Fujimura K, Kagaya H, Onaka H, Okochi Y, Yamada M, Teranishi T, Kanada Y, Saitoh E. Improvement in Disability Assessment Scale after Botulinum toxin A treatment for upper limb spasticity. Jpn J Compr Rehabil Sci 2017; 8: 4-9.
Objective: We investigated the effect of botulinum toxin type A for upper limb spasticity on activities of daily living using the Disability Assessment Scale (DAS).
Methods: The subjects were 47 patients who received botulinum therapy for upper limb spasticity. They were assessed before administration and 2, 6, and 12 weeks after administration by using the DAS, the Modified Ashworth Scale (MAS), and upper-limb-related parameters from the Fugl-Meyer Assessment (FMA).
Results: DAS scores for hygiene, dressing, and limb position improved significantly 2 and 6 weeks after administration (p < 0.05), but there was no significant change in pain. MAS scores exhibited significant improvement 2, 6, and 12 weeks after administration, and the total scores for FMA upper-limb parameters exhibited significant improvement 2 and 6 weeks after administration (p < 0.05).
Conclusion: Botulinum therapy contributes to improving not only the spasticity itself, but also to improving difficulties in activities of daily living associated with upper limb spasticity.

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Teranishi T, Kondo I, Okuyama Y, Tanino G, Miyasaka H, Sonoda S. Investigation of factors involved in patient falls during the early stage of hospitalization in a Kaifukuki rehabilitation ward. Jpn J Compr Rehabil Sci 2017; 8: 10-15.

Objective: To investigate factors affecting the occurrence of falls during the early stage of hospitalization in a Kaifukuki (convalescence) rehabilitation ward.

Methods: The subjects were 545 hospitalized patients, divided into a fall group (having experienced a fall within 14 days following admission) and a non-fall group. Differences between the two groups in terms of the Standing Test for Imbalance and Disequilibrium (SIDE) level and in the subscales of the Functional Independence Measure (FIM) were investigated. Logistic regression was carried out on items for which there were significant differences between the groups as dependent variables and the occurrence of falls as the objective variable, and the odds ratios were computed.

Results: The fall group comprised 36 subjects. Significant differences between groups were found in the SIDE level, lower body dressing, bath transfer, stairs, social interaction, problem solving, and memory. Logistic regression only identified problem solving as associated with the occurrence of falls (odds ratio, 0.288; p=0.035). For the SIDE level, complete separation of non-fall subjects was seen at levels of 2b or higher.

Conclusion: Falls in the early stage following admission do not occur among individuals with good balance, and problem solving according to the FIM is involved in falls.

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Tokunaga M, Katsura K, Tokisato K, Honda S, Nakanishi T, Takai S, Nakashima Y, Nojiri S, Watanabe S. Increasing the prediction accuracy of FIM gain by adding FIM improvement for one month from admission to the explanatory variables in multiple regression analyses. Jpn J Compr Rehabil Sci 2017; 8: 16-20.

Objective: The coefficient of determination in multiple linear regression analyses using the gain in Functional Independence Measure (FIM) as objective variables is low. We aimed to improve the prediction accuracy of FIM gain by adding FIM improvement for one month from admission to the explanatory variables.

Methods: A total of 547 stroke patients admitted to a Kaifukuki (convalescent stage) rehabilitation ward were included. In multiple regression analyses using motor FIM gain as the objective variable, we created a prediction formula using only data available at admission (model 1), and a prediction formula adding FIM improvement for one month from admission (model 2). The coefficient of determination adjusted for the degrees of freedom R^*2 and the residuals obtained by subtracting the predicted value from the measured value of motor FIM gain were investigated.

Results: The R^*2 of model 1 was 0.364 and that of model 2 was 0.711. The residual of model 1 was 0 ± 12.3 and that of model 2 was 0 ± 8.3. In model 2, the standard deviation of the residual was reduced.

Conclusion: Adding FIM improvement for one month to the explanatory variables increased the prediction accuracy of FIM gain.

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Tokunaga M, Tori K, Eguchi H, Kado Y, Ikejima Y, Ushijima M, Miyabe S, Tsujimoto S, Fukuda E. The stratification of motor FIM and cognitive FIM and the creation of four prediction formulas to enable higher prediction accuracy of multiple linear regression analysis with motor FIM gain as the objective variable ― An analysis of the Japan Rehabilitation Database. Jpn J Compr Rehabil Sci 2017; 8: 21-29.

Objective: The aim of our study was to stratify the contributing factors in order to increase the prediction accuracy of the multiple linear regression analysis with motor FIM gain as the objective variable.

Methods: The subjects for our study were 2,542 stroke patients. In the multiple linear regression analysis with motor FIM gain as the objective variable, eight contributing factors were stratified. Prediction formulas were created and the correlation between the measured motor FIM gain values and the predicted values was investigated.

Results: The correlation coefficient was higher with the stratification of gender (0.509), stroke type (0.512), number of hospital days (0.516), days from onset to admission (0.518), modified Rankin Scale before onset (0.520), age (0.541), cognitive FIM at admission (0.588) and motor FIM at admission (0.641), than with the use of one prediction formula (0.507), and it was 0.653 with stratification into four groups with the two factors of motor FIM and cognitive FIM at admission.

Conclusion: By stratifying the contributing factors, we were able to increase the prediction accuracy of motor FIM gain.

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Kojima K, Nakayama T, Watanabe A, Yoshimura S, Yamaya T, Sato K, Doi A, Ogino T, Moriyasu N, Watanabe S. Activities of daily living and quality of life assessment during home-based rehabilitation - A multi-institutional study. Jpn J Compr Rehabil Sci 2017; 8: 30-36.
Objective: The purpose of this study was to examine the relationship between activities of daily living (ADL) performance and quality of life (QOL) in participants in a home-based rehabilitation program, and to assess the associated changes during the program.
Methods: The subjects were participants newly enrolled in home-based rehabilitation in six facilities. The Functional Independence Measure motor subscore was used to evaluate the current ADL performance. We used PGC-MS to evaluate the emotional aspect of QOL, and ADL satisfaction for the cognitive aspect.
Results: Participants were divided into two groups: <1 year from onset and >1 year from onset; ADL satisfaction had significantly improved in the latter group (p = 0.008). A strong correlation between ADL performance and ADL satisfaction was found. On the other hand, the correlation between ADL satisfaction and PGC-MS was weaker.
Conclusions: The ‘cognitive aspect’ of QOL improved due to the rehabilitation staff’s approach in explaining the participants’ ADL abilities and motivating them to accept their limitations. It is considered that the ‘emotional aspect’ of QOL is difficult to change with only three months of home-based rehabilitation.

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Onogi K, Kondo I, Asagai Y, Saitoh E. Differences in evaluation of functional skills of the Pediatric Evaluation of Disability Inventory (PEDI) between normally developing children and children with cerebral palsy. Jpn J Compr Rehabil Sci 2017; 8: 37-43.
Objective: The Pediatric Evaluation of Disability Inventory (PEDI) provides functional skills scales based on the data obtained from normally developing children. In the present study, we performed an analysis of children with cerebral palsy using the same methodology as set originally to examine differences in discrete skill items between the two groups of children.
Methods: Six hundred and two children with cerebral palsy were divided into groups based on the severity of disorder as described in the Gross Motor Function Classification System (GMFCS). The scaled scores for the PEDI functional skills were computed by Rasch analysis.
Results: Correlation coefficients between the scaled scores of children with cerebral palsy and those presented in the PEDI original data were r = 0.890 for self-care, r = 0.795 for mobility, and r = 0.943 for social function. In children in GMFCS level I, discrete scores increased with age, whereas in children in levels III, IV, and V, scores for mobility almost reached the plateau in the age band of 4 to <6 years.
Discussion: In the difficulty level of functional skills, the greatest difference was observed in mobility, suggesting the need to establish a difficulty level of functional skills that is adapted to the abilities of children with cerebral palsy.

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Nakashima N, Miyasaka H, Kondo I, Iwata K, Uematsu H, Yamamura C, Sonoda S. The relationship between proximal function of the upper extremity on the paralyzed side and upper extremity skills in daily life of subacute stroke patients. Jpn J Compr Rehabil Sci 2017; 8: 44-50.

Objectives: The effects of proximal function of the upper extremity on the paralyzed side on daily life skills were examined in stroke patients.

Methods: One hundred and forty-seven stroke patients were evaluated using the Functional Skills Measure After Paralysis (FSMAP), the Finger-Function test (FF), and the Knee-Mouth test (KM) of the Stroke Impairment Assessment Set (SIAS). The FSMAP score for each subgroup of the SIAS-KM level was compared.

Results: The FSMAP score was significantly higher in patients with a KM score of 2/3 compared to patients with a KM score of 0/1 when SIAS-FF was 0/1A; in patients with a KM score of 2/3 compared to patients with a KM score of 0/1 and in patients with a KM score of 4/5 compared to patients with a KM score of 2/3 when SIAS-FF was 1B, 1C, or 2; and in patients with a KM score of 4/5 compared to patients with a KM score of 2/3 when SIAS-FF was 3, 4, or 5.

Conclusion: The cross-sectional study indicated that differences in the level of proximal function affect the upper extremity skills when the level of distal function is equivalent.

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Sawada K, Saitoh E, Horii M, Imoto D, Itoh N, Mikami Y, Ikeda T, Ohashi S, Terauchi R, Fujiwara H, Kubo T. MMT measurements are acceptable in routine clinical practice: Results from periodic medical examinations of polio survivors. Jpn J Compr Rehabil Sci 2017; 8: 51-55.

Purpose: The aim of this study was to investigate whether manual muscle test (MMT) for the hip (abduction, flexion, and extension), knee (flexion and extension), and ankle (dorsal flexion) muscles are acceptable in routine clinical practice.

Methods: The study included 222 participants (487 examinations, 974 legs) of periodic medical examinations for polio survivors in the Tokai district of Japan. The subjects were 175 men (350 legs) and 312 women (624 legs) with an average age at the time of examination of 62.2 (32-82) and 61.6 (47-83) years, respectively. The results of handheld dynametric muscle test were compared for each MMT grade and joint motion.

Results: Significant differences in muscle strength were observed for the majority of pairs of MMT grades, excluding the MMT 0/1 pair. The specific combinations with no significant differences were MMT 1/2 for knee flexion (women); and MMT 0/2 (both men and women), 1/2 (both men and women), and 3/4 (men) for ankle dorsal flexion.

Conclusion: Clinical MMT measurements seem to be generally acceptable, at least when performed by physical therapists with 5 or more years of clinical experience. However, ankle dorsal flexion requires especially careful assessment.

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Konno S, Ishima E, Kubota T, Murata M, Kawanami N, Wakasa M, Sato T, Haraki R, Okuyama Y, Nishimura M, Shimizu F, Yamazaki D, Fujioka T. The effect of a mousse diet on mood and food intake in healthy young females. Jpn J Compr Rehabil Sci 2017; 8:56-65.

Objective: This study investigated whether a dysphagia diet, such as a mousse diet, caused low diet intake with a deterioration of psychological status.

Methods: Eleven healthy females were divided into two groups: normal and mousse diet. Subjects ate these diets three times a day for three consecutive days. The changes over time in diet intake, dietary assessment, appetite, craving for a specific taste, and mood status were compared between the two groups.

Results: At almost all evaluation points, the diet intake and dietary assessment values were higher in the normal diet group than in the mousse diet group. The anger-hostility and fatigue-inertia measures of mood status temporarily differed significantly between the two groups; anger-hostility increased in the mousse diet group, while fatigue-inertia decreased in the normal diet group (p = 0.040, p = 0.041). Positive effectors of diet intake amount were the taste of the diet and a craving for sweet-tasting items before the meals (partial regression coefficients 0.798 and 0.207, p < 0.001 and p = 0.005, respectively), while appetite, mood status, and a craving for other specific tastes before the meals did not have a considerable effect on diet intake.

Conclusions: These results demonstrate that a mousse diet is one of the causes of low diet intake and mood fluctuation.

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Konishi M, Tanimoto K. Scanning electron microscopy observations of rice cooked with non-ionic water-soluble iodine for videofluoroscopic swallowing study. Jpn J Compr Rehabil Sci 2017; 8: 66-70.

Objective: The aim of this study was to investigate the distribution of contrast medium on and inside rice for videofluoroscopic swallowing study (VFSS) as observed by scanning electron microscopy (SEM) and radiography. We also examined the influence on texture of mixing the contrast medium.

Methods: Cooked rice for VFSS was prepared using non-ionic water-soluble iodine liquid (Visipaque^® 270) and barium sulfate, and SEM and radiography were performed. Enhancement of the X-ray image was evaluated using the gray-scale. The textures of hardness, adhesiveness, and cohesiveness were measured using a texture analyzer. The Kruskal-Wallis test and Steel-Dwass test were used to compare the measured values.

Results: On SEM, barium sulfate was only attached to the surface of the rice but Visipaque^® 270 was observed inside the rice. The X-ray image of the rice cooked with barium sulfate was mottled; however, Visipaque^® 270 demonstrated uniform enhancement. The gray-scale values of the X-ray images were statistically different (p < 0.001), whereas the textures showed no statistical difference.

Conclusion: The rice cooked with Visipaque^® 270 revealed good X-ray enhancement. This was because the contrast medium was distributed not only on the rice surface but also inside the rice.

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Hirano S, Kagaya H, Saitoh E, Sonoda S, Tanabe S, Katoh M, Yamada J, Tanino G, Suzuki A, Itoh N. Effectiveness of Gait Exercise Assist Robot (GEAR) for stroke patients with hemiplegia. Jpn J Compr Rehabil Sci 2017; 8: 71-76.

Objective: This study examined whether subacute stroke patients with hemiplegia who receive gait training using the Gait Exercise Assist Robot (GEAR) show early improvement in gait independence compared to patients who receive orthosis-assisted gait training.

Methods: Six patients who satisfied the following criteria were included in the study: patients with hemiplegia caused by primary supratentorial intracerebral hemorrhage or cerebral infarction, within 60 days after onset, aged 20 to 75 years, Functional Independence Measure (FIM) walking score ≤ 3, Stroke Impairment Assessment Set (SIAS) lower extremity total score ≤ 6, and use of a knee-ankle-foot orthosis. Rehabilitation was conducted for a maximum of 3 h a day, including 40 min of gait training using GEAR. A historical control group was selected from among patients admitted to the ward for intensive inpatient rehabilitation at Nanakuri Memorial Hospital. One control patient matching the criteria of each subject was selected, with a total of six in the control group. The primary outcome measure was the improvement in efficiency of FIM-walk, defined as the gain in FIM walking score from the baseline to supervised walking divided by the number of weeks required.

Results: The mean improvement in efficiency of FIM-walk was 1.0 in the GEAR group and 0.54 in the control group, and was significantly higher in the GEAR group (p = 0.042).

Conclusion: Gait training using GEAR may facilitate early improvement in gait independence.

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Kakuta H, Yamaguchi M, Sugawara K, Kuge N, Imai H, Rikimaru A, Yokomichi H, Sakamoto T, Sugiyama K, Izumi S, Hongo M. Improved activities of daily living in a patient with subtrochanteric femur fracture through incorporation of continuous positive airway pressure therapy following convalescent rehabilitation. Jpn J Compr Rehabil Sci 2017; 8: 77-81.

Objective: Sleep disorders interfere with activities of daily living (ADL) in elderly individuals. In Japan, at least 3 million people are estimated to have sleep apnea syndrome (SAS), and many potential patients are yet to be diagnosed and treated. In women, the incidence of SAS increases 2-4 fold after menopause due to reduced hormone levels. In addition, women rarely present with typical symptoms of SAS, such as daytime sleepiness and snoring, and thus they are not screened for SAS as often as men. This study aimed to evaluate the utility of continuous positive airway pressure therapy (CPAP) to improve ADL.

Methods: This report describes an elderly woman with dementia, depression, and angina who developed disuse syndrome after surgery for subtrochanteric fracture of the left femur, and was treated with CPAP and other general measures.

Results: The patient showed progressive improvement in ADL by the simplification of medications, management of general health, diagnosis of SAS, and incorporation of CPAP therapy following convalescent rehabilitation.

Conclusion: Activities of daily living can be improved in orthopedic patients with SAS by using CPAP and other general lifestyle measures.

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Shibata S, Kagaya H, Tanaka S, Fujii W, Nakagawa K, Matsuo K, Abe K, Ishibashi N, Inamoto Y, Saitoh E. Efficacy of a novel training food based on the process model of feeding for mastication and swallowing: A study among dysphagia patients. Jpn J Compr Rehabil Sci 2017; 8: 82-87.

Objective: Our goal was to verify the validity and safety of chew-swallow managing food (CSM) for dysphagia patients.

Methods: We conducted a study on 14 inpatients diagnosed with dysphagia and judged to be capable of ingesting pureed foods. We instructed each participant to ingest and freely swallow 4-g samples of CSM and pureed food. For each sample, we measured the number of chewing cycles, number of swallows, position of the leading edge of the bolus at the time of swallowing initiation, amount of residue in the oral cavity and pharynx, and occurrence of laryngeal penetration or aspiration.

Results: The number of chewing cycles was significantly higher for the CSM. The position of the leading edge of the bolus at the time of swallowing initiation was primarily in the valleculae for both the CSM and pureed food, and the rate of laryngeal penetration did not significantly differ between the two test foods. There was a high rate of residue on the dorsum of tongue with the CSM and in the valleculae with the pureed food.

Conclusion: The CSM induced chewing in dysphagia patients, and the prevalence of penetration did not differ from the pureed food. Therefore, we concluded that the CSM could be used in chewing exercises with the same level of safety as the pureed food.

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Izumi S, Furusawa Y, Bansho M, Tonomura I. Identification of communication skills that improve patient safety culture: analysis of a communication skills training program for university hospital staff. Jpn J Compr Rehabil Sci 2017; 8: 88-97.

Purpose: To elucidate the relationship between patient safety culture and communication skills (CS).

Methods: A CS training program based on coaching theory was conducted at a university hospital, and the relationship between the improvement of patient safety culture and the improvement of CS before and after training was analyzed. The trainees were 57 full-time staff members of the hospital. Each trainee selected around five close coworkers (collaborators; a total of 285). For seven months, the trainees received class lessons via an audio conference system, and at the same time conducted coaching interviews with their collaborators. The collaborators assessed the trainees' CS and patient safety culture using questionnaires before and after training.

Results: Excluding missing data, 259 subjects were analyzed. The patient safety culture improved group showed a higher degree of improvement in CS regarding “suggestions/requests” compared to the non-improved group. Furthermore, improvement of the “suggestions/requests” skill was related to the improvement of patient safety culture regarding “supervisor/manager expectations and actions in promoting safety” and “non-punitive response to errors.”

Conclusion: The present results suggest that improvement in “suggestions/requests” skill may be associated with improvement in patient safety culture.

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Fujitaka Y, Tanaka N, Nakadai H, Sato R, Watanabe M, Kageyama N, Okamoto T. Differences in FIM improvement rate stratified by nutritional status and age in stroke patients in kaifukuki (convalescent) rehabilitation ward. Jpn J Compr Rehabil Sci 2017; 8: 98-103.

Purpose: This study aimed to investigate the differences in improvement rate of Functional Independence Measure score (FIM) stratified by nutritional status and age in stroke patients admitted to a kaifukuki (convalescent) rehabilitation ward (KRW).

Methods: Stroke patients aged 60 years or older admitted to the KRW in our hospital between May 2013 and February 2015 were studied. Patients with Mini Nutritional Assessment-Short Form (MNA-SF) score 7 or below at admission were classified in the malnutrition group, and those with score 8 or above in the normal nutrition group. Each group was further stratified by age into 60s, 70s, and 80 and older, with a total of 6 groups. FIM effectiveness was calculated as an indicator of FIM improvement rate, and multiple comparison was conducted among groups.

Results: FIM effectiveness did not differ among age groups in the normal nutrition group, but was significantly lower in patients aged ≥80 compared to those aged 60s and 70s in the malnutrition group.

Conclusion: In stroke patients with malnutrition, the FIM improvement rate decreased as age increased. This finding suggests that in order to conduct rehabilitation efficiently, the nutritional status should be taken into consideration when planning the rehabilitation program, especially in patients of advanced age.

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Kono Y, Aoyagi Y, Kayukawa T, Mori E, Ishikawa A, Yatsuya K, Mizokoshi E, Izawa H, Saitoh E. Efforts and effects of additional medical coverage to maintain or improve activities of daily living in an acute cardiovascular internal medicine ward. Jpn J Compr Rehabil Sci 2017; 8; 104-108.

Purpose: This study investigated the effects of additional medical coverage to maintain or improve ADLs on the length of hospital stay and level of ADLs.

Methods: This retrospective study included patients who were admitted to the cardiovascular internal medicine ward and were referred to the rehabilitation (rehab) department. Patients who were referred to the rehab department within one year after the implementation of additional medical coverage to maintain or improve ADLs were categorized as the added-coverage ADLs group, and those who were referred to the rehab department within one year before the implementation were categorized as the control group. The evaluation items included age, number of days before initiation of rehab, duration of rehab intervention, length of hospital stay, and Functional Independence Measure (FIM) score at discharge.

Results: While the added-coverage ADLs group had 147 patients (women, 101; mean age, 82 ± 10 years), the control group had 102 patients (women, 54; mean age, 82±10 years). In the added-coverage ADLs group, we found a significant decline in the number of days before initiation of rehab, duration of rehab intervention, and length of hospital stay; however, we found no difference in the FIM score at discharge between the two groups.

Conclusions: The implementation of additional medical coverage to maintain or improve ADLs allowed early initiation of rehab intervention and decreased the duration of rehab intervention and the length of hospital stay while maintaining the level of ADLs at discharge.

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Kamiya M, Kondo I, Osawa A. Development of a reaction scale for dementia patients during recreational activities: a trial study of interobserver reliability and criterion-related validity. Jpn J Compr Rehabil Sci 2017; 8: 109-114.

Objective: Recreational therapy is often provided for patients with dementia, but there are few indices on the reactions of patients during therapy, making evaluation difficult. The objective of this study was to create a new observational index capable of evaluating the reactions of elderly people with dementia, and to demonstrate its utility.

Methods: The observational index developed by Ishihara et al. was modified, and its interobserver reliability was examined by two assessors who evaluated 16 patients (mean age: 80.2 ± 7.2 years, mean Mini Mental State Examination [MMSE] score: 18.3 ± 7.9) hospitalized on dementia and geriatric wards to calculate the kappa coefficients. Criterionrelated validity was examined by evaluating 33 patients meeting the same conditions (mean age: 80.8 ± 8.4 years, mean MMSE score: 15.6 ± 6.8) using this index and the Observed Emotion Rating Scale to calculate Spearman's rank correlation coefficient.

Results: The examination of interobserver reliability produced kappa coefficients of 0.57 to 0.67, while the examination of criterion-related validity produced correlation coefficients of 0.56 to 0.86 (p < 0.001).

Conclusion: The interobserver reliability and criterionrelated validity of the index examined in this study were of a sufficient level for this index to be used in clinical settings to evaluate dementia patients.

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