Tian D, Izumi S. TMS and neocortical neurons: an integrative review on the micro-macro connection in neuroplasticity. Jpn J Compr Rehabil Sci 2023; 14: 1-9.

Neuroplasticity plays a pivotal role in neuroscience and neurorehabilitation as it bridges the organization and reorganization properties of the brain. Among the numerous neuroplastic protocols, transcranial magnetic stimulation (TMS) is a well-established non-invasive protocol to induce plastic changes in the brain. Here, we review the findings of four plasticity-inducing TMS protocols in the human motor cortex with relatively evident mechanisms: conventional repetitive TMS (rTMS), theta-burst stimulation (TBS), quadripulse stimulation (QPS) and paired associative stimulation (PAS). Based on the reviewed evidence and a preliminary TMS neurocytological model proposed in our previous report, we further integrate the neurophysiological evidence and plasticity rules of these protocols to present an updated micro-macro connection model between neocortical neurons and the neurophysiological evidence in TMS. This prototypical model will guide further efforts to understand the neural circuit of the motor cortex, the mechanisms of TMS, and the advance of neuroplasticity technologies and their outcomes.

Akimoto K, Asano S, Satoh Y, Yokogushi K. Changes in respiratory, physical, and mental conditions in moderate and severe COVID-19 cases at our convalescent rehabilitation ward. Jpn J Compr Rehabil Sci 2023; 14: 10-15.

Purpose: This study clarified the changes in respiratory condition, and physical and mental functions pertaining to them, of patients with the coronavirus disease 2019 (“COVID-19”) who were admitted to our convalescent rehabilitation ward. It also examined the conditions remaining after the disease (long-COVID).

Methods: We focused on 16 moderate and severe patients with COVID-19 who were transferred to our convalescent rehabilitation ward and discharged home between March and September 2021. We evaluated the patients' respiratory, physical, and mental conditions at the time of admission, four weeks after admission, and at the time of discharge.

Results: We confirmed an improvement in the shortness of breath in those with respiratory conditions, and a significant improvement in the walking distance related to physical function before the time of discharge, but anxiety and depression remained.

Conclusion: Patients with moderate to severe COVID-19 can be discharged home after convalescent rehabilitation. Despite improved dyspnea and walking distance, the patients tend to have incomplete recovery, including physical deconditioning, mood disorders, and other long-COVID conditions at discharge.

Taniguchi S, Yamamoto A. Measurement instruments to assess basic functional mobility in Parkinson's Disease: A systematic review of clinimetric properties and feasibility for use in clinical practice. Jpn J Compr Rehabil Sci 2023; 14: 16-25.

Objective: To systematically review the evaluation of clinimetric properties and feasibility of the “Modified Parkinson Activity Scale (M-PAS)” and the “Lindop Parkinson's Disease Mobility Assessment (LPA),” which are Parkinson's Disease (PD)-specific measurement instruments to assess basic functional mobility, and to discuss their considerations for use in clinical practice.

Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A risk of bias assessment was also performed.

Results: Eleven studies were included: five studies used M-PAS (45%), five studies used LPA (45%), and one study used M-PAS and LPA (13%). The risk of bias was low for all evaluated studies.

Conclusion: M-PAS and LPA showed adequate reliability, validity, and responsiveness in detecting intervention changes. M-PAS has more detailed qualitative scoring options, a lack of ceiling effect, and can be used by a non-expert in PD.

In contrast, the drawback of M-PAS is that it is timeconsuming to apply in everyday clinical practice. On the other hand, LPA with greater simplicity may lead to lower burdens for both patients and raters in situations with strict time limitations. Further research is required to identify new resources.

Hishikawa N, Sawada K, Shono S, Sakurai M, Yokozeki M, Maeda H, Ohashi S, Ueshima K, Mikami Y. Accurate diagnosis of sarcopenia without using a body composition analyzer in a convalescent rehabilitation ward. Jpn J Compr Rehabil Sci 2023; 14: 26-32.

Objective: The Asian Working Group for Sarcopenia 2019 recommends diagnosing sarcopenia without using a body composition analyzer and initiating treatment early. The present study aimed to investigate the accuracy of diagnosing sarcopenia without a body composition analyzer in a convalescent rehabilitation ward.

Methods: Eighty-five patients admitted to a convalescent rehabilitation ward were included, and sarcopenia diagnoses were performed with and without a body composition analyzer. To assess the accuracy of diagnosing sarcopenia without using a body composition analyzer, sensitivity, specificity, positive predictive value, and negative predictive value were calculated relative to sarcopenia diagnoses made using a body composition analyzer.

Results: The sensitivity of the technique for diagnosing sarcopenia was 0.94, specificity was 0.77, positive predictive value was 0.86, and negative predictive value was 0.90.

Conclusion: The accuracy of diagnosing sarcopenia without using a body composition analyzer was high. However, this technique may miss sarcopenia cases in patients with increased calf circumference due to adipose tissue and/or edema.

Arai N, Abe Y, Metani H, Hiraoka T, Hanayama K.

Effect of cranioplasty on FIM in patients with severe cerebral infarction after cerebral decompression. Jpn J Compr Rehabil Sci 2023; 14: 33-38.

Objective: The functional effects of cranioplasty were measured in patients with severe cerebral infarction who had undergone cerebral decompression by comparing the functional independence measure (FIM) during convalescent rehabilitation before and after cranioplasty.

Methods: The study design was a single-center retrospective cohort study.

Results: Fifty-five patients underwent cerebral decompression after cerebral infarction at our hospital, six of whom were included in this study. Two patients who exhibited cranial depression had no changes in FIM one month prior to cranioplasty. However, the FIM increased one month postoperatively. These patients showed a large increase in the scores for movement and transfer.

Discussion: Cranioplasty may play a role in improving ability during convalescent rehabilitation in patients with severe cerebral infarction who undergo cerebral decompression, especially in movement and transfer items.

Sato M, Hyakuta T. Awareness and support for poststroke fatigue among medical professionals in the recovery phase rehabilitation ward. Jpn J Compr Rehabil Sci 2023; 14: 39-48.

Objective: To clarify the level of awareness of and support for post-stroke fatigue among medical professionals working in recovery phase rehabilitation wards.

Methods: We conducted a questionnaire survey targeting all medical professionals (physicians, nurses, physical therapists, occupational therapists, and speech therapists) working in recovery phase rehabilitation wards of three facilities to evaluate their awareness of post-stroke fatigue and the support they were offering to address this. Quantitative data were subjected to statistical analysis and free description data were subjected to content analysis.

Results: Of the 130 participants, we obtained responses from 94 (collection rate, 72.3%; valid response rate, 100%). Those who felt that post-stroke patients are always tired or tire easily comprised 63.8%. Those who acknowledged the importance of post-stroke fatigue as a problem and that it is an issue that must be addressed comprised 70.2% and 73.4%, respectively. Issues emerging due to post-stroke fatigue were extracted as follows: “Difficulty continuing with rehabilitation,” “Decreased drive,” “Difficulty with emotional control/ depression,” “Fewer interactions with others,” and “Loss of goals.” Support for post-stroke fatigue was offered by 57.4% of medical professionals, most commonly as individual support such as “Ensure rest.” The effects of support were described as “Cannot say either way” (44.4%), with 3.7% noting that they were not very effective. Awareness and support rates among therapists were significantly higher than those among nurses.

Conclusions: Post-stroke fatigue is acknowledged by medical professionals as a critical issue that negatively influences the patient's physical, emotional, and daily living functions. Unfortunately, effective support is not currently being offered, demonstrating the need for the development of appropriate interventions.

Kikkawa T, Takashima A. Practice of gait training using lower-limb orthosis and body weight-supported walker for severe acute motor axonal neuropathy: a case report. Jpn J Compr Rehabil Sci 2023; 14: 49-53.

Introduction: Acute motor axonal neuropathy (AMAN) requires aggressive gait rehabilitation from the early phase of its onset due to the long time required to achieve independent gait. In this report, we describe the progress of gait training using a combination of lower-limb orthosis and body weightsupported (BWS) walker in a patient with severe AMAN.

Case: A 30-year-olds man diagnosed with AMAN underwent two high-dose intravenous immunoglobulin treatments and combined steroid pulse therapy. The patient was admitted to the convalescent rehabilitation ward for 87 days with a Medical Research Council (MRC) score of 7 points for muscle strength and 13 points for Functional Independence Measure (FIM) motor items. He started gait training with a kneeankle- foot orthosis on the 128th day. Thereafter, the distance of gait training increased with the use of lower-limb orthosis and BWS walker. At the time of discharge, the patient's MRC score had improved to 24 points and his FIM motor items score to 31 points. He was able to walk 90 m using ankle-foot orthosis and forearm walker and was transferred to a rehabilitation facility on day 237.

Discussion: Gait training with lower-limb orthosis and BWS walker was performed on a patient with severe AMAN. As a result, gait training distance increased without adverse events. Gait training can be performed safely and effectively by combining lowerlimb orthosis and BWS walker when gait ability is expected to improve, even in severely ill patients.

Miyasaka H, Nakagawa Y, Okazaki H, Sonoda S. Influence of sitting posture on anterior buttock sliding during wheelchair propulsion of hemiplegic stroke patients. Jpn J Compr Rehabil Sci 2023; 14: 54‒59.

Objectives: This study investigated the influence of different sitting postures on wheelchair propulsion ability.

Methods: The subjects were stroke patients who scored at least 2 points on the Stroke Impairment Assessment Set for abdominal muscle strength and trunk verticality and 3 points for non-paralytic side lower-limb muscle strength. Moreover, the patients were divided by their everyday wheelchair propulsion posture: Lean on Back Support (LBS); n = 8), those who leaned their back against the back support; and non-LBS (n = 11), those who moved their back away from the back support. For the wheelchair propulsion method, straight one-hand, one-leg propulsion was used on the non-paralyzed side for 10 m, followed by turning around a target 3 m ahead on each of the paralyzed and non-paralyzed sides. We then compared the propulsion times, number of propulsions, and difference in length from the front end of the patella on the non-paralyzed side to the front end of the seat surface (buttock sliding distance) between the groups.

Results: The buttock sliding distance was significantly shorter in the non-LBS group than in the LBS group in the paralyzed and non-paralyzed side turning tasks (p < 0.05). Propulsion times, number of propulsions, and grip strength did not differ significantly between the groups.

Conclusion: Even in patients with good trunk function, propulsion while leaning against the back support can easily result in anterior buttock sliding, leading to a secondary risk of injury. These results suggest that it is necessary to provide guidance on the propulsion posture and seating to hold the trunk vertically to minimize anterior sliding during propulsion.

Hatakeyama M, Shirahase M, Suzuki S, Morita K, Yamashita S. A study of patients whose mode of food intake changed during long-term bedside care. Jpn J Compr Rehabil Sci 2023; 14: 60‒68.

Objective: The objective of this study was to determine the characteristics of patients who exhibited changes in their food intake level (as determined by the Food Intake Level Scale [FILS] score) while hospitalized for long-term bedside care.

Methods: The subjects were 264 patients hospitalized for long-term bedside care. The FILS was used to assess the subjects' mode of food intake on the admission and survey dates. The FILS score was used to divide the patients into three stages: no oral intake, combined oral intake and alternative nutrition, and exclusively oral intake; the patients whose FILS stage on the survey date was different from that on the admission date were examined to determine whether there were any characteristic tendencies with regard to their age, sex, length of hospital stay, level of longterm care needed, primary illness, and dysphagia rehabilitation.

Results: Overall, 6.8%, 9.8%, and 4.5% of the subjects showed improvement in the FILS stage, experienced deterioration of the FILS stage, and transitioned to exclusively oral intake, respectively. Further, 33.3% of the improved-FILS stage group were in their ≥90s. The results of the exact binomial test with the entire study cohort as the population proportion showed that there were significantly more females in the improved-FILS group. In addition, 83.3% of those who improved from no oral intake to exclusively oral intake had cerebrovascular disease. No difference in the length of hospital stay and level of long-term care needed was observed in either the improved-FILS or deteriorated- FILS group in comparison to their proportions in the entire study cohort. In the entire study cohort, a greater proportion of the subjects in the improved-FILS group underwent indirect or direct swallowing training than those in the deteriorated-FILS group; the improved- FILS group had no subjects who were assigned to watchful waiting.

Conclusion: Most patients who exhibited marked positive changes in their mode of food intake were females or patients with cerebrovascular disease. However, no characteristic attributes were observed among those whose FILS stage deteriorated.

Chiba T, Yokota J, Takahashi R, Sasaki K, Suzuki H. Prealbumin level is a predictor of activities of daily living at discharge in older patients with heart failure who became ADL-independent after hospitalization - Acute and early recovery cardiac rehabilitation trials. Jpn J Compr Rehabil Sci 2023; 14: 69-77.

Objective: To determine the relationship between prealbumin level and activities of daily living (ADL) at discharge in patients with heart failure (HF) and assess the usefulness of prealbumin measurement in predicting discharge Barthel Index (BI) in older patients with HF who become non-independent in ADL after hospital admission.

Methods: Patients with HF, aged ≥75 years, who were admitted to an acute hospital and underwent acute and early recovery cardiac rehabilitation (CR) were studied retrospectively. The exclusion criteria were non-independent ADL before admission (BI < 85 points) and independent ADL at the start of CR (BI ≥ 85 points). The usefulness of prealbumin level in predicting discharge BI was compared between four models. Albumin and Controlling Nutritional Status (CONUT) were used as comparison variables. The models and independent variables were model 1 (covariates only), model 2 (prealbumin + covariates), model 3 (albumin + covariates), and model 4 (CONUT score + covariates). Adjusted R², a measure of model fit, was used to compare predictive ability.

Results: A total of 152 patients were included in the analysis. Prealbumin level was a significant variable for BI at discharge but not albumin or CONUT. The adjusted R² was higher in model 2 with the addition of prealbumin than that in model 1 (0.362 vs. 0.347).

Conclusion: Prealbumin levels are useful in predicting discharge BI in older patients with HF who become non-independent in ADL after hospitalization.

Nonaka Y, Fujii R, Tanaka S, Tabira K. Effect of cognitive impairment at admission on activities of daily living at discharge in older patients with heart failure. Jpn J Compr Rehabil Sci 2023; 14: 78‒83.

Objective: Hasegawa's Dementia Scale-Revised (HDS-R) is widely used as a screening test for cognitive function in older adults. In this study, we examined the effect of cognitive impairment (CI) at admission on activities of daily living (ADL) at discharge in older patients with heart failure (HF).

Methods: This retrospective observational study included 394 patients hospitalized for acute decompensated HF between April 2016 and December 2022. Data on age, sex, body mass index, length of hospital stay, initiation of rehabilitation, New York Heart Association (NYHA) class, Charlson Comorbidity Index, medication, brain natriuretic peptide levels, left ventricular ejection fraction, renal function, hemoglobin level, serum albumin level, Geriatric Nutritional Risk Index (GNRI), Barthel Index (BI), and HDS-R score were analyzed using the χ² test, unpaired t test, Mann―Whitney U test, and multiple linear regression.

Results: Among 394 patients, 102 who met the final inclusion criteria were included in the study. Based on previous studies, patients were divided into a high BI group (N = 44) and a low BI group (N = 58). Multiple linear regression analysis showed that CI at admission independently affected BI at discharge even after adjusting for confounding effects of age, NYHA class, GNRI, and BI at admission.

Conclusions: Our study showed that the presence or absence of CI may influence ADL improvement in rehabilitation interventions aimed at improving ADL in older patients with HF.