S-2-10-05
A New Concept of Walking Exercise For Paraplegia Using Walking Orthosis
- the rhythm and amlitude of the EMG activities of paralyzed muscles during -
HIDEO YANO, MD, PhD (The Institute of National Rehabilitation Center, JAPAN)
Abstract:
The professionals have stressed the cautions concerning the lowering of the quality of life in the advanced age of paraplegic patient. A paraplegic patient should make efforts to facilitate his own physical activities in younger daily life, not only with wheel-chair exercise, but also with reciprocal walking. In the past, many devices were developed to assist paraplegic to walk, but these trials have fallen short of the paraplegic's desire. A new concept of reciprocal walking orthosis had been developed to restore a locomoter function of paraplegic. A complete paraplegic (Th 7 level, SEP, MEP silent) achieved a maximum walking speed of 34.1 m/min for a distance of 10 meters, and the walking distance reached 521m. The EMG responses in paralyzed muscles were observed while walking. The pattern of rhythm and amplitude of EMG responses were examined whether the forced orthotic gait would contribute to restore a spinal cord or not. The synchronized EMG responses were observed in reciprocal pattern in tibialis anterior and soleus muscle corresponding to the motion of hip joint flexion and extension. The EMG pattern of reciprocal inhibition seemed to support Dietz's hypothesis that the load effect might activate the reforming of central pattern generator, regarding to the estimate of the thrust force of 120% weight of subject's body weight while orthotic gait. But the pattern had not always observed in any walking test, so another unknown parameters except the mechanical stimulation of hip joint motion and the load effect, which control the output of activities of central pattern generator should be persuaded by farther investigation.
EL-2-09-01
FUNCTIONAL EVALUATION OF STROKE PATIENTS (Part 1: IMPAIRMENT)
Naoichi Chino (Dept of Rehab Med, Keio Univ Schl of Med, Tokyo, JAPAN)
Functional evaluation of stroke patients is now carried out according to ICIDH; impairments, disabilities and handicaps.
There are numerous number of functional evaluation instruments regarding DISABILITIES, however, the FIM (Functional Independence Measure) has been most widely adopted in the world.
As for evaluation method of IMPAIRMENT of stroke patients, we developed Stroke Impairment Assessment Set (SIAS), and found it can be used to evaluate various aspects of impairment in the hemiplegic, including motor, sensory, ROM, pain, visuospacial, speech, etc.
The SlAS consists of 8 items, scoring from 0 to 5 or 0 to 3 depending on the patient performance, the full score being 76 points. It uses single-task assessment to examine each item and an evaluation procedure can be performed during an ordinary physical examination not only by physiatrists but also by other medical professionals such as neurologists, neurosurgeons, and allied rehab. medical professionals.
Accurate evaluation of stroke patients will promote rehabilitation setting more scientifically, bringing the patient quality of life and a better feedback of the effective rehabilitation regimen.
