Balance exercises led to improvements in static balance function, and gait exercises resulted in improvements to dynamic balance and gait functions in the very frail elderly.
Most falls experienced by elderly people are caused by tripping or slipping during walking. The fact that walking balance function did not correlate with standing balance function indicates that multifaceted evaluation is important to comprehend dynamic balance function while standing and walking.
To investigate the influence of daily activity on changes in the physical fitness of people with post-stroke (cerebrovascular disorders) hemiplegia, we evaluated the follow-up exercise load test of 30 ambulatory male patients with post-stroke hemiplegia. Between the times of the two tests, patients had no special supervised training. They were advised by their physicians to exercise according to the result of an exercise-loading test. We determined peak oxygen uptake and O2 consumption at the ventilatory threshold point. After 9.4 months, the mean peak oxygen uptake improved significantly from 17.7 to 21.1 ml/min/kg, and ventilatory threshold point also improved significantly from 11.4 to 13.6 ml/min/kg. Among the nine subjects who returned to their jobs, subjects who previously went to their offices by public transportation showed more improvement in ventilatory threshold point level than did subjects who previously walked to their offices. Among the 21 subjects who did not return to work, those who exercised regularly (primarily by walking) showed more improvement of peak oxygen uptake level than did subjects who did not exercise regularly. In conclusion, people with hemiplegia who are living in the community can improve their physical fitness without formal supervised training by simply increasing their daily activities.
As rehabilitation for post-stroke hemiplegic patients has become widely accepted practice, there has been an increase in patients who are more difficult to treat. In the prescription rationale of orthoses for hemiplegics, the knee-ankle-foot orthosis (KAFO) for the lower limb has generally been underestimated because of its inhibitory effect on the normal walking pattern and also its interference with gait training. The authors had an experience of 28 hemiplegics with severe physical impairments who were fitted with a convertible plastic KAFO. Among these patients, there were 11 cases in which the KAFO was replaced by an ankle-foot orthosis (AFO) within 1.5 to 8 months (average 4 months) following initial prescription when they were able to control their knee actively. Ambulatory capability in these patients was superior to that of the remaining KAFO group. The Barthel index of the AFO group patients was higher than the KAFO group (p<0.01). However neither age, sex, severity of hemiplegia, starting time of rehabilitation following onset of stroke, time of fitting with the orthosis, nor the functional recovery stage were critical factors between the two groups, only the incidence of major complications affected ambulatory capability.
This study was conducted to determine the effect of footwear modification on patients with neuromusculoskeletal disorders. Two analyses, the center of pressure and the in-shoe plantar pressures, were studied with the help of healthy volunteers so that the effect of shoe modifications could be assessed. The ground force under the sole of the shoe was measured while the subjects were walking, and the plantar pressure at the foot-insole interface and its distribution were measured while the subjects were in both the standing and walking positions, wearing the trial shoes. The trial shoes had three different types of heels-standard heel, Thomas heel, and reverse Thomas heel-and had three different locations for the rocker bar--just under the metatarsophalangeal joint, 1 cm behind the metatarsophalangeal joint, and 1 cm before the metatarsophalangeal joint. The shift change at the center of pressure showed that the Thomas heel generally pushed the center of pressure more laterally and the reverse Thomas heel shifted it medially more than the standard heel did. While the subjects were in a stable standing position wearing the Thomas heel shoes, the medial forefoot and the lateral heel region's pressure showed significant reduction in the plantar pressure and the lateral forefoot and the medial heel showed a tendency to rise, compared with the standard heel condition. When the trial shoes' heels were changed to the reverse Thomas heel, the above changes tended to reverse. Tests at the foot-insole interface showed that the different types of heels and the location of the bar could change not only the pressure distribution but also the duration of the plantar pressure under the lateral area that shifted to the medial area when the subjects walked. This pressure measurement method was very useful for the design and evaluation of such footwear.
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