Biomedical subjects

Tetsuya Tsuji

Publications and source records attributed to Tetsuya Tsuji.

13 recordsLinked to original sources

PubMed2007

Electromyographic findings after different selective neck dissections.

OBJECTIVES: The objective was to compare electrophysiologic investigations of the upper trapezius muscle (UT) after different selective neck dissections (SND) and analyze the differences between types of SND and the preservation and excision of the cervical nerves (the C2-4 rami of the cervical plexus). STUDY DESIGN: Retrospective study of 54 patients (average age, 65.1 +/- 9.6 yr, 45 males) with 70 SND. METHODS: Patients underwent needle electromyography (EMG) of the UT by 4 months after surgery. The findings were rated according to the 5 point EMG scale system from 1 (total denervation: positive sharp wave or fibrillation potential at rest and electrical silence at voluntary contraction) to 5 (normal pattern). RESULTS: The average EMG scale was 1.7 +/- 1.1, 58.6% for score 1 and only 5.7% for score 5. There was not a significant difference in the EMG scale between the types of SND, whereas the group in which the cervical nerves were excised was significantly lower than in that in which it was preserved. The average EMG scales in the former and latter were 1.5 +/- 0.8 and 2.0 +/- 1.3, 68.8%. CONCLUSIONS: The study data confirm that complete or incomplete denervation of the UT was caused by axonal injury of the spinal accessory nerve, even though it was spared, because of traction of the nerve during neck dissection. Second, the excision of the C2 to 4 rami of the cervical plexus caused worse damage of the UT. It is suggested that it is important to preserve the cervical nerves to avoid denervation of the UT.

Accessory Nerve↗

PubMed2006

The effect of zaltoprofen on physiotherapy for limited shoulder movement in breast cancer patients: a single-blinded before-after trial.

OBJECTIVE: To determine the efficacy of oral administration of zaltoprofen on shoulder range of motion (ROM) exercises for breast cancer patients after surgery. DESIGN: Single-blind, before-after trial. SETTING: Rehabilitation facility in a Japanese university hospital. PARTICIPANTS: Forty breast cancer patients (age range, 37-72y) with limited shoulder movement after surgery. INTERVENTION: Single session of physiotherapy (PT) with or without oral administration of zaltoprofen. MAIN OUTCOME MEASURES: Active shoulder ROM in flexion, abduction, and external rotation, as well as subjective pain score during shoulder movements. RESULTS: Active shoulder movements after ingesting a zaltoprofen tablet significantly improved in flexion, abduction (P<.001), and external rotation (P<.005). PT treatment improved flexion and abduction ROM in both the zaltoprofen and control groups and led to significantly larger flexion and abduction movements in the zaltoprofen group than in the control group (P<.01). There were no differences in pain scores between groups, but 2 patients who did not receive zaltoprofen complained of increased pain just after ROM exercises. CONCLUSION: Zaltoprofen taken orally before ROM exercises for painful shoulder after breast cancer surgery may enhance the effects of PT.

Adult↗

PubMed2006

Development of a short version of the motor FIM for use in long-term care settings.

OBJECTIVE: To develop a short version of the motor Functional Independence Measure (FIM) for use in long-term care settings. PARTICIPANTS: For model construction, the participants were 398 community-dwelling persons with disability (mean age 79.3 years (SD 10.3)) who were receiving visiting nurse services. For cross-validation, 169 patients with stroke (mean age 78.0 years (SD 11.2)) in the chronic phase and 187 patients with stroke (mean age 63.4 years (SD 12.7)) in the recovery phase. DESIGN: Model construction and cross-validation study. MAIN OUTCOME MEASURES: The second power of correlation coefficient (R2) was used for agreement analysis between the short and the full version. Cross-validation of the models was estimated with the intraclass correlation coefficient (ICC). RESULTS: Five to 7 motor FIM items were selected for the models based on Rasch calibration and consideration of internal consistency. Total motor FIM was estimated with the 6-item and 7-item models with regression analysis, which yielded high correlations with the original 13-item motor FIM score (R2>0.95). Regression formulas derived from the models could estimate total motor FIM scores accurately in the 2 cross-validation samples (ICC > 0.98). CONCLUSION: The short version of the motor FIM developed is a useful measure of functional status, not only in long-term care but in the recovery phase rehabilitation settings.

Activities of Daily Living↗

PubMed2005

Identification of a simple screening tool for dysphagia in patients with stroke using factor analysis of multiple dysphagia variables.

OBJECTIVE: To identify a most useful and simple clinical screening tool to predict videofluoroscopic aspiration in patients with stroke. DESIGN: Factor analysis of multiple dysphagia variables and sensitivity and specificity testing with chi-square test. PATIENTS: Sixty-one consecutive stroke patients with symptoms suggestive of dysphagia admitted to a university hospital and its 4 affiliated hospitals in Japan. METHODS: Factors were extracted from 6 oromotor examinations (lip closure, tongue movement, palatal elevation, gag reflex, voice quality and motor speech function), 2 swallow screen tests (saliva swallowing test and our modified water swallowing test using 30 ml of water) and 4 parameters evaluated with a videofluoroscopic swallow study. Sensitivity and specificity of each dysphagia-related variable was determined against aspiration in a videofluoroscopic swallow study. RESULTS: Factor analysis revealed that cough/voice change in the water swallowing test and aspiration on videofluoroscopic swallow study belonged to the same factor. Chi-square analysis showed that cough/voice change in the water swallowing test was the only variable that was significantly associated with aspiration on videofluoroscopic swallow study, with a sensitivity of 72% (95% CI: 61-83%) and a specificity of 67% (CI: 55-79%) as a predictor of aspiration (p<0.05). CONCLUSION: We recommend our modified 30 ml water-swallowing test as a useful single task-screening tool to detect aspiration.

Adult↗

PubMed2005

Clinical electromyography and electrodiagnosis course at Keio University Hospital--a 7-year experience.

Although electromyography and electrodiagnosis (EMG-EDX) is one of the most fundamental skills in rehabilitation medicine, the number of residency programs that can provide comprehensive postgraduate EMG-EDX training is still limited in Japan. Under these circumstances, we started a 2-day primer course in EMG-EDX at Keio University Hospital in 1998. To review our 7-year experience with the course, we analyzed the number and specialty of the participants, their appraisal of the lectures and practical sessions, and the score distribution of the final examination. The number of participants totaled 288 during the past 7 years, and the mean number for each year was 41. The distribution by specialty for the whole period was 64.0% for rehabilitation medicine, 25.4% for orthopedic surgery, 5.1% for neurology, 1.0% for pediatrics, 0.5% for gerontology and 4.1% for physical therapists and occupational therapists. The difficulty levels of the lectures were judged as appropriate by 81 to 95.5% of the participants, and the presentation was judged as good by 34 to 67% of them. For the practice sessions, the difficulty levels were judged as appropriate by 88% of the participants, and the quality of the supervisors was judged as good by 64% of them. The mean score for the final examination was 56.0 (SD 15.2, median 60). In conclusion, our course has played an important role to promote EMG-EDX in our country by providing compact introductory exposure to EMG-EDX for beginners. A follow-up system for the course graduates is planned to support their EMG-EDX practice.

Diagnostic Techniques, Neurological↗

PubMed2004

Twenty-seven years of complication-free life with clean intermittent self-catheterization in a patient with spinal cord injury: A case report.

Currently, clean intermittent self-catheterization (CISC) is the most prevalent method of bladder management in patients with spinal cord injury (SCI) at discharge from rehabilitation centers. However, half of the patients discontinue using CISC and change to other methods of bladder management several months postdischarge despite the fact that it the best way to prevent urinary tract complications. Few studies, however, report the long-term consequences of CISC. In this case, we present a woman in her early fifties who had sustained thoracic SCI and had continued using CISC for 27 years without developing any complications. The possible reasons for her success were absence of incontinence because of underactive and normal capacity bladder; normal upper-extremity functions and absence of marked spasticity of lower extremities that facilitated CISC technique; and absence of sociovocational problems, enabling her to keep proper intervals between catheterizations each day. This case indicates that CISC is useful for long-term bladder management in patients with SCI, even for 25 years or more. Long-term outcomes of CISC and factors leading to success need to be delineated in future studies with larger samples.

Female↗

PubMed2004

Functional status and muscle strength in people with Duchenne muscular dystrophy living in the community.

OBJECTIVE: To describe activity limitation of people with Duchenne muscular dystrophy who are living in the community and to correlate it with age and muscle strength. DESIGN: Descriptive, correlational. SUBJECTS: Twenty-seven children with Duchenne muscular dystrophy aged 7-14 years who are living in the community. METHODS: The subjects' activity limitation was evaluated using the Functional Independence Measure and the muscle strength of their major upper and lower limb muscles was evaluated with manual muscle testing. The Functional Independence Measure was correlated with age and manual muscle testing, and the pattern of activities of daily living limitations and factors related to it were analysed. RESULTS: There were significant correlations between age and averaged MMT score (Spearman's rho = -0.63, p < 0.01), age and Functional Independence Measure motor score (rho = -0.52, p < 0.01), and Functional Independence Measure motor score and averaged manual muscle testing (rho = 0.77, p < 0.01). At similar manual muscle testing level, children with good cognitive function (Functional Independence Measure cognitive score > or = 26) showed significantly higher Functional Independence Measure motor scores than those with poor cognitive function (Mann-Whitney U test, p < 0.01). For individual Functional Independence Measure items, eating and bowel management were the easier, whereas transfer and stair climbing were the more difficult. Patients with mean muscle strength > or = grade 3 were rated as relatively independent, while those with a mean muscle strength < grade 3 were rated as maximal or total assistance (Mann-Whitney U test, p < 0.05). CONCLUSION: Activities of daily living in patients with Duchenne muscular dystrophy are related to age and muscle strength, and manual muscle testing grade 3 is an important cut-off point to predict their disability.

Activities of Daily Living↗

PubMed2004

Development of a new measure to assess trunk impairment after stroke (trunk impairment scale): its psychometric properties.

OBJECTIVE: The purpose of this study was to investigate reliability, validity, internal structure, and responsiveness of our newly developed Trunk Impairment Scale (TIS) for patients with stroke. DESIGN: A total of 73 patients with stroke participated in this prospective study. Interrater reliability (weighted kappa statistics), content validity (principal component analysis), concurrent validity (Spearman's rank correlation with the Trunk Control Test), predictive validity (prediction of discharge FIM scores), and responsiveness (standardized response mean values) were examined. Internal consistency and item difficulties were analyzed with Rasch analysis. RESULTS: The weighted kappa of each TIS item ranged from 0.66 to 1.0. Principal component analysis revealed that the TIS measured a domain similar to the Stroke Impairment Assessment Set trunk items but different from the Stroke Impairment Assessment Set motor and visuospatial items. The TIS correlated with the Trunk Control Test (r = 0.91). To predict discharge FIM motor scores, addition of the TIS as one of the predictors to age, time from onset, and admission FIM score increased the adjusted R2 from 0.66 to 0.75. With Rasch analysis, the misfit was acceptable, except for the abdominal muscle strength item. The difficulty patterns were similar at admission and discharge, except for the abdominal muscle strength item. The responsiveness of the TIS was satisfactory and comparable with that of the Trunk Control Test (standardized response mean values, 0.94 and 1.06). CONCLUSIONS: Our newly developed TIS is reliable, valid, and responsive for use in stroke outcome research.

Adult↗

PubMed2004

Physical fitness in persons with hemiparetic stroke: its structure and longitudinal changes during an inpatient rehabilitation programme.

OBJECTIVE: To test the hypothesis that the structure of fitness in patients with hemiparetic stroke can be categorized into impairment/disability, cardiopulmonary, muscular and metabolic domains, and to study longitudinal changes in their fitness during an inpatient rehabilitation programme. DESIGN: Structure analysis of multiple fitness parameters with principal component analysis (PCA), and a before and after trial. SETTING: Tertiary rehabilitation centre in Japan. PATIENTS: One hundred and seven consecutive inpatients with hemiparetic stroke. INTERVENTION: A conventional stroke rehabilitation programme consisting of 80 minutes of physical therapy and occupational therapy sessions five days a week, and daily rehabilitation nursing for a median duration of 105.5 days. MAIN OUTCOME MEASURES: Principal component scores extracted from measurement of paresis/daily living (the Stroke Impairment Assessment Set (SIAS) and the Functional Independence Measure (FIM)); muscular (grip strength (GS), knee extensor torque, and cross-sectional areas of thigh muscles); metabolic (body mass index (BMI) and fat accumulation on CT); cardiopulmonary (heart rate oxygen coefficient (HR-O2-Coeff) obtained with a graded bridging activity and a 12-minute propulsion distance). RESULTS: PCA categorized the original 15 variables into four factors corresponding to paresis/activities of daily living, muscular, metabolic and cardiopulmonary domains, and explained 78.1% of the total variance at admission and 69.6% at discharge. Except the metabolic domain, PCA scores for the other three domains improved significantly at discharge (paired t-test, p < 0.05). CONCLUSION: The hypothetical structure of fitness was confirmed, and the PCA scores were useful in following longitudinal changes of fitness during inpatient rehabilitation.

Adult↗

PubMed2003

Rehabilitation research from a non-English speaking country published in peer-reviewed English journals--the Japanese experience.

PURPOSE: To study the status of contribution by non-English speaking countries to international rehabilitation literature taking Japan as an example, and to suggest recommendations to overcome the language barrier. METHOD: Descriptive study using a systematic MEDLINE search with outcome measures of annual numbers and proportions of articles by Japanese physiatrists published in peer-reviewed English rehabilitation journals, and of categories and types of studies. A database containing 292 relevant articles were used for analysis. RESULTS: The publications have steadily increased annually both in absolute number and in proportion. The number was the largest for Arch Phys Med Rehabil (16.8%), followed by Am J Phys Med Rehabil (12.3%), Prosthet Orthot Int (8.6%), Disabil Rehabil (5.1 %) and so on. The percentage by category was the highest for stroke (26.0%), followed by spinal cord injury (11.6%), neurophysiology (11.6%) and amputation (6.2%), 67.8% of the articles were related to evaluation, 6.5% to outcome studies and 25.7% to therapy. The majority were descriptive studies (45.5%), followed by case control studies (13.0%), before-and-after trials (12.3%), case reports (7.2%) and others. CONCLUSION: The contribution from Japan to international rehabilitation literature is increasing. Measures were suggested to facilitate more scientific contribution by non-English speaking researchers.

Humans↗

PubMed2003

Trunk muscles in persons with hemiparetic stroke evaluated with computed tomography.

OBJECTIVES: To analyse side difference in bilateral trunk muscles in patients with hemiparetic stroke, to relate it with impairment and disability variables and to evaluate longitudinal changes. METHODS: In a sample of 83 inpatients with hemiparetic stroke undergoing rehabilitation, we measured the cross-sectional area of the paravertebral muscle and thigh muscles using computed tomography at admission and discharge. Classifying them by paravertebral muscle side difference (group I: contralateral > ipsilateral; II: contralateral = ipsilateral; III: contralateral < ipsilateral) we analysed group difference in the Stroke Impairment Assessment Set, the Functional Independence Measure and walk velocity. RESULTS: In contrast to thigh muscles, the paravertebral muscle cross-sectional area was significantly greater on the side contralateral to the brain lesion. Discharge paravertebral muscle cross-sectional area increased significantly from admission values. The Stroke Impairment Assessment Set, Functional Independence Measure and walk velocity were significantly lower in group I. CONCLUSION: The contralateral paravertebral muscle cross-sectional area was larger than the ipsilateral ones, and this was related to the degree of impairment and functional limitations.

Adult↗

PubMed2003

Physical fitness in persons with hemiparetic stroke.

In persons with hemiparetic stroke, assessment and promotion of fitness have so far received limited attention, partly because of the lack of appropriate measures applicable to them. Because these mobility-impaired persons are prone to inactivity, disuse and insulin resistance are likely to occur, and can aggravate the already significant health and economic consequences that stroke entails. It is therefore important to assess objectively their fitness to devize effective and efficient fitness promotion programs. Because of physical limitations, however, many persons with stroke cannot perform traditional stress testing using a treadmill or a cycle ergometer, and maximal oxygen consumption, which is regarded as a gold standard, is not a practical measure. In this article, we reviewed the current status of research on fitness in persons with hemiparetic stroke from the perspectives of evaluation, structure analysis of fitness, and longitudinal changes during a rehabilitation program. As a measure of fitness, indices obtainable with a submaximal exercise are proposed, such as anaerobic threshold and heart rate oxygen coefficient. Protocols applicable to persons with hemiparetic stroke with a variety of functional limitations have been developed (basic bedside activities, bridging activity, or single arm ergometry). The structure of their fitness is demonstrated to be described by a fitness model of healthy persons (cardiopulmonary, muscular and metabolic dimensions) if the paresis/activities of daily living dimension is added. Several studies suggest that fitness improves during a conventional stroke rehabilitation program. Studying the changes of the above four dimensions can help develop more effective fitness training programs.

Humans↗

PubMed2002

Long lasting effects of rTMS and associated peripheral sensory input on MEPs, SEPs and transcortical reflex excitability in humans.

We tested the effect of repetitive transcranial magnetic stimulation (rTMS) over the motor cortex on the size of transcortical stretch and mixed nerve reflexes. Fourteen healthy subjects were investigated using either 25 min of 1 Hz rTMS or 30 min of 0.1 Hz rTMS paired with electrical stimulation of the motor point of the first dorsal interosseous muscle (FDI). Following treatment, we measured the effect on the size of: (1) EMG responses evoked in FDI by transcranial magnetic stimulation (MEPs), (2) somatosensory evoked potentials (SEPs) evoked by ulnar nerve stimulation, and (3) transcortical stretch or electrically elicited reflexes. rTMS at 1 Hz reduced the amplitude of both MEPs and long latency reflexes by 20-30 % for about 10 min after the end of stimulation. Short latency reflexes were unaffected. SEPs were not studied, as it has been shown previously that they are also suppressed. rTMS at 0.1 Hz paired with motor point stimulation (interstimulus interval of 25 ms) increased the amplitude of the MEP and the cortical components of the SEP (N20/P25 and later peaks) for up to 10 min. Long latency reflexes were facilitated with the same time course. We conclude that rTMS over the motor cortex either alone or in conjunction with peripheral inputs can decrease or increase the excitability of the sensory and motor cortex for short periods after the end of stimulation. These changes affect not only MEPs and SEPs but also EMG responses to more 'natural' inputs involved in transcortical stretch reflexes.

Adult↗