six patients in a sitting position and a group of six patients in a standing position. Upper extremity training for 30 min per day, five times a week for six weeks was given to subjects in both groups. In order to assess trunk alignment, lumbar lordosis and thoracic kyphosis were examined before and after upper extremity training using Formetric 4D. [Results] After training the standing position group had no significant change in lumbar lordosis but a significant change in thoracic kyphosis. The sitting position group showed no significant changes in either lumbar lordosis or thoracic kyphosis. The comparison between groups showed there was no significant difference in the change in lumbar lordosis but there was a significant difference in the change in thoracic kyphosis. [Conclusion] Examination of trunk alignment showed that upper extremity training conducted in a standing position reduced thoracic kyphosis more than in a sitting position.

The purpose of the present study was to evaluate the effects of a trunk exercise program on the gait and muscle activity in stroke patients. The participants of this pilot study included six hemiplegic stroke patients. The outcomes were surface electromyography (sEMG) and spatiotemporal gait parameters. In analysis of sEMG, no statistically difference was found between pre- and post-training of Maximal Voluntary Isometric Contraction (MVIC) in rectus abdominis and external abdominal oblique muscle, but it tended to increase. However, the gait parameter significantly increased in walking speed, walking cycle, and affected stride length in stroke patients. These results suggest that the trunk exercise program may in part improve the gait of chronic stroke patients.

The aim of this study is to compare the time-course changes in neurologic impairments (trunk control, motor function, sensory, and cognition) and recovery in functional impairments (activity of daily livings and gait) simultaneously from initiating rehabilitation to 6 months after stroke. Consecutive stroke patients were recruited from the department of nervous surgery, and transferred into the department of rehabilitation medicine and continued on treatment during the acute stage. Outcome measures were examined at the initial rehabilitation baseline, 1, 2, and 4 weeks after rehabilitation treatment, and 3, 4, 5, and 6 months after stroke. Patients were assessed using the Trunk Impairment Scale, the Fugl-Meyer Motor and Sensory Assessments for the upper and lower limbs, Mini-Mental State Examination, Functional Ambulation Category, and Modified Barthel Index. Twenty consecutive patients were analyzed in the study with complete assessments. The recovery was relatively rapid during the 4 weeks after treatment (P value ranges from

The focus of gait rehabilitation for walking in real-life settings should vary according to different aspects of gait performance. Investigation of factors related to impairments specific to community ambulation or activity participation may be helpful in determining and targeting appropriate treatment for gait rehabilitation. Objective To investigate the relationship between community ambulation and factors determining gait ability. Methods Forty-six outpatients with a previous stroke participated in a cross-sectional assessment. Community ambulation was assessed using a self-administered questionnaire. Outcome measures included impairments (strength, sensation, muscle tone, and balance) and ambulatory activity limitations (self-paced and maximum 10-m gait speed, 6-minute walking test, and concurrent manual/cognitive dual-task walking speed). Ability to increase speed and the dual-tasks cost were calculated. Multivariate analysis of variance and multiple regression analyses were used to determine differences in walking and identify important factors related to community ambulation. Results Pearson and Spearman analyses revealed that impairments (balance, r = .665; muscle strength, r = 0.653) and ambulatory activity limitation (gait speed, r = 0.684; walking distance, r = 0.654; ability to increase speed, r = 0.413) were significantly positively correlated with community ambulation level. Balance was an important factor in predicting increasing speed (P 0.001). Muscle strength and tone were positive contributors to gait speed (P = 0.001 for both) and distance (P = 0.019 and P = 0.002, respectively). Cognitive and manual dual tasks showed no significant relationship to other variables. Stepwise multivariate regression analysis showed that important determinants of community ambulation level were strength (P 0.001) and gait endurance (P = 0.001). Conclusions Muscle strength and walking distance are contributing factors in community ambulation for patients with chronic stroke.

Although studies have demonstrated that several specific brain lesions are related to the severity of functional outcomes, the effects of specific brain lesions are not yet clear. This study investigated the effects of hemorrhagic stroke lesions on motor recovery. Eleven subjects with hemorrhagic stroke were assessed. Using the Fugl-Meyer Assessment and functional ambulation category, clinical motor and sensory impairments were tested four times in total: initially within 2 weeks and 1, 3, and 6 months after the onset of stroke. Brain lesions and size were evaluated using MRIcron, SPM8, and Talairach Daemon software. Trunk control, motor function in the lower limbs, and sensory function improved significantly within 3 months, after which the change was no longer significant. Upper limb function and gait were unchanged within 1 month but improved significantly 3 months after onset and continued to improve for 6 months. Involvement of the anterior putamen, internal capsule, thalamus, periventricular white matter, and premotor cortex was related to poor upper limb recovery in patients with hemorrhagic stroke. These results should be useful for planning rehabilitation strategies and understanding the prognosis of hemorrhagic stroke.

[Purpose] The purpose of this review was to elucidate the deoxycorticosterone acetate (DOCA)-salt-related hypertensive mechanism and to contribute to future studies of cardiovascular physiotherapy. [Methods] This paper focuses on the signal transductions that control hypertension and its mechanisms. We include results reported by our laboratory in a literature review. [Results] Our results and the literature show the various mechanisms of DOCA-salt hypertension. [Conclusion] In this review paper, we carefully discuss the signal transduction in hypertension based on our studies and with reference to cardiovascular physiotherapy research.

Repetitive transcranial magnetic stimulation (rTMS) has recently been demonstrated to improve motor function after stroke. However, no study has yet tested the synergetic effects of physical exercise on rTMS in clinical settings. We investigated the effect of a 6-session course of low frequency rTMS on contralesional primary motor cortex combined with range-of motion (ROM) exercise on paretic hand function in female stroke patients. This was a single-blind study of the effects of rTMS with or without ROM exercise in female hemiplegic patients after stroke. All patients underwent rTMS on the contralesional primary motor cortex for 15 minutes and ROM exercise on the paretic hand. The cortical excitability determined by the amplitude and latency of the motor evoked potential (MEP) was measured in both first dorsal interosseous (FDI) muscles. We also evaluated arm function using Box and Block, arm reach, 9-hole pegboard, power grip, and pinch grip force tests. The rTMS-induced MEP amplitude of the paretic side significantly increased whereas the non-paretic side showed a decrease through every session. However, the MEP latency significantly increased on the non-paretic hand at post-rTMS with exercise, but a tendency of decrement on paretic hand at same application. Motor function showed improvement in the 9-hole pegboard and arm reach tests at post-rTMS with exercise on the paretic side compared with the non-paretic side. A significant correlation was especially noted between motor function and MEP on the paretic side of stroke patients. Low frequency rTMS with ROM exercise improved hand function after stroke. This may, in part, result in additional rehabilitation in stroke patients.

[Purpose] The aim of this study was to identify the contributions of balance to gait and motor function in chronic stroke. [Subjects and Methods] Twenty-three outpatients participated in a cross-sectional assessment. Gait ability was assessed using the functional ambulation category, self-paced 10-m walking speed, and fastest 10-m walking speed. Standing balance and trunk control measures included the Berg Balance Scale and the Trunk Impairment Scale. Univariate and multivariate regression analyses were performed. [Results] Balance was the best predictor of the FAC, self-paced walking speed, and fastest walking speed, accounting for 57% to 61% of the variances. Additionally, the total score of TIS was the only predictor of the motor function of the lower limbs and the dynamic balance of TIS was a predictor of the motor function of the upper limbs, accounting for 41% and 29% of the variance, respectively. [Conclusion] This study demonstrated the relative contribution of standing balance and trunk balance to gait ability and motor function. They show that balance has a high power of explanation of gait ability and that trunk balance is a determinant of motor function rather than gait ability.

The purpose of this study is to investigate the cardiopulmonary function and the energy metabolism of stroke patients and normal persons of graded load exercise using lower ergometer. Targeting 11 normal persons(male: 6, female: 5) and 9 stroke patients (male: 4, female: 5), an graded load exercise was performed with the use of lower ergometer by increasing 25 watts every 6 minute and Quark were used for the cardiopulmonary function and the energy metabolism. With respect to normal persons, there were significant increases in the phase of graded load exercise, maximum oxygen uptake time, exercise time with respect to the cardiopulmonary function. In addition, there was a significant correlation between cardiopulmonary function and energy metabolism, but there was no significant difference energy metabolism. As a result, there were no significant differences between stroke patients and normal persons of the cardiopulmonary function and the energy metabolism within 18 minutes, but it had significant differences between maximum oxygen uptake and exercise time. Moreover, it was possible to identify that the cardiopulmonary function and the energy metabolism of stroke patients and normal persons are related with maximum oxygen uptake.

The purpose of this study was to investigate the differences in the sensory threshold between the paretic and nonparetic sides of hemiplegic patients. 28 patients who were hemiplegic post-stroke (14 men and 14 women) participated in the electrical sensory and pain thresholds study; 22 patients who were hemiplegic post-stroke (13 men, 9 women) participated in a study measureing the sensory threshold with light touch. Electrical sensory and pain thresholds were measured in the forearm via transcutaneous electrical nerve stimulation. The light-touch threshold was measured in the forearm using monofilaments. The light-touch, electrical sensory, and pain thresholds for the paretic side were significantly higher than for the nonparetic side in our population, respectively. In both the nonparetic and paretic sides, the male group generally showed higher thresholds for pain and sensation than did the female group. These results suggest that the different evaluations of sensory thresholds performed in this study for healthy rehabilitation will be a valuable clinical tool in hemiplegic patients after stroke.

[Purpose] The temporal changes of pain scale and sensory threshold after the application of a moist hot-pack (HP) were investigated in chronically painful body regions of geriatric patients. [Methods] The subjects were 74 geriatric patients (45 female; 29 male) with pain in the low back, knee, or shoulder regions. HP was applied to each of the painful regions for 30 min. Pain was assessed using a Visual Analogue Scale (VAS), the Faces Pain Rating Scale (FPRS), and the Iowa Pain Thermometer (IPT), before and 0, 1, 3, 6, 12, and 24 h after HP application. The sensory threshold was measured, before and 0, 1, and 24 h after HP application using an electro-stimulator. [Results] The level of pain was significantly decreased by HP application for 30 min, as shown by VAS, FPRS and, IPT, and the effect was maintained for at least for 3 h. The effect of HP gradually wore off and pain had returned to the basal level at 24 h. The effect of HP was more potent and long term in the shoulder region of male patients than in that of females. Moreover, the sensory threshold also increased after HP application for 30 min in all regions. [Conclusion] These results suggest that the application of HP alone may be effective for treating chronic pain experienced by geriatric patients.

[Purpose] The present study was designed to evaluate the effect of symmetric self-performed facial muscle exercises on the facial muscle function of patients with facial palsy. [Subjects] The subjects were 26 persons (men=12, women=14) who suffered from facial palsy and were treated by western-oriental medical treatment. [Methods] We educated patients to conduct symmetric self-performed facial muscle exercises three times per day for four weeks by themselves to facilitate neuromuscular function. We evaluated them before and after the exercise period using Yanagihara's Unweighted Grading System and the House-Brackmann Grading System. [Results] After 4 weeks' symmetric self-performed facial muscle exercises, patients showed a significant improvement in facial palsy. The control group also showed a significant improvement. According to both Yanagihara's Unweighted Grading System and the House-Brackmann Grading System, the intervention group showed a greater improvement of scores than the control group. [Conclusion] These results suggest that adding symmetric self-performed facial muscle exercises to the western-oriental medical treatment is a more effective treatment than western-oriental medical treatment alone for recovery from facial palsy.

[Purpose] The measurement of foot pressure (FP) is widely used for the evaluation of gait. The fluctuating changes of FP parameters according to various types of crutch gait, however, are not fully understood. This study examined the changes of FP during normal, two-point, and four-point crutch gait of healthy volunteers. [Subjects] The subjects were thirty-three adults who were 26.5 ± 1.4 years old, weighed 64.2 ± 10.3 kg, and were 168.8 ± 8.7 cm in height. [Methods] FP parameters were collected by a force plate with 2,304 resistive sensors. Regional plantar FP, trajectories of center of pressure (COP) in the anterior-posterior (AP) and the medio-lateral (ML) directions, contact time of foot on the ground, and the relative durations of sub-stages of the stance phase were measured during gait with or without a crutch. [Results] The regional plantar FP significantly decreased during two-point and four-point crutch gait compared with that during normal gait in the AP direction and overall. Analyzed by its trajectory, displacement of COP in the AP direction was significantly smaller during four-point gait than during normal gait. Contact time during two-point and four-point gait was significantly longer than during normal gait. Also, the relative duration of heel contact stage during four-point gait was significantly smaller than during normal gait. The relative durations of the midstance stage during two-point and four-point gait, however, were longer than that of normal gait. [Conclusion] These results suggest that types of gait with or without a crutch affect the fluctuation of FP and that may lead to a change of body position and gait pattern. The present data therefore may be useful for understanding the variations of crutch gait.

Objectives Gait recovery is an important goal in stroke patients. Several studies have sought to uncover relationships between specific brain lesions and the recovery of gait, but the effects of specific brain lesions on gait remain unclear. Thus, we investigated the effects of stroke lesions on gait recovery in stroke patients. Materials and Methods In total, 30 subjects with stroke were assessed in a retrograde longitudinal observational study. To assess gait function, the functional ambulation category (FAC) was tested four times: initially (within 2 weeks) and 1, 3, and 6 months after the onset of the stroke. Brain lesions were analyzed via overlap, subtraction, and voxel-based lesion symptom mapping (VLSM). Results Ambulation with FAC improved significantly with time. Subtraction analysis showed that involvement of the corona radiata, internal capsule, globus pallidus, and putamen were associated with poor recovery of gait throughout 6 months after onset. The caudate nucleus did influence poor recovery of gait at 6 months after onset. VLSM revealed that corona radiata, internal capsule, globus pallidus, putamen and cingulum were related with poor recovery of gait at 3 months after onset. Corona radiata, internal capsule, globus pallidus, putamen, primary motor cortex, and caudate nucleus were related with poor recovery of gait at 6 months after onset. Conclusion Results identified several important brain lesions for gait recovery in patients with stroke. These results may be useful for planning rehabilitation strategies for gait and understanding the prognosis of gait in stroke patients.

Skeletal muscle atrophy is a common phenomenon during the prolonged muscle disuse caused by cast immobilization, extended aging states, bed rest, space flight, or other factors. However, the cellular mechanisms of the atrophic process are poorly understood. In this study, we investigated the involvement of mitogen-activated protein kinase (MAPK) in the expression of muscle-specific RING finger 1 (MuRF1) during atrophy of the rat gastrocnemius muscle. Histological analysis revealed that cast immobilization induced the atrophy of the gastrocnemius muscle, with diminution of muscle weight and cross-sectional area after 14 days. Cast immobilization significantly elevated the expression of MuRF1 and the phosphorylation of p38 MAPK. The starvation of L6 rat skeletal myoblasts under serum-free conditions induced the phosphorylation of p38 MAPK and the characteristics typical of cast-immobilized gastrocnemius muscle. The expression of MuRF1 was also elevated in serum-starved L6 myoblasts, but was significantly attenuated by SB203580, an inhibitor of p38 MAPK. Changes in the sizes of L6 myoblasts in response to starvation were also reversed by their transfection with MuRF1 small interfering RNA or treatment with SB203580. From these results, we suggest that the expression of MuRF1 in cast-immobilized atrophy is regulated by p38 MAPK in rat gastrocnemius muscles.