Funahashi R, Mukaino M, Otaka Y, Senju Y, Yoneda C, Ozeki Y, Shimizu Y, Koike T, Saito E. Feasibility of the International Classification of Functioning, Disability and Health Rehabilitation Set for inpatient rehabilitation: Selection and validity of a set of categories for inpatients in a convalescent rehabilitation ward. Jpn J Compr Rehabil Sci 2020; 11: 1-8.

Objective: To evaluate the feasibility of the International Classification of Functioning, Disability and Health (ICF) Rehabilitation Set for inpatients in a convalescent (Kaifukuki) rehabilitation ward.

Methods: Overall, 295 inpatients in convalescent rehabilitation wards were rated using the ICF Rehabilitation Set, and the proportion of missing values was investigated. Categories with missing values <10% were selected, and internal construct validity of the total score of the selected categories was examined using Rasch analysis.

Results: Missing values were detected in 25 items, of which seven had missing values of ≥10%. No ceiling or floor effects were noted. Rasch analysis of 23 categories with missing values <10% showed a good fit to the model after applying testlet solution and item splitting, which supported the internal construct validity of the ICF Rehabilitation Set.

Conclusion: This identified the set of categories of the ICF Rehabilitation Set that could be used for evaluating rehabilitation inpatients. These categories had good internal construct validity based on Rasch analysis.

Senju Y, Mukaino M, Ozeki M, Watanabe M, Okochi Y, Mizutani K, Saito E, Sonoda S. Interrater agreement between clinician ratings and patient self-assessments for body function categories of ICF Rehabilitation Set. Jpn J Compr Rehabil Sci 2020; 11: 9-16.

Objective: This study investigates interrater agreement between clinician ratings using the Rating reference guide developed in Japan for the International Classification of Functioning, Disability and Health (ICF) Rehabilitation Set and patient self-assessments for body function categories of the ICF Rehabilitation Set.

Methods: Eighty-eight inpatients and/or outpatients who received rehabilitation participated in this study. For the assessment of the nine body function categories of the ICF Rehabilitation Set, the patients were asked to complete the self-assessment questionnaires, and the clinicians rated the patients using the Rating reference guide. Interrater agreement between clinicians and patients was investigated using weighted kappa statistics and an intraclass correlation coefficient (ICC (2,1)) to determine interrater agreement of each category and the total score, respectively.

Results: The weighted kappa statistics ranged from 0.58 to 0.87. Eight out of nine categories presented with weighted kappa statistics greater than 0.61. The total score of all categories showed no significant difference between clinicians and patients and presented with an ICC (2,1) of 0.85.

Conclusion: No significant difference was observed between clinician ratings with the Rating reference guide for body function categories and patient self-assessments, showing feasibility of the Rating reference guide as a means of describing the status of patients' functioning.

Aoki K, Iguchi A, Watabe T. Evaluation of Functional Independence Measure item scores for predicting home discharge after acute stroke rehabilitation. Jpn J Compr Rehabil Sci 2020; 11: 17-20.

Objective: To determine whether certain Functional Independence Measure (FIM) items assessed early during acute-stage rehabilitation are predictive of home discharge for patients with stroke following intervention.

Methods: Medical record data were retrospectively compiled and analyzed for 103 patients with stroke admitted to our hospital between December 2016 and March 2017. Patients were either discharged to their own homes (n=41) or transferred to another facility (n=62) after acute-phase rehabilitation. Fisher's exact test was used to compare characteristics between the home and transfer groups. Stepwise multiple logistic regression analysis was also performed to identify FIM items predictive of patients' discharge destination.

Results: Significant differences between the home and transfer groups were observed for all FIM items, except for shower/tub transfer and stairs. Eating and social interaction were identified as significant predictors of the post-rehabilitation destination in multiple logistic regression analysis (p=0.001, odds ratio [OR]: 10.956, 95% confidence interval [CI]: 0.638-1.755; p=0.008, OR: 4.273, CI: 0.182-1.269, respectively).

Conclusion: In some cases, early assessment of FIM items, particularly eating and social interaction, after a stroke can help predict a patient's discharge destination after rehabilitation.

Fujihara H, Goto K, Higashino M, Nakamura S, Tanaka E, Sunaga T, Kawate N, Kawazoe K, Watanabe T, Sasaki T. The impact of lesion location on medication self-management ability in patients with cerebrovascular disease. Jpn J Compr Rehabil Sci 2020; 11: 21-27.

Objective: To elucidate the impact of cerebrovascular lesion location on patients' ability to manage their own medications, we retrospectively investigated the differences in ability between the left hemisphere damage group (Group L) and the right hemisphere damage group (Group R).

Methods: In patients with cerebrovascular disease who were discharged from the Kaifukuki rehabilitation ward of our hospital between October 2011 and March 2013 and between January 2016 and December 2017, Group L and Group R were compared.

Results: The study subjects were 282 patients, and both Group L and Group R had 141 patients each. The length of time required for achieving medication self-management was longer in Group L than in Group R (p=0.02), showing a significant difference.

Conclusion: The delay in achieving medication self-management in Group L was considered due to impairment of the dominant arm by right hemiplegia, which, unlike in Group R, hindered the dexterity required for taking medications. In order for patients with cerebrovascular disease to become capable of managing their own medications, it is considered essential to assist in developing medication support plans according to lesion location.

Fujita T, Ohashi T, Yamane K, Yamamoto Y, Sone T, Ohira Y, Otsuki K, Iokawa K. Relationship between the number of samples and the accuracy of the prediction model for dressing independence using artificial neural networks in stroke patients. Jpn J Compr Rehabil Sci 2020; 11: 28-34.

Objective: To determine the lower limit of the number of samples that is useful for creating a prediction model on dressing independence in stroke patients by using artificial neural networks.

Methods: Five datasets consisting of 120, 100, 80, 60, and 40 were created from 121 stroke patients by repeated random sampling. The models for predicting independent dressing one month after admission were created by an artificial neural network and logistic regression in each dataset from the variables upon admission to the convalescent rehabilitation ward. The accuracy of both models was compared.

Results: The accuracy of the artificial neural network model was significantly higher than that of the logistic regression model in the 120, 100, and 80 patient datasets, and there were no differences in the accuracy of both models in the 60 and 40 patient datasets.

Conclusion: Our results suggested that the lower limit of the number of samples for creating a useful prediction model of dressing independence by using artificial neural networks is approximately 80.

Aihara K, Inamoto Y, Aoyagi Y, Shibata S, Kagaya H, Sato Y, Kobayashi M, Saitoh E. Effect of tongue-hold swallow on pharyngeal cavity: kinematic analysis using 320-row area detector CT. Jpn J Compr Rehabil Sci 2020; 11: 35-42.

Purpose: This study analyzed the effect of the tongue-hold swallow (THS) on the pharyngeal cavity during swallowing three-dimensionally using 320-row area detector computed tomography (320-ADCT). We hypothesized a greater decrease in pharyngeal volume with the THS than with the saliva swallow (SS); that is, the pharyngeal cavity would be more constricted with the THS.

Methods: The THS and SS were examined using 320-ADCT in six speech language pathologists (22-29 years old). Pharyngeal volume, hyolaryngeal displacement, and cross-sectional area of the upper esophageal sphincter (UES) were measured frame-by-frame and compared between the two swallows.

Results: Although some participants showed smaller pharyngeal volume with the THS than hypothesized, others showed larger pharyngeal volume. With the THS, the hyoid bone was positioned significantly higher at swallow onset, the hyoid and larynx were significantly higher at maximum superior displacement, and the cross-sectional area of the UES was significantly larger.

Discussion: No constant effect of the THS on pharyngeal volume was found. The THS may influence hyolaryngeal elevation and UES opening. Further study is necessary to consider the methodology of the THS, such as tongue protrusion length.

Sato K: Predictive factors of home discharge in elderly stroke patients hospitalized in a convalescent rehabilitation ward. Jpn J Compr Rehabil Sci 2020; 11: 43-48.

Purpose: To identify predictive factors of home discharge in elderly stroke patients hospitalized in our convalescent rehabilitation ward based on markers determined during hospitalization and to evaluate their predictive capability.

Methods: Parameters measured at hospitalization in 179 elderly stroke patients aged ≥65 years hospitalized between April 1, 2015 and July 1, 2018 were compared after dividing the patients into two groups depending on whether they were discharged home. In addition, multivariate analysis was performed using whether home discharge was possible as the objective variable to prepare a prediction formula and receiver operating characteristic (ROC) curves.

Results: A total of 150 patients (84%) were discharged home. Differences in acute phase hospitalization duration, number of cohabiting people, National Institutes of Health Stroke Scale at the time of onset, functional independence measure (FIM) at hospitalization, food type, and nutritional evaluation were significant between the two groups. Multivariate analysis revealed significant differences f or a cute p hase h ospitalization duration, number of cohabiting people, and FIM at hospitalization. The area under the curve for the ROC curve was 0.891.

Conclusions: The results indicated that the combination of acute phase hospitalization duration, number of cohabiting people, and FIM at hospitalization could be used as a predictive factor for home discharge in elderly stroke patients hospitalized in a convalescent rehabilitation ward.

Mori H, Izumi S, Kagaya H, Oyama H, Abe G, Yashima K, Takagi T. Evaluation of the myoelectric potential of the infrahyoid muscles as a means of detecting muscle activity of the suprahyoid muscles. Jpn J Compr Rehabil Sci 2020; 11: 52-58.

Objective: To investigate the use of the myoelectric potential of the infrahyoid muscles as a synchronizing signal for the contraction of the suprahyoid muscles during swallowing.

Methods: The myoelectric potentials of the anterior belly of the digastric muscle and the sternohyoid muscle of 10 healthy adults during swallowing were measured, and the activity of each muscle was analyzed. Additionally, the real-time process of muscle activity detection was simulated using the measured waveform of the myoelectric potentials.

Results: The ratio of the “elapsed time from the activity of the anterior belly of the digastric muscle to the activity of the sternohyoid muscle” to the “time of activity of the anterior belly of the digastric muscle” was 22.5 ± 19.6%. The sternohyoid muscle activity started in the early period of activity of the digastric muscle. In the simulation, differential processing enabled detection of the activity of the sternohyoid muscle in 49 of 50 trials within the activation time of the anterior belly of the digastric muscle.

Conclusion: The myoelectric potential of the sternohyoid muscle can be used as a synchronization signal for the contraction of the anterior belly of the digastric muscle during swallowing.

Ujikawa T, Koga T. Effects of static and dynamic stretching of lower limb muscles on oxygen uptake, heart rate variability, oxidized hemoglobin of muscular blood vessels and muscular discharges during incremental exercise. Jpn J Compr Rehabil Sci 2020; 11: 59‐64.

Objective: This study was conducted to clarify the effects of three types of warming up (WU), namely static stretching (SS), dynamic stretching (DS) and cycle ergometer riding at 20 watts (ergo), on cardiopulmonary function and muscle activity during incremental exercise.

Methods: Ten healthy adult males (aged 20.6 ± 0.5 years) participated in this study. Oxygen uptake, heart rate variability, oxidized hemoglobin and discharges of lower limb muscle were continuously recorded during WU and the subsequently performed incremental exercise.

Results: The sympathetic nervous activity index analyzed from heart rate variability, oxygen uptake and cardiac output significantly increased, and the parasympathetic nervous activity index decreased after DS and ergo compared to those after SS. However, no significant differences were found between those values while exercise was maintained at the anaerobic threshold level.

Conclusion: DS and ergo were suggested to be effective for adapting to exercise, but these effects seemed to disappear at the anaerobic threshold level.

Tokunaga M, Yamanaga H. Comparison of the accuracy of multiple regression analysis using four methods to predict the functional independence measure at discharge. Jpn J Compr Rehabil Sci 2020; 11: 65-72.

Objective: This study aims to compare the accuracy of four methods of multiple regression analysis in predicting the motor functional independence measure (mFIM) at discharge.

Methods: The subjects of this study were 1,064 stroke patients who had been hospitalized in a convalescent rehabilitation hospital. Standard multiple regression analysis (S prediction) with mFIM at discharge as the objective variable, multiple regression analysis with reciprocal number of mFIM at admission as one of the explanatory variables (R prediction), prediction of the effectiveness of mFIM by multiple regression analysis, the conversion to mFIM at discharge (E prediction), and the creation of two multiple regression prediction formulas (S2 prediction) were performed. The absolute values of residuals (actual value minus predicted value) of mFIM at discharge were compared for the four methods.

Results: The absolute value of the residuals was significantly smaller in the R prediction, E prediction, and S2 prediction than that in the S prediction. In addition, the absolute value was found to be significantly smaller in the E prediction and S2 prediction than that in the R prediction.

Conclusion: In multiple regression analysis, the use of E prediction or S2 prediction is recommended because of their high prediction accuracies.

Tanaka T, Kagaya H, Yamanouchi N, Iida T, Shibata S, Saitoh E. Colonic retention of barium with and without use of laxatives after videofluoroscopic examination of swallowing. Jpn J Compr Rehabil Sci 2020; 11: 73-77.

Objective: Barium is generally used as the contrast medium in videofluoroscopic examination of swallowing (VF) to evaluate swallowing function. However, no consensus has been reached on the use of laxatives following VF. The objectives of the present study were to assess the status of colonic retention of barium after VF and to examine the usefulness of laxatives.

Methods: In study 1, 88 patients who underwent VF and abdominal radiography 3 days after VF were studied. Barium dose, site of retention, number of sites of retention, and gastrointestinal symptoms were evaluated. In study 2, 51 patients who received ≥10 g of barium at VF and laxatives were compared with 63 patients who received ≥10 g of barium without laxatives in study 1.

Results: In study 1, barium retention was observed in 60 patients. The barium retention and number of sites of retention were significantly greater in patients who received ≥10 g of barium (p < 0.001). In study 2, barium at the most oral side moved more distally toward the anal side in patients who received laxatives (p = 0.043) and the number of sites of barium retention was reduced (p = 0.017).

Conclusions: Barium retention is common when ≥10 g is used in VF. Administration of laxatives promotes barium excretion.

Tanaka M, Oguchi K, Sakai M, Goto S, Hoshino T, Ino R, Katafuchi R, Asai N, Takatsu S, Naito R, Sonoda S. Utilizing the self-training handouts creation system “Pattore!”: a report of two cases. Jpn J Compr Rehabil Sci 2020; 11: 78-84.

Objective: To report two cases of utilizing the selftraining handouts creation system “Pattore!” (“Pattore !” hereinafter).

Methods: In two patients, handouts were created using “Pattore !” which is a system to compile self-training menus tailored individually for each patient on paper. The handouts were updated at appropriate timing, and the time required for creation was measured. Each patient made entries in the self-training record, and the therapist confirmed the implementation status. A questionnaire on patient satisfaction and self-efficacy was conducted before discharge from hospital. The same procedures were also conducted in a group of patients for whom the handouts were developed without utilizing “Pattore!”.

Results: The average time required to prepare the handouts was shortened by using “Pattore!”. Case 1 rated good patient satisfaction and self-efficacy, while Case 2 was not able to achieve high self-efficacy. The implementation rate was 100% for Case 1 and 85% for Case 2.

Conclusion: Effective use of “Pattore!” enhances the quality of self-training and contributes to implementation and continuation of training. Updating the handouts at appropriate timing and feedback that allows patient to perceive the exercise effect are expected to enhance patient satisfaction and self-efficacy.

Wada Y, Otsuka N, Kawate N, Moriyama H, Ezure H, Inoue Y. Effect of two doses of botulinum toxin type A on maximum plantar contact area in hemiplegic stroke patients with pes equinovarus. Jpn J Compr Rehabil Sci 2020; 11: 85-90.

Objectives: To quantitatively demonstrate the therapeutic effects of two doses of botulinum toxin type A (BoNT-A) on pes equinovarus in hemiplegic stroke patients.

Methods: The subjects of this study included eight chronic stroke patients who received two BoNT-A doses (mean dose interval: 136.0 (10.5) days) from April 2011 to March 2013 and underwent a sheet-type weight-bearing lower limb test. The maximum plantar contact area on the paralyzed side, ratio of maximum plantar contact areas on the paralyzed and non-paralyzed sides, and Modified Ashworth Scale (MAS) were measured before BoNT-A administration and 4 weeks after both the first and second doses.

Results: A significant increase in the maximum plantar contact area was observed after administration of the second dose compared to that of the first dose on the paralyzed side. Additionally, a significant increase was observed in the ratio of paralyzed/non-paralyzed maximum plantar contact areas after the administration of both the first and second doses compared to that before BoNT-A administration. MAS was observed to decline significantly after the administration of both the first and second doses compared to that prior to BoNT-A administration.

Conclusions: We suggest that comparison of the plantar contact area is useful for assessing the therapeutic effects of BoNT-A doses on pes equinovarus in hemiplegic stroke patients.

Sugioka J, Suzumura S, Kawahara Y, Osawa A, Maeda N, Ito M, Nagahama T, Kuno K, Shiramoto K, Kizuka S, Mizuguchi T, Sano Y, Kandori A, Kondo I. Assessment of finger movement characteristics in dementia patients using a magnetic sensing finger-tap device. Jpn J Compr Rehabil Sci 2020; 11: 91-97.

Objective: Differences in finger movement characteristics during finger-tapping movements among Alzheimer's Disease (AD) patients, Mild Cognitive Impairment (MCI) patients, and healthy elderly individuals were examined using a magnetic sensing finger-tap device (UB-2; Maxell, Tokyo), and relationships with cognitive function were investigated.

Methods: Finger-tapping movements were measured and multiple comparisons using mean values of parameters from each group were conducted. Cognitive function was evaluated using the Mini-Mental State Examination (MMSE), and Spearman rank-correlation coefficients were used to analyze relationships between these parameters and MMSE scores.

Results: Significant differences were observed in total traveling distance, standard deviation (SD) of contact duration, SD of inter-tapping interval, and SD of phase difference between left- and right-hand tapping. MMSE score showed a weak negative correlation with the SD of contact duration of the left hand (r = -0.28, p < 0.05). Weak positive correlations were observed in total traveling distance of the left hand (r = 0.3, p < 0.05) and right hand (r = 0.25, p < 0.05) and the inphase task for the right hand (r = 0.28, p < 0.05).

Conclusion: These parameters may represent finger movements that are characteristic of AD and MCI.

Ikechi Y, Inoue K, Ishimaru M. The role of occupational therapists in palliative care teams: differences of rehabilitation occupations expected by other occupations. Jpn J Compr Rehabil Sci 2020; 11: 98-101.

Objective: This study aimed to compare the role of occupational therapy (OT) with that of rehabilitation occupations in palliative care teams (PCT).

Methods: A questionnaire survey was conducted on PCT representatives and OT department managers at cancer hospitals.

Results: Approximately 40% of facilities had an occupational therapist registered (OTR) in the PCT. Differences among the roles of each rehabilitation occupation were not found. Regarding the role of the OTR in the PCT, items that had significantly higher scores in the responses of PCT representatives were “support for transition and selection of treatment places” and “care for outpatient/home care patients.” Items that had significantly higher scores in the responses of OT department managers were assessment approaches for mental distress, patient decision support, and family care.

Conclusions: It is necessary to clarify the role of not only OT but also all rehabilitation occupations in the PCT. It is also important for OTRs to take advantage of their own strengths and focus on the roles required by other occupations.

Tokunaga M, Sannomiya K. Explanatory variables to use in a multiple regression analysis to predict stroke patients' motor FIM score at discharge from convalescent rehabilitation wards: an investigation of patients with a motor FIM score of less than 40 points at admission. Jpn J Compr Rehabil Sci 2020; 11: 102-108.

Objective: This study aimed to clarify the explanatory variables to use in a multiple regression analysis to predict improvement in the motor Functional Independence Measure (FIM) during the hospitalization of patients with severe stroke in a convalescent rehabilitation ward.

Methods: The subjects of this study were 230 patients with stroke with a motor FIM score of less than 40 points at admission. In total, 17 factors were stratified and those with a significant difference in motor FIM effectiveness between stratified groups were used as the explanatory variables of a stepwise regression analysis, which employed the motor FIM score at discharge as the objective variable.

Results: There were significant differences in motor FIM effectiveness among the 12 factors. The 10 factors selected through a stepwise regression analysis were age, cognitive FIM score at admission, motor FIM score at admission, number of days from onset to admission, modified Rankin Scale before onset, Brunnstrom stage of paralyzed lower limb, body mass index, sitting stability, Japan Coma Scale, and hemispatial neglect.

Conclusion: It is desirable to use these 10 factors as explanatory variables in multiple regression analyses.

Kikumura K, Kagaya H, Shibata S, Matsuo K, Toda F, Ogawa M, Ito Y, Ozeki M, Otaka Y. Value of the Hyodo score in predicting dysphagia severity, recommended diet, and liquid consistency. Jpn J Compr Rehabil Sci 2020; 11: 109-115.

Objective: To define whether the Hyodo score can be used to predict dysphagia severity and determine the appropriate diet and liquid consistency in a retrospective observational study.

Methods: A total of 741 patients with suspected dysphagia were enrolled. The median patient age was 77 years, and the major primary diseases were respiratory disease and cerebrovascular disease. The results of a videoendoscopic evaluation of swallowing were used to determine the Hyodo score, dysphagia severity, and recommended diet and liquid consistency. Dysphagia severity was rated using the Dysphagia Severity Scale (DSS). There were seven choices of recommended staple food, eight choices of side dish, and six choices of liquid intake.

Results: The median DSS score was 4, and the median Hyodo score was 4. Ordinal logistic regression analysis revealed that resting, swallowing, and the total Hyodo scores were significantly correlated to the DSS score, recommended staple food, side dish, and liquid intake (p < 0.001).

Conclusion: The Hyodo scores are useful to predict the dysphagia severity as well as determine the recommended diet and liquid consistency.

Tashiro N, Sato T, Suzuki H, Kasai F. A case of acute aortic dissection with successful return to normal daily life following severe acute respiratory distress syndrome through continuous rehabilitation from the acute stage to the convalescent stage. Jpn J Compr Rehabil Sci 2020; 11: 116-120.

A 70-year-old male with back pain presented to the hospital for Stanford type B acute aortic dissection. Treatment was initiated using rest and a combination of antihypertensive drugs and analgesics. On day 2 of hospital stay, he developed hypoxemia and was diagnosed with acute respiratory distress syndrome (ARDS). On day 4 of hospital stay, PaO₂/FiO₂ (P/F ratio) of 124.7 indicated persistence of hypoxemia and physical therapy was initiated. Prone positioning therapy for 11―16 hours per day was performed continuously for four days. On day 7, his P/F ratio was maintained at ≥300. Image findings also indicated improvement. On day 10, he was weaned off the ventilator and began meals and ambulation. On day 12, his grip strength (right/left) was 26.8/25.5 kg, quadriceps muscle strength (right/left) was 0.22/0.19 kgf/kg, Medical Research Council (MRC) score was 56, and Functional Status Score for the Intensive Care Unit (FSS-ICU) was 28. He was therefore discharged from the ICU. His exercise load was gradually increased in stages while maintaining his systolic blood pressure at ≤140 mmHg. On day 37, he was able to walk with a cane and ascend/descend stairs. Therefore, he was transferred to the rehabilitation hospital. On day 65 of hospital stay, he was able to walk and stand without mechanical assistance. His grip strength was 34.0/33.0 kg, quadriceps muscle strength was 0.48/0.49 kgf/kg, MRC score was 60, FSS-ICU score was 35, and six-minute walking distance was 342 m, indicating satisfactory recovery of functions, and therefore he was discharged home.