Search

Control of cutaneous circulation is critically important to maintain thermoregulation, especially in individuals with cervical spinal cord injury (CSCI) who have no or less central thermoregulatory drive. However, the peripheral vasoconstrictor mechanism and capability have not been fully investigated after CSCI. Post- and presynaptic sensitivities of the cutaneous vasoconstrictor system were investigated in 8 CSCI and 7 sedentary able-bodied (AB) men using an intradermal microdialysis technique. Eight doses of norepinephrine (NE, 10−8 to 10−1 M) and five doses of tyramine (TY, 10−8, 10−5 to 10−2 M) were administered into the anterior right and left thigh, respectively. Endogenous catecholamines, noradrenaline, and dopamine, collected at the TY site, were determined by high-performance liquid chromatography with electrochemical detection. Regardless of vasoconstrictor agents, cutaneous vascular conductance decreased dose-dependently and responsiveness was similar between the groups (NE: Group P = 0.255, Dose P = 0.014; TY: Group P = 0.468, Dose P < 0.001), whereas the highest dose of each drug induced cutaneous vasodilation. Administration of TY promoted the release of noradrenaline and dopamine in both groups. Notably, the amount of noradrenaline released was similar between the groups ( P = 0.819), although the concentration of dopamine was significantly greater in individuals with CSCI than in AB individuals ( P = 0.004). These results suggest that both vasoconstrictor responsiveness and neural functions are maintained after CSCI, and dopamine in the skin is likely to induce cutaneous vasodilation.

Experimental study.To compare lipid profiles during moderate-intensity exercise between persons with cervical spinal cord injuries (SCIWakayama Medical University, Japan.Six participants with SCICatecholamine concentrations in SCISerum ketone bodies in SCI

Background: A new role of a regional core hospital for educating medical personnel through a regional therapy association has been previously reported in the COVID-19 crisis. In the present study, physical (PT), occupational (OT), and speech language hearing therapist (ST) and physiatrists, who have been providing COVID-19 rehabilitation in a regional core hospital, were instructed how to control infection via a webinar. The purpose of this report was to investigate the effects of webinars on therapists working in local facilities. Methods: The webinar was sponsored by the Wakayama Physical Therapy Association. A PT, OT, ST, and physiatrist from Wakayama Medical University Kihoku Hospital, who had been providing rehabilitation for mildly and/or moderately infected COVID-19 patients. All participants answered the 18-item online questionnaire after the webinar to assess the educational effects. Results: There were 41 participants in this region and 30 participants from 19 facilities responded the questionnaire (valid responses ratio was 73%) and 30% of the respondents had experienced COVID-19 rehabilitation. Most responders (83%) felt that difficulty level of the contents was appropriate and 80% of the respondents replied that rehabilitation was necessary for the patients. 70% of the respondents replied that got confidence after this webinar, even 7 of the 13 respondents (43%), who attended the webinar about infection control of COVID-19 for the first time, were involved. Conclusion: A webinar from therapists and physiatrists in a regional core hospital, who had experiences to provide COVID-19 rehabilitation, were satisfactory and effective for the education of regional therapists.

22 ABSTRACT 23 Study design Experimental study 24 Objectives To compare lipid metabolism in individuals with a cervical spinal cord injury (SCIC) 25 and able-bodied (AB) persons in response to mild cold stress. 26 Settings Laboratory of Wakayama Medical University, Japan. 27 Methods Nine males with SCIC and 11 AB wore a water-perfusion suit in a supine position. 28 Following 30-min rest thermoneutrality, the whole body was cooled by perfusing 25°C water 29 through the suit for 15-20 minutes (CS). Blood samples were collected before, immediately, and 60 30 (post-CS60) and 120 minutes after CS (post-CS120). Concentrations of serum free fatty acid 31 ([FFA]s), total ketone bodies ([tKB]s), insulin ([Ins]s) and plasma adrenaline ([Ad]p), noradrenaline 32 ([NA]p) and glucose ([Glc]p) were assessed. 33 Results [Ad]p in SCIC were lower than AB throughout the study (p=0.0002) and remained largely 34 unchanged in both groups. [NA]p increased after cold stress in AB only (p

Hori et al. have suggested previously that blood pressure during a head-up tilt (HUT) in a patient after CABG at discharge was likely to decrease, even they took exercise therapy. Medication status after CABG and reduced stroke volume, one of index for blood volume, would be related with it. On the other hand, some natural adaptations to orthostatic stress in the patients may be expected over long-term recovery. However, there was no study to assess blood pressure during HUT after CABG while monitoring medication status and stroke volume over a long period. Changes in cardiovascular responses to HUT in 6 patients were preliminarily tested during supine and 15-min 60°HUT before (P0) and after coronary artery bypass grafting (CABG) (P1) and over 1-year after surgery (P2). Mean arterial pressure (MAP) decreased during HUT at P0 and P1 and the decrease at P1 was greater than P0, while it remained unchanged at P2. Heart rate (HR) increased during HUT at P0 and P1 and the increase at P1 tended to be greater than P0, while that at P2 were comparable to P0. Stroke volume (SV) was 30% lower during baseline at P1 and P2 than P0. Cardiac output reduced by HUT at P0, but was not affected at P1 and P2, while the baseline at P2 was lower than P0. Ejection fraction remained unchanged at 3 periods. In conclusion, baseline SV at P2 remained lower than P0, but MAP was maintained during HUT. The present results suggest that although the poor control of blood pressure just after is improved over 1 year after CABG, hypovolemia might not be corrected. Assessments of an exercise regimen over long term after CABG would be expected in the future.

Background: Spastic hemiplegia causes slow and unstable walking in post-stroke patients. Dynamic tilt table with robotic leg movement (DTTRLM) is safe and effective in improving walking. Functional electric stimulation (FES) improves walking speed in post-stroke patients with spastic hemiplegia. The aim of this study was to determine the effects of combined DTTRLM + FES on walking speed compared with DTTRLM alone. Methods: Twenty post-stroke patients were randomly assigned to receive either a single session of stepping + FES treatment or a single session of stepping alone treatment. After a one-week washout period, the same two groups underwent a single session of the other treatment, and the same measurements were taken. We measured walking speed, cadence, and the number of steps in a 10 m walking test (10MWT) and assessed Modified Ashworth Scale (MAS), Fugl–Meyer Assessment (FMA), and range of motion (ROM) before and after the intervention. Results: Stepping + FES significantly improved walking speed, number of steps, and ankle inversion ROM, compared with stepping alone. Adverse events were not observed in any subject. Conclusions: Robotic stepping therapy combined with FES significantly improved 10 m walking speed (10MWS) compared with stepping only in patients with post-stroke and spastic hemiplegia. Further studies are needed to determine the long-term effects of the combination treatment.

Study Design: Acute experimental study Objectives: Cold-induced vasodilation (CIVD) is a local mechanism of protection against frostbite in able-body persons. This study assessed whether CIVD was observed in the sensate and non-sensate area in spinal cord injuries (SCIs) and whether the response patterns were different between the region levels or sites. Setting: Laboratory of Wakayama Medical University, Japan Methods: A local cooler device (diameter 4 cm) was placed on the chest (sensate) and thigh (non-sensate) in persons with cervical (SCIC; n=9) and thoracolumbar spinal cord injuries (SCITL; n=9). After the surface temperature was controlled at 33°C for 10 min (baseline), local cooling (LC) with a rate of 0.045°C/s was applied and the temperature was maintained at 15 and 8°C for 15 min of each stage. Skin blood flow (SkBF; laser Doppler flowmetry) was monitored using a 1-mm needle-type probe inserted into its center. CIVD was observed on the both sites in all participants at 8°C LC. Results: % change in SkBF (%ΔSkBF) on the chest remained unchanged until the end of the 15°C stage in both groups, then it increased at 8°C stage over the baseline. %ΔSkBF on the thigh remained unchanged throughout the measurement in SCIC, but decreased during the periods from 33 to 15°C and from 15 to 8°C, then recovered to around the baseline level at 8°C in SCITL. Conclusions: CIVD was observed both in the sensate and non-sensate areas in SCIs. The magnitudes of the response were different between the both areas.

Study design Acute experimental study. Objectives To investigate the acute response of markers of lipid metabolism and interleukin (IL)-6 to dopamine infusion in people with a cervical spinal cord injury (CSCI). Setting Laboratory of Wakayama Medical University, Japan. Methods Ten participants, four with CSCI and six AB individuals, underwent 50 min of dopamine infusion. Blood samples were collected prior to, immediately after and 1 h following cessation of dopamine infusion for the determination of circulating catecholamine, lipid, ketone body and IL-6 concentrations. Results The adrenaline concentration following dopamine infusion was increased by 59 ± 7% in CSCI (p = 0.038, Cohen's d effect size (ES): 1.47), while this was not changed in AB (p = 0.223). Triglycerides and acetoacetic acid concentration were increased in both groups, immediately after and 1 h post-infusion (triglycerides p ≤ 0.042, ES CSCI: 1.00, ES AB: 1.12; acetoacetic acid p ≤ 0.030; ES CSCI: 1.72, ES AB: 1.31). 3-Hydroxybutyric acid concentration was increased in CSCI only (48 ± 15%, p = 0.039, ES: 1.44; AB p = 0.115). Dopamine infusion did not affect plasma IL-6 concentration in either group (p ≥ 0.368). Conclusions Dopamine infusion induced a sustained increase in triglyceride and ketone body concentrations in persons with CSCI. In contrast, cytokine concentrations were not affected by dopamine infusion. These findings suggest that circulating catecholamines can stimulate metabolism in people with CSCI despite the presence of autonomic dysfunction.

Objectives To evaluate acute changes in serum brain-derived neurotrophic factor (BDNF) concentration following combined endurance exercise and heat stress through head-out water immersion (HOI). Setting Observational study with crossover design. Methods Ten healthy young male participants performed HOI at 40 °C (40 °C HOI) or continuous cycling at 60% of maximal oxygen uptake while immersed in 40 °C (40 °C HOI-ex) or 23 °C water (23 °C HOI-ex) for 15 min. Serum BDNF, cortisol and lactate concentrations, and core temperature (Tcore) were measured pre, immediately post, and 15 and 30 min post-immersion. Results BDNF concentration increased immediately and 15 min after 40 °C HOI-ex, but not after 40 °C or 23 °C HOI-ex. No changes in Tcore concentration were observed during 23 °C HOI-ex (Pre; 37.3 °C ± 0.3 °C, Post; 37.8 °C ± 0.2 °C, Post 15; 37.4 °C ± 0.3 °C, Post 30; 37.2 °C ± 0.2 °C). Tcore increased significantly post, post 15, and post 30 min of 40 °C HOI (Pre; 37.1 °C ± 0.4 °C, Post; 38.8 °C ± 0.5 °C, Post 15; 37.9 °C ± 0.4 °C, Post 30; 37.9 °C ± 0.2 °C) and 40 °C HOI-ex (Pre; 37.2 °C ± 0.2 °C, Post; 40.2 °C ± 0.7 °C, Post 15; 38.9 °C ± 0.5 °C, Post 30; 38.3 °C ± 0.5 °C). Tcore was higher in 40 °C HOI-ex compared with 40 °C HOI and 23 °C HOI-ex immediately post and post 15 min. Plasma lactate and cortisol were significantly higher in 40 °C HOI-ex compared with 40 °C HOI and 23 °C HOI-ex after immersion (p = 0.001). Conclusion While 15 min HOI alone or thermoneutral exercise do not increase BDNF concentration, both combined may form a time-efficient strategy to acutely elevate BDNF.

Prospective cardiovascular adjustment occurs before starting voluntary exercise, increasing heart rate and arterial pressure followed by muscle vasodilation; however, the precise mechanisms and significance for this vasodilation remain unknown. We found that during the countdown before starting exercise cerebral blood flow velocity increased, followed by increases in heart rate and arterial pressure, which suppressed MSNA through baroreflex, resulting in thigh muscle vasodilation to increase oxygen consumption rate, which might make it easier to start exercise.

Background: The peak oxygen consumption (V.O2peak) and blood hemoglobin concentration [Hb] are lower in stroke patients than in age-matched healthy subjects. The ability of skeletal muscles to extract oxygen is diminished after stroke. We hypothesized that the oxygen extraction capacity of skeletal muscles in stroke patients depends on [Hb]. To test the hypothesis, we determined the relationship between V.O2peak and total hemoglobin mass (tHb-mass) in stroke patients. Methods: The subjects were 19 stroke patients (age: 74 ± 2, mean ± SD, 10 males) and 11 age-matched normal subjects (age 76 ± 3, 6 males). Plasma volume (PV) and V.O2peak were measured on the same day. PV was measured using Evans Blue dye dilution method. Blood volume (BV) was calculated from PV and hematocrit, while tHb-mass was estimated from BV and [Hb]. Each subject underwent cardiopulmonary exercise test on a bicycle ergometer using a V.O2peak respiratory gas analyzer. Results: There were no differences in age, height, and weight between the two groups. V.O2peak was lower in stroke patients than in the control. BV and tHb mass were not significantly different between the two groups, but [Hb] was significantly lower in stroke patients. In stroke patients, V.O2peak correlated significantly with tHb-mass (r = 0.497, p < 0.05), but not with BV. Conclusion: Our results suggested that low [Hb] seems to contribute to V.O2peak in stroke patients. The significant correlation between tHb-mass and V.O2peak suggested that treatment to improve [Hb] can potentially improve V.O2peak in stroke patients.

With a relatively high percentage of type I fibers in the vastus medialis (VM), its fatigability may be more sensitive to the effects of muscle activity in the quadriceps. However, sex-related differences in the muscle fatigability of the VM remain unknown. The purpose of the present study was to assess the differences in fatigability of the VM between healthy adult men and women.Surface electromyographic (EMG) activities of VM oblique (VMO) and VM long (VML) were recorded during sustained isometric contraction on a leg press machine. The results of EMG power spectral analysis were compared between healthy adult men and women. The decline in the median frequency (MF), defined as MF slope, was calculated using spectrum analysis after fast Fourier transform of the raw EMG signals of VMO and VML.The endurance time and the MF slopes of the VMO and VML were significantly longer and lower, respectively, in women than in men. The present results demonstrated that both VMO and VML are more fatigue-resistant in women than in men.Understanding the sex differences in fatigability could help to design more effective exercise regimens for VMO and VML in healthy individuals. A similar approach should be considered when prescribing practical exercise regimens for patients with muscle atrophy.

The aim of this study was to assess renal functions and endocrine responses to arm exercise in persons with cervical spinal cord injury (CSCI) under euhydrated conditions (free drinking of water), and to determine the physiological effects of exercise on renal function in these subjects. Eleven CSCI individuals (spinal lesions between C6 and C8, American Spinal Injury Association impairment scale A) and nine able-bodied (AB) persons rested for 30 min before performing 30 min arm-crank ergometer exercises at 50% of their maximum oxygen consumption, followed by 60-min of rest/recovery. Urine and blood samples were collected before and immediately after the exercise and recovery period. The CSCI patients showed no increase in plasma adrenaline and plasma renin activity compared with the AB controls, but showed similar changes in plasma aldosterone and the plasma antidiuretic hormone in response to the exercise. Creatinine clearance, osmolal clearance, free water clearance, and the fractional excretion of Na+ did not change during exercise in both groups of subjects, however free water clearance in the CSCI group was higher than in the AB group throughout the study. These findings suggested that activated plasma aldosterone without an increase in adrenaline or renin activity during exercise in CSCI individuals may reflect an adaptation to the disturbance of the sympathetic nervous system to compensate for renal function. As a result, no adverse effects of exercise on renal function in CSCI patients were observed.

Surface electromyographic activities of the erector spinae and multifidus during graded arm- and leg-ergometer exercise were investigated. Fifteen young healthy male participants performed arm- and leg-ergometer exercises at 50W and 100W for 1 min, while monitoring the electrocardiograms of the paraspinal muscles and heart rate, and the root mean squares of the electromyograms were calculated. Time series of contractions of the paraspinal and extremity muscles during both exercises were assessed (n = 7). Both paraspinal muscle activities increased with increased workload in both exercises similarly (P

We aimed to investigate whether out-patient rehabilitation with the same concept as physiatrist and registered therapist operating rehabilitation (PROr) would improve activities of daily living in out-patients with chronic cerebrovascular disorder and whether the improvements were related to the frequency and/or time of therapy.Out-patients with chronic cerebrovascular disorder, who visited a clinic affiliated with a university hospital for at least a month between April 2010-September 2020, were retrospectively selected. Changes in the functional independence measure (FIM) from the first visit to the 12Initially, 174 patients were selected and 125 were excluded based on the exclusion criteria. Three patients terminated rehabilitation because of improvements. In 18 of 49 patients, FIM improved at the 12Approximately 40% of the patients displayed improved FIM even during the chronic phase, and the improved out-patients took PROr for at least 108 min/day and twice a week. A longer rehabilitation time would be reinforced by patients' motivation.

Previous research indicates a better improvement of functional independence measure (FIM) at discharge in acute-stroke patients who received physiatrist and registered therapist operating rehabilitation (PROr) within 24 hrs compared with those who received after 24 hrs was reported. The aim of this prospective cohort study was to determine whether PROr provided within 24 hrs for new-onset stroke patients affects home-discharge rate at 6 months later.Acute new-onset stroke patients admitted to our hospital and received PROr (A total of 139 patients [VEM (Starting PROr within 24 hrs of new-onset stroke may help to increase home-discharge rates at 6-month follow-up, simultaneously with a higher FIM. Very early mobilization in our hospital did not increase the risks of recurrence or death.

Objective: To determine the relationship between physical findings, wheelchair sitting time, and interface pressure on ischial region in subjects with spinal cord injury (SCI). Design: Cross-sectional study. Setting: Rehabilitation center in Japan. Participants: Manual wheelchair users with chronic SCI (n = 45). Interventions: Pressure ulcers (PU) were diagnosed by inspection, palpation, and ultrasonography. Self-reports were obtained on wheelchair sitting time and pressure mapping was recorded while the subject was seated on the wheelchair. Outcome measures: Subjects were divided into those with ultrasonographically low-echoic lesions (PU-positive group, n = 11) and no such lesions (PU-negative group, n = 34). Outcome measures included wheelchair sitting time and interface pressure at bilateral ischial regions. Results: Using ultrasonography, 13 low-echoic lesions were identified in 11 subjects of the PU-positive group. The pressure duration was longer and interface pressure was significantly higher in subjects of the PU-positive group compared with those of the PU-negative group (P

Acute experimental study.To investigate the acute response of markers of lipid metabolism and interleukin (IL)-6 to dopamine infusion in people with a cervical spinal cord injury (CSCI).Laboratory of Wakayama Medical University, Japan.Ten participants, four with CSCI and six AB individuals, underwent 50 min of dopamine infusion. Blood samples were collected prior to, immediately after and 1 h following cessation of dopamine infusion for the determination of circulating catecholamine, lipid, ketone body and IL-6 concentrations.The adrenaline concentration following dopamine infusion was increased by 59 ± 7% in CSCI (p = 0.038, Cohen's d effect size (ES): 1.47), while this was not changed in AB (p = 0.223). Triglycerides and acetoacetic acid concentration were increased in both groups, immediately after and 1 h post-infusion (triglycerides p ≤ 0.042, ES CSCI: 1.00, ES AB: 1.12; acetoacetic acid p ≤ 0.030; ES CSCI: 1.72, ES AB: 1.31). 3-Hydroxybutyric acid concentration was increased in CSCI only (48 ± 15%, p = 0.039, ES: 1.44; AB p = 0.115). Dopamine infusion did not affect plasma IL-6 concentration in either group (p ≥ 0.368).Dopamine infusion induced a sustained increase in triglyceride and ketone body concentrations in persons with CSCI. In contrast, cytokine concentrations were not affected by dopamine infusion. These findings suggest that circulating catecholamines can stimulate metabolism in people with CSCI despite the presence of autonomic dysfunction.

Blood pressure response to head-up tilt (HUT) in 7 healthy subjects and 9 patients before and after coronary artery bypass grafting (CABG) was measured during supine and 15-min 60° HUT. Stroke volume (SV) and ejection fraction (EF) were assessed by echocardiography. Baseline mean arterial pressure (MAP) and heart rate (HR) in patients before CABG were similar to healthy subjects. MAP in patients decreased by 6 (4–9) mmHg [median (1st–3rd quartiles)] during 7–12 mmHg of HUT with decreased cardiac output (CO = SV × HR) while HR remained unchanged. MAP in healthy subjects remained unchanged during HUT with increased HR. Body weight decreased by 3.5 (2.5–3.7) kg and MAP decreased by 6 (2–13) mmHg during the last 3-min HUT while HR increased after CABG. Decreases in SV and CO during HUT disappeared after CABG. Blood pressure decreased during HUT in patients before and after CABG regardless of HR response.

Key points In hyperthermia, plasma hyperosmolality suppresses both cutaneous vasodilatation and sweating responses and this suppression is removed by oropharyngeal stimulation such as drinking. Hypovolaemia suppresses only cutaneous vasodilatation, which is enhanced by rapid infusion in hyperthermia. Our recent studies suggested that skin sympathetic nerve activity (SSNA) involves components synchronized and non-synchronized with the cardiac cycle, which are associated with an active vasodilator and a sudomotor, respectively. In the present study, plasma hyperosmolality suppressed both components; drinking removed the hyperosmolality-induced suppressions, simultaneously with increases in cutaneous vasodilatation and sweating, while not altering plasma volume and osmolality. Furthermore, a rapid saline infusion increased the synchronized component and cutaneous vasodilatation in hypovolaemic and hyperthermic humans. The results support our idea that SSNA involves an active cutaneous vasodilator and a sudomotor, and that a site where osmolality signals are projected to control thermoregulation is located more superior than the medulla where signals from baroreceptors are projected. Abstract We reported that skin sympathetic nerve activity (SSNA) involved components synchronized and non-synchronized with the cardiac cycle; both components increased in hyperthermia and our results suggested that the components are associated with an active vasodilator and a sudomotor, respectively. In the present study, we examined whether the increases in the components in hyperthermia would be suppressed by plasma hyperosmolality simultaneously with suppression of cutaneous vasodilatation and sweating and whether this suppression was released by oropharyngeal stimulation (drinking). Also, effects of a rapid saline infusion on both components and responses of cutaneous vasodilatation and sweating were tested in hypovolaemic and hyperthermic subjects. We found that (1) plasma hyperosmolality suppressed both components in hyperthermia, (2) the suppression was released by drinking 200 mL of water simultaneously with enhanced cutaneous vasodilatation and sweating responses, and (3) a rapid infusion at 1.0 and 0.2 ml min-1 kg-1 for the first 10 min and the following 20 min, respectively, increased the synchronized component and cutaneous vasodilatation in diuretic-induced hypovolaemia greater than those in a time control; at 0.1 ml min-1 kg-1 for 30 min no greater increases in the non-synchronized component and sweating responses were observed during rapid infusion than in the time control. The results support the idea that SSNA involves components synchronized and non-synchronized with the cardiac cycle, associated with the active cutaneous vasodilator and sudomotor, and a site of osmolality-induced modulation for thermoregulation is located superior to the medulla where signals from baroreceptors are projected.

Study design: Experimental study. Objectives: To characterize static and dynamic cerebral autoregulation (CA) of individuals with cervical spinal cord injury (SCI) compared to able-bodied controls in response to moderate increases in mean arterial pressure (MAP) caused by mild whole-body cold stress. Setting: Japan Methods: Five men with complete autonomic cervical SCI (sustained>5y) and six age-matched able-bodied men participated in hemodynamic, temperature, catecholamine and respiratory measurements for 60 min during three consecutive stages: baseline (10 min; 330C water through a thin-tubed whole-body suit), mild cold stress (20 min; 250C water) and post-cold recovery (30 min; 330C water). Static CA was determined as the ratio between mean changes in middle cerebral artery blood velocity and MAP, dynamic CA as transfer function coherence, gain and phase between spontaneous changes in MAP to middle cerebral artery blood velocity. Results: MAP increased in both groups during cold and post-cold recovery (mean differences: 5 to 10 mm Hg; main effect of time: p=0.001). Static CA was not different between the able-bodied vs the cervical SCI group (mean [95% CI] of between-group difference: -4 [-11 to 3] and -2 [-5 to 1] cm/s/mmHg for cold (p=0.22) and post-cold (p=0.24), respectively). At baseline, transfer function phase was shorter in the cervical SCI group (mean [95% CI] of between-group difference: 0.6 [0.2 to 1.0] rad; p=0.006), while between-group differences in changes in phase were not different in response to the cold stress (interaction term: p=0.06). Conclusions: This pilot study suggests that static CA is similar between individuals with cervical SCI and able-bodied controls in response to moderate increases in MAP, while dynamic CA may be impaired in cervical SCI due to disturbed sympathetic control.

Rehabilitation medicine has made dramatic and successful progress in recent years, and neurologists and physiatrists have faced greater challenges in coordinating the clinical management of patients with spinal cord injuries (SCI). To ensure the best clinical outcome in SCI, physiatrist need to comprehend the dysfunctions of various body systems and the physiological aspects of the central nervous, musculoskeletal and autonomic nervous system, as well as the social support system. Furthermore, the rehabilitation team, including physiatrists, nurses, physical therapists, social workers and peer supporters, should provide surgical treatment, clinical management, drug therapy and optimal assistance for SCI. We believe that the first important task in the management of SCI patients is precise diagnosis of the site of the spinal cord lesion. This should be followed as soon as possible by spinal surgery to stabilize the vertebral column. The day after surgery, the patient should be handled by the rehabilitation team. Orthostatic loads should be applied, and exercise of the remaining muscles should begin in order to ensure early mobilization and satisfactory repair. Our group has carried out extensive research into the pathophysiology of the cardiovascular, respiratory, endocrine and autonomic nervous systems and exercise responses in SCI, and reported the benefits and improvements of early mobilization and exercise, and the safety of physical medicine and rehabilitation. The rehabilitation team should follow these individuals closely to provide long-term clinical care, and deal with social issues arising during the chronic phase. Participation in sports activities (para-sports) could work well to improve the physical condition of these individuals.

The aim of this study was to determine the within-day and between-days reliability of surface electromyographic (EMG) power spectral analysis in assessing fatigability of the vastus medialis (VM) muscle during knee and hip flexion under constant load application. The subjects were 13 healthy adult men free of knee abnormalities. Surface EMG was recorded from vastus medialis obliquus (VMO) and vastus medialis longus (VML) during sustained isometric contractions at 60% of maximal voluntary contraction until exhaustion on the leg press machine (static leg press test). Linear regression analysis was applied to median frequency (MF) time series to calculate initial MF and MF slope. For VMO and VML, the initial MF showed moderate to high reliability, while the MF slope showed high reliability (Intraclass correlation coefficient (ICC) = initial MF: 0.63 - 0.92, MF slope: 0.70 - 0.86). The results demonstrated that spectral analysis of surface EMG recording during isometric VM muscle contraction has high within-day and between-days reliability in the assessment of fatigability of the VMO and VML.

This study investigates the relationship between autonomic function and the inflammatory response to a wheelchair half-marathon in people with a spinal cord injury (SCI). Seventeen wheelchair athletes with a cervical SCI (CSCI, N = 7) and without CSCI (NON-CSCI, N = 10) participated in a wheelchair half-marathon. Blood was taken prior, post and 1 h post-race to determine the concentrations of adrenaline, noradrenaline, extracellular heat shock protein 72 (eHsp72) and interleukin-6 (IL-6). A sit-up tilt test was performed to assess autonomic function at rest. CSCI showed a lower supine ratio of the low and high frequency power of the variability in RR intervals (LF/HF RRI

Our aim was to determine differences in thermal comfort during simulated one-day parcel home delivery between summer and winter. Six young healthy males performed experiments in summer (up to 31°C) and winter (up to 8°C). After baseline measurement in a chamber, subjects drove a truck to a prespecified location for outside measurements. They performed 4 sets of 100-m walk with carrying 5-kg plate during the first 50-m walk at 100 m/min, separated by 7-min driving in each of the morning and the afternoon. Subjects could ingest water ad libitum in outside and set the cockpit temperature by themselves during driving. Thermal sensation and comfort were recorded using a subjective scale at the first and the last sets of each morning and afternoon session, while esophageal temperature (Tes) was monitored (thermocouples). Body weight was measured before and the end of experiment. We found that 1) whole-body comfort decreased in summer and the decrease was greater than winter with higher Tes and 2) changes in body weight were 0.7 and 0.3 kg through whole day in summer and winter, respectively. In summary, thermal comfort during working worsened in summer, possibly related with higher core temperature and greater decrease in body weight.

In humans, the cutaneous vasodilatation response to hyperthermia has been suggested to be suppressed by baroreflexes to maintain arterial pressure when the posture was changed from supine to upright, and if the reflexes do not function sufficiently, it can cause heat syncope. However, the efferent signals of the reflexes have not been identified. To identify the signals, we continuously measured skin sympathetic nerve activity (SSNA; microneurography), right atrial volume (RAV; echocardiography, the baroreceptors for the reflexes are reportedly located), cutaneous vascular conductance on the chest (CVCchest; laser Doppler flowmetry), and oesophageal temperature (Toes; thermocouple) in young men before and after passive warming with a perfusion suit, during which periods the posture was changed from supine to 30° head-up tilt positions. During these periods, we also simultaneously measured muscle sympathetic nerve activity (MSNA) to distinguish the SSNA from MSNA. We found that an increase in Toes by ∼0.7°C (P 0.26) although an increase in CVCchest (P

In Japan, the incidence of heat illness in older people has rapidly increased during midsummer in the last decade, and we suggested that whey-protein+carbohydrate supplementation during aerobic training would increased plasma volume (PV) to enhance thermoregulatory adaptation in older men ( J Appl Physiol 107: 725-733, 2009); however, >60% of people age 65 and older suffer from hypertension, and the symptoms may be worsened by hypervolemia. To examine this, we randomly divided 21 older men (∼69 yr) with ∼160 mmHg for systolic and ∼90 mmHg for diastolic blood pressure at rest into two groups: Glc ( n = 11) consuming glucose alone (25 g) and Pro-Glc ( n = 10) consuming whey protein (10 g) + glucose (15 g), immediately after cycling exercise at 60–75% of peak aerobic capacity (V̇o2 peak) for 60 min/day, 3 days/wk, for 8 wk. Before and after training, we measured PV (dye dilution), baroreflex sensitivity (BRS) of heart rate (Valsalva maneuver), and carotid arterial compliance (CAC) from carotid arterial diameter (ultrasound imaging) responses to pulsatile arterial pressure change (photoplethysmography) at rest. Additionally, we measured esophageal temperature (Tes) and forearm skin blood flow (plethysmography) during exercise at 60% pretraining V̇o2 peak for 20 min in a warm environment. We found that the forearm skin vascular conductance response to increased Tes was enhanced in Pro-Glc with increased PV, but this was not found in Glc; however, despite the increased PV, arterial blood pressures rather decreased with increased CAC and BRS in Pro-Glc. Thus, the prescription was applicable to older men with hypertension to prevent heat illness during exercise.

Background Brain-derived neurotrophic factor (BDNF) has been implicated in enhancing neuronal health. Exercise and noninvasive positive-pressure ventilation (NPPV) are known to independently alter BDNF levels in patients with depression, dementia, type 2 diabetes, chronic obstructive pulmonary disease, and obstructive sleep apnea syndrome. However, the combined effects of exercise and NPPV on serum BDNF in normal subjects are unknown. Objective To determine the effects of the combination of acute aerobic exercise under NPPV on serum BDNF in normal adults. Design Cross-over design study. Setting Wakayama Medical University. Participants Ten healthy young men. Intervention The subjects exercised on a cycle ergometer at 60% of pretraining maximal oxygen uptake ( V . O 2max ) for 30 minutes daily for 5 consecutive days with or without NPPV (12 cmH 2 O). The 5-day exercise protocol was repeated after a 3-week washout period with or without NPPV. Main Outcome Measurements Serum BDNF, plasma cortisol, and platelet, lymphocyte, and monocyte counts were measured at 24 hours before the first day exercise with or without NPPV and 24 hour after last day exercise with or without NPPV at resting condition. Measurements were also made on the first day exercise; serum BDNF level was measured immediately before and immediately after exercise, as well as at 1, 2, and 3 hours after exercise with or without NPPV. Results The 5-day exercise protocol significantly ( P P P Conclusions The results indicated that a 5-day exercise protocol combined with NPPV increased serum BDNF, suggesting that NPPV synergistically enhances the effect of aerobic exercise on serum BDNF level. Level of Evidence II

A reduction in exercise efficiency with aging limits daily living activities. We examined whether 5-aminolevulinic acid (ALA) with sodium ferrous citrate (SFC) increased exercise efficiency and voluntary achievement of interval walking training (IWT) in older women. Ten women [65 ± 3(SD) yr] who had performed IWT for >12 mo and were currently performing IWT participated in this study. The study was conducted in a placebo-controlled, double-blind crossover design. All subjects underwent two trials for 7 days each in which they performed IWT with ALA+SFC (100 and 115 mg/day, respectively) or placebo supplement intake (CNT), intermittently with a 2-wk washout period. Before and after each trial, subjects underwent a graded cycling test at 27.0°C atmospheric temperature and 50% relative humidity, and oxygen consumption rate, carbon dioxide production rate, and lactate concentration in plasma were measured. Furthermore, for the first 6 days of each trial, exercise intensity for IWT was measured by accelerometry. We found that, in the ALA+SFC trial, oxygen consumption rate and carbon dioxide production rate during graded cycling decreased by 12% ( P < 0.001) and 11% ( P = 0.001) at every workload, respectively, accompanied by a 16% reduction in lactate concentration in plasma ( P < 0.001), although all remained unchanged in the CNT trial ( P > 0.2). All of the reductions were significantly greater in the ALA+SFC than the CNT trial ( P < 0.05). Furthermore, the training days, impulse, and time at fast walking were 42% ( P = 0.028), 102% ( P = 0.027), and 69% ( P = 0.039) higher during the ALA+SFC than the CNT intake period, respectively. Thus ALA+SFC supplementation augmented exercise efficiency and thereby improved IWT achievement in older women.

Experimental study. Individuals with spinal cord injuries (SCI) may present with impaired sympathetic control over thermoregulatory responses to environmental and exercise stressors, which can impact regional core temperature (Tcore) measurement. The purpose of this study was to investigate whether regional differences in Tcore responses exist during exercise in individuals with SCI. Rehabilitation centre in Wakayama, Japan. We recruited 12 men with motor-complete SCI (7 tetraplegia, 5 paraplegia) and 5 able-bodied controls to complete a 30-min bout of arm-cycling exercise at 50% VO2 peak reserve. Tcore was estimated using telemetric pills (intestinal temperature; Tint) and esophageal probes (Teso). Heat storage was calculated from baseline to 15 and 30 min of exercise. At 15 min of exercise, elevations in Teso (Δ0.39 ± 0.22 °C; P