Tokunaga M, Sannomiya K, Watanabe S, Nakanishi R, Yamanaga H, Yonemitsu H, Terasaki T, Mita S, Kawano S, Hirata Y, Yamaga M, Hashimoto Y, Sonoda S. Relationship between hospital ranking based on Functional Independence Measure (FIM) efficiency and factors related to rehabilitation system for stroke patients —A study of three hospitals participating in Kumamoto Stroke Liaison Critical Pathway—. Jpn J Compr Rehabil Sci 2012; 3: 51-58.
Purpose: The purpose of this study was to clarify the factors related to rehabilitation systems that yield high functional independence measure (FIM) efficiency by conducting a questionnaire survey in the kaifukuki rehabilitation hospitals (KRHs) participating in the Kumamoto Stroke Liaison Critical Pathway.
Methods: A total of 765 stroke patients were studied. FIM score gain and length of stay (LOS) at three hospitals in Kumamoto were classified into two groups according to patients’ age and into three groups according to their FIM score at the time of admission. Then, FIM score gain and LOS were adjusted by the standard severity distribution value of the 765 patients to obtain the adjusted FIM efficiency. The hospitals were ranked by the adjusted FIM efficiency. In addition, we conducted a questionnaire survey on six factors related to the rehabilitation system and determined the factors that ranked the hospitals in the same order as that from ranking based on adjusted FIM efficiency.
Results: The adjusted FIM efficiencies were 0.251 in Hospital A, 0.205 in Hospital B, and 0.225 in Hospital C. Among the six factors surveyed, the factors that gave the same hospital ranking as that based on adjusted FIM efficiency were the number of rehabilitation and nursing staff members, and the number of patients hospitalized for stroke.
Conclusion: Among the three hospitals in Kumamoto, the FIM efficiency was high in the hospital with a large number of rehabilitation and nursing staff members and a large number of patients hospitalized for stroke.

View full abstract

Inamoto Y, Kagaya H, Saitoh E, Kanamori D, Shibata S, Fujii N, Katada K, Palmer J B. Inter-rater and intra-subject reliability for the evaluation of swallowing kinematics using 320-row area detector computed tomography. Jpn J Compr Rehabil Sci 2012; 3: 59-65.
Objective: The purpose of this study was to examine the inter-rater reliability and intra-subject reproducibility of 320-row area detector computed tomography (320-ADCT) for the evaluation of swallowing kinematics.
Methods: Eleven healthy volunteers were each instructed to sit on a reclining chair set at a 45° angle, hold a 10-ml portion of honey-thick liquid in the mouth, and swallow it when cued by the examiner. Scanning was performed for 3.15 s using a 320-ADCT device. Images were reconstructed at an interval of 0.1s. Two raters measured the timing of each swallowing event, and inter-class correlation coefficient (ICC) analysis was performed to examine the inter-rater reliability. One week later, the same trial was repeated for each volunteer, and the ICC was obtained to analyze the intra-subject reproducibility.
Results: Average inter-rater ICC was 0.98, showing ‘almost perfect’ concordance. There were no differences among measured items and volunteers. Average intra-subject ICC was 0.75, indicating ‘moderate’ concordance of swallowing kinematics between two swallows.
Conclusion: Given the high inter-rater reliability and intra-subject reproducibility, 320-ADCT is a reliable tool for swallowing evaluation.

View full abstract

Itoh N, Kagaya H, Horio K, Hori K, Itoh N, Ota K, Kanada Y, Saitoh E. Relationship between movement asymmetry and sit-to-stand/stand-to-sit duration in patients with hemiplegia. Jpn J Compr Rehabil Sci 2012; 3: 66-71.
Objective: To elucidate the relationship between side-to-side asymmetry and sit-to-stand and stand-to-sit duration in patients with right or left hemiplegia by three-dimensional motion analysis of the two movements.
Methods: Forty-five patients with hemiplegia (right hemiplegia in 21, left hemiplegia in 24) and 20 normal healthy adults were studied. Using three-dimensional motion analysis, an asymmetry index (AI) was calculated from the trajectory of the left-right component at the midpoint between two acromion markers as a function of time. Normal range of the sit- to-stand and stand-to-sit duration was calculated as the mean ± SD obtained from normal subjects. Patients were divided into two groups according to duration: normal duration (within the mean ± 2SD of normal subjects) and abnormal duration (outside the mean ±2SD of normal subjects). Motor function of the affected lower extremity and other parameters were compared between the normal and abnormal duration groups.
Results: Sit-to-stand and stand-to-sit duration was significantly prolonged in both right hemiplegic and left hemiplegic patients compared with normal subjects. In left hemiplegic patients, AI was significantly higher in those with abnormal duration for both sit-to-stand and stand-to-sit movements. In left hemiplegic patients, the lower extremity motor function was significantly poorer in those with abnormal duration for sit-to-stand movement.
Conclusion: In patients with left hemiplegia, AI deviates toward the unaffected side, and impaired lower extremity motor function is associated with prolonged sit-to-stand duration.

View full abstract

Maeshima S, Osawa A, Nishio D, Hirano Y, Kigawa H. Approaches to hip fractures in convalescent rehabilitation wards - Consideration of length of stay, number of sessions, and discharge destination. Jpn J Compr Rehabil Sci 2012; 3: 72-77.
Purpose: Factors that influence activities of daily living (ADL) and the discharge destination of hip fracture patients hospitalized in convalescent rehabilitation wards were examined from the viewpoint of the amount of time spent in rehabilitation sessions and the duration of hospitalization.
Methods: The study subjects were 50 patients suffering from hip fracture. We evaluated the pre- injury condition, cognitive function, uninjured side leg extensor muscle strength, and activities of daily living (ADL) for each patient. The discharge destination was generally divided into a “home” group and a “facility/ hospital transfer” group, and a comparative examination was carried out regarding the relationship between the overall number of rehabilitation sessions conducted, including physiotherapy and occupational therapy, and the daily number of sessions.
Results: FIM efficiency declined greatly from 0.32 (n= 30) for the 4th through 6th weeks after hospitalization to 0.11 (n = 20) for the 6th to 8th weeks, and in a post hoc test, a significant difference (p = 0.0069) was observed in FIM efficiency between weeks 2-4 and weeks 6-8.
Conclusion: The results suggest that for hip fractureCorrespondence: Shinichiro Maeshima, MD, PhD Department of Rehabilitation Medicine, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan E-mail: aeshima@saitama-med.ac.jp Accepted: September 2, 2012 No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. patients, about 6 weeks after being admitted to a convalescent rehabilitation ward, post-discharge guidance including nursing care service and family coaching is necessary.

View full abstract

Itoh N, Kagaya H, Saitoh E, Ohtsuka K, Yamada J, Tanikawa H, Tanabe S, Itoh N, Aoki T, Kanada Y. Quantitative assessment of circumduction, hip hiking, and forefoot contact gait using Lissajous figures. Jpn J Compr Rehabil Sci 2012; 3: 78-84.
Objective: To quantitatively assess gait abnormalities using Lissajous figures obtained from three-dimensional motion analysis of treadmill gait, with the goal of applying the findings to the treatment of gait disorders.
Methods: Thirty-nine healthy subjects and 30 hemiplegic patients were studied. Treadmill gait analysis was conducted using a three-dimensional motion analysis system. Using the Lissajous figures obtained from the gait analysis, quantitative indexes were developed for three gait abnormalities: circumduction, hip hiking, and forefoot contact. The indexes were validated through comparison with observational assessment by physiotherapists with expertise in gait analysis.
Results: The values obtained for all the indexes were significantly higher in hemiplegic patients compared to healthy subjects (p < 0.001). Correlation analysis was conducted between the index values and observational scores for each gait abnormality, yielding Spearman’s rank correlation coefficients of -0.82 for circumduction, -0.64 for hip hiking, and -0.84 for forefoot contact (p < 0.001).
Conclusion: We successfully developed objective quantitative indexes for gait abnormalities, which were not influenced by rater bias.

View full abstract