Search

Cardiopulmonary function is usually assessed by cardiopulmonary exercise testing (CPX) using a cycle ergometer (CE-CPX) or a treadmill, which is difficult in patients with lower extremity motor dysfunction. A stepping and handshaking (SHS) exercise has been developed that can be performed safely and easily while sitting on a chair. This study compared peak oxygen uptake (peak V.O2) between CE-CPX and SHS-CPX in healthy adults and investigated the safety and validity of SHS-CPX. Twenty young adults (mean age 27.8 ± 4.4 years) were randomly assigned to perform CE-CPX or SHS-CPX, with the other test to follow 1–2 weeks later. The peak V.O2, respiratory exchange ratio (RER), peak heart rate, blood pressure, and test completion time were compared between CE-CPX and SHS-CPX. All subjects completed the examination and met the criteria for peak V.O2. SHS-CPX and CE-CPX showed a strong correlation with peak V.O2 (r = 0.85, p < 0.0001). The peak V.O2 (40.4 ± 11.3 mL/min/kg vs. 28.9 ± 8.0 mL/min/kg), peak heart rate (190.6 ± 8.9 bpm vs. 172.1 ± 12.6 bpm), and test completion time (1052.8 ± 143.7 s vs. 609.1 ± 96.2 s) were significantly lower in the SHS-CPX (p < 0.0001). There were no adverse events. The peak V.O2 with SHS-CPX was equivalent to about 70% of that with CE-CPX despite the exercise being performed in a sitting position, suggesting its suitability as a submaximal exercise test.

Compared with land-walking, water-walking is considered to be beneficial as a whole-body exercise because of the characteristics of water (buoyancy, viscosity, hydrostatic pressure, and water temperature). However, there are few reports on the effects of exercise in water on muscles, and there is no standard qualitative assessment method for muscle flexibility. Therefore, we used ultrasound real-time tissue elastography (RTE) to compare muscle hardness after water-walking and land-walking. Participants were 15 healthy young adult males (24.8 ± 2.3 years). The method consisted of land-walking and water-walking for 20 min on separate days. The strain ratio of the rectus femoris (RF) and medial head of gastrocnemius (MHGM) muscles were measured before and immediately after walking using RTE to evaluate muscle hardness. In water-walking, the strain ratio significantly decreased immediately after water-walking, with p < 0.01 for RF and p < 0.05 for MHGM, indicating a significant decrease in muscle hardness after water-walking. On the other hand, land-walking did not produce significant differences in RF and MHGM. Muscle hardness after aerobic exercise, as assessed by RTE, was not changed by land walking but was significantly decreased by water walking. The decrease in muscle hardness induced by water-walking was thought to be caused by the edema reduction effect produced by buoyancy and hydrostatic pressure.

Background and aim We examined oral dyskinesia (OD), wearing artificial tooth, food test findings and conducted a video - fluoroscopic swallowing study (VFSS) in bedridden elderly patients before they were received parenteral nutrition once daily. However, the validity and properties of these deglutition foods have not been evaluated. Therefore, in this study, we clarified four deglutition foods as four aspects. Method Forty-five patients (23 males, mean age: 82.5 years) receiving deglutition foods were evaluated. The OD and food tests were performed at the bedside. The VFSS (dynamics of swallowing, oropharyngeal transit time, distance of hyoid bone displacement and difference in the oropharyngeal transit time) was conducted via X-rayunder administration of contrast medium mixed with food. Additionally, the physical properties of the deglutition foods were evaluated in accordance with thestandard methods for patients with dysphagia by the Ministry of Health, and Labour, Welfare and Consumer Affairs Agency. Results The mean duration receiving deglutition foods was 8 months. Although OD and wearing artificial tooth were observed in 42% of the patients, the rate of OD was significantly higher in patients receiving thick than in patients receiving jelly. The deglutition foods were classified into four types based on their physical properties (thick 1, n=18; thick 2, n=10; jelly 1, n=10; and jelly 2, n=7). The food test scores markedly differ among the four types of deglutition food. The mean score for swallowing dynamics was significantly different among the four types. Although the oropharyngeal transit time was similar for each type, the thick 1 group was divided into fast and slow transitors. The distance of hyoid bone displacement was significantly different among the four types. The oropharyngeal transit time was significantly correlated with the number of teaspoons ingested at a time. In the physical properties test, all four deglutition foods showed appropriate results; thick 1 and 2 were within the standardII category, while jelly 1 and 2 were within the standardIII category. Conclusion The results of swallowing tests suggest that these four deglutition foods may be safe and reasonable for administration to bedridden elderly patients receiving parenteral nutrition.

【目的】デンプン系，グアーガム系，キサンタンガム系およびその他の各種市販とろみ調整食品が緑茶，牛乳，オレンジジュースおよび味噌汁に与える影響を物性面から解析し，性能に基づくとろみ調整食品の分類を行うことを目的とした。【方法】15種類のとろみ調整食品を4種類の食材に溶解して調製した各種とろみ液の粘度およびテクスチャーを測定し，とろみ調整食品の機能性を反映する指標として，粘度力価，添加時および安定時粘度ばらつき，初期粘度発現率および付着性を算出した。さらにこれら5つの指標を用いて主成分分析およびクラスター分析を行った。【結果】粘度力価は4種の食材すべてについてグアーガム系が大きかった。添加時および安定時の粘度のばらつきはとろみ調整食品の種類と食材の組合せによって傾向が異なった。初期粘度発現率は食材によって特徴があり，緑茶ではキサンタンガム系が，オレンジジュースではデンプン系が高い値を示した。付着性は4種の食材すべてについてデンプン系が大きかった。5つの指標を用いて食材別に主成分分析を行なうと，とろみ成分による分類とは異なる分布を示した。一方，全食材の5つの指標を説明変数にとり，クラスター分析を行った結果，とろみ成分に応じたクラスターが形成された。【結論】市販とろみ調整食品が食材の物性に及ぼす影響をもとに分類を行なうと，各とろみ剤の特徴が食材の種類によって異なることが明らかとなった。したがって，とろみを付与する食材や目的に応じて適切な製品を選択することが重要である。

【目的】延髄外側症候群患者における摂食・嚥下リハビリテーションが，脳卒中急性期のリスクとなる再発/進行や誤嚥性肺炎に対してどのような影響を及ぼすか検討した．【対象と方法】延髄外側症候群の連続症例を対象として，2004年9月の摂食・嚥下リハビリテーション立ち上げ以前の2年間の10例（未介入群）と立ち上げ後2年間の10例（介入群）をそれぞれの年齢，入院期間，絶食期間，リスク（再発/進行率・誤嚥性肺炎発生率）及び転帰を比較検討した．【結果】未介入群は平均年齢64歳（男9例，女1例；梗塞8例，出血2例）であった．介入群は平均年齢60歳（男8例，女2；梗塞10例）であった．発症から経口摂食（直接訓練）開始までの期間は，未介入群10.9日に対して介入群2.3日（p=0.005）であった．嚥下造影は介入群9例に施行した．転帰では自宅退院が未介入群4例，介入群6例で，機能ゴールでは，歩行自律が両群とも7例であり有意差を認めなかった．未介入は転院が多かった．退院時の食事形態（藤島の嚥下食1））は未介入群で嚥下III 3例・移行食5例・普通食2例で，介入群は移行食3例・刻み粥食2例，普通食4例と回復がやや早かった．退院時フォロー時の最終摂食能力は普通食が両群とも7例で有意差がなかった．誤嚥性肺炎は未介入群6例，介入群3例であり有意差（p=0.04）を認めた．脳卒中の再発/進行は，6例（両群ともに3例）で，発症3∼8日目に座位開始などの安静を変更した時に再発/進行していた（p>0.05）．【考察】最終的摂食・嚥下機能には有意差がないが，発症2日目より摂食・嚥下リハビリテーションが関わることで，誤嚥性肺炎予防と早期機能回復を促していると考えられた．また摂食・嚥下リハビリテーションを早期に開始することは，脳卒中の再発/進行リスクにならないと考えられた．

BACKGROUND In some stroke patients blood pressure (BP) fluctuates extensively during medical rehabilitation, so the present study investigated the influence of autonomic nervous dysfunction on the change in BP during exercise. METHODS AND RESULTS The subjects consisted of 55 stroke inpatients (males, 29; mean age, 58.8 years old; ischemic/hemorrhagic etiology, 30/25) who were admitted to the Stroke Center within 2 weeks of their first stroke. The control group consisted of 15 age-matched healthy volunteers. The 24-h heart rate (HR) variability (HRV) and BP variability (BPV) were examined, and then the increase and recovery of BP and HR were measured during bicycle ergometer exercise at 4 METs. Components of 24-h HRV (low-frequency power (LF), high-frequency power (HF), LF/HF, and asleep-awake ratio of LF/HF (LF/HF(d-n)) were lower (p < 0.01) and BPV was greater in the stroke group (p < 0.05) than in the control group. There was a negative correlation between BP change during exercise and LF/HF or LF/HF(d-n) (r = -0.43 or r = -0.58, p < 0.01), and a greater increase in systolic BP (102 +/-9.8 mmHg, n = 7) during exercise was observed in stroke patients with lower LF/HF(d-n) (< or = 1.0). CONCLUSIONS Lower HRV in stroke patients may relate to an increase in BP during exercise. HRV is useful for estimating the risk during medical rehabilitation.

Background:Two persons presented with severe stump pain following transfemoral amputation.Case description and methods:A 21-year-old female and a 31-year-old male with transfemoral amputation were ambulatory with prostheses and suffered from severe stump pain caused by the presence of masses around the tip of the bone stump. From the clinical courses, imaging studies, and the intraoperative findings, the masses were diagnosed as a relatively rare condition known as chronic expanding hematoma.Findings and outcome:The two patients were treated successfully with surgical resection. The hematomas were soft cystic masses with a thick capsule containing old blood clots and serous fluid. There were no pathological signs of malignancy. After surgical treatment, the patients achieved walking without stump pain.Conclusion:Although chronic expanding hematoma is a rare condition, it should be considered as a possible cause of stump pain.Clinical relevanceStump pain is caused by many conditions. Although chronic expan...