Yoneda C, Saitoh E, Suzuki M, Yamada M. Effects of prism directionality and active movement adaptation on the symptoms of unilateral spatial neglect. Jpn J Compr Rehabil Sci 2011; 2: 1-4.
Objective: Prism adaptation therapy is one of the treatment methods for unilateral spatial neglect (USN). In this study, we examined the influence of prism deviations toward the right and toward the left. We also studied the additional effects of hand movements as performance adaptation to prisms.
Methods: Patients with left USN caused by stroke were split into 2 groups on the basis of whether or not they performed adaptation movements. In all the patients, prisms deviating the visual field 10° to the right and to the left were used, and the adaptation task consisted of right index finger movements to reach 3 targets on a desk, 50 times each. During the movements, hand trajectories were visible. In the group in which adaptation movements were not performed, the participants wore the prisms for 20 minutes. A line bisection test using a 50-cm tape was used to evaluate the USN before and after treatment.
Results: The use of left-deviating prisms resulted in worsening of the USN in the group in which adaptation movements were performed (p=0.01). In this group, the point of bisection showed a tendency to move toward the left (p=0.29) when right-deviating prisms were used.
Conclusions: The results indicated that adaptation treatment using right-deviating prisms might be effective for USN, even when the trajectory of the movements is visible.

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Takahashi H, Sugawara K, Satake M, Shioya T, Kagaya H, Kawatani M. Effects of low-intensity exercise training (Chronic Obstructive Pulmonary Disease Sitting Calisthenics) in patients with stable Chronic Obstructive Pulmonary Disease. Jpn J Compr Rehabil Sci 2011; 2: 5-12.
Objective: The purpose of this study was to investigate the effectiveness of pulmonary rehabilitation (PR), consisting of chronic obstructive pulmonary disease (COPD) sitting calisthenics (CSC), which are performed in a seated position by outpatients with stable COPD.
Methods: Sixty-seven males with stable COPD undergoing outpatient treatment were recruited. They were randomly assigned to either a calisthenics group (n = 35), which underwent PR consisting of CSC performed at home for 3 months and an educational program at the outpatient department, or a control group (n = 32) that underwent only a monthly outpatient educational program.
Results: The peak oxygen uptake (VO₂) values for the aerobic CSC performed at target dyspnea ratings of 2 were 39.4-52.1% of the peak VO₂ values obtained from the 6-min walking test; these findings indicated that the calisthenics were low-intensity exercises. The actual home implementation rates of CSC were as follows: stretching, 92.0%; arm strength training, 40.4%; leg strength training, 44.2%; and aerobic exercise, 76.2%. A significant improvement was noted in VC, %VC, FVC, FRC, RV, RV/TLC, 6MWD and CRQ after 3 months of PR in the calisthenics group, whereas no significant change was observed in any parameter in the control group.
Conclusion: CSC is an effective treatment strategy in patients with stable COPD.

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Shirayama Y, Nakajima Y. A study of burnout characteristics among support coordinators for persons with high brain dysfunction. Jpn J Compr Rehabil Sci 2011; 2: 13-17.
Objective: We conducted a quantitative investigation of burnout (BO) characteristics among support coordinators (SCs) for persons with high brain dysfunction.
Methods: We administered a questionnaire, including the Japanese BO scale items and questions on individual attributes, to 66 persons who attended the national SC Conference.
Results: Of the 66 participants, 65 were SCs. The average scores for sub-factors in the Japanese BO scale were 13.40 ± 4.36 for emotional exhaustion, 11.18 ± 3.65 for depersonalization, and 16.98 ± 3.92 for personal accomplishment. Burnout tendencies were seen in ± SCs (13.8%). Comparison of the attributes of the sub-factor scores showed significant differences with regard to the sex of the individual, with women experiencing greater levels of emotional exhaustion than those experienced by men; professional role, with the sense of personal accomplishment being greater in management positions than in non-management positions; and job satisfaction, with the levels of emotional exhaustion and depersonalization being greater among dissatisfied participants than those in satisfied participants.
Conclusion: Our results suggest that care tailored to SCs' individual attributes, as well as swift systemwide responses are necessary to prevent BO among SCs.

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Kanamori D, Kagaya H, Fujii N, Inamoto Y, Nakayama E, Suzuki S, Mizutani H, Okada S, Katada K, Saitoh E. Examination of the distance measurement error and exposed dose when using a 320-row area detector CT: A comparison with videofluoroscopic examination of swallowing. Jpn J Compr Rehabil Sci 2011; 2: 18-23
Purpose: The purpose of this study was to compare the distance measurement error and exposed dose in 320-row area detector computed tomography (320-ADCT) and videofluoroscopic examination of swallowing (VF).
Method: We used markers of radiopacity attached to adult skull specimens to measure the distances between various sets of 2 points. In VF, we made the corrections using the mentalis marker. In 320-ADCT, we used a distance measurement tool. After obtaining the distance measurements, we compared the errors from VF and 320-ADCT. We used a RANDO Phantom to calculate the exposed dose by using thermoluminescence dosimeter (TLD) elements.
Results: In the case of VF, the relative error associated with the actual measured values was largest (12.9%) in the area between the mentalis and the left mandibular angle. In 320-ADCT, even the measurements with the largest error had a relative error within 0.34%. In VF, the dose absorbed through the skin on the incident side was 4.8 to 12.1 times higher than the dose absorbed on the opposite side, up to a maximum of 25.30 mGy; the effective dose was 1.05 mSv. Using 320-ADCT, the maximum dose absorbed through the skin was 47.07 mGy, and the effective dose was 1.65 mSv.
Conclusion: Compared with VF, the 320-ADCT approach produces a smaller measurement error, and observation is possible from a variety of directions. However, because the exposed dose is greater, a combination of both approaches should be skillfully used to evaluate eating and swallowing functions.

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Miyasaka H, Kondo I, Kato H, Takahashi C, Uematsu H, Yasui C, Tani A, Miyata M, Wada N, Teranishi T, Wada Y, Sonoda S. Assessment of the content validity of Functional Skills Measure after Paralysis with nominal group discussion and revision of its content. Jpn J Compr Rehabil Sci 2011; 2: 24-30
Purpose: The purposes of this study were to assess the content validity of Functional Skills Measure after Paralysis (FSMAP) and to revise its content to make it appropriate for use in the clinical setting.
Methods: Eight occupational therapists (OTs) participated in the questionnaire study. Nominal Group Technique (NGT) was used to measure the content validity. Before using the NGT, we set an 80% agreement as the criterion for consent. If the agreement for an item did not reach this level and the item’s content validity was not high enough, we revised its content. We repeated the same assessment for the revised FSMAP by using a questionnaire.
Results: In the first assessment, 8 out of 15 items (including the subitems and descriptions) did not reach the predetermined agreement level. In the second assessment, 1 out of 15 items did not reach the agreement level. We finished the assessment process because we judged that the content validity of FSMAP reached a satisfactory level after the revision of this item.
Discussion: We think that FSMAP should be revised to make it appropriate for use in the clinical setting after assessing its content validity.

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Ito T, Tsubahara A, Seno Y, Tokuhiro H, Watanabe S. Consideration of ways to generate hip flexion torque by using electrical stimulation: Measurement of torque and the degree of pain. Jpn J Compr Rehabil Sci 2011; 2: 31-35
Objective: To determine the best method to effectively generate hip flexion torque by using transcutaneous electrical stimulation in a fundamental study to restore the motor function of those with disabilities caused by central nervous system disorders.
Methods: Eleven healthy men participated in this study. Isometric hip flexion torque and the degree of pain during electrical stimulation were measured to determine the optimal stimulation site. The interferential frequency was 30 Hz. The duration of stimulation was 2 seconds, which was followed by a 15-second pause, and this was repeated 3 times. The electrodes were placed at 3 different sites: (1) on the sartorius and the tensor fasciae latae, (2) on the sartorius and the rectus femoris, and (3) on the rectus femoris and the tensor fasciae latae. The maximum tolerable intensity was determined for each of the 3 methods. Then the lowest current was used as the stimulus intensity for measurements. The contraction ratio was calculated by dividing the torque value of each individual muscle by the sum of the torque values of all muscles.
Results: The contraction ratio of the rectus femoris was significantly larger than that of the sartorius. Significant differences were not observed in the torque values or the degree of pain.
Conclusion: Electrical stimulation should be applied to the rectus femoris at the lowest stimulus intensity to produce the largest hip flexion torque.

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Ota K, Saitoh E, Kagaya H, Sonoda S, Shibata S. Effect of postural combinations-the reclined seated position combined with head rotation-on the transport of boluses and aspiration. Jpn J Compr Rehabil Sci 2011; 2: 36-41
Purpose: The purpose of this study was to determine combinations of compensatory postural maneuvers used for dysphagic patients that could increase the risk of aspiration.
Methods: Study 1: The pathway of the transported bolus was examined in various combinations of 30° head flexion, head rotation to the right (0°, 30°, or 60°) and reclined seated position (90°, 60°, or 45°) by using synchronized imaging of videofluoroscopic (VF; AP view) and videoendoscopic (VE) evaluation of swallowing in 5 healthy volunteers (24-45 years). Study 2: The occurrence of aspiration was evaluated in combinations of 30° head flexion, head rotation (0° and 30° left and right), and a reclined seated position (90°, 60°, or 45°) by using VF lateral view in 10 dysphagic patients (74.7 ± 6.7 years).
Results: Study 1: In a combined posture of 45° in a reclined seated position with a 30° head rotation to the right, the bolus reached the pyriform sinus on the side of rotation before the onset of the swallowing reflex in 2 of the 5 healthy volunteers. Study 2: The aspiration rate was highest (40%) at a combined posture of 30° head rotation and 45° reclined seated position.
Conclusion: These findings suggest that certain postural combinations may increase the risk of aspiration.

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von Wild KRH, Kemper B. Emotional adjustment after stroke: The role of early neuropsychotherapeutic interventions in patients following brain damage. Jpn J Compr Rehabil Sci 2011; 2: 42-47.
Objective: Post-stroke depression has been considered the most common neuropsychiatric consequence of stroke, even in the presence of successful neurological recovery and good health-related quality of life. This report describes a patient’s catastrophic reactions to his unexpected illness, with a focus on the therapeutic process, to provide an understanding of managing denial and how to approach and engage brain-damaged patients.
Methods: This is a case study of a 65-year-old businessman with mental-cognitive and behavioral impairments following hypertensive cerebellar massive hemorrhage and secondary hydrocephalus, who made a complete recovery following psychotherapeutic intervention.
Results: Our supportive psychotherapeutic approach combined with cognitive interventions enabled this patient overcome moderate mental-cognitive and behavioral deficits and extreme defensive coping strategies, and facilitated his successful social re-entry.
Conclusions: Brain-damaged patients with preserved self-awareness and a high level of independence in activities of daily living (ADL), who do not have pre-existing psychiatric conditions, can benefit from individualized psychotherapy over time. Attention needs to be focused on a recovery beyond functional outcomes, with understanding of holistic neurorehabilitation as a (an )method of reconstructing lives within a social context. Further research and education is needed for the development of proper psychotherapeutic approaches to address aspects such as emotional coping and finding sense in life following brain damage.

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Fujii W, Kondo I, Baba M, Saitoh E, Shibata S, Okada S, Onogi K, Mizutani H: Examination of chew swallow in healthy elderly persons: Does the position of the leading edge of the bolus in the pharynx change with increasing age? Jpn J Compr Rehabil Sci 2011; 2: 48-53
Objective: To determine whether aging influences the position of the leading edge of the bolus during chew swallow as identified using videofluorography (VF).
Methods: Subjects comprising 53 healthy individuals (35 men and 18 women; mean age of 54.5 ± 19.3 years and range of 25-89 years), were subdivided into 4 groups: young adults, middle age, sixties, and seventy and over. Subjects underwent lateral VF to evaluate the position of the leading edge of the bolus just prior to the onset of swallowing, with normal chew swallow for solid foods and swallowing on command for liquids.
Results: For solid foods, the position of the leading edge of the bolus during chewing changed with increasing age. Mastication time and the number of chew cycles increased with increasing age and were much higher in women than in men for the seventy and over group.
Conclusion: For solid foods, the position of the leading edge of the bolus during chewing in the pharynx changed with increasing age; this may affect the number of chew cycles and increasing age. Gender may also affect both of these factors, with women tending to show a deeper transition of the bolus into the pharynx.

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Shibata S, Kagaya H, Inamoto Y, Saitoh E, Okada S, Ota K, Kanamori D. Swallowing maneuver analysis using 320-row area detector computed tomography (320-ADCT). Jpn J Compr Rehabil Sci 2011; 2: 54-62
Objective: Our objective was to examine whether swallowing maneuvers such as the Mendelsohn maneuver (MM) and the super-supraglottic swallow (SSGS) can be analyzed three-dimensionally and kinematically by using 320-row area detector computed tomography (320-ADCT).
Methods: The subject was instructed to lean against a seat reclined at a 45° angle, hold 4 ml of 5% thickened liquid barium in the oral cavity, and then swallow normally or using the MM or the SSGS. Data were acquired for 3.15 s by using 320-ADCT, and images were reconstructed using a half-reconstruction method. The timing of each swallowing event was compared among the 3 swallowing methods.
Results: We were able to determine the timing of vocal-cord closure and pharyngoesophageal segment (PES) opening during the normal swallowing method, the MM, and the SSGS.
Conclusion: Swallowing maneuvers can be analyzed three-dimensionally and kinematically by using 320-ADCT.

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Shimizu M, Suzukamo Y, Fujiwara K, Izumi S. The involvement of mora segmentation skills in the auditory comprehension process of aphasic patients. Jpn J Compr Rehabil Sci 2011; 2: 63-70.
Purpose: This study was conducted to assess the involvement of mora segmentation skills in the auditory comprehension process of aphasic patients.
Methods: Several tests, such as an auditory word comprehension test, a mora segmentation test (using meaningful and meaningless words), speech discrimination test, and verbal short-term memory test, were conducted in 28 patients with aphasia, owing to left hemisphere brain damage, who had agreed to participate in the study.
Results: There was no significant relationship between mora segmentation skills for meaningful words and auditory comprehension (F = 0.72, p = 0.407). When mora types were analyzed separately for comparative purposes, a significant relationship between auditory comprehension and mora segmentation skills for meaningful words, including only a single-kana sound, was observed (F = 7.50, p < 0.05). However, such a relationship was not observed with words that include the sound of kana “n.” There was no significant difference between meaningful words and meaningless words in terms of the relationship between mora segmentation skills and auditory comprehension (total correct answers for meaningless words: F = 0.03, p = 0.857; meaningless words containing only single-kana sounds: F = 4.40, p < 0.05).
Conclusions: The results suggest that phoneme segmentation assists phonological perception during the process of auditory word comprehension. Furthermore, it is conceivable that the segmentation unit involved in this process is a syllable, rather than a mora; however, this possibility requires further study.

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Wada Y, Kondo I, Sonoda S, Yamada K, Narukawa A, Kawakami K, Nonoyama S, Miyasaka H, Teranishi T, Nagai S, Takeshima N: Mirror therapy for severely affected ankle joints of stroke patients. Jpn J Compr Rehabil Sci 2011; 2: 71-76.
Objective: This study investigated the improvement in dorsiflexion of severely affected ankle joints of first-stroke patients after mirror therapy.
Methods: Nine first-stroke patients participated in this study. A mirror was placed to reflect the non-paralyzed lower limb. A set of 50 dorsiflexion movements of the ankle joint was performed 4 times a day for 7 days. Foot functions of the Stroke Impairment Assessment Set (SIAS-F) and the foot-floor angle at active dorsiflexion were measured every 7 days starting from 14 days before initiation of the mirror therapy training to 7 days after, for a total of 5 times.
Results: SIAS-F did not differ among the cases before mirror therapy training. After the mirror therapy training, 5 of the 9 patients showed SIAS-F improvement. Significant differences were found between the scores at the beginning and at the end of the mirror therapy training, and between the scores at the beginning and 7 days after training. The mean foot-floor angle changed from 0 degrees at the beginning of training to 3.0 degrees at the end of training and 1.2 degrees 7 days after the training; however, these values did not differ significantly.
Conclusion: Significant improvement in dorsiflexion of the ankle joint, as measured by SIAS-F, was achieved with mirror therapy.

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Nagai S, Sonoda S, Miyai I, Kakehi A, Goto S, Takayama Y, Ota T, Itoh I, Yamamoto S, Takizawa Y, Kaku K, Inoue Y, Ishikawa M. Relationship between the intensity of stroke rehabilitation and outcome: A survey conducted by the Kaifukuki Rehabilitation Ward Association in Japan (second report). Jpn J Compr Rehabil Sci 2011: 77-81.
Objective: To verify the scientific basis for “additional remuneration for providing rehabilitation services on holidays” and “additional remuneration for enrichment of rehabilitation programs,” 2 new medical remuneration systems that were introduced in 2010.
Methods: Stroke patients admitted to kaifukuki rehabilitation wards were included in this study. Questionnaire forms were mailed to 11 member facilities of the Kaifukuki Rehabilitation Ward Association in Japan, and relevant data were collected. The 11 facilities were divided into 3 groups according to the total hours spent on physical, occupational, and speech-language-hearing therapy at each facility. Rehabilitation outcomes were compared between facilities that provided ≥6 units/day of rehabilitation 7 days per week for each patient (1 unit = a 20-minute rehabilitation) (≥6 units group), those providing ≥4 and <6 units/day of rehabilitation (4-6 units group), and those providing <4 units/day of rehabilitation (<4 units group).
Results: Total scores of the motor and cognitive items of the Functional Independence Measures on admission were significantly lower in the ≥6 units group than in the other 2 groups. The number of days spent in the rehabilitation facility was significantly lower, by approximately 12 days, in the ≥6 units group than in the other groups.
Conclusion: These results revealed that facilities providing ≥6 units/day of rehabilitation even on holidays enabled patients to be discharged from the facility in significantly fewer days, despite accepting patients with more severe stroke, compared to facilities providing fewer units of rehabilitation.

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Kawarada S, Kondo I, Sonoda S, Yokoyama E, Tazawa Y, Yabunaka Y. Relationship between range of motion of lower extremity and gross motor function in children with cerebral palsy who have walking ability. Jpn J Compr Rehabil Sci 2011; 2: 82-88.
Purpose: The purpose of this study was to investigate the relationship between range of motion of lower extremity and gross motor function in children with cerebral palsy (CP) who have walking ability.
Methods: The subjects were 30 children with CP who were able to walk and were classified as level I - III according to the Gross Motor Function Classification System for children with CP (GMFCS). We measured range of motion (ROM) of lower extremity as follows: 1) hip joint extension in Thomas posture; 2) knee joint extension; and 3) ankle joint dorsiflexion under knee joint extension. At the same time, we evaluated gross motor function at the dimension of standing and the dimension of walking, running and jumping by gross motor function measure (GMFM).
Results: There was a significant difference in ROM of hip joint extension between GMFCS level I and III and also between GMFCS level II and III, and hip joint ROM was closely related to gross motor function. ROM of knee joint extension was more limited in GMFCS level I - II children than in GMFCS level III. ROM of ankle joint extension did not differ significantly among the 3 GMFCS levels, and the correlation between ankle joint ROM and gross motor function was weak.
Conclusion: The results suggested that lower extremity ROM is one of the factors related to gross motor function in children with CP.

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