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To investigate the effects of walking with a cane on frontal plain bilateral hip joint loading in patients with late-stage unilateral hip osteoarthritis (OA).Nonrandomized experimental design.Urban inpatient hospital.Adults (men, n=10; women, n=17) with osteoarthritis who were scheduled for total hip arthroplasty (N=27).Gait with and without a T-cane was assessed using a 3-dimensional motion analysis system.Peak hip adduction moment and hip adduction moment impulse, vertical ground reaction force, and ground reaction force impulse were assessed under 4 different conditions: OA side vs non-OA side with non-cane gait, OA side vs non-OA side with cane gait, non-cane vs cane gait on OA side, and non-cane vs cane gait on non-OA side. The lateral trunk lean angle in the stance phase on both sides was compared between with and without a cane. Pain during walking with and without a cane was also determined using a visual analog scale (0=no pain; 100=most painful).Walking with a cane reduced the peak hip adduction moment from an average of 0.76 to 0.57 Nm/kg (reduction approximately 25%) and the mean hip adduction moment impulse from 50.58 to 42.78 Nm/kg (reduction approximately 15%) on the affected side. Walking with a cane reduced the peak ground reaction force from an average of 10.15 to 9.20 N/kg but did not markedly affect the mean ground reaction force impulse on the affected side. The mean impulse of vertical ground force and hip adduction moment on the nonaffected side with a T-cane was larger than that without a cane (940.4 vs 899.2, 73.7 vs 68.8, respectively), albeit without statistical significance. The mean lateral trunk lean angle on the affected side was 5.85±3.95 degrees with a non-cane gait and 4.46±2.66 degrees with a T-cane gait, showing a significant difference. Furthermore, walking with a cane was associated with a significant decrease in the visual analog scale of pain from 42.1 to 26.4.These findings indicate that walking with a cane reduces the load and pain on the affected hip joint. The effect of the cane on the trunk lean was small, but it is worth noting that walking with a cane may increase the load on the healthy side.

Stroke patients with hemiplegia can sometimes achieve independent life at home or in light care facilities after rehabilitation. This study examined the outcomes of rehabilitation in stroke patients with severe hemiplegia.This study included 50 patients with Brunnstrom recovery stage I-II hemiplegia at the start of rehabilitation for stroke. Good outcome after rehabilitation was defined as independent life with functional independence measure (FIM) score of 100 or greater. Predictors for post-rehabilitation functional recovery were statistically analyzed.FIM scores of 100 or greater in 12 of 50 patients (24%) allowed independent life after stroke rehabilitation. According to univariate analysis, factors associated with a FIM score of 100 or greater and good prognosis after rehabilitation were younger age (70 years), paralysis caused by intracerebral hematoma (ICH), no cortical lesions, short time from admission to comprehensive inpatient rehabilitation (CIR) for stroke (within 1 month), and good status at the start of early rehabilitation and CIR. Eleven of the 12 patients with good prognosis (FIM ≥100) had ICH and a basal ganglia lesion with no cortical damage. Analysis of the location of lesions suggested that many patients with basal ganglia ICH lesions and little cortical involvement have good prognoses.Stroke patients with severe hemiplegia showed a slightly different distribution of lesions between ICH and cerebral ischemia. Cortical involvement may be a prognostic factor for outcome after rehabilitation in stroke patients with severe hemiplegia. More aggressive rehabilitation interventions may be important for patients with severe hemiplegia, especially without cortical involvement.

Background：Although insoles made of various materials and shapes have been developed to improve performance in sport activities, few objective evaluations on their effectiveness have been conducted. We investigated the effect of insoles supporting the cuboid bone and anterior part of the calcaneus in healthy individuals.Methods:The subjects included 18 healthy males and females. They walked in standardized shoes with a flat insole (a flat insole made of polyurethane without an arched shape on the surface) and a functional insole (made of carbon and supporting the cuboid and anterior part of the calcaneus). We used a three-dimensional motion analysis device and a force plate to analyze gait and quantitatively compared the effect of functional insoles.Results:There was no difference in the parameters of gait analysis (walking speed, cadence, step length, stride length) between flat insoles and functional insoles. The functional insoles reduced ankle power without reducing walking ability. A comparison between Group A (n = 7), in which the left-right difference in ankle power was more than 20%, and Group B (n = 11), in which the left-right difference in ankle power was less than 20%, indicated that the use of functional insoles reduces the left-right difference of ankle power in the group with a larger difference in power.Conclusion：We believe that the use of functional insoles reduced ankle power without reducing walking ability and equalized left-right power. It may therefore reduce the burden on the muscles of the unilateral lower limbs and improve sport performance.Trial registration：The medical research ethics review committee for individuals at Gunma University (study number HS2017-229) Registered 20 febluary 2018, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000034362

Background: Vertebral compression fracture (VCF) is a major injury that occurs in elderly individuals. The aim ofthis study is to predict the functional outcomes of elderly female patients with acute VCF based on their nutritional status. Methods: A total of 69 female patients with acute VCF were included in the present study. The age, fracturelocation, body mass index, grasping power, the amount of the patientʼs daily nutritional intake, Mini-Mental StateExamination (MMSE) score and nutritional status (determined from laboratory findings) were evaluated at the time ofadmission. After in-hospital rehabilitation, the patients were divided into two groups based on their motor FunctionalIndependence Measure (mFIM) scores at the time of discharge. A multivariable logistic regression analysis was performedto identify factors that predicted the outcome. Results: The patients were divided into the high mFIM (score ≥79, n＝36) and the low mFIM (score＜79, n＝33) groups. The multivariate logistic regression analysis showed that theamount of the patient’s nutritional intake and the MMSE score were associated with the outcome. Conclusions: hecognitive status and the amount of the patient’s nutritional intake were associated with the prognosis of elderly womenwith acute VCF.

Patients with hip osteoarthritis (OA) show abnormal movement patterns, including the leaning of the trunk toward the affected limb (Duchenne limp). Patients with severe OA, especially those with OA due to hip dysplasia, show a lateral pelvic drop (Trendelenburg sign).The aim of this preoperative study is to investigate the relationship between superior migration of the arthritic femoral head, pain, and hip abductor muscle strength, and to clarify the relationship between the coronal plane gait patterns with pain and hip abductor muscle strength.The subjects of this study were 18 patients with unilateral hip OA secondary to dysplasia. A radiographic analysis was performed on standardised anteroposterior pelvis films. The abductor muscle strength of the OA hip joint was measured with a handheld dynamometer. The tilt angle of the pelvis and trunk lean angle during gait were obtained using a 3-dimensional motion analysis system. Visual analogue scale (VAS) of pain was obtained after trial.The 2 lateral pelvic angle patterns at the mid-stance of the affected limb during gait were detected. 1 is a pattern that was pelvic rise, and the other was a contralateral pelvic drop. Subjects with pelvic drop showed more superior femoral migration than that with pelvic rise (r = 0.69The pelvic drop Trendelenburg sign was influenced by superior migration of the femoral head, whereas the trunk lean Duchenne limp was found to be affected by pain.

Objective Epidemiological longitudinal investigations of the association between not eating three meals regularly and changes in BMI and weight are scarce. The aim of this study was to investigate whether or not regularly eating three meals was associated with changes in BMI and weight in young Japanese men and women. Methods Study participants were 1241 men and 897 women aged 19.0 ± 1.2 and 18.8 ± 0.8 years, respectively, who underwent health checkups at a university in Japan in 2001 as the baseline and subsequently in 2003. Weight and height were measured at baseline and 2 years later. Whether an individual ate three meals regularly was determined by a self-report questionnaire in 2001. Results During the 2-year follow-up, the BMI gain was 0.347 for men and 0.067 for women. In the logistic regression analysis, for men, eating three meals irregularly was significantly associated with a 4% BMI gain (OR 1.60, CI 1.11–2.30), 6% BMI gain (OR 1.72, CI 1.12–2.63), 4 kg weight gain (OR 2.01, CI 1.29–3.13), 6 kg weight gain (OR 1.86, CI 1.02–3.37), and incidence of obesity (BMI ≧ 25)(OR 2.96, CI 1.22–7.17). For women, eating three meals irregularly was significantly associated with a 4% BMI loss (OR 1.99, CI 1.01–3.94), 6% BMI loss (OR 2.79, CI 1.29–6.03), 4 kg weight loss (OR 3.85, CI 1.62–9.12), 6 kg weight loss (OR 7.65, CI 2.06–28.46), and the incidence of underweight (OR 3.95, CI 1.32–11.89). Conclusions The current results suggested that eating three meals irregularly was associated with subsequent BMI and weight gains for men and subsequent BMI and weight losses for women; both groups were around 20 years of age. Self-reported eating behavior in this study might be used to screen and evaluate young Japanese men and women at high risk for changes in BMI and weight in a practical clinical setting.

Objective The supplementary motor area (SMA) is important for the prediction of post-operative symptoms after surgical resection of gliomas. We investigated the relationships between clinical factors and the resection range of SMA gliomas, and the post-operative neurological symptoms. Methods We retrospectively studied 18 consecutive surgeries for gliomas involving the SMA proper performed in 13 patients. Seven cases were recurrence of the tumour. Clinical factors and details of specific resection of the SMA proper (resection of posterior part, medial wall) and cingulate motor area (CMA) were examined. Results Eight cases suffered new post-operative neurological deficits. Six of these eight cases had transient deficits. Permanent deficits persisted in two cases with partial weakness or paresis, after rapid improvement of post-operative global weakness or hemiplegia, respectively. The risk of post-operative neurological deficits was not associated with the resection of the posterior part of the SMA proper or the CMA, but was associated with resection of the medial wall of the SMA proper. Surgery for recurrent tumour was associated with post-operative neurological deficits. The medial wall was frequently resected in recurrent cases. Discussion The frequency of post-operative neurological symptoms, including SMA syndrome, may be higher after resection of the medial wall of the SMA proper compared with the resection of only the lateral surface of the SMA proper.

Identifying subjects at high risk of weight gain according to consumption of food groups is important for individualizing nutritional education, but prospective studies of this issue have been few. We determined whether intake of specific food groups could predict future weight gain. We evaluated data from health checkups on 1236 Japanese men aged 28 to 87 years in 2005 and 2006. Dietary intake was assessed by a 24-h dietary recall at baseline. Weight change was measured after 1 year. Weight increased in 44.7% (n = 553) of participants. Multivariate regression analysis involving many food groups showed a significant association between sugar intake and weight gain after adjustment for age, body mass index (BMI), total energy intake, alcohol, smoking and regular physical exercise (β = 0.22, P = 0.04). The effect of intake of 'fats and oils' was significant when adjusted for age and BMI, however, it became insignificant after adjustment for age, BMI and total energy intake. Intake of sugar, which was evaluated as a food group, was predictive of subsequent weight gain among Japanese men, even after adjustment for many confounders. This corroborates the evidence so far concerning the links between sugar intake and weight gain. Further long-term research is required to give robust recommendation to the public.

Introduction: results after non-operative management for knees sustaining combined acute anterior and posterior cruciate ligament tears were presented. Subjects: 13 patients, 10 with medial, and 3 with lateral ligament injury. Methods: non-operative management consisted of employing a brace to prevent sagittal translation of the tibia. Quadriceps muscle and early passive knee motion exercises in the brace was encouraged immediately after arthroscopy. Weight-bearing was forbidden for 3 weeks. The brace was not removed for 3 months. Follow-up periods ranged from 2 to 6 years (mean, 3 years 2 months). Results: none, but one patient had a slight restriction of knee flexion. Quadriceps muscle strength revealed an average of 89.0% of normal side. The knee score indicated 2 patients rated good, 3 rated fair, and 8 rated poor. The score correlated with measurements of anterior and posterior translation on the stress radiograph significantly. Stress radiography revealed that anterior laxity was reduced better than posterior laxity significantly. Conclusion: non-operative brace therapy can be considered for this combined injury as the initial treatment. A late reconstruction would be performed when the result was not satisfactory. Preserved range of motion and muscle strength after brace therapy had a great advantage to the late reconstructive surgery.

Introduction/Background The studies of repetitive transcranial magnetic stimulation (rTMS) of the brain have demonstrated the modulation of cortical excitability. Combination of rTMS with physical therapy (PT) might affect the therapeutic effects for movement disorders. The aim of this study was to investigate the effect of combination of intensive PT with rTMS in patients with degenerative cerebellar disease. Material and method Twelve patients with degenerative cerebellar disease participated in the study. The rTMS and PT were carried out five days a week for three weeks. The gait parameters were determined using a three-dimensional motion analysis system, and the total length and the velocity of the center of pressure (COP) in standing position using a stabilometer and the International Cooperative Ataxia Rating Scale (ICARS) were assessed in all patients before and after the intervention. Results The changes in the walking speed, step width, the total length of the COP and the velocity of the COP in standing position were not significant. The amplitude of the lateral head and body sway when walking were reduced after intervention (P Conclusion In our study, combination of intensive PT and rTMS conferred positive effects on the dynamic balance in patients with degenerative cerebellar disease in earlier stages of the disease.

Positron emission tomography with fluorine-18 fluorodeoxyglucose ([18F]FDG-PET) usually shows ganglioglioma as hypometabolic, in the absence of malignant transformation or high grade. We report a case of benign ganglioglioma in the left precentral gyrus showing hypermetabolism on [18F]FDG-PET, which was associated with intractable focal motor seizures. An 11-year-old girl started having simple partial seizures refractory to anti-epileptogenic medication since 4 years of age. Magnetic resonance imaging revealed a tumorous lesion in the left precentral gyrus. Interictal [18F]FDG-PET showed high [18F]FDG uptake in the lesion. Gross total resection was carried out. The histological diagnosis was low-grade ganglioglioma. The hypermetabolism on [18F]FDG-PET may be associated with epileptogenic activity of the ganglioglioma.

Shinobu Okamura,1 Naoki Wada,1 Masayuki Tazawa,1 Makoto Sohmiya,1 Yoko Ibe,1 Toru Shimizu,1 Shigeru Usuda,2 Kenji Shirakura1 1Department of Rehabilitation Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan; 2Department of Physical Therapy, Gunma University School of Health Science, Maebashi, Gunma, Japan Abstract: This study retrospectively investigated 192 teenage speed and figure skaters with prior injuries documented by an athletes’ questionnaire, who underwent a physical examination to assess their muscle tightness and generalized joint laxity. In all athletes, the degree of muscle tightness and joint laxity were measured by a standardized physical examination. A descriptive report of the types of injuries showed a predominance of fractures, ligament injuries, enthesitis, and lower back pain. Approximately 5% of all skaters tested positive for tightness, while 25.8% of figure skaters and 15.2% of speed skaters had generalized ligamentous laxity. Statistical testing showed an association between ankle sprains and muscle tightness, and an association between knee enthesitis and muscle tightness in skating athletes. There was also an association between lower back pain and generalized joint laxity, which held true only for the male skaters. Keywords: sports injury, skating, junior athlete, tightness, joint laxity, medical checkup

ObjectiveThe present study aimed to evaluate the quality of Internet information on the Mediterranean diet and to determine the relationship between the quality of information and the website source.DesignWebsite sources were categorized as institutional, pharmaceutical, non-pharmaceutical commercial, charitable, support and alternative medicine. Content quality was evaluated using the DISCERN rating instrument, the Health On the Net Foundation's (HON) code principles, andJournal of the American Medical Association(JAMA) benchmarks. Readability was graded by the Flesch Reading Ease score and Flesch–Kincaid Grade Level score.SettingThe phrase ‘Mediterranean diet’ was entered as a search term into the six most commonly used English-language search engines.SubjectsThe first thirty websites forthcoming by each engine were examined.ResultsOf the 180 websites identified, thirty-two met our inclusion criteria. Distribution of the website sources was: institutional,n8 (25 %); non-pharmaceutical commercial,n12 (38 %); and support,n12 (38 %). As evaluated by the DISCERN, thirty-one of the thirty-two websites were rated as fair to very poor. Non-pharmaceutical commercial sites scored significantly lower than institutional and support sites (P= 0·002). The mean Flesch Reading Ease score and mean Flesch–Kincaid Grade Level were 55·9 (fairly difficult) and 7·2, respectively. The Flesch–Kincaid Grade Level score determines the difficulty of material by measuring the length of words and sentences and converting the results into a grade level ranging from 0 to 12 (US grade level).ConclusionsDue to the poor quality of website information on the Mediterranean diet, patients or consumers who are interested in the Mediterranean diet should get advice from physicians or dietitians.

In Western countries, skipping breakfast is associated with a high prevalence of overweight and obesity. This meta-analysis aimed to determine if the same relationship exists in Asian and Pacific regions.A systematic literature search was performed for observational studies using a cross-sectional design that examined the relationship between frequency of eating breakfast and overweight or obesity. Odds ratios (ORs) for overweight or obesity were pooled with a variance-based method.Nineteen studies (93,108 total participants and 19,270 overweight or obese cases) were included. The pooled OR [95% confidence intervals (CI)] of overweight or obesity for the lowest vs. highest category of breakfast frequency was 1.75 [1.57 to 1.95] (P0.001). Between-study heterogeneity in the association's strength was highly significant (I-squared=36.4%, P0.001), although a positive OR was shown in all but one included study. However, no study characteristics could be identified to explain the heterogeneity.This meta-analysis suggests that a positive association between skipping breakfast and overweight and obesity is globally observed regardless of cultural diversity among countries. Promoting the eating of breakfast in all populations may be beneficial.

Background: Gait disturbance is major disturbance of Parkinson's disease (PD). Although continuous physical therapy (PT) has been demonstrated to improve gait disturbance and prevent falls among PD patients