A study of the upper limb motion of patients with spinal cord injury while eating using two types of self-helping device

頸髄損傷者の食事動作に関して,スプーンの使用方法を替えることにより,上肢各関節(肩･肘・前腕・手関節)の角度と運動の範囲がどのように変化するかを明らかにするために,三次元動作解析を行った.対象はC6レベルの頸髄損傷者5人で,「ヨーグルトを食べる」という課題を2種類の自助具(自助具1:母指側使用,自助具2:手掌側使用)を用い実施した.撮影された画像から時間と上肢各関節角度を求め,自助具1,自助具2使用時で比較検討した.結果,自助具1使用時には自助具2使用時と比べ,1回の食事動作におけるすくう動作が占める割合が多い傾向にあった.また,食物をすくう際に肩関節屈曲,肩関節外転の運動が多く必要とされ,一連の動作を通じて前腕が回内方向に移行し,肩関節が屈曲・外転方向に移行することが明らかとなった.以上より,前腕の回外運動が十分可能である場合には手掌側使用の自助具の導入が望ましく,また母指側使用で食事を行う場合には,食物を口へ運ぶ動作だけでなく,すくう動作においても肩関節の運動が必要になることを十分に考慮した上で,自助具の提供やセッティングを行うことが重要であることが示唆された.The purpose of the present experiment was to examine how the upper limb movements (shoulder, elbow, forearm, wrist) of patients with spinal cord injury (C6 level) were affected while using two types (type 1: pronation type, type 2: supination type) of self-helping device. Five subjects were required to eat 5 spoonfuls of yoghurt. We recorded the position of 11 light reflecting markers attached to the subjects' body with three cameras. We divided the eating action into three phases, the scoop phase, reach-to-mouth phase, and reach-to-plate phase. These kinematic landmarks were used to define the dependent variables. We calculated five joint angles (shoulder flexion, shoulder abduction, elbow flexion, forearm supination, wrist extension) with a three-dimensional video-based motion analysis system (APAS System, Ariel Dynamics), and analyzed how they changed at each phase. We compared them while using type 1 and type 2. While using type 1, the scoop phase played a larger part than other phases, and shoulder flexion, shoulder abduction and elbow flexion angles increased, not only in the reach-to-mouth phase but also in the scoop phase, and the supination angle decreased. This result suggests that patients who can supinate their forearm had better use type 2, and also that it is important to consider upper limb movements in the scoop phase when we provide patients with a self-helping device. In this study, however, we focused only on upper limb movements. We also have to analyze head, neck and trunk movements and examine the relationship among upper limb, head, neck and trunk

Upper limb coordination differs among ages and between dominant and non-dominant hands utilizing digital trace test

Evaluation of motor coordination is carried out in the rehabilitation scene at the clinical site. However, most of the conventional evaluation methods are too subjective, or rather most are insufficiently elaborate to trace the target of diachronic change. Thus, we attempted evaluation of upper extremity motor coordination utilizing an originally developed ‘Digital trace method' on 65 persons of physically unimpaired status, ages 8 to 90. In this experiment, four types of measurement were tried for both the dominant and non-dominant hand for the large and small circle, and factors of age, sex and handedness were analyzed. As a result, the trace error of the dominant hand decreased significantly compared with that of the non-dominant hand. A change in the error value of the small circle was hardly observed in the dominant hand. However, it was admitted that the error value of the large circle was significantly smaller in the non-dominant hand. Observing this when separated by age, it was found that the error at trace testing indicated a drastic decrease from childhood period to adult age. In constant, it indicated a gradual increase from the thirties. From these observations, it was found that variations in motor coordination depend on age and thus have a bearing on the use status of the dominant hand and the non-dominant hand. Operability of the dominant hand and the supplement role of the non-dominant hand are considered to be affected by such conditions

Discrimination of athletic characteristics based on exercise physiology and serum biochemistry

The purpose of the present study is to determine whether athletic characteristics can be discriminated by changes in serum components during exercise which are considered to reflect systemic endurance capacity, muscle strength, and the energy metabolism system. Thirteen male long-distance athletes and 8 male short-distance and field athletes performed an incremental exercise test, muscle strength, and endurance test. They were also observed for changes in serum components during exercise. According to data analysis, the discriminant function thus obtained was: Z=0.8220×peakVO2+0.0037×AT+0.0010×MVC+(-0.0276)×60deg/sec+0.2629×MVC500me+(-0.8715)×UN+36.1659(peakVO2: measured value of peak VO2, AT: 0xbfffa670eakVO2, MVC: measured value of the isometric muscle strength, 60deg/sec: peak torque of the isokinetic muscle contraction at 60deg/sec, MVC50-1230722560me: the time for the previously determined isometric muscle strength value to become less than 50%, UN: the increase rate of UN from the value at rest to the maximum value). Subjects were classified into the actual group correctly, while the erroneous discriminant rate was 0.73%.0 In particular, weighting of the discriminant coefficient of peakVO2 and UN was large, indicating that these are useful as parameters for discriminating athletic characteristics

Increased amygdala reactivity following early life stress : a potential resilience enhancer role

Background: Amygdala hyper-reactivity is sometimes assumed to be a vulnerability factor that predates depression; however, in healthy people, who experience early life stress but do not become depressed, it may represent a resilience mechanism. We aimed to test these hypothesis examining whether increased amygdala activity in association with a history of early life stress (ELS) was negatively or positively associated with depressive symptoms and impact of negative life event stress in never-depressed adults. Methods: Twenty-four healthy participants completed an individually tailored negative mood induction task during functional magnetic resonance imaging (fMRI) assessment along with evaluation of ELS. Results: Mood change and amygdala reactivity were increased in never-depressed participants who reported ELS compared to participants who reported no ELS. Yet, increased amygdala reactivity lowered effects of ELS on depressive symptoms and negative life events stress. Amygdala reactivity also had positive functional connectivity with the bilateral DLPFC, motor cortex and striatum in people with ELS during sad memory recall. Conclusions: Increased amygdala activity in those with ELS was associated with decreased symptoms and increased neural features, consistent with emotion regulation, suggesting that preservation of robust amygdala reactions may reflect a stress buffering or resilience enhancing factor against depression and negative stressful events

Characteristic of postoperative treatment after repair of flexor tendon rupture in Zone II : Comparison between 3 weeks immobilization and modified Kleinert method in the progress of range of motion

ZoneII屈筋腱断裂後の後療法について,3週間固定法とKleinert変法における獲得可動域の推移について,34例35指(3週間固定法:20例20指,Kleinert変法:14例15指)を対象とし調査した.最終成績を群別に分けて検討した結果,3週間固定法,Kleinert変法ともに,近位指節間関節,遠位指節間関節の伸展方向への改善が良好な成績へと結びつく要因であった.また,Kleinert変法の成績良好例では遠位指節間関節での伸展可動域回復が著明に認められ,深指屈筋腱の単独滑走回復の重要性が示唆された. 以上から,早期運動療法の利点を3週間固定法に活かし良好な成績を得るには,屈曲可動域を維持しながら自動伸展あるいは他動伸展運動での回復を図り,可及的早期に深指屈筋腱の独立した滑走を促進させる事が推奨された.This study compared progress of range of motion(ROM)outcomes between 3 weeks of immobilization(20 cases, 20 fingers)and modified Kleinert method(14 cases, 15 fingers)as postoperative treatments following surgical repair of flexor tendon rupture in ZoneⅡ. Both postoperative treatments were divided into outcomes by Strickland's evaluation method. As a result, both treatment methods showed an improvement to the extension of the proximal interphalangeal joint(PIP joint)and the distal interphalangeal joint(DIP joint). In addition, good recovery of the DIP joint was clearly observed in the modified Kleinert method, and the importance of single excursion of flexor digitorum profundus(FDP)was indicated. As above, we recommend that therapists promote active or passive extension exercise, and promote single excursion of FDP, if using the 3 weeks immobilization method, as soon as possible

Problems in communication and their solutions between severe aphasics and their wives at home

本研究の目的は,家庭での重度失語症者と妻のコミュニケーションでどのような困難が生じ,どのように解決されるかを明らかにすることである.重度失語症者3名とその妻の昼食時の会話をビデオに記録し,すべて文章化した.その中から15分間を分析対象とし,話題の変化で区切り,その区分ごとにコミュニケーション困難の有無と原因,困難解決の有無と解決理由を調べた.その結果,3組の対象は,喚語困難,錯語,聴覚的理解障害等により,全話題の半分またはそれ以上にコミュニケーション困難を生じていたが,その内の約7割は解決されていた.解決行動には「言語的補完」「内容の明確化」「相手への行動の促し」「自己の身体の使用」「道具の使用」「共有情報の使用」等があり,どの行動を使用するかは対象の組,または患者・妻のいずれであるかにより異なっていた.全ての組で1話題をめぐる発話数が,困難の有無にかかわらず健常者よりも多くなっていた.The purpose of the present study was to clarify what kinds of problems arose in communication between severe aphasics and their wives at home and how and to what extent they were solved. Three pairs consisting of a severe aphasic and his wife were asked to freely talk to one another during their lunch time at home, while they were videotaped. All the conversation was transcribed. 15 minutes from these typical communication scenes were selected and subjected to study. They were divided into "cuts" according to topics. Regarding each "cut", it was determined 1)whether a communication problem arose or not, 2)what caused the problem, if it occured, 3)whether the problem was solved or not, and 4)how it was solved, if this were the case. The results showed that each pair of subjects had the communication problems in half or more of the topics about which they communicated, because of word finding difficulty, paraphasia or impaired auditory comprehension and other problems. However, it was found that approximately 70% of the problems were solved by themselves. Their means of solving the problems were classified into six categories, namely "Verbal complementation", "Content clarification", "Encouraging of verbal expression", "Using their bodies", "Using of tools", "Guessing through previously shared information". Each pair, each patient and each wife, differed in what kind of solving procedure he or she used. Each pair showed a greater frequency of conversation turn for each topic than normally expected

高齢者における跨ぎ動作のアフォーダンス知覚と実際のパフォーマンスの関係

The purpose of this study is to examine the difference between perception of affordances and motor performance in young adults (in their 20s) and aging adults (in their 60s, 70s and 80s). In the first experiment, to determine the distance which would be used in the second experiment, we examined how viewing distances affected the perception of affordances on a stepping-over task. As a result, we found that a 4 meter distance was suitable for the following experiment. In the second experiment, we compared, in young adults and aging adults, the perceived maximum height to the actual maximum height of a bar which the subjects could step over. We found that for the stepping-over task the perception of affordances did not show a generational difference, while the actual motor performance did. In particular, aging adults older than 80 years showed this difference more clearly. This suggests that if young adults can estimate their motor performance precisely, then motor perceptual ability progressively declines in aging

Further evidence for excitability changes in human primary motor cortex during ipsilateral voluntary contractions

The present study aimed to further investigate whether the intracortical neural circuits within the primary motor cortex (M1) are modulated during ipsilateral voluntary finger movements. Single- and paired-pulse (interstimulus intervals, ISIs; 3 ms and 12 ms) transcranial magnetic stimulations of the left M1 were applied to elicit motor evoked potential (MEP) in the right first dorsal interosseous (Rt-FDI) muscle during voluntary contractions (10% and 30% maximum voluntary contraction) of the left FDI (Lt-FDI) muscle. F-waves of Rt-FDI muscle were recorded under these left index-finger conditions for ensuring that the excitability changes occur at the supraspinal level. MEPs were also recorded during motor imagery of the left index-finger abduction instead of overt movement. The results showed that, in single-pulse transcranial magnetic stimulation (TMS) paradigm, MEPs in Rt-FDI muscle were markedly enhanced during voluntary contractions of Lt-FDI muscle compared with the complete resting state. In paired-pulse TMS paradigm, the short intracortical inhibition was significantly reduced in proportion to increments of the ipsilateral muscle contraction, whereas the intracortical facilitation had no change. F-wave of Rt-FDI muscle was unchanged under these conditions, while MEP in Rt-FDI muscle was also enhanced during motor imagery of the left index-finger abduction. Based on the present results, it is suggested that the intracortical inhibitory neural circuits may be modulated in the transition from rest to activity of the ipsilateral homonymous muscle. The excitability changes in M1 might be induced by overflows of voluntary drive given to the ipsilateral limb, probably via the transcallosal pathway