Hase K. Current perspectives on quantitative gait analysis for patients with hemiparesis. Jpn J Compr Rehabil Sci 2022; 13: 1-3.

Otsubo H, Kishimoto K, Hirano I, Nakano H, Itaya K, Kumaki R, Osumi H. Relationship between cognitive function affecting motor Functional Independence Measure and hypnotics. Jpn J Compr Rehabil Sci 2022; 13: 4-11.

Purpose: The purpose of this study was to examine the relationship between cognitive dysfunction affecting motor Functional Independence Measure (FIM) and hypnotics.

Methods: This was a retrospective study involving 509 patients aged ≥ 65 years who were discharged from a convalescent rehabilitation ward.

Results: Multiple regression analysis was performed with motor FIM efficiency and motor FIM effectiveness (motor FIM-e) as independent variables and the presence or absence of cognitive dysfunction as the dependent variable. The use of hypnotics in patients with cognitive dysfunction showed a positive relationship with motor FIM efficiency (β = 0.147, P = 0.019) and motor FIM-e (β = 0.141, P = 0.026). Multiple regression analyses were performed after further classifying hypnotics by therapeutic class into hypnotics with new mechanisms, non-benzodiazepine (BZ) hypnotics, and BZ hypnotics. Non-BZ hypnotics (β = 0.141, P = 0.021) showed a positive relationship with motor FIM efficiency. Non-BZ hypnotics (β = 0.158, P = 0.009) and BZ hypnotics (β = 0.178, P = 0.003) showed a positive relationship with motor FIM-e, whereas hypnotics with new mechanisms of action did not. In contrast, none of the three combinations of hypnotics showed any significant relationship with either motor FIM efficiency or motor FIM-e in patients without cognitive dysfunction.

Conclusion: The results suggested that the use of hypnotics in patients with cognitive dysfunction increases motor FIM efficiency and motor FIM-e.

Mita M, Suzumori K, Kudo D, Saito K, Chida S, Hatakeyama K, Shimada Y, Miyakoshi N. Utility of a wearable robot for the fingers that uses pneumatic artificial muscles for patients with post-stroke spasticity. Jpn J Compr Rehabil Sci 2022; 13: 12-16.

Objective: We investigated the utility of a wearable robot for the fingers that we developed using pneumatic artificial muscles for rehabilitation of patients with post-stroke spasticity.

Methods: Three patients with post-stroke finger spasticity underwent rehabilitation for 20 minutes a day, 5 days a week, for 3 weeks. Passive range of motion, Modified Ashworth Scale (MAS), and circumference of each finger were measured before and after training and compared.

Results: The range of motion and finger circumference increased when using a wearable robot. The MAS improved partially, and no exacerbation was observed.

Conclusions: The wearable robot we developed is useful for rehabilitation of post-stroke spasticity and may improve venous return.

Oishi K, Nishioka S, Okazaki Y, Hirakawa K, Nakamura M, Ichinose A, Kurihara M. Relationship between oral hygiene and function and activities of daily living at discharge in convalescent patients with stroke. Jpn J Compr Rehabil Sci 2022; 13: 17-25.

Objective: This study was designed to examine the relationship between improvement in oral hygiene and function and activities of daily living (ADLs) at discharge in patients admitted to convalescent rehabilitation wards.

Methods: Eligible criteria were patients with stroke with a score of 13 or higher (i.e., severe oral problems) on the Revised Oral Assessment Guide (ROAG) at admission. Age, gender, primary diseases, rehabilitation dose, dentist visits and denture status, Eichner classification, eating status at admission and discharge, and body mass index at admission were collected. The patients were classified into two groups: those with ROAG scores of less than 9 points at discharge (good ROAG group) and those with scores of 9 points or more (poor ROAG group), and Functional Independence Measure (FIM) gain and total FIM discharge scores were compared using univariate and multivariate analyses.

Results: The good and poor ROAG groups comprised 126 and 366 patients, respectively. The good ROAG group had significantly higher total FIM score, FIM efficiency, and FIM gain at discharge than the poor ROAG group (112 vs. 82; P < 0.001). The ROAG scores at discharge were independently associated with FIM gain (partial regression coefficient = −9.889, 95% confidence interval = −13.499 to −6.279) and total FIM score at discharge.

Conclusion: Improvement in oral hygiene and function in convalescent patients with stroke was associated with ADLs at hospital discharge.

Murata S, Koike Y, Kasukawa Y, Saito K, Okada K, Kudo D, Shimada Y, Miyakoshi N. Contralaterally controlled functional electrical stimulation immediately improves hand function. Jpn J Compr Rehabil Sci 2022; 13: 26-30.

Objective: The purpose of this study was to investigate the immediate effects of contralaterally controlled functional electrical stimulation (CCFES) on upper limb function in stroke patients.

Methods: CCFES and mirror therapy (MT) exercises were conducted for 13 stroke patients at least 4 weeks post-onset. A sufficient interval of at least 24 hours was left between the two types of rehabilitation exercises. Before treatment and immediately after each training session, grip strength, Fugl-Meyer Assessment for Upper Extremity (FMA-UE) score and FMA-UE subscores for the shoulder/elbow/forearm, wrist, hand, and coordination were evaluated.

Results: Grip strength, FMA-UE and FMA-UE shoulder/elbow/forearm, wrist, and coordination did not differ significantly after CCFES and MT compared to before therapy. FMA-UE hand did not change significantly after MT compared to before therapy, but it improved significantly after CCFES (p = 0.013).

Conclusion: CCFES for the upper extremities immediately improves hand function and may be effective in maintaining and improving patients' motivation for rehabilitation treatment.

Sakai R, Koike Y, Saito K, Matsunaga T, Shimada Y, Miyakoshi N. Aphasia testing (auditory comprehension domain) using a new eye-tracking system in healthy participants. Jpn J Compr Rehabil Sci 2022; 13: 31‒35.

Objective: We administered a conventional pointingmethod test with eye-tracking to evaluate items associated with auditory comprehension and examined the concordance between the obtained results.

Methods: The enrolled participants were 10 healthy volunteers. We performed tests after extracting auditory comprehension items from the SLTA, the WAB, and the Supplementary tests for the SLTA using the eye-tracking system and the pointing method.

Results: The mean test duration was 9 min 51 s ± 1 min 41 s (mean ± SD), and the percentage of correct answers was 100% and in perfect agreement for the pointing method and the eye-tracking system. The mean response time was 0.96 ± 0.36 s for the pointing method and −0.39 ± 0.21 s for the eye-tracking system. Hence, the latter was faster than the former, and examinees completed their responses before listening to the end of the questions.

Conclusion: The new eye-tracking system makes it possible to perform aphasia tests (auditory comprehension items) comparable to the conventional pointing method.

Watabe T, Suzuki H, Abe M, Uchibori K, Senga K. Rehabilitation practice for external ophthalmoplegia including voluntary training for patients with medial longitudinal fasciculus syndrome. Jpn J Compr Rehabil Sci 2022; 13: 36‒40.

Introduction: This report presents a case of external ophthalmoplegia caused by medial longitudinal fasciculus (MLF) syndrome. The patient underwent oculomotor rehabilitation by an occupational therapist during hospitalization and voluntary training supervised by the occupational therapist after discharge.

Case: The patient presented with MLF syndrome due to bridge infarction. The left eye had a pronounced adduction disorder, and diplopia was observed in the median vision, resulting in severe discomfort in daily life. During the hospitalization, the patient underwent eye movement rehabilitation led by an occupational therapist that included pursuit, fixation, saccades, and convergence, and after discharge from the hospital, the patient underwent two sets of voluntary training for 10 min daily to induce pursuit, fixation, and convergence under the guidance of the occupational therapist. As a result, the angle of squint, degree of diplopia, and degree of inconvenience in daily life improved.

Discussion: Eye movement rehabilitation, including voluntary training, improved external ophthalmoplegia.

Matsumoto A, Yoshimura Y, Shimazu S, Nagano F, Bise T, Kido Y, Shiraishi A, Sunahara T. Association of polypharmacy at hospital discharge with nutritional intake, muscle strength, and activities of daily living among older patients undergoing convalescent rehabilitation after stroke. Jpn J Compr Rehabil Sci 2022; 13: 41‒48.

Objective: To investigate the association between polypharmacy at discharge and nutritional intake, muscle strength, and activities of daily living (ADL) among older patients undergoing convalescent rehabilitation after stroke.

Methods: This cross-sectional study involved hospitalized patients aged 65 or older who underwent convalescent rehabilitation after stroke. Polypharmacy was defined as the use of six or more medications. Study outcomes included energy intake, protein intake, handgrip strength (HG), and motor subscore of Functional Independence Measure (FIM-motor) at hospital discharge. Multiple linear regression analysis was used to examine the association between polypharmacy at discharge and outcomes.

Results: Of 361 eligible patients (mean [±SD] age, 78.3±7.7 years; 49.3% male), 62.9% had polypharmacy. Multiple regression analysis revealed that polypharmacy at discharge was negatively associated with energy intake (β = -0.122, p = 0.003), protein intake (β = -0.133, p = 0.013), HG (β = -0.070, p = 0.022), and FIM-motor score (β = -0.069, p = 0.031) at discharge.

Conclusion: The impact of polypharmacy should be considered when designing nutritional management strategies for rehabilitation patients to maximize rehabilitation outcomes.

Fujii R, Tamari M, Nonaka Y, Tamiya F, Hosokawa H, Tanaka S. Influence of gait exercise using a walkingassist robot for swing-leg motion in hemiplegic stroke patients: A preliminary study focusing on the immediate effect. Jpn J Compr Rehabil Sci 2022; 13: 49-55.

Objective: We analyzed the effect of gait training using a walking-assist robot that assists a subject's knee joint movement and leg swing to achieve toe clearance of the paralyzed-side lower limb during treadmill walking.

Methods: The subjects were 10 hemiplegic stroke patients in a rehabilitation ward. The intervention consisted of gait training using the Welwalk WW-1000 (Welwalk) robot for 40 min. Immediately before and after this intervention, a gait analysis of the patients' treadmill walking was performed by a three-dimensional motion capture system. Statistical analyses compared the foot-to-floor distance and the shortening of hip-toe length (SHTL) of the paralyzed side before and after the intervention, and examined the relationship between the change of lower-limb joint kinematics and toe clearance before and after the intervention.

Results: The post-intervention SHTL was significantly lower compared to before the intervention, and there was a significant negative correlation between the change in the SHTL and the knee flexion angle from before to after the intervention.

Conclusion: Gait exercise using the Welwalk could contribute to the acquisition of more normal leg-swing strategies.

Igarashi T, Hayashi S, Ogawa K, Matsui S, Nishimatsu T. Relationship between daily rehabilitation time and functional gain in inpatient rehabilitation medicine of hospitalized older adults with subacute stroke. Jpn J Compr Rehabil Sci 2022; 13: 56-63.

Objective: Although there have been reports examining the relationship between daily rehabilitation time and functional gain, few have fully considered background factors such as severity of motor paralysis and comorbidities. This study aimed to examine the relationship between the daily rehabilitation time and improvement in functional status, longitudinally in hospitalized older adults with subacute stroke.

Method: From the results of the Functional Independence Measure (FIM), we calculated the FIM gain and FIM effectiveness, a measure that is less sensitive to the ceiling effect of FIM. Adjusted for covariates, multiple regression analysis was performed for daily rehabilitation time and FIM gain and effectiveness.

Results: This study enrolled 298 hospitalized older adults with subacute stroke (mean age, 78.1 ± 8.1 years, 112 females). The total scores of functional independence measure gain and effectiveness were 31.6 ± 22.5 points and 54.4 ± 35.2%, respectively. There was an association between FIM gain (total score) and total rehabilitation time (β = 0.29, p < 0.01) and between FIM effectiveness (total score) and total rehabilitation time (β = 0.22, p < 0.01).

Conclusions: Although prognosis after stroke is poorer in older adults than in young adults, this study shows that increased daily rehabilitation time may improve functional status.