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Electromyographic Interference Pattern Analysis-Various Qualitative and Quantitative Analyses and their Limitations-

The Japanese Journal of Rehabilitation Medicine.2009;46(10):649-658. doi:10.2490/jjrmc.46.649

Needle electromyography is used to investigate motor unit abnormalities, consisting of the anterior horn cell, the axon, the nerve end-plate, and the associated muscle fibers. The characteristics of the firing and recruitment patterns of motor units during voluntary contraction are identified as an interference pattern that is used clinically for the diagnosis of neuropathy and myopathy. Quantitative analysis of this interference pattern, using such factors as zero-crossing, spike count, number of turns (NT), the peak-to-peak amplitude, mean amplitude (MA), and automatic amplitude of the interference pattern envelope, is used to identify interference patterns resulting from specific pathologies. It is difficult, however, to improve the sensitivity and specificity of the analysis for the diagnosis of neuropathy and myopathy by separately analyzing the number or amplitude of the spikes involved in the interference pattern. Therefore, turn amplitude analysis has been developed, which combines the number and amplitude of the spikes. For the NT:MA ratio and peak ratio analysis (PRA), the turns are examined during a constant voluntary contraction. In contrast, for the cloud analysis, the distribution of NT and MA at various muscle strengths is plotted. Expert Quantitative Interference Pattern Analysis (EQUIP), which applies the expertise of an electromyographer, provides practical sensitivity and specificity for the clinical diagnosis of neuropathic and myopathic diseases. Understanding these various quantitative interference pattern analysis modalities will not only improve the ability of physiatrists to interpret electromyographic findings, but will also expand their knowledge of motor unit diseases.

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Disaster Rehabilitation-What We have done in the Stricken Area following the Great East Japan Earthquake for 3 Months afterwards-

Masahiro KOHZUKI

The Japanese Journal of Rehabilitation Medicine.2011;48(8):576-587. doi:10.2490/jjrmc.48.576

The Great East Japan Earthquake occurred on March 11, 2011. As a representative of a local earthquake relief headquarters, I report what we have done in the stricken area following the Great East Japan Earthquake for the three months afterwards. As a result of this report, I strongly recommend the establishment of a “Disaster Rehabilitation” and “Disaster Acute Rehabilitation Team (DART)” as well as creating a “Disaster Rehabilitation Manual or Guideline” in order to pass the knowledge learned through our experience on to future generations and to be able to respond to any forthcoming disaster quickly and efficiently.

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Rehabilitation Support in the Kesen-Numa Earthquake and Tsunami Disaster Area

Michiaki TAKAGI

The Japanese Journal of Rehabilitation Medicine.2012;49(1):37-45. doi:10.2490/jjrmc.49.37

A Major earthquake and giant tsunami occurred on 3.11, which broadly affected the eastern Japan area along the Pacific Ocean. A large elderly population was confined to their place of refuge and faced a high risk of disuse syndrome due to immobility. Elderly survivors aged 65 and over who were markedly found in an inactive state due to immobilization were regarded as the “risk group” for inactive lifestyles, possibly leading to disuse syndromes. Intervention by means of rehabilitation assistance was required in approximately one third of these inactive survivors (“high risk group”), a rate which was significantly higher in the elderly over 65 years than in younger survivors. Establishment of a rehabilitation assistance system for use in the event of a mass disaster is one of the critical lessons learned following 3.11, which will contribute to serve as a prophylaxis against disuse syndromes arising from inactivate locomotive function. Legal reform of relief actions in mass disasters is highly required to also include physical therapists as official members.

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Regional Cerebral Blood Flow (rCBF) after Low-frequency Repetitive Transcranial Magnetic Stimulation (rTMS) Combined with Intensive Occupational Therapy for Upper Limb Hemiplegia after Stroke : A Study using Single Photon Emission Computed Tomography

Takatoshi HARA ; Wataru KAKUDA ; Kazushige KOBAYASHI ; Ryo MOMOZAKI ; Masachika NIIMI ; Masahiro ABO

The Japanese Journal of Rehabilitation Medicine.2013;50(1):36-42. doi:10.2490/jjrmc.50.36

We performed a 15 day protocol of low-frequency repetitive transcranial magnetic stimulation (rTMS) combined with intensive occupational therapy in hemiplegic upper limbs in poststroke and investigated the effect of cerebral blood flow using single photon emission computed tomography (SPECT). Seventeen chronic stroke patients were studied with SPECT at rest before and 4 weeks after undergoing the 15 day protocol. Before and after the treatment, Fugl-Meyer Assessment (FMA) score and Wolf Motor Function Test (WMFT) -Log performance time showed a significant improvement. The specific areas with a significant increase in perfusion in the affected hemisphere were the insula (BA 13), the precentral gyrus (BA 44) and the cerebellum. In the nonaffected hemisphere, perfusion was significantly increased in the lingual gyrus and cerebellum. On the other hand, perfusion was significantly decreased in the middle frontal gyrus (BA 6), precentral gyrus (BA 4) and postcentral gyrus (BA 3) in the nonaffected hemisphere. It was suggested that low-frequency rTMS combined with intensive occupational therapy effects the cerebral blood flow and contributes to improving upper limb hemiplegia after stroke.

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Diverse Muscular Adaptation between Aged and Young Groups in a Rabbit Model of Tibial Lengthening

Mitsuhiko TAKAHASHI ; Tetsuya ENISHI ; Nori SATO ; Kosaku HIGASHINO ; Shinjiro TAKATA ; Shinsuke KATO ; Natsuo YASUI

The Japanese Journal of Rehabilitation Medicine.2013;50(1):43-47. doi:10.2490/jjrmc.50.43

Skeletal muscles are overstretched following limb lengthening procedures. Muscles can adapt to this lengthening by adding new sarcomeres in series. Recent developments in limb lengthening provide adult patients more opportunities to undergo limb lengthening procedures. The purpose of this study was to clarify the difference in muscle adaptation between adult and young groups using a rabbit model of limb lengthening. Five mature (10-43 month old) and 6 immature (3-4 month old) white rabbits underwent tibial osteotomy. After a 1-week lag phase, tibial lengthening was applied at a rate of 1.4 mm/day for 2 weeks. Animals were euthanized after the completion of lengthening. Both hindlimbs were immersed in buffered formalin with the ankle and knee at a right angle. Muscle belly length, muscle fiber bundle length and sarcomere length were measured, and sarcomere number and internal tendon length were calculated in five representative muscles around the lengthened segment. Muscle belly length increased in all the lengthened muscles compared with the corresponding contralateral muscles regardless the group. Aponeurosis length increased significantly in one muscle for the adult group and three muscles for the young group. Sarcomere length tended to be longer or was significantly longer in the lengthened muscles. Serial sarcomere number significantly increased in 3 lengthened muscles in the adult group with a more conspicuous increase in the amount, while this occurred in 2 muscles in the young group with only a tiny increase. The predominant processes of skeletal muscle adaptation to the limb lengthening are sarcomere number addition in muscle fibers for the adult group and elongation of internal tendon for the young group.

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Locomotive Syndrome, Musculoskeletal Ambulation Disorder Symptom Complex, Frailty and Sarcopenia

Etsuo CHOSA

The Japanese Journal of Rehabilitation Medicine.2013;50(1):48-54. doi:10.2490/jjrmc.50.48

As Japan has become a super-aging society a new focus has been placed on locomotive syndrome (Locomo), musculoskeletal ambulation disorder symptom complex (MADS), frailty and sarcopenia. Locomo is a condition whereby long-term care or support is needed or may be needed in the future due to weakness of the locomotive organs. MADS is a condition presenting with unstable balance or walking difficulty, which leads to a high risk of the patient falling down or giving up excursions outside the home. In a broad sense, MADS patients also belong in the Locomo category. The prevention and treatment of Locomo and MADS are very important, because these conditions typically result in deterioration of the exercise function and loss of mental and physical health. The aim of Locomotive syndrome exercises is to reduce pain, and to restore and improve joint function. We need to take a comprehensive approach to Locomotive syndrome, including lifestyle modification, muscle exercise, stretching and therapeutic exercise. Two basic, simple and commonly used exercises are single-leg standing and squats exercises.

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Remembering 1963

Satoshi UEDA

The Japanese Journal of Rehabilitation Medicine.2013;50(10):791-794. doi:10.2490/jjrmc.50.791

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Yumiko KAMIOKA ; Hideyuki SAITO ; Yayoi IIJIMA ; Tadahiro HOSOTA ; Tomoyuki MATSUDA ; Yuuji MIURA ; Motohide ARITA ; Takashi ISAJI ; Susumu KOSEKI

The Japanese Journal of Rehabilitation Medicine.2013;50(10):831-839. doi:10.2490/jjrmc.50.831

Objective : This study aimed to investigate the changes in the functioning of users of visiting rehabilitation services and related factors. Methods: Among 107 users in 22 visiting rehabilitation centers, we analyzed the data of 80 who completed the 6-month study. Their Functional Independence Measure (FIM), Life-Space Assessment (LSA), and level of caregiver burden (J-ZBI_8) were compared at the commencement of this study, and at 3 and 6 months afterwards. A multiple linear regression analysis was performed to examine the factors related to the variables, which changed over 6 months. Results : Over a period of 6 months from the commencement of the study, we found that FIM and LSA scores significantly improved from 82.4 to 87.3 (p=0.016) and from 9.9 to 12.3 (p=0.05), respectively, in the group who were still within 1 year from the time since onset/injury. A multiple regression analysis revealed that the period of time since onset/injury, independence degree of daily living for the demented elderly, and presence of goal setting for activities of daily living/domestic work significantly influenced changes in total FIM scores (p=0.001, R²=0.32). Furthermore, the change in LSA scores was significantly influenced by gender, presence of cerebrovascular diseases, period of time since onset/injury, number of occupations involved in visiting rehabilitation services, and J-ZBI_8 scores (p=0.0001, R²=0.36). Conclusion : Effective visiting rehabilitation requires having appropriate goals set for daily living activities and the establishment of interprofessional collaboration within visiting rehabilitation centers.

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Shoulder Joint Motion Analysis of Daily Living Activities Using a Global Coordinate System

Yukiya INOUE ; Mayumi KIHARA ; Junko YOSHIMURA ; Naoki YOSHIDA ; Kenji MATSUMOTO ; Tomosaburo SAKAMOTO ; Kazuhisa DOMEN

The Japanese Journal of Rehabilitation Medicine.2013;50(10):840-844. doi:10.2490/jjrmc.50.840

Objective : With clinical application in mind, we developed a method to measure the movement of a selected joint three-dimensionally as a conic domain (joint sinus cone). The method was applied to shoulder joint motion during daily living activities exercises in a group of hemiparetic poststroke patients. The results were compared to the exercise range of physically unimpaired persons. Methods : The subjects dressed in jackets and performed certain other tasks in a sitting position and the range of motion of the shoulder joint in three dimensions was measured using a 6-dimensional electromagnetic tracking system. Measurement results were analyzed with a plane display using a Lambert Azimuthal equal area. Results : This method was able to determine findings difficult to see with the naked eye, such as the narrow range of motion in a paralyzed shoulder joint and poor functionality also in the contralateral shoulder. Conclusion : The dressing measurement was achieved using magnetic measurement equipment. By displaying the results through a map projection it was possible to appreciate the whole range of the motion. Because this method facilitates the expression of complex joint exercise ranges, it will be useful in the analysis of daily behavior restrictions due to impairment.

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The Relation between the Number, Kind and Total Amount of Psychoactive Drugs Used and the Outcome of Dysphagia in Patients with Psychiatric Disorders

Tomoyuki NAKAMURA ; Ichiro FUJISHIMA ; Norimasa KATAGIRI ; Ritsu NISHIMURA ; Naoki KATAYAMA ; Koji WATANABE

The Japanese Journal of Rehabilitation Medicine.2013;50(9):743-750. doi:10.2490/jjrmc.50.743

Objective : To examine the relation between psychoactive drugs and the outcome of dysphagia in patients with psychiatric disorders. Methods : We examined 53 inpatients who were prescribed speech therapy in the psychiatry ward of our hospital from January 2011 to April 2012. We categorized the patients into a poor outcome group and a good outcome group by the necessity for alternative nutrition at discharge and analyzed the number and kind of typical antipsychotic, atypical antipsychotic, hypnotic, antidepressant and mood stabilizer, total amount of typical antipsychotic, atypical antipsychotic used at admission and at discharge, sex, psychiatric disorder, central nervous system disease, aspiration pneumonia, duration of hospitalization, psychiatric disorder disease period, speech therapy intervention period and GAF scale at admission. Results : The outcome of dysphagia had a significant relation with the number and kind of antipsychotic used, especially typical antipsychotic used at admission. The good outcome group had a higher total amount of antipsychotic use, especially atypical antipsychotics. Conclusion : Long-term practical oral intake should not comprise antipsychotic polypharmacy, especially typical antipsychotics before onset of dysphagia, but should instead consist of a monopharmacy approach with atypical antipsychotics.

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