Muraoka Y, Ishio A, Takeda K. Low-cost 2ch EMG biofeedback device using a stereo microphone port. Jpn J Compr Rehabil Sci 2014; 5: 1-6.
Objectives: EMG-BF therapy in rehabilitation clinics requires the installation of an expensive electromyographic biofeedback (EMG-BF) device. However, many medical institutions find it difficult to purchase the device because of the high cost, and so the availability of EMG-BF therapy is limited. This study aimed to develop a low-cost and simply designed EMG-BF device using a stereo microphone port. The device can be easily fabricated even by people without knowledge and skills related to electronics.
Methods: The proposed device comprises an EMG amplifier, personal computer (PC) with a microphone port, electrodes, and their cables. The device is designed to be as simple as possible and with minimum components so that medical staff can obtain the required components and easily fabricate the device themselves.
Results: The amplifier consists of approximately 20 easily obtained components, and costs approximately 1,600 yen in total. This device can display the voluntary EMG of the extensor carpi radialis and flexor carpi ulnaris muscles in normal adults on a PC screen, enabling the amount of muscle contraction to be identified.
Conclusion: This device may help increase the use of EMG-BF therapy, and thus improve the quality of rehabilitation in clinics and homes.

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Tokunaga M, Nakanishi R, Watanabe S, Maeshiro I, Hyakudome A, Sakamoto K, Okubo T, Nojiri S, Yamanaga H. Corrected FIM effectiveness as an index independent of FIM score on admission. Jpn J Compr Rehabil Sci 2014; 5: 7－11.
Objective: To correct Functional Independence Measure (FIM) effectiveness for low FIM scores to obtain an index independent of FIM score on admission.
Methods: A total of 1,101 stroke patients in Kaifukuki rehabilitation wards were studied. They were divided into 13 groups according to the motor FIM score on admission, in 6-point increments. The parameter “A” was derived so that motor FIM effectiveness, calculated as motor FIM gain/(A － motor FIM score on admission), was around 0.65.
Results: Motor FIM effectiveness was an index independent of motor FIM score on admission when A was 42, 64, 79, 83, 87, 89, or 91 points (when motor FIM on admission was 13－18 points, 19－24 points, 25－30 points, 31－36 points, 37－42 points, 43－48 points, or 49－90 points).
Conclusions: Corrected FIM effectiveness, which is independent of FIM on admission, may be useful for comparisons between hospitals admitting patients with varying degrees of severity.

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Imada Y, Tokunaga M, Fukunaga K, Sannomiya K, Inoue R, Hamasaki H, Noguchi D, Nakashima Y, Watanabe S, Nakanishi R, Yamanaga H. Relationship between cognitive FIM score and motor FIM gain in patients with stroke in a
Kaifukuki rehabilitation ward. Jpn J Compr Rehabil Sci 2014; 5: 12-18.
Objective: To clarify the relationship between cognitive Functional Independence Measure (FIM) and motor FIM gain.
Methods: We examined 1,137 patients with stroke in a Kaifukuki rehabilitation ward. Both motor and cognitive FIM scores at admission were divided into six separate groups (three groups per parameter), and we then compared these groups with motor FIM gain as the objective variable. We also performed a multiple regression analysis using motor FIM gain as the objective variable.
Results: In the groups where motor FIM scores at admission were 13–38 points and 39–64 points, motor FIM gain was significantly higher in individuals that had high cognitive FIM scores at admission. In the multiple regression analysis, we found that motor FIM gain increased by 0.889 points when cognitive FIM scores at admission increased by 1 point in patients whose motor FIM score at admission was between 13 and 34 points and whose cognitive FIM score at admission was between 5 and 14 points.
Conclusion: This study clarified the relationship between cognitive FIM scores at admission and motor FIM gain in individuals with stroke.

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Jeong S, Inoue Y, Kondo K, Matsumoto D, Shiraishi N. Formula for predicting FIM for stroke patients at discharge from an acute ward or convalescent rehabilitation ward. Jpn J Compr Rehabil Sci 2014; 5: 19-25.
Objective: To develop formulas for predicting Functional Independence Measure (FIM) at the time of discharge from an acute or convalescent hospital ward using multicenter data.
Methods: Data from 4,311 acute patients (22 hospitals) and 1,941 convalescent patients (24 hospitals) were divided into two groups (calculation group and verification group). Multiple regression analysis was performed to develop formulas for predicting discharge FIM and test their validity with data from the verification group.
Results: The formula derived for predicting discharge FIM for acute patients was 85.04 + (-0.53 × age) + (12.06 × subarachnoid hemorrhage) + (-7.90 × complication present) + (-0.70 × number of days from onset of stroke until admission) + (1.24 × admission GCS) + (-1.08 × admission NIHSS) + (-4.15 × modified Rankin Scale score before stroke) + (0.30 × admission motor FIM) + (1.03 × admission cognitive FIM), with R² = 0.78. The formula derived for predicting discharge FIM for convalescent patients was 33.04 + (-0.34 × age) + (-3.88 × complication present) + (-0.11 × number of days from onset of stroke until admission) + (2.44 × admission GCS) + (-1.68 × modified Rankin Scale score before stroke) + (0.53 × admission motor FIM) + (1.25 × admission cognitive FIM) (R² = 0.66).
Conclusion: Using a large multicenter database, we developed separate formulas for predicting FIM at discharge from an acute ward and from a convalescent ward with proven external validity.

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Tokunaga M, Sannomiya K, Ohashi T, Yonemura M, Sakata D, Imaya M, Sugitani E, Mitsunaga W, Shiiba S, Nakashima Y. Three different methods for demonstrating that gain in Functional Independence Measure increases with higher cognitive ability. Jpn J Compr Rehabil Sci 2014; 5: 26-32.
Objective: To use three different methods to elucidate the association between the degree of improvement in the motor items of the Functional Independence Measure (motor FIM gain) and cognitive ability.
Methods: The subjects were 1,101 cerebral stroke patients admitted to Kaifukuki rehabilitation wards. Three different methods were used to investigate the association between total score on FIM cognitive items on admission (cognitive FIM on admission) and motor FIM gain: (1) multiple regression analysis with motor FIM effectiveness as the target variable, (2) multiple regression analysis with motor FIM on admission restricted to narrow bands, and (3) adjustment using a standard severity distribution.
Results: In multiple regression analysis used in methods (1) and (2), cognitive FIM on admission was selected as an explanatory variable, with a positive coefficient of regression. In method (3), mean adjusted motor FIM gain for dementia patients was lower than mean motor FIM gain for non-dementia patients.
Conclusion: All three methods were capable of showing that FIM gain increases with higher cognitive function.

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Inamoto, Saitoh E, Shibata S, Kagaya H, Nakayama E, Ota K, Onogi K, Kawamura Y. Effectiveness and applicability of a specialized evaluation exercise-chair in posture adjustment for swallowing. Jpn J Compr Rehabil Sci 2014; 5: 33-39.
Aim: To evaluate the effectiveness of a newly-developed evaluation exercise-chair, Swallow Chair (SC), in terms of simplicity, applicability, and comfort for dysphagic patients, in comparison with a bed for adjusting posture.
Methods: The subjects were three dysphagic patients who underwent videofluoroscopy (VFSS) and the effectiveness of the combined posture of reclining with rotation of the trunk and head for safe swallowing was evaluated. The recommended posture was adjusted and video-recorded under two conditions— using the SC or using a bed—during swallowing training, and the posture was then analyzed and compared. The evaluation criteria included the following: items necessary for posture adjustment and their number (simplicity), time required for posture adjustment (ease of use), and level of fatigue and pain experienced by the patient (comfort).
Results: In all patients, SC required fewer items and less time for posture adjustment and caused lower subjective fatigue and pain compared with using the bed. The compensatory posture recommended in the evaluation was adjusted properly during swallowing training and meal consumption using the SC and all patients improved their posture along with food type and meal frequency.
Conclusions: The SC is a simple, easy-to-use, and comfortable device for posture adjustment during evaluation, training, and meal consumption.

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Tanino G, Sonoda S, Watanabe M, Okuyama Y, Sasaki S, Murai H, Tomida K, Suzuki A, Kawakami K, Miyasaka H, Orand A, Tomita Y. Changes in the gait ability of hemiplegic patients with stroke in the subacute phase―A pattern based on their gait ability and degree of lower extremity motor paralysis on admission―. Jpn J Compr Rehabil Sci 2014; 5: 40- 49.
Purpose: To examine changes in gait ability of stroke patients in the subacute phase based on their gait ability and severity of lower extremity motor paralysis.
Methods: The subjects were 1,698 hemiplegic patients with stroke. Patients were stratified by their gait ability on admission based on the Functional Independence Measure (FIM) (scores 1 to 7), and by their severity level of lower extremity motor paralysis based on the Stroke Impairment Assessment Set (complete, severe, moderate, and mild paralysis). Then the patients were classified into 28 groups using a combination of the seven FIM walk scores and the four severity levels of motor paralysis, and the relations with gait ability at discharge and various time points were analyzed.
Results: Patients in the complete paralysis group with an admission FIM walk score of 1 or 2 showed significantly lower FIM walk scores at discharge, compared to patients in the other groups. When patients had a FIM walk score of 3 or 4 on admission, the contribution of the severity of paralysis to the FIM walk score at discharge tended to be relatively small.
Conclusion: There were diverse courses of recovery of walking ability among stroke patients depending on their gait ability and severity of motor paralysis on admission.

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Minami K, Nagatomi F, Watanabe S, Tsubahara A. Effect of fingertip touch on postural sway during static standing in patients with femoral neck or trochanteric fracture. Jpn J Compr Rehabil Sci 2014; 5:50-55.
Objective: Patients with femoral neck or trochanteric fracture (hip fracture) are considered to be at high risk for falling. We investigated whether a light fingertip touch on a stable surface (LT) with a force insufficient to provide mechanical support of the body could stabilize static standing. We also investigated whether the effect differed between LT and heavy fingertip touch (HT) or between ipsilateral and contralateral fingertip touch (relative to the fracture).
Methods: Eleven patients with hip fracture who were hospitalized in a kaifukuki (convalescence) rehabilitation ward participated in the study. The sway of the center of pressure (COP) during static standing was measured and compared under five fingertip touch conditions.
Results: The COP path length was significantly shorter under every fingertip touch condition than for the condition without touch: LT with a finger contralateral to the fracture, 65.5 ± 38.4 cm; LT with a finger ipsilateral to the fracture, 64.5 ± 32.6 cm; HT with a finger contralateral to the fracture, 45.1 ± 23.4 cm; HT with a finger ipsilateral to the fracture, 46.1 ± 26.2 cm; and without touch, 88.4 ± 33.0 cm (F = 26.9, p < 0.01). It was also shorter for the HT conditions than for the LT conditions. However, there was no difference in the COP path length between fingertip touch with the upper extremity ipsilateral to the fracture versus that contralateral to the fracture.
Conclusions: We attribute the beneficial effect of LT on postural stability during static standing to somatosensory inputs through the fingertip. The additional benefit of HT relative to LT must have stemmed from the addition of mechanical support to this somatosensory feedback.

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Tokunaga M, Nakanishi R, Eguchi G, Kihara K, Tokisato K, Katsura K, Watanabe S, Yamanaga H. The influence of age on corrected motor FIM effectiveness. Jpn J Compr Rehabil Sci 2014; 5: 56-60.
Objective: This study aimed to clarify the influence of age on rehabilitation outcome by using corrected motor FIM (FIM-M) effectiveness, an outcome indicator in which the influence of FIM-M at admission was corrected.
Methods: The subjects were 1,101 stroke patients. The value of A in the equation, Corrected FIM-M effectiveness = FIM-M gain / (A-FIM-M at admission) was set as 42, 64, 79, 83, 87, 89, and 91 points (for FIM-M score at admission of 13-18, 19-24, 25-30, 31-36, 37-42, 43-48, and 49-90 points, respectively). The subjects were divided into 10 groups by age with a 5-year range in which the average of corrected FIM-M effectiveness was calculated.
Results: The mean corrected FIM-M effectiveness was almost constant in five groups below 69 years and decreased almost linearly as age increased in five groups over 70 years.
Conclusion: The outcome decreases almost linearly after the age of 70 years old.

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Arai N, Metani H, Abe R, Shimizu S, Seki S, Hiraoka T, Hanayama K, Tsubahara A. Utility of full-body thermotherapy for an elderly patient with multiple organ complications requiring lower-leg amputation. Jpn J Compr Rehabil Sci 2014; 5: 61-65. This report describes the case of an elderly amputee (lower leg) with obstructive arteriosclerosis, diabetes, angina (post CABG), and intractable ulcers on the non-amputated leg. The patient received full-body thermotherapy using heat packs and thermal sheeting and was subsequently able to walk. Despite drug therapy to improve peripheral circulation in addition to meticulous foot care, ulcers on the foot of the non-amputated side worsened. After full-body thermotherapy, however, skin perfusion pressure improved, and the ulcers gradually healed. The patient was discharged home, at which time the combined use of Lofstrand crutches, a prosthesis, and a footplate for pressure relief enabled outdoor walking for short distances. Patients with skin lesions who undergo amputation as a consequence of peripheral circulation disorders often have difficulty walking with a prosthetic limb. Moreover, the full-body thermotherapy provided similar effectiveness to the Waon dry sauna therapy, which is available only at a limited number of institutions. This thermotherapy is a promising supplemental therapy for elderly amputees with circulatory disorders, and could easily be provided by many institutions.

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Sannomiya K, Tokunaga M, Nakanishi R, Watanabe S, Terasaki T, Kawano S, Yamakuma K, Kanazawa C, Hirata Y, Yamaga M, Hashimoto Y. A comparison of the corrected Functional Independence Measure (FIM) effectiveness at Kaifukuki rehabilitation hospitals participating in the Kumamoto Stroke Liaison Critical Pathway. Jpn J Compr Rehabil Sci 2014; 5: 66-71.
Objective: To compare the mean corrected FIM effectiveness (which is insusceptible to FIM score on admission) at six Kaifukuki rehabilitation hospitals.
Methods: A total of 2,192 stroke patients were studied. Using data from all the Kaifukuki rehabilitation hospitals, the value of “A” was found where the corrected FIM effectiveness [FIM gain/(A - FIM score on admission)] is approximately 0.63. Then a Kruskal-Wallis test was conducted to determine whether there was a significant difference between the mean corrected FIM effectiveness of the six hospitals.
Results: The mean corrected FIM effectiveness ranged from 0.567 (Hospital D) to 0.841 (Hospital C) showing a significant difference between the six hospitals (p<0.001).
Conclusion: Using the corrected FIM effectiveness enabled a comparison of FIM improvement at the six Kaifukuki rehabilitation hospitals which had differing levels of severity distribution.

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Nakagawa K, Matsuo K, Shibata S, Inamoto Y, Ito Y, Abe K, Ishibashi N, Fujii W, Saitoh E. Efficacy of a novel training food based on the process model of feeding for mastication and swallowing ― a preliminary study in elderly individuals living at a residential facility ―. Jpn J Compr Rehabil Sci 2014; 5: 72-78.
Purpose: We examined the validity and safety of a newly developed chew-swallow managing food (CSM) as a training material for chewing and swallowing.
Methods: Twenty-three elderly individuals (mean age: 82.8 ± 8.6 years) who followed a regular diet at a residential facility were enrolled in this study. The subjects ate 4 g each of CSM and puree 3 times while bolus transport and swallowing were recorded with a fiberoptic endoscope. For each trial, the number of chewing and swallowing movements was counted. We also identified the location of the leading edge of the food at swallow initiation, the amount of food residue in the oral cavity and pharynx, and the incidence of aspiration. The differences in measurements between CSM and puree trials were then compared statistically.
Results: With the CSM, the number of chewing and swallowing movements was significantly higher than that with puree and the leading edge of the food was deeper in the pharynx at swallow initiation. There were no significant differences in food residue or aspiration between the 2 foods.
Conclusion: Our findings suggest that CSM has an initial consistency that requires chewing but changes to a texture equivalent to puree at the time of swallowing. We are currently planning to verify the safety and efficacy of CSM in individuals with dysphagia.

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Tokunaga M, Watanabe S, Nakanishi R, Yamanaga H, Yonemitsu K, Tanaka M, Nakazono K, Kurotsuchi T, Kanaba S, Kawano S. Relationships between training dose and Functional Independence Measure improvement in elderly stroke patients 75 years and older. Jpn J Compr Rehabil Sci 2014; 5: 79-86.
Objective: To determine the relationships between training dose and functional independence measure (FIM) improvement in elderly stroke patients aged 75 years and older.
Methods: The subjects were 245 stroke patients hospitalized in a kaifukuki rehabilitation ward. Each subject's score can be calculated as follows: the value of A in the equation, Corrected motor FIM effectiveness = motor FIM gain / (A – motor FIM score at admission) was set as 38, 59, 80, 87, 91 (for motor FIM score at admission of 13-18, 19-24, 25-30, 31-36, 37-90 points, respectively). The subjects were divided into two groups according to the training dose: those with less than 5 sessions, and those with 5 or more sessions, and corrected motor FIM effectiveness was compared between these two groups.
Results: In patients aged 75-84 years and 85-96 years, corrected motor FIM effectiveness was significantly higher in the group attending 5 or more sessions than in the group attending less than 5 sessions.
Conclusion: Our study indicates that not only in elderly patients aged 75-84 years but also in those 85-96 years FIM improvement (corrected motor FIM effectiveness) was significantly higher in the subjects with a larger amount of training dose.

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Onogi K, Saitoh E, Kondo I, Ozeki M, Kagaya H. Immediate effectiveness of balloon dilatation therapy for patients with dysphagia due to cricopharyngeal dysfunction. Jpn J Compr Rehabil Sci 2014; 5: 87-92.
Purpose: To determine the immediate effectiveness of balloon dilatation therapy for patients with dysphagia due to cricopharyngeal dysfunction on videofluoroscopy (VFSS).
Methods: The subjects were 11 consecutively recruited patients with central nervous system disease who were suspected of having upper esophageal sphincter (UES) insufficiency based on the presence of a large amount of residue in the pharynx on VFSS. The amount of residue and the occipitofrontal diameter of the UES were measured before and after dilatation.
Results: The mean amount of pharyngeal residue was significantly smaller after than before dilatation. However, no significant difference was seen in the occipitofrontal diameter of the upper esophagus after dilatation. When the subjects’ brain lesions were divided into brainstem and supratentorial lesions, the pharyngeal residue was significantly lower in patients with supratentorial lesions than in those with brainstem lesions.
Conclusion: Balloon dilatation therapy immediately decreases the amount of pharyngeal residue in patients with dysphagia due to cricopharyngeal dysfunction.

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Sonoda S, Shirayama Y, Tanabe S, Shimomura K, Suzuki S. Validity of the progress notebook in supporting patients with higher cortical dysfunction. Jpn J Compr Rehabil Sci 2014; 5: 93-96.
Purpose: To validate the usefulness of a progress notebook (p-notebook) in supporting patients with higher cortical dysfunction by analyzing the difference in interview time in a new hospital or facility with and without the p-notebook. The p-notebook was created to assist those with higher cortical dysfunction, which is not well understood by non-experts.
Methods: Interview times with and without the p-notebook (notebook group: n=34, non-notebook group: n=32) were compared when patients with higher cortical dysfunction went to a new hospital or facility. Impressions of the families and support coordinators of patients in the notebook group were evaluated using visual analogue scales.
Results: The average interview time was 32.4 ± 10.7 minutes in the notebook group and 57.2 ± 28.9 minutes in the non-notebook group, and this difference was significant (p<0.0001). Regarding the impressions of family and support coordinators, the length of explanation was shorter and understandability was improved when using the p-notebook. These tendencies were dominant in families compared with support coordinators.
Conclusion: Our p-notebook is useful since it decreases the interview time and lowers the burden of giving explanations.

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Shimizu S, Metani H, Hiraoka T, Seki S, Hanayama K, Tsubahara A. Electrode position and hyoid movement in surface electrical stimulation of the suprahyoid muscle group. Jpn J Compr Rehabil Sci 2014; 5: 97- 101.
Objective: To determine the relationship between electrode position and hyoid movement for effective surface electrical stimulation in the treatment of dysphagia.
Methods: Surface electrode pairs targeted on the suprahyoid muscle group were placed in mesial, distal, or pervasive placement patterns on the skin anterior to the suprahyoid muscle group of five healthy subjects, and the vertical and horizontal movements of the hyoid induced by electrical stimulation in the three pattern groups were measured and compared.
Results: The mesial electrode-pair pattern induced significant anterior movement of the hyoid. The distal pattern showed a tendency to induce upward hyoid movement. The distance of hyoid movement induced by the electrical stimulation was about half of that found for actual water swallowing. No significant difference in electrical stimulus intensity was found among the electrode patterns.
Conclusion: Surface electrical stimulation with mesial electrode-pair placement anterior to the hyoid presumably induces contraction of the digastric muscle anterior belly and the geniohyoid muscle, and was found to pull the hyoid forward. This information and further elucidation of the relationship between surface electrode position and hyoid movement is expected to increase the range of clinical applications.

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Mori S, Osawa A, Maeshima S, Ozaki K, Sakurai T, Kondo I, Saito E. Clinical examination of reliability/validity of scoring methods for Cube-Copying Test (CCT). Jpn J Compr Rehabil Sci 2014; 5: 102-108.
Objective: Various scoring methods for the Cube-Copying Test (CCT) have been assessed for their validity, but few have been examined for reliability. Additionally, a comparison of multiple scoring methods applied to an identical group of patients has not been reported to date. The present study examined both the reliability and validity of multiple scoring methods and their role in the evaluation of spatial cognitive function.
Method: Thirty-three patients who visited the Medical Center for Dementia at our hospital were included in the study. The Cube-Copying Test was independently scored by two raters using two different scoring methods.
Results: Both scoring methods showed significant inter- and intra-rater reliability. The assessment of criterion-related validity showed a significant correlation with Raven’s Colored Progressive Matrices and Frontal Assessment Battery, demonstrating that the CCT reflects visual cognitive functioning and executive functioning. The CCT also showed a significant correlation with education years, suggesting that the CCT scores are more affected by years of education than by age or duration of illness.

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Ozaki K, Kagaya H, Kondo I, Saitoh E, Imai S, Sonoda S, Itoh N. Reliability and minimal detectable change of Quantified Paralysis Performance Assessment (QPPA) using a three-dimensional motion analysis device. Jpn J Compr Rehabil Sci 2014; 5: 109-116.
Purpose: We developed a quantitative evaluation method for motor impairment in hemiplegia using a three-dimensional motion analysis device, the Quantified Paralysis Performance Assessment (QPPA). As a pre-clinical study, we verified the reproducibility and minimal detectable change of the method.
Methods: Sixty-six patients who had the first stroke [39 males, 27 females; aged 60 ± 12 years (mean ± standard deviation)] were studied. QPPA measurement was conducted two times to obtain one set of data. The following measurements were performed; upper limb function (arm; QPPA-UE) and lower limb functions (hip joint; QPPA-Hip, knee joint; QPPA-Knee, and ankle joint; QPPA-Ankle). The lifted distance and maximum velocity for each marker were used as the typical values. From the typical values obtained from one set, the intraclass correlation coefficient (ICC) and 95% confidence intervals of minimal detectable change (MDC₉₅ ) were calculated
Results: In the case that two sets of data were obtained from the same acute stage patient at an interval of over two weeks, the two sets were analyzed individually. With a total of 91 sets of measurements, the ICCs of the QPPA indices ranged from 0.956-0.989, and MDC ₉₅ ranged from 4.56-6.79%.
Conclusion: The typical values of QPPA showed high reproducibility. In addition, the minimal detectable change was small, suggesting that this method captures clinical changes with higher sensitivity than evaluation methods using ordinal scales.

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Miyasaka H, Ohnishi H, Hieda C, Kawakami K, Tanino G, Okuyama Y, Tomita Y, Sonoda S. A study of the training method of sub-acute stroke patients of the upper extremity: decision tree analysis. Jpn J Compr Rehabil Sci 2014; 5: 117-124.
Objective: We examined how differences in training method affected the improvement of paralysis.
Methods: One hundred and thirty-one patients with stroke were admitted to Nanakuri Sanatorium, Fujita Health University. We divided the patients randomly into five groups, mirror therapy (MT), integrated volitional control electrical stimulation (IVES), therapeutic electrical stimulation (TES), repetitive facilitative exercises (RFEs), and conventional training (control group). Each group performed an assigned exercise for 20 minutes. Decision tree analysis was performed to identify the effectiveness of rehabilitation training for improving motor function. The predicted variables were the FMA upper extremity items at 4 weeks. The explanatory variables were age, days after stroke onset, treatment technique, and evaluation test results.
Results: When patients had scores of FMA-finger < 3 and FMA-shoulder < 3, MT, TES, and RFEs were chosen as favorable determinants. If FMA-finger ≥ 8 and FMA-wrist < 8, MT, IVES, TES, and RFEs were chosen as favorable determinants.
Conclusion: Decision tree analysis appears to be a valid mean for deciding the best rehabilitation method for sub-acute stroke patients.

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Koeda S, Sumigawa K, Koike Y, Sato C, Imai H, Osanai E, Shimizu T, Muto Y, Harigae A, Mizunashi A, Osanai T. Relationship between sleep disorder and subjective feelings of recovery in convalescent stroke patients. Jpn J Compr Rehabil Sci 2014; 5: 125-130.
Objective: Sleep disorder occurs at a high frequency in stroke patients and can disrupt the progress of rehabilitation. Here, we investigated stroke patients’ recognition of their improvement (i.e. their subjective feelings of recovery). We also explored ways of preventing and treating sleep disorder in these stroke patients by determining the relationship between subjective feelings of recovery and sleep disorder.
Methods: The study subjects were 42 patients who had been hospitalized in a kaifukuki (convalescent) rehabilitation ward for stroke. Subjects were scored on a Visual Analog Scale (VAS) for subjective feelings of recovery and on the Pittsburgh Sleep Quality Index (PSQI) as an indicator of sleep disorder.
Results:A significant negative correlation was found in the relationship between subjective feelings of recovery and PSQI score. PSQI scores in the group with Low subjective feelings of recovery (VAS < 35%) were significantly higher than those in the group with High subjective feelings of recovery (VAS≥ 35%). Sleep disorder in the former group was severe. Subjective feelings of recovery were significantly positively correlated with the stage of recovery from motor paralysis and with Activities of Daily Living (ADL) ability. However, the PSQI score was not correlated with either of these latter two measures.
Conclusions: We speculated that a decrease in subjective feelings of recovery caused by motor paralysis and a decline in ADL abilities in patients with VAS scores lower than 35% led to impairment of the sleep state. These results suggest that evaluation of subjective feelings of recovery is an effective predictor of sleep disorder in stroke patients.

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Tokunaga M, Nakanishi R, Kiyota K, Kubota K, Takahashi T, Shigemoto H, Takahashi S, Nakane N, Yonemitsu H. Relationship between motor FIM improvement (corrected motor FIM effectiveness) and age in proximal femoral fractures. Jpn J Compr Rehabil Sci 2014; 5: 131-135.
Objective: The objective of the present study was to determine the differences in FIM improvement (corrected FIM-M effectiveness) in proximal femoral fracture patients due to age.
Methods: The subjects were 886 proximal femoral fracture patients. For the formula, Corrected FIM-M effectiveness = FIM-M gain / (A − FIM-M at admission), we determined values of A that would yield a mean FIM-M effectiveness of roughly 0.65. We divided the subjects into seven groups each covering an age range of five-year increments, and we determined the mean corrected FIM-M effectiveness for each group.
Results: For FIM-M of 13-18, 19-24, 25-30, and 31- 90 points at admission, the value of A was 47, 70, 85, and 91 points, respectively. Corrected FIM-M effectiveness declined with advancing age, especially above 80 years old.
Conclusion: Mean FIM improvement in proximal femoral fracture patients begins to decline at age 80, while it was reported to be at age 70 in stroke patients.

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Tokunaga M, Watanabe S, Nakanishi R, Yamanaga H, Yonemitsu H, Mita S, Terasaki T, Hirata Y, Yamaga M, Hashimoto Y. The influence of stroke type, gender, and age on FIM improvement. Jpn J Compr Rehabil Sci 2014; 5: 136-140.
Objective: The aim of this study was to elucidate the influence of stroke type, gender, and age on a corrected Functional Independence Measure (FIM) effectiveness score, an FIM improvement indicator corrected for FIM at the time of admission.
Methods: The subjects comprised 3,034 stroke patients enrolled in a stroke liaison clinical pathway. The subjects were divided into four groups based on stroke type (infarction or hemorrhage) and sex (male or female), and were stratified into nine different five-year age groups. We then investigated the mean corrected FIM effectiveness score.
Results: Mean corrected FIM effectiveness decreased in all four groups among subjects aged 70 years or older. Among subjects aged 69 or younger, cerebral hemorrhage was significantly greater than cerebral infarction, but no clear statistical difference was seen for gender.
Conclusion: During an investigation of FIM improvement in stroke patients, there is no great need to divide subjects by gender, but the patients should be stratified by stroke type and age.

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Igari M, Tomita Y, Miyasaka H, Orand A, Tanino G, Inoue K, Sonoda S. Development of a method for measuring joint torque using an isokinetic machine. Jpn J Compr Rehabil Sci 2014; 5: 141-146.
Objective: To develop a method to measure knee joint resistance torque during passive motion by using isokinetic equipment (e.g., the Biodex, Cybex, and Kin-Com).
Method: We used the Biodex System 3 isokinetic equipment in the present study. To determine the resistance torque in human knee joints, we first established a method to correct for the torque due to gravity and inertia, based on the angle, angular velocity, and torque output from this equipment. Thereafter, to estimate the active torque due to muscle contraction, we measured the electromyograph (EMG) signals and fitted a potentiometer on the driving arm of the Biodex to synchronize the EMG signals with the Biodex output.
Results: At the angle θ₀, and denoting the torque that occurs in the lower leg due to gravity as T₀, the torque due to gravity (T_g) at angle θ is given by T_g=T₀ cosθ/ cosθ₀. Denoting the moment of inertia of the lower leg as I and the angular acceleration as α, the torque caused by inertia (T_I) is given by T_I=Iα. Letting the value of the torque that is output by the Biodex be T_total, the resistance torque caused by the subject (T) is given by T=T_total-T_g-T_I. The changes in T that occur simulta-neously with the EMG signals indicate the active torque that is caused by muscle contraction.
Conclusion: We measured the resistance torque that occurred during passive joint motion by correcting for the angle, gravity, and inertia, based on the angle and torque that were output by the Biodex. The joint torque, angle, and EMG signals were measured simultaneously by monitoring the output of a potentiometer mounted on the arm of the Biodex.

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Tomita Y, Tanino G, Mizuno S, Maeda H, Miyasaka H, Orand A, Takeda K, Sonoda S. Development of stiffness measurement system and biomechanical model of ankle joint to estimate viscoelastic and muscle contraction. Jpn J Compr Rehabil Sci 2014; 5: 147-155.
Objective: This research aimed to develop a system to measure the stiffness of the ankle joint for evaluating spasticity or contracture, and for quantifying the characteristics of spasticity. Functionality of the system was verified by testing it on an able-bodied individual and a hemiplegic patient. Additionally, a biomechanical model was developed to estimate the plantar flexion torque caused by viscoelasticity and muscle contraction.
Methods: An electromotor, rack and pinion, potentiometer, and torque sensor were installed on a double Klenzak ankle-foot orthosis (AFO). By rotating the electromotor, the ankle joint of the AFO moves dorsally at a fixed speed. The angle and torque of dorsiflexion were measured simultaneously. The subjects sat either in a chair or a wheelchair and wore the abovementioned AFO in the knee-extension and knee-flexion positions, while the AFO moved dorsally. Electromyograms of the tibialis anterior and gastrocnemius muscles were recorded concurrently. The contributions of elastic, viscous, and muscle-contraction components to the plantar flexion torque were calculated using the system identification approach.
Results: The system’s ability to measure dynamic characteristics, and also its accuracy, were confirmed. The plantar flexion torque was found to be larger in the knee-extension position than in the knee-flexion position in both the able-bodied person and the patient. Moreover, the patient showed larger plantar flexion torque than the able-bodied subject.
Conclusions: A system that measures ankle-joint stiffness for evaluating spasticity was developed, and sufficient functionality was verified by applying it to both an able-bodied individual and a hemiplegic patient. In addition, plantar flexion torque caused by viscoelasticity and muscle contraction was estimated.

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