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INTRODUCTION: Gait asymmetry can become very pronounced in patients who have suffered a stroke. The impairment of trunk function in some stroke patients can restrict thorax mobility and cause respiratory muscle weakness. Trunk and neck dysfunction are believed to affect the gait in stroke patients. OBJECTIVE: This study aimed to investigate the relationship between gait asymmetry and respiratory function in stroke patients by measuring the step time and trunk acceleration. METHODS: This study employed a cross-sec- tional design. Thirty stroke patients participated in this study. The symmetry index (SI) and Lissajous index (LI) were used to evaluate asymmetry during walking. The respiratory function and respiratory muscle strength were evaluated by spirometry. We examined the relation between SI or LI and the respiratory function/respiratory muscle strength in patients with stroke. RE- SULTS: The results of our analysis demonstrated that the SI was significantly correlated with the inspiratory and expiratory muscle strength and the LI was significantly correlated with the percentage of the predicted vital capacity (respectively, r = ﹣0.386, r = ﹣0.392, r = ﹣0.446; p CONCLUSION: The present study is the first to indicate a relationship between gait asymmetry and respiratory function in stroke patients.

Purpose: Mechanically assisted coughing (MAC) is an airway clearance method in which the thorax/abdomen is compressed in synchronization with mechanical insufflation-exsufflation (MI-E). MAC can be performed with manual assistance at the upper thorax (MAC-UT), lower thorax (MAC-LT), and upper thorax + abdomen (MAC-UT/A). This study aimed to determine the most effective approach under different conditions (air stacking or tracheostomy) in patients with neuromuscular disorders (NMDs). Methods: The study included 34 patients with NMDs. The patients were categorized into air stacking group (n=15), no air stacking group (n=9), and tracheostomy/tracheostomy positive-pressure ventilation (TPPV) group (n=10). Results: In each group, the cough peak flow (CPF) at 75% of the forced vital capacity (V̇75), V̇50, V̇25, and V̇10 were investigated during the approaches. In the air stacking group, the CPF was higher with MAC-UT, MAC-LT, and MAC-UT/A than with MI-E (p < 0.05). Additionally, V̇75 was higher with MAC-LT and MAC-UT/A than with MI-E (p < 0.05 and p < 0.01, respectively). In the no air stacking group, V̇75 was higher with MAC-UT/A than with MI-E (p < 0.05). In the tracheotomy/TPPV group, there were no significant differences. Conclusions: MAC approaches, especially MAC-LT and MAC-UT/A, are preferred in air stacking patients. However, in tracheostomy/TPPV patients, the CPF might not increase with MAC.

Physical activity (PA) is defined as bodily movement produced by skeletal muscles with energy expenditure beyond resting levels. PA is closely related to reduced morbidity and mortality in chronic obstructive pulmonary disease (COPD). Self-report questionnaires are often subject to recall bias, correlating poorly with objectively qualified PA, and do not provide an accurate estimate of free-living energy expenditure. PA may be objectively evaluated by newly developed tri-axial accelerometers by quantifying steps or body movements over a period of time. Low-intensity, home-based pulmonary rehabilitation (PR) using pedometer feedback improves PA. Improvement in physiological factors correlates with increased walking time in stable elderly COPD patients. This review focuses on the effects of PR and pharmacological treatment on PA in COPD patients. We selected 32 studies from our literature search evaluating the effects of PR and 11 studies examining the effects of pharmacological treatment on PA. Findings in both categories were inconsistent. Nineteen studies showed a positive effect with PR whereas 13 showed no effect. Eight studies showed a positive effect, while three revealed no effect from pharmacological intervention. As both interventions increase exercise capacity without a consistent effect on PA, counseling with behavioral changes may be necessary to achieve a significant and lasting increase in PA. Changing PA behavior in COPD patients requires an interdisciplinary approach involving specialists in respiratory medicine, rehabilitation, social, and behavioral sciences. Future research in this area is warranted to advance our knowledge in this area, specifically with regard to the interaction of pharmacological and non-pharmacological interventions.

OBJECTIVES The purpose of this study was to confirm the intra-rater reliability and absolute reliability of Lissajous Index (LI) in evaluating the symmetry of trunk movement during gait in patients with stroke and to examine the relation between LI and body function in patients with stroke. METHODS Twenty-one healthy subjects (11 males and 10 females, age 63.3±2.0 yrs) and 45 patients with stroke (33 males and 12 females, age 58.7±13.4 yrs) were included in the study. The accelerometer was fixed to a belt at the level of the L3 spinous process. The 10-m walk test was performed twice to record definitive data on trunk acceleration. LI was calculated from trunk accelerations. We confirmed the intra-rater reliability and absolute reliability of LI in patients with stroke and we examined the relation between LI and body function in patients with stroke. RESULTS There was no fixed bias and proportional bias in the LI of patients with stroke. It was found that BBS significantly correlated with LI in stroke patients (p

Introduction Bathing, especially with hot spring with various mineral compositions, is known to facilitate / improve sleep by warming the body. Artificial carbonated bathing (ACB) is known to keep the body warm too. Previous our study examined that ACB before sleep more specifically affected body temperature and sleep on healthy young subjects. In this study, we evaluated the effects of usual (plain hot water; PH) and artificial carbonated bathing, on sleep using clinical thermometers and EEG in healthy elderly subjects. Methods Nine healthy elderly women (average age 71.3 years old) were divided into 2 groups ACB (858 ppm, Awacomachi, Danrei Co.) and PH with a week interval. Subjects soaked in the bath (38 C degree) deep enough their chests touched the water for 10 min. From the time they finished bathing to the next morning, we measured their distal skin temperature (top side of the foot), proximal skin temperature (lower part of the clavicle) and EEG using a single channel portable device (Brain wave sensor, Proassist Co.). Subjects were told to sleep from 23:00-6:00. As the same time, subjects were examined with visual analog scale (VAS) and clinical flicker fusion test (CFF). Results There was no significant difference in body temperature (proximal, distal, distal-proximal temperature gradient: DPG) before and during sleep between ACB and PH. The condition of the ACB tended to have less light sleep compared to PH (150min vs 201min, p=0.08), but there was no significant difference in the SWS (44.1min vs 39.1min, ns), EEG delta power analysis, VAS and CFF. In the previous study, bathing was performed for 15 min at a water temperature of 40 C degree, but this condition was considered to be a high risk for the elderly. The reason why there was no significant difference in body temperature. The effects of ACB were not fully demonstrated due to changes in hot water temperature and bathing time. Conclusion The effect of ACB on the body temperature of healthy elderly people could not be confirmed. However, a tendency to reduce light sleep was observed. Support This work was supported by JSPS KAKENHI Grant Number JP19K11294

Yoshino Terui,1 Masahiro Iwakura,1,2 Eriko Suto,3 Atsuyoshi Kawagoshi,2 Keiyu Sugawara,2 Hitomi Takahashi,2 Kouichi Hasegawa,3 Sachiko Uemura,1 Masahiro Satake,1 Takanobu Shioya1,4 1Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan; 2Department of Rehabilitation Medicine, Akita City Hospital, Akita, Japan; 3Department of Rehabilitation, Akita Prefectural Center for Rehabilitation and Psychiatric Medicine, Daisen, Japan; 4Geriatric Health Services Facility Nikonikoen, Akita, Japan Background: Individuals with COPD may experience ambulatory difficulty due to both effort intolerance arising from respiratory dysfunction and impaired balance control during walking. However, the trunk movement during walking has not been evaluated or adjusted for patients with COPD. The Lissajous index (LI) visually and numerically evaluates the left–right symmetry of the trunk movement during walking and is useful in clinical practice. In COPD patients, the LI is used as an indicator of the left–right symmetry of the trunk during walking. Here, we used the LI to evaluate the symmetry of COPD patients based on bilateral differences in mediolateral and vertical accelerations, and we investigated the correlation between the patients’ symmetry evaluation results and their physical function.Patients and methods: Sixteen stable COPD patients (all males; age 71.3±9.2 years) and 26 healthy control subjects (15 males; age 68.2±6.9 years) participated in this study. They performed the 10-minute walk test at a comfortable gait speed wearing a triaxial accelerometer, and we measured their trunk acceleration for the evaluation of symmetry. Motor functions were also evaluated in the patients with COPD.Results: The average mediolateral bilateral difference and LI values of the COPD patients were significantly larger than those of the healthy subjects. The COPD patients’ LI values were significantly correlated with their static balance.Conclusion: The LI measured using a triaxial accelerometer during walking is useful in balance assessments of patients with COPD. Keywords: chronic obstructive pulmonary disease, gait, accelerometer, Lissajou index, balance

Purpose: We investigated the validity of a triaxial accelerometer system for measuring the time spent lying down, sitting, standing, walking, and operating a wheelchair by control subjects and stroke patients in a convalescence ward. Methods: Physical activities were measured using a new triaxial accelerometer system (A-MES; Activity Monitoring and Evaluation System) that consists of two sensors, a station, and analytical software used with a personal computer. In Experiment 1, the times that the healthy subjects (n = 12) spent operating a wheelchair, lying down, sitting, standing, and walking were measured both by the A-MES and by videotaping (video time). In Experiment 2, the amounts of time spent by the stroke patients not able to walk without support (n = 30) as they were lying down, sitting, standing, walking, and operating a wheelchair were measured by the A-MES. Results: The time spent operating a wheelchair measured with the A-MES was significantly correlated with the video time in the healthy subjects. The stroke patients’ average times (minutes) of total, operating a wheelchair, lying down, sitting, standing, and walking were 601.0 ± 18.1, 57.1 ± 28.8, 265.0 ± 86.3, 263.3 ± 60.6, 7.8 ± 7.0, and 7.7 ± 6.0, respectively. Conclusions: The A-MES accurately evaluated the stroke patients’ time spent operating a wheelchair. The stroke patients’ mean time spent operating a wheelchair over the course of one day was 57.1 ± 28.8 min in a Center for Rehabilitation.

Objective: The aim of this study was to assess gait symmetry/asymmetry using a tri-axial accelerometer in elderly COPD. Methods: Gait symmetry/asymmetry wasevaluated in 16 elderly COPD (age; 71.3±9.2 years, FEV 1 ; 58.4±20.1%pred), 17 healthy subjects(age; 63.4±2.0 years) and 16 stroke patients with hemiplegia(age; 54.9±12.3 years) as for control. They performed 10m walking twice wearing a tri-axial accelerometer (MG-M1110, LSI Medience, Japan) attached to the back at lower lumbar spine (L3). Medio-lateral and vertical acceleration during walking were expressed as continuous waveforms and the bilateral surrounded area by waveforms was compared as Lissajous Index (LI). LI of 0 indicates perfect symmetry. Pulmonary function, leg muscle strength and one-leg standing test (OLST) were evaluated. Intra-class correlation coefficients (ICC) and Bland-Altman analysis were used for the relative reliabilities of LIs of COPD and stroke patients. Results: ICCs of COPD and stroke patients were 0.934 (p Conclusion: LI measured by a tri-axial accelerometer evaluated gait symmetry/asymmetry accurately and might be clinically useful for the evaluation of balance in elderly COPD patients.

Background: The Short Physical Performance Battery (SPPB) is commonly used in frail older people and in screening for sarcopenia. In general older population, the SPPB relates to functional exercise capacity and skeletal muscle function. However, it has been unclear whether SPPB score is associated with physical activity (PA) in chronic obstructive pulmonary disease (COPD). The aim of this study was to investigate the usefulness of SPPB as an assessment tool for PA in elderly patients with stable COPD. Methods: In twelve patients with COPD (Age 69.9±8.9years, FEV 1 48.8±26.4%pred), SPPB score, spirometry, 6-min walk distance (6MWD), quadriceps strength (QS), one leg standing (OLS), physical activity (PA: steps/day), health status (COPD Assessment Test; CAT), nutritional status (body mass index; BMI), and modified Medical Research Council dyspnea (mMRC) score were measured. Correlation analysis was conducted to determine whether SPPB score was associated with PA in COPD. Results: SPPB score (10.3±2.2) was significantly correlated with PA (4619.3±2753.3steps/day, r=.649, p=.042), age (r=.824, p=.002), mMRC score (2.0±0.7, r=.746, p=.021), OLS (33.4±21.0sec, r=.716, p=.020), and 6MWD (424.7±164.3m, r=.664, p=.036). While, SPPB score was not significantly correlated with FEV 1 (r=.237, p=.539), QS (66.6±16.6%body weight, r=.266, p=.458), CAT (15.7±4.7, r=.142, p=.695), and BMI (21.1±2.1kg/m 2 , r=.363, p=.302). Conclusions: The SPPB that is a valid, simple and practical assessment tool might be associated with physical activity, dyspnea, exercise capacity, and balance in patients with elderly COPD in home-based or clinical setting.