Fujimura K, Kagaya H, Onaka H, Okochi Y, Yamada M, Teranishi T, Kanada Y, Saitoh E. Improvement in Disability Assessment Scale after Botulinum toxin A treatment for upper limb spasticity. Jpn J Compr Rehabil Sci 2017; 8: 4-9. Objective: We investigated the effect of botulinum toxin type A for upper limb spasticity on activities of daily living using the Disability Assessment Scale (DAS). Methods: The subjects were 47 patients who received botulinum therapy for upper limb spasticity. They were assessed before administration and 2, 6, and 12 weeks after administration by using the DAS, the Modified Ashworth Scale (MAS), and upper-limb-related parameters from the Fugl-Meyer Assessment (FMA). Results: DAS scores for hygiene, dressing, and limb position improved significantly 2 and 6 weeks after administration (p < 0.05), but there was no significant change in pain. MAS scores exhibited significant improvement 2, 6, and 12 weeks after administration, and the total scores for FMA upper-limb parameters exhibited significant improvement 2 and 6 weeks after administration (p < 0.05). Conclusion: Botulinum therapy contributes to improving not only the spasticity itself, but also to improving difficulties in activities of daily living associated with upper limb spasticity.
Teranishi T, Kondo I, Okuyama Y, Tanino G, Miyasaka H, Sonoda S. Investigation of factors involved in patient falls during the early stage of hospitalization in a Kaifukuki rehabilitation ward. Jpn J Compr Rehabil Sci 2017; 8: 10-15.
Objective: To investigate factors affecting the occurrence of falls during the early stage of hospitalization in a Kaifukuki (convalescence) rehabilitation ward.
Methods: The subjects were 545 hospitalized patients, divided into a fall group (having experienced a fall within 14 days following admission) and a non-fall group. Differences between the two groups in terms of the Standing Test for Imbalance and Disequilibrium (SIDE) level and in the subscales of the Functional Independence Measure (FIM) were investigated. Logistic regression was carried out on items for which there were significant differences between the groups as dependent variables and the occurrence of falls as the objective variable, and the odds ratios were computed.
Results: The fall group comprised 36 subjects. Significant differences between groups were found in the SIDE level, lower body dressing, bath transfer, stairs, social interaction, problem solving, and memory. Logistic regression only identified problem solving as associated with the occurrence of falls (odds ratio, 0.288; p=0.035). For the SIDE level, complete separation of non-fall subjects was seen at levels of 2b or higher.
Conclusion: Falls in the early stage following admission do not occur among individuals with good balance, and problem solving according to the FIM is involved in falls.
Tokunaga M, Katsura K, Tokisato K, Honda S, Nakanishi T, Takai S, Nakashima Y, Nojiri S, Watanabe S. Increasing the prediction accuracy of FIM gain by adding FIM improvement for one month from admission to the explanatory variables in multiple regression analyses. Jpn J Compr Rehabil Sci 2017; 8: 16-20.
Objective: The coefficient of determination in multiple linear regression analyses using the gain in Functional Independence Measure (FIM) as objective variables is low. We aimed to improve the prediction accuracy of FIM gain by adding FIM improvement for one month from admission to the explanatory variables.
Methods: A total of 547 stroke patients admitted to a Kaifukuki (convalescent stage) rehabilitation ward were included. In multiple regression analyses using motor FIM gain as the objective variable, we created a prediction formula using only data available at admission (model 1), and a prediction formula adding FIM improvement for one month from admission (model 2). The coefficient of determination adjusted for the degrees of freedom R*2 and the residuals obtained by subtracting the predicted value from the measured value of motor FIM gain were investigated.
Results: The R*2 of model 1 was 0.364 and that of model 2 was 0.711. The residual of model 1 was 0 ± 12.3 and that of model 2 was 0 ± 8.3. In model 2, the standard deviation of the residual was reduced.
Conclusion: Adding FIM improvement for one month to the explanatory variables increased the prediction accuracy of FIM gain.
Tokunaga M, Tori K, Eguchi H, Kado Y, Ikejima Y, Ushijima M, Miyabe S, Tsujimoto S, Fukuda E. The stratification of motor FIM and cognitive FIM and the creation of four prediction formulas to enable higher prediction accuracy of multiple linear regression analysis with motor FIM gain as the objective variable ― An analysis of the Japan Rehabilitation Database. Jpn J Compr Rehabil Sci 2017; 8: 21-29.
Objective: The aim of our study was to stratify the contributing factors in order to increase the prediction accuracy of the multiple linear regression analysis with motor FIM gain as the objective variable.
Methods: The subjects for our study were 2,542 stroke patients. In the multiple linear regression analysis with motor FIM gain as the objective variable, eight contributing factors were stratified. Prediction formulas were created and the correlation between the measured motor FIM gain values and the predicted values was investigated.
Results: The correlation coefficient was higher with the stratification of gender (0.509), stroke type (0.512), number of hospital days (0.516), days from onset to admission (0.518), modified Rankin Scale before onset (0.520), age (0.541), cognitive FIM at admission (0.588) and motor FIM at admission (0.641), than with the use of one prediction formula (0.507), and it was 0.653 with stratification into four groups with the two factors of motor FIM and cognitive FIM at admission.
Conclusion: By stratifying the contributing factors, we were able to increase the prediction accuracy of motor FIM gain.
Kojima K, Nakayama T, Watanabe A, Yoshimura S, Yamaya T, Sato K, Doi A, Ogino T, Moriyasu N, Watanabe S. Activities of daily living and quality of life assessment during home-based rehabilitation - A multi-institutional study. Jpn J Compr Rehabil Sci 2017; 8: 30-36. Objective: The purpose of this study was to examine the relationship between activities of daily living (ADL) performance and quality of life (QOL) in participants in a home-based rehabilitation program, and to assess the associated changes during the program. Methods: The subjects were participants newly enrolled in home-based rehabilitation in six facilities. The Functional Independence Measure motor subscore was used to evaluate the current ADL performance. We used PGC-MS to evaluate the emotional aspect of QOL, and ADL satisfaction for the cognitive aspect. Results: Participants were divided into two groups: <1 year from onset and >1 year from onset; ADL satisfaction had significantly improved in the latter group (p = 0.008). A strong correlation between ADL performance and ADL satisfaction was found. On the other hand, the correlation between ADL satisfaction and PGC-MS was weaker. Conclusions: The ‘cognitive aspect’ of QOL improved due to the rehabilitation staff’s approach in explaining the participants’ ADL abilities and motivating them to accept their limitations. It is considered that the ‘emotional aspect’ of QOL is difficult to change with only three months of home-based rehabilitation.
Onogi K, Kondo I, Asagai Y, Saitoh E. Differences in evaluation of functional skills of the Pediatric Evaluation of Disability Inventory (PEDI) between normally developing children and children with cerebral palsy. Jpn J Compr Rehabil Sci 2017; 8: 37-43. Objective: The Pediatric Evaluation of Disability Inventory (PEDI) provides functional skills scales based on the data obtained from normally developing children. In the present study, we performed an analysis of children with cerebral palsy using the same methodology as set originally to examine differences in discrete skill items between the two groups of children. Methods: Six hundred and two children with cerebral palsy were divided into groups based on the severity of disorder as described in the Gross Motor Function Classification System (GMFCS). The scaled scores for the PEDI functional skills were computed by Rasch analysis. Results: Correlation coefficients between the scaled scores of children with cerebral palsy and those presented in the PEDI original data were r = 0.890 for self-care, r = 0.795 for mobility, and r = 0.943 for social function. In children in GMFCS level I, discrete scores increased with age, whereas in children in levels III, IV, and V, scores for mobility almost reached the plateau in the age band of 4 to <6 years. Discussion: In the difficulty level of functional skills, the greatest difference was observed in mobility, suggesting the need to establish a difficulty level of functional skills that is adapted to the abilities of children with cerebral palsy.
Nakashima N, Miyasaka H, Kondo I, Iwata K, Uematsu H, Yamamura C, Sonoda S. The relationship between proximal function of the upper extremity on the paralyzed side and upper extremity skills in daily life of subacute stroke patients. Jpn J Compr Rehabil Sci 2017; 8: 44-50.
Objectives: The effects of proximal function of the upper extremity on the paralyzed side on daily life skills were examined in stroke patients.
Methods: One hundred and forty-seven stroke patients were evaluated using the Functional Skills Measure After Paralysis (FSMAP), the Finger-Function test (FF), and the Knee-Mouth test (KM) of the Stroke Impairment Assessment Set (SIAS). The FSMAP score for each subgroup of the SIAS-KM level was compared.
Results: The FSMAP score was significantly higher in patients with a KM score of 2/3 compared to patients with a KM score of 0/1 when SIAS-FF was 0/1A; in patients with a KM score of 2/3 compared to patients with a KM score of 0/1 and in patients with a KM score of 4/5 compared to patients with a KM score of 2/3 when SIAS-FF was 1B, 1C, or 2; and in patients with a KM score of 4/5 compared to patients with a KM score of 2/3 when SIAS-FF was 3, 4, or 5.
Conclusion: The cross-sectional study indicated that differences in the level of proximal function affect the upper extremity skills when the level of distal function is equivalent.
Sawada K, Saitoh E, Horii M, Imoto D, Itoh N, Mikami Y, Ikeda T, Ohashi S, Terauchi R, Fujiwara H, Kubo T. MMT measurements are acceptable in routine clinical practice: Results from periodic medical examinations of polio survivors. Jpn J Compr Rehabil Sci 2017; 8: 51-55.
Purpose: The aim of this study was to investigate whether manual muscle test (MMT) for the hip (abduction, flexion, and extension), knee (flexion and extension), and ankle (dorsal flexion) muscles are acceptable in routine clinical practice.
Methods: The study included 222 participants (487 examinations, 974 legs) of periodic medical examinations for polio survivors in the Tokai district of Japan. The subjects were 175 men (350 legs) and 312 women (624 legs) with an average age at the time of examination of 62.2 (32-82) and 61.6 (47-83) years, respectively. The results of handheld dynametric muscle test were compared for each MMT grade and joint motion.
Results: Significant differences in muscle strength were observed for the majority of pairs of MMT grades, excluding the MMT 0/1 pair. The specific combinations with no significant differences were MMT 1/2 for knee flexion (women); and MMT 0/2 (both men and women), 1/2 (both men and women), and 3/4 (men) for ankle dorsal flexion.
Conclusion: Clinical MMT measurements seem to be generally acceptable, at least when performed by physical therapists with 5 or more years of clinical experience. However, ankle dorsal flexion requires especially careful assessment.
Konishi M, Tanimoto K. Scanning electron microscopy observations of rice cooked with non-ionic water-soluble iodine for videofluoroscopic swallowing study. Jpn J Compr Rehabil Sci 2017; 8: 66-70.
Objective: The aim of this study was to investigate the distribution of contrast medium on and inside rice for videofluoroscopic swallowing study (VFSS) as observed by scanning electron microscopy (SEM) and radiography. We also examined the influence on texture of mixing the contrast medium.
Methods: Cooked rice for VFSS was prepared using non-ionic water-soluble iodine liquid (Visipaque® 270) and barium sulfate, and SEM and radiography were performed. Enhancement of the X-ray image was evaluated using the gray-scale. The textures of hardness, adhesiveness, and cohesiveness were measured using a texture analyzer. The Kruskal-Wallis test and Steel-Dwass test were used to compare the measured values.
Results: On SEM, barium sulfate was only attached to the surface of the rice but Visipaque® 270 was observed inside the rice. The X-ray image of the rice cooked with barium sulfate was mottled; however, Visipaque® 270 demonstrated uniform enhancement. The gray-scale values of the X-ray images were statistically different (p < 0.001), whereas the textures showed no statistical difference.
Conclusion: The rice cooked with Visipaque® 270 revealed good X-ray enhancement. This was because the contrast medium was distributed not only on the rice surface but also inside the rice.
Hirano S, Kagaya H, Saitoh E, Sonoda S, Tanabe S, Katoh M, Yamada J, Tanino G, Suzuki A, Itoh N. Effectiveness of Gait Exercise Assist Robot (GEAR) for stroke patients with hemiplegia. Jpn J Compr Rehabil Sci 2017; 8: 71-76.
Objective: This study examined whether subacute stroke patients with hemiplegia who receive gait training using the Gait Exercise Assist Robot (GEAR) show early improvement in gait independence compared to patients who receive orthosis-assisted gait training.
Methods: Six patients who satisfied the following criteria were included in the study: patients with hemiplegia caused by primary supratentorial intracerebral hemorrhage or cerebral infarction, within 60 days after onset, aged 20 to 75 years, Functional Independence Measure (FIM) walking score ≤ 3, Stroke Impairment Assessment Set (SIAS) lower extremity total score ≤ 6, and use of a knee-ankle-foot orthosis. Rehabilitation was conducted for a maximum of 3 h a day, including 40 min of gait training using GEAR. A historical control group was selected from among patients admitted to the ward for intensive inpatient rehabilitation at Nanakuri Memorial Hospital. One control patient matching the criteria of each subject was selected, with a total of six in the control group. The primary outcome measure was the improvement in efficiency of FIM-walk, defined as the gain in FIM walking score from the baseline to supervised walking divided by the number of weeks required.
Results: The mean improvement in efficiency of FIM-walk was 1.0 in the GEAR group and 0.54 in the control group, and was significantly higher in the GEAR group (p = 0.042).
Conclusion: Gait training using GEAR may facilitate early improvement in gait independence.
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