Sugawara H, Ishikawa M, Takayama M, Okamoto T, Sonoda S, Miyai I, Fujitani J, Tsubahara A. Effect of tube feeding method on establishment of oral intake in stroke patients with dysphagia: comparison of intermittent tube feeding and nasogastric tube feeding. Jpn J Compr Rehabil Sci 2015; 6: 1-5.
Purpose: To compare the effects of two tube feeding management methods; nasogastric tube feeding and intermittent tube feeding, implemented during the process of rehabilitation for dysphagia due to cerebrovascular disorders on the outcome of oral intake.
Methods: Dysphagic patients who were admitted to convalescent rehabilitation wards because of cerebrovascular disorders were divided into two groups: 398 patients who underwent nasogastric tube feeding (NG group) and 114 patients who underwent intermittent tube feeding (ITF group). The two groups were compared with respect to outcome of dysphagia rehabilitation.
Results: The proportion of patients who were able to meet nutrition needs by oral intake of three meals alone at discharge was significantly higher in the ITF group than in the NG group (71% versus 53%, p = 0.0007). The proportion of patients showing improvement in food intake level scale (FILS) during hospitalization was also significantly higher in the ITF group (p = 0.007). The mean duration from admission to start of direct training was significantly shorter in the ITF group than in the NG group (9.6 ± 13.9 days versus 19.1 ± 25.8 days, p = 0.001). The mean duration from admission to start of oral food intake was also significantly shorter in the ITF group than in the NG group (20.1 ± 26.4 days versus 27.3 ± 31.8 days, p = 0.049).
Conclusion: The results in this study suggest that tube feeding management using ITF achieves better outcome of dysphagia rehabilitation compared to using NG.

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Tokunaga M, Sannomiya K, Nakashima Y, Nojiri S, Tokisato K, Katsura K, Watanabe S, Nakanishi R, Yamanaga H. Formula for Predicting FIM Gain and Discharge FIM —Methods using Median Values of FIM Gain Stratified by Admission FIM, Age, Cognitive Function, and Transfer Interval—. Jpn J Compr Rehabil Sci 2015; 6: 6-13.
Objective: To predict FIM gain and discharge FIM score by multiplying the standard value by influence coefficients for age, cognitive function, and transfer interval.
Methods: The subjects were 1,118 stroke patients admitted to a Kaifukuki rehabilitation ward of hospital A. The median value of motor FIM (mFIM) gain and discharge mFIM based on mFIM at the time of admission was used as the standard value. We then created a formula for predicting mFIM gain and discharge mFIM by multiplying the standard value by the influence coefficients for age, cognitive function, and transfer interval.
Results: The correlation coefficient between the actual and predicted values was 0.681 in the prediction of mFIM gain and 0.874 in the prediction of discharge mFIM. The residual of the subtraction of the predicted value from the actual value was 1.4±12.5 (median value: 0) in the prediction of mFIM gain, and 1.3±12.6 (median value: 0) in the prediction of discharge mFIM.
Conclusion: The correlation coefficient is comparable with those of reports that use multiple regression analysis. This new method clearly showed the relationship between factors and mFIM gain/discharge mFIM.

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Tokunaga M, Sannomiya K, Nakanishi R, Yonemitsu H. The external validity of multiple regression analyses predicting discharge FIM score in patients with stroke hospitalized in Kaifukuki rehabilitation wards—An analysis of the Japan Rehabilitation Database—. Jpn J Compr Rehabil Sci 2015; 6: 14-20.
Objective: To compare the prediction accuracy of multiple regression analyses for predicting the discharge FIM score in stroke patients reported to date in Japan.
Methods: The subjects were 1,229 stroke cases in Kaifukuki rehabilitation wards registered in the Japan Rehabilitation Database (2014). The subject patient data was inputted into the six types of prediction formulas described in four reports, and prediction values were obtained. The residuals between the measured values and predicted values were then analyzed.
Results: The residuals were the smallest in the prediction equation of Jeong et al. (mean 0.44 ± 15.60; median - 0.16), Sonoda et al. (mean 0.26 ± 13.49; median 1.22), and Iwai et al. (mean - 0.92 ± 15.85; median - 2.09). Further, the residuals of the prediction equation of Sonoda et al. which uses the reciprocal of motor FIM at admission as the explanatory variable, and those of the two equations of Inouye, were larger compared to the three prediction equations above.
Conclusion: It is necessary to assess the external validity of the reported multiple regression analyses, and to compare them against other prediction equations.

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Hirano S, Saitoh E, Tanabe S, Katoh M, Shimizu Y, Yatsuya K, Tanaka H, Kagaya H, Ishihara K, Uno A. Comparison between gait-assisting robot (WPAL) and bilateral knee-ankle-foot orthoses with a medial single hip joint in gait reconstruction for patients with paraplegia. Jpn J Compr Rehabil Sci 2015; 6: 21-26.
Objective: To evaluate the utility of a gait-assisting robot, Wearable Power-Assist Locomotor (WPAL), in gait reconstruction for patients with paraplegia.
Subjects and Methods: The subjects were 12 patients with paraplegia who were able to walk with minimum assistance, under supervision, or without any assistance and supervision using a bilateral knee-ankle-foot orthoses with a medial single hip joint or WPAL. The duration and distance of walking were measured and the required level of assistance was evaluated with the Functional Ambulation Category (FAC) scale as the subjects walked at a comfortable speed with the orthoses or WPAL.
Results: The duration and distance of walking with the WPAL were significantly longer in 8 and 11 subjects, respectively, compared with use of the orthoses. FAC scores were 2, 3 or 4 with orthoses and 4 using the WPAL, indicating less assistance was needed with the WPAL.
Conclusion: The WPAL enabled patients with paraplegia to walk for a longer time and longer distance with less assistance.

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Miyasaka H, Tomita Y, Orand A, Tanino G, Takeda K, Okamoto S, Sonoda S. Robot-aided training for upper limbs of sub-acute stroke patients. Jpn J Compr Rehabil Sci 2015; 6: 27-32.
Purpose: To evaluate the effects of short-term robot-assisted training on upper extremity paralysis after a stroke.
Methods: The subjects consisted of 21 patients 6-12 weeks after their first stroke. Two weeks of robot-assisted training and 2 weeks of conventional training were performed using a crossover method. During the robot-assisted training period, robot-assisted training (1 hour/day, 5 days/week) was added to conventional training. At the initiation of training and after 2 and 4 weeks, motor function was evaluated in terms of the upper extremity items of the Stroke Impairment Assessment Set and Fugl-Meyer Assessment (FMA), active angles of shoulder flexion and abduction, and items of the Motor Activity Log (MAL). Values before and after each type of training and gains were compared between robot-assisted and conventional training using the Wilcoxon signed-rank test.
Results: Compared with the conventional training after 2 weeks, significant improvements could be seen for the scores of the FMA of shoulder and elbow, the Amount of Use of MAL, and Quality of Movement of MAL items of robot-assisted training.
Conclusion: After intensive robot-assisted training of the paralyzed extremity even for a short period, improvement was observed in the proximal function and frequency of use of the affected extremity in daily life.

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Ohtsuka K, Saitoh E, Kagaya H, Itoh N, Tanabe S, Matsuda F, Tanikawa H, Yamada J, Aoki T, Kanada Y. Application of Lissajous overview picture in treadmill gait analysis. Jpn J Compr Rehabil Sci 2015; 6: 33-42.
Objective: To examine the usefulness of the Lissajous overview picture (LOP) that uses Lissajous figures generated from trajectories of markers in three-dimensional treadmill gait analysis.
Methods: Nineteen healthy subjects, two hemiplegic patients, and one patient with coxarthrosis were studied. Three-dimensional treadmill gait analysis was conducted and the LOP was constructed for each healthy subject and patient. Furthermore, three trained physical therapists evaluated the gait of the three patients by visual inspection of video images. The normal grand average LOP, which was obtained by averaging the LOP of all healthy subjects, was compared with the LOP of the three patients.
Results: The LOP of the patients revealed the same findings as obtained from visual evaluation of video images: circumduction in the swing phase, decreased toe clearance, hiking, and medial whip in the hemiplegic patients; as well as bilateral Duchenne gait and excessive knee flexion in the patient with coxarthrosis. In addition to the above results, the LOP of the patients showed several findings which could not be observed by visual inspection of video images only.
Conclusion: The LOP allows easy understanding of not only the movement pattern of each limb segment, but also the complete picture of gait, including the posture and symmetry, from the positional relations between the limb segments.

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Metani H, Tsubahara A, Hiraoka T, Seki S, Hasegawa T. Risk factors for patients who develop pneumonia either before or after hip fracture surgery. Jpn J Compr Rehabil Sci 2015; 6: 43-49.
Objective: The objectives of this study were to examine the risk factors for patients who develop pneumonia either before or after hip fracture surgery and to investigate the utility of dysphagia rehabilitation and oral care.
Methods: The medical histories of 145 patients who were hospitalized for a new hip fracture and underwent surgical treatment were retrospectively investigated, and the rate of and risk factors for pneumonia were evaluated.
Results: The rate of pneumonia with hip fracture was 14.5%. Psychiatric disorders, history of stroke, time between admission and surgery, blood hemoglobin concentration, serum total protein level, and serum albumin level were risk factors associated with pneumonia. In particular, the serum albumin level and psychiatric disorders were independent risk factors.
Conclusion: The majority of pneumonias that develop either after admission or after hip fracture surgery are considered to be aspiration pneumonias, and their frequency was greater than expected. Since patients with malnutrition or psychiatric disorders are more susceptible to pneumonia, ascertaining the patient's activities of daily living prior to injury and conducting thorough oral care are considered essential for preventing aspiration pneumonia.

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Toda F, Kagaya H, Baba M, Shibata S, Ozeki Y, Kanamori D, Tanaka T, Miki T, Ishigame K, Nishimura K, Onogi K, Saitoh E. Effect of swallowing rounds on the outcome of dysphagic patients. Jpn J Compr Rehabil Sci 2015; 6: 50-55.
Objective: To retrospectively investigate the effect of ward rounds to check swallowing function (hereafter, swallowing rounds) on the outcome of dysphagic patients.
Methods: Upon requests from ward nurses or clinical departments in our hospital, a full-time certified nurse specialist in dysphagia examines the general condition of patients and performs screening for dysphagia. For patients who require detailed investigations, a transdisciplinary dysphagia care team conducts ward rounds and evaluates these patients in principle by videoendoscopic evaluation of swallowing. We reviewed the records of patients in whom swallowing rounds were conducted between September 2006 and March 2010, and analyzed the food texture and eating status scale (ESS) scores at the first intervention, after the first intervention and at the last observation; dysphagia severity scale (DSS) scores at the first intervention and at the last observation; and onset of pneumonia during intervention.
Results: Among 1,330 patients suspected of dysphagia, 998 were judged to require detailed investigations and swallowing rounds were conducted. As a result of intervention, significant improvements in food texture, ESS score, and DSS score were observed. The incidence of pneumonia was 3.7%.
Discussion: Improvements in food texture, ESS score, and DSS score were achieved by conducting swallowing rounds.

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Suzuki K, Hiraoka T, Tsubahara A, Ito T, Izumi S, Yashima K, Iwachidou N. Considerations for safety of high frequency repetitive peripheral magnetic stimulation of skeletal muscles in rats: Assessment by histological analysis of muscles and biochemical blood tests. Jpn J Compr Rehabil Sci 2015; 6: 56-63.
Objective: The purpose of the present study was to investigate the safety of high-frequency repetitive peripheral magnetic stimulation (rpMS) of skeletal muscles using histological analyses of muscles and biochemical blood tests.
Methods: Twenty male Wistar rats were divided into the rpMS group that received rpMS and the control group (CON group) that did not receive rpMS. Hematoxylin and eosin, modified Gomori trichrome, NADH-tetrazolium reductase, acid phosphatase, and Periodic acid-Schiff (PAS) stains were used for histological analyses of the muscles. Creatine kinase, aldolase, and lactate dehydrogenase (LDH) were measured for the biochemical blood tests. Additionally, the histological analyses of the muscles were performed in two rats at 4 and 12 hours after completion of rpMS application.
Results: PAS stain showed glycogen depletion in the muscle fibers of the rpMS group. However, this finding was not observed in the rats at 4 hours after rpMS application. There was a significantly larger LDH decrease in the rpMS group compared with the CON group. No significant differences were observed for any of the other staining methods or serum enzymes between the two groups. There were no other abnormal findings in the rpMS group.
Conclusion: It was established that rpMS could be utilized safely on skeletal muscles since it did not cause muscle damage in this study.

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Beppu H, Takayanagi N, Tomita Y, Mizutani K, Orand A, Tamai I, Takahashi H, Sonoda S. Improvement of gait and coordinated movement by forced gait training in cerebellar ataxic B6-wob/t mice. Jpn J Compr Rehabil Sci 2015; 6: 64-70.
Objective: The effect of forced gait training was investigated in cerebellar ataxic mice (B6-wob/t) using gait analysis and a rota-rod test.
Methods: B6 and B6-wob/t mice were divided into non-exercise (NEx) and exercise (Ex) groups. The Ex group received forced gait training with a running wheel at 2 m/min for 50 minutes, three times a day, six days a week, for 12 weeks. The rota-rod test was performed every 4 weeks during this period, and gait was evaluated using our pelvic axis-based gait analysis method (pelvic axis method) when a significant difference was noted between the NEx and Ex groups. The multiple comparison test was used for statistical analysis.
Results: After gait training for 12 weeks, the time until falling in the rota-rod test was significantly extended to 115 seconds in the Ex group compared to that (90 seconds) in the NEx group, and the hindlimb step width measured using the pelvic axis method was significantly narrower in the EX than NEx group.
Conclusion: Forced gait training may be effective for ataxic symptoms of B6-wob/t. The combination of the pelvic axis-based gait analysis and rota-rod test was useful to evaluate the improvement of ataxia.

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Tsuchiya K, Kanayama Y, Ono K, Kobara K, Koga T. Changes in subjective Quality of Life after making a Daruma doll and recreation in elderly patients with dementia. Jpn J Compr Rehabil Sci 2015; 6: 71-77.
Objective: As a part of a day-care rehabilitation program, we conducted table work and recreational activities with elderly patients with dementia once a week for 12 weeks. We examined the influence of the differences in the contents and process of the activities on the subjective QOL of the patients.
Methods: We used a modified version of the Affect Rating Scale (ARS) to measure the changes in subjective QOL, before and after performing the task. Subsequently, we compared the rates of each change.
Results: The contents of table work were different in each session. The rate of change in ARS scores was significantly high after the 3rd session of table work using red washi, which was made with traditional methods of Japan, compared with those after the 5th and 6th sessions. The recreational activity was the same throughout the study. The 1st and 2nd trials showed a slight difference, which was lower than that observed in the 3rd to 6th session.
Conclusion: Each activity related to table work may have influenced the rate of change. However, the rate of change in the recreational activity remained the same after it peaked. Thus, the characteristics of each activity influenced the subjective QOL of the elderly patients.

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Tokunaga M, Taniguchi M, Nakakado K, Mihono T, Okido A, Ushijima T, Eguchi G, Watanabe S, Nakanishi R, Yamanaga H. Assessment of the effects of factors in stroke rehabilitation using eight multiple regression analyses—An analysis of the Japan Rehabilitation Database—. Jpn J Compr Rehabil Sci 2015; 6: 78-85.
Objective: The objective of the present study was to determine via multiple regression analysis what types of patient groups demonstrate large effects for factors in stroke rehabilitation.
Methods: The subjects were 1,465 stroke patients in Kaifukuki rehabilitation wards who were registered in the 2014 Japan Rehabilitation Database. The subjects were stratified into eight groups based on age, motor functional independence measure (FIM) score at hospital admission, and cognitive FIM score at admission; multiple regression analysis was then performed with motor FIM score at discharge as the dependent variable.
Results: Among the eight groups, the following independent variables were significant: motor FIM score at admission in seven groups, Nichijo-seikatsu-kino-hyokahyo at admission in five groups, age and post-onset duration of hospitalization in four groups, cognitive FIM score at admission in three groups, and pre-onset modified Rankin Scale in one group.
Conclusion: The creation of multiple predictive formulas in multiple regression analysis enables identification of the types of patient groups which demonstrate large effects for factors in stroke rehabilitation.

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Tokunaga M, Nishikawa M, Matsumoto A, Nanbu S, Nakagawa A, Maeda Y, Kamiyoshi M. The relationship between measured values and values predicted using multiple regression analysis for mean motor FIM at discharge - A study at 13 Kaifukuki rehabilitation hospitals for stroke patients in the Japan Rehabilitation Database. Jpn J Compr Rehabil Sci 2015; 6: 86-90.
Objective: The purpose of this study was to predict mean Functional Independence Measure (FIM) at discharge in patients with stroke from Kaifukuki rehabilitation wards using multiple regression analysis, and to clarify the measured values and predicted values at each hospital.
Methods: The subjects were 2,320 stroke patients of 13 Kaifukuki rehabilitation wards registered in the 2014 Japan Rehabilitation Database. For each patient, we found a “measurement/prediction ratio” by dividing the “measured value for motor FIM at discharge” by the “predicted value for motor FIM at discharge obtained by multiple regression analysis”, and compared the mean values among hospitals.
Results: The 13 hospitals had significant differences in the measurement/prediction ratio for the motor FIM at discharge, ranging from 0.91 to 1.09.
Conclusion: The technique of using multiple regression analysis to predict FIM at discharge and comparing the measurement/prediction ratio between hospitals is advantageous in that it can correct the effects of various factors and enables statistical comparisons.

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Kisa T, Sakai Y, Tadenuma T, Maniwa S. History, application, procedures, and effects of intermittent oral catheterization (IOC). Jpn J Compr Rehabil Sci 2015; 6: 91-104.
Intermittent catheterization (IC), developed in Japan, involves inserting a catheter or feeding tube from the patient's mouth or nose for the purpose of dysphagia rehabilitation or feeding. Among the various IC methods, intermittent oral catheterization (IOC) involves inserting a catheter from the mouth to the lower part of the esophagus or stomach. Because the gag reflex is decreased in encephalopathy patients with dysphagia, oral insertion of a catheter is generally easy, and can be applied to patients who are capable of complaining of incorrect insertion or showing an objective symptom (regardless of dementia, etc.). IOC is effective for dysphagia patients, including those with cancer of the oral cavity or head and neck, neuromuscular disease, and for stroke patients in the acute convalescent, and chronic stages. Stroke patients receiving IOC showed higher oral intakes of regular meals than patients fed by a gastrostomy tube or continuous nasogastric catheterization (CNG). IOC care requires less monitoring and restraining time than CNG and results in better stomach discharge function than a gastrostomy. Gastrostomy should be applied to patients for whom IOC is not applicable or those in the convalescent stage who previously received IOC but who require alternative nutrition over a long period because only small amounts can be ingested via IOC.

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Ishihara K, Hirano S, Saitoh E, Tanabe S, Itoh N, Yanohara R, Katoh T, Sawada Y, Tsunoda T, Kagaya H. Characteristics of leg muscle activity in three different tasks using the balance exercise assist robot. Jpn J Compr Rehabil Sci 2015; 6: 105-112.
Objective: The balance exercise assist robot (BEAR) is a balance training device that uses robotic technology. The aim of this study was to clarify the characteristics of leg muscle activity while using the BEAR.
Methods: Subjects, comprising seven healthy adults, played three types of games composed of center of gravity movement tasks (tennis and skiing) and a coping with disturbance task (rodeo). The games had four levels of difficulty and each game was played for 90 seconds. Surface electromyography was used to measure the gluteus maximal muscle, gluteus medius muscle, rectus femoris muscle, vastus medialis muscle, biceps femoris muscle, tibialis anterior muscle, gastrocnemius and peroneus longus muscle on both sides. Mean muscle activity was calculated from muscle integrated electromyography.
Results: Muscle activity in each game increased with the degree of difficulty. Comparison of muscle activity between games indicated greater muscle activity in the tibialis anterior muscle during rodeo than tennis (p = .009) and skiing (p = .017). In the gastrocnemius, muscle activity was greater during rodeo than during skiing (p = .045) and in the peroneus longus muscle, muscle activity was greater during skiing than tennis (p = .041).
Conclusions: With the BEAR, the degree of difficulty can be altered to adjust the load placed on the legs. The three types of games each were able to promote different types of leg activity.

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Sato Y, Ohi K, Takahashi A, Murakami H, Murata M, Natori T, Yonezawa H, Terayama Y. A case of paraneoplastic syndrome definitively diagnosed from progressive ataxia during rehabilitation. Jpn J Compr Rehabil Sci 2015; 6: 113-117.
We report a case of paraneoplastic syndrome (PNS) definitively diagnosed after the patient's previous doctor requested a detailed examination when her ataxia worsened during rehabilitation in the recovery stage. Exacerbation of limb ataxia and positive results for anti-neural antibodies were suggestive of PNS, but no clear neoplastic lesion could be identified on systematic examination, so the patient was admitted to the recovery-stage rehabilitation ward without definitive diagnosis. She underwent another detailed examination when ataxia worsened after starting rehabilitation, leading to a diagnosis of gynecological malignant tumor based on fluorodeoxyglucose positron emission tomography (FDG-PET). The patient underwent hysterectomy and bilateral salpingo-oophorectomy, which confirmed the presence of PNS concomitant with serous adenocarcinoma of the left ovary. Although the numbers are low, patients on recovery-stage rehabilitation wards usually have unstable neurological disorders. Anti-Yo antibody-positive PNS often shows a poor prognosis, and when ataxia worsens after starting rehabilitation, differentiating PNS early to make a definitive diagnosis can influence the prognosis. We report this rare case of PNS.

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Maeda H, Sonoda S, Tomita Y, Mizuno S, Takeda K, Miyasaka H, Tanino G, Orand A, Ohno K. Factors influencing the therapeutic effectiveness of phenol motor point block on using ankle plantar flexion torque. Jpn J Compr Rehabil Sci 2015; 6: 118-123.
Objective: The therapeutic effectiveness of phenol motor point block in patients with spasticity of the lower extremity was assessed by measuring ankle plantar flexion torque. Patient factors influencing therapeutic effectiveness were evaluated.
Methods: Twelve patients with spasticity of the lower extremity after cerebrovascular disorders were enrolled in this study. Plantar flexion torques at 5°/s or 90°/s under passive ankle dorsiflexion were measured before and after treatment with phenol motor block in flexor muscles of the lower leg. Patient factors influencing therapeutic effectiveness were evaluated before and after treatment using torque changes as an indicator of therapeutic effectiveness.
Results: Therapeutic effectiveness showed a significantly negative correlation with plantar flexion torques at 5°/s before treatment (ρ= -0.741, p = 0.006) and with the time from onset (ρ= -0.680, p = 0.015). A significantly positive correlation between therapeutic effectiveness and presence of self-exercise (ρ= 0.661, p = 0.019) was observed.
Conclusion: Patients who were less affected by immobilization including those with small plantar flexion torque at 5°/s or those who engaged in self-exercise are expected to achieve large therapeutic effects with regard to phenol motor point block against spasticity of the lower extremity.

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Nishimura K, Kagaya H, Shibata S, Onogi K, Inamoto Y, Ota K, Miki T, Tamura S, Saitoh E. Accuracy of Dysphagia Severity Scale rating without using videoendoscopic evaluation of swallowing. Jpn J Compr Rehabil Sci 2015; 6: 124-128.
Objective: This study compared the Dysphagia Severity Scale (DSS) scores obtained from clinical findings and screening tests by a skilled nurse with the DSS scores obtained by videoendoscopic evaluation of swallowing (VE).
Methods: Forty-five dysphagic patients (average age: 75 years) were enrolled in this study between July 2011 and March 2012. DSS scores were obtained from clinical findings and screening tests done by a certified nurse of dysphagia nursing (CNDN). DSS scores were re-evaluated by a dysphagia care team in swallowing rounds using VE. DSS scores obtained using our protocol, CNDN, and swallowing rounds were compared.
Results: DSS scores revealed 64% consistency between the protocol and the swallowing rounds, 91% consistency between the CNDN and the swallowing rounds, and 69% consistency between the protocol and the CNDN.
Conclusion: Our results indicate that the DSS scores based on clinical findings and screening tests obtained by a skilled CNDN are accurate and consistent with the DSS rating obtained by the swallowing rounds and the protocol.

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Aoki Y, Kabuto S, Ozeki Y, Tanaka T, Ota K. The effect of tongue pressure strengthening exercise for dysphagic patients. Jpn J Compr Rehabil Sci 2015; 6: 129-136.
Objective: The purpose of this study was to investigate the efficacy and the effect of tongue pressure strengthening exercise for dysphagic patients by quasi-randomized controlled trial.
Methods: Thirty-four dysphagic patients were randomly assigned to either an intervention group that received rehabilitation including tongue pressure strengthening exercise or a control group that received conventional rehabilitation. Both groups participated in a 40-minute rehabilitation program five times a week for three weeks, and the intervention group also participated in tongue pressure strengthening exercise for ten minutes. We evaluated the Maximum Tongue Pressure (MTP), Swallowing Tongue Pressure (STP), Dysphagia Severity Scale (DSS), Eating Status Scale (ESS), Functional Oral Intake Scale (FOIS), and Mann Assessment of Swallowing Ability (MASA) before and after the intervention.
Results: Both groups demonstrated a significant improvement in the DSS, ESS, FOIS and MASA scores (p < 0.01). Only the intervention group showed a significant improvement in the MTP and STP scores. A comparison of the degree of change between the two groups showed a significant improvement in the MTP, STP and MASA of the intervention group. The intervention group also showed five improvements in the oral and the pharyngeal function in the MASA items.
Conclusion: The tongue pressure strengthening exercise promoted the improvement of dysphagia. Furthermore, this finding suggests that the exercise led to the improvement of not only the oral phase but also the pharyngeal phase of the swallowing function.

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Tanikawa H, Mukaino M, Matsuda F, Inagaki K, Ohtsuka K, Kagaya H, Saitoh E, Kanada Y. Influence of contralateral lower limb stabilization on hip abductor muscle strength measured by Hand-Held Dynamometer. Jpn J Compr Rehabil Sci 2015; 6: 137-142.
Objective: To investigate the influence of contralateral lower limb function on hip abductor muscle strength using a hand-held dynamometer.
Method: Thirty healthy subjects and fifty-nine hemiplegic patients participated in this study. Hip abductor muscle strength was measured in the supine position with or without stabilization of the contralateral lower limb (stabilizing vs. nonstabilizing method, respectively). Strength as measured using both methods was compared on each side for the lower limb and correlation coefficients for the two methods were calculated. In addition, correlation coefficients between measurements of strength using the two methods on both sides were calculated. In the hemiplegic patients, multiple regression analysis was performed using the strength on the affected side as the dependent variable, and the strength on the unaffected side and the degree of paralysis as independent variables.
Results: Strength measured using the stabilizing method was significantly lower than when using the nonstabilizing method. The correlation between the strength on both sides was high in the healthy subjects despite contralateral lower limb stabilization, but low in the hemiplegic patients when using the nonstabilizing method. The strength on the affected side was strongly influenced by the unaffected lower limb function in measurements using the stabilizing method.
Discussion: Measurements of hip abduction strength when using the stabilizing method are not an accurate reflection of the strength due to the influence of contralateral lower limb function.

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Osada Y, Simabukuro M, Iwasaki Y, Kaneko K, Fuchi M, Ibayashi S. Development of an independent ambulation rating chart for post-stroke hemiplegic patients in the recovery stage: at what level is patients free to walk within rehabilitation ward. Jpn J Compr Rehabil Sci 2015; 6: 143-150.
Objective: This study aimed to identify subjective and objective assessment items to rate independent ambulation in hemiplegic patients, and to develop an effective independent ambulation rating chart.
Methods: Logistic regression analyses were conducted on subjective assessment items extracted from a questionnaire survey of 25 physical therapists and on objective assessment items using the Fugl-Meyer Assessment (FMA) to identify factors that influence independent ambulation in hemiplegic patients. The factors identified were used to construct an independent ambulation rating chart. Forty-five hemiplegic patients were assessed using the chart, and the concordance with the actual independence status was analyzed.
Results: Unsteadiness, distribution of attention, associated reaction, and balance subscale of FMA were identified as factors influencing independent ambulation. The results obtained from the rating chart constructed using the above factors showed high concordance with the actual independence status.
Conclusion: We developed a rating chart from analyzing independent ambulation factors. Since the rating chart assesses higher level brain functions and clinical context including self-management, good concordance with the actual independence status was obtained. The chart is useful for the rating of independence.

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Watabe T, Sako R, Suzuki H, Mano H, Kawate N, Mizuma M. Falls in the sitting position—Characteristics and efficacy of preventive measures—. Jpn J Compr Rehabil Sci 2015; 6: 151-157.
Introduction: In the prevailing definition, falls in the standing position and falls in the sitting position with the buttocks touching the ground or floor are not distinguished from each other. In practice, however, the types of motion that lead to the fall differ between these two types of falls. The present study was undertaken to investigate the characteristics of individuals falling in the sitting position and to evaluate the efficacy of preventive measures taken with such characteristics considered.
Study 1: The characteristics of the individuals experiencing falls in the sitting position were investigated retrospectively. These patients tended to demonstrate retained cognitive function, and the fall often occurred when the individuals attempted to reach for an object at the bedside. On the basis of these findings, measures for prevention of falls (primarily patient education) were attempted.
Study 2: The frequency of falls before the preventive measures were established was compared with that after the measures. The frequency of falls in the standing position did not decrease after these measures, while the frequency of falls in the sitting position decreased to about one-fifth after the measures.
Discussion: The preventive measures taken were useful in preventing falls. In future, it may be necessary to extensively apply measures for preventing specific types of falls.

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