Nishioka S, Sugawara H, Takayama M, Urushihara M, Watanabe M, Kiriya Y, Shintani K, Nakagomi H, Kageyama N, Okamoto T, Sumita S, Fujita M, Hashimoto S, Ishikawa M, Tsushima E, Ogawa A. Relationship between weight gain, functional recovery and nutrition monitoring in underweight tube-fed stroke patients. Jpn J Compr Rehabil Sci 2018; 9: 3-10.

Objective: To investigate the relationship between the frequency of nutritional monitoring, and both weight gain and functional recovery in underweight, tube-fed stroke patients.

Methods: Data for tube-fed stroke patients aged ≥40 with an (age-dependent) body mass index (BMI) of either <18.5, <20.0, or <21.5 kg/m² were extracted from two studies included in the “Algorithm for Post-stroke Patients to improve oral intake Level (APPLE)” study, conducted at five Kaifukuki (convalescent) rehabilitation wards in Japan. The outcome measurements were compared between the wards participating in either weekly (WM), or monthly (MM) nutritional monitoring protocols by dietitians. Primary outcomes were a change in BMI, and functional independence measure (FIM) at discharge.

Results: There were 37 WM patients (18 women; mean age, 77 years) and 29 MM patients (19 women; mean age, 78 years) with no differences in stroke subtype, BMI, functional independence measure (FIM) and swallowing function. At discharge, WM patients showed a significantly higher BMI gain compared to MM patients (+0.2 kg/m² vs. -0.5 kg/m², p=0.009). A greater proportion of WM patients than that of MM patients achieved full oral intake (81.1% vs. 44.8%, p=0.002). WM was independently correlated with BMI change and discharge FIM on multivariable analyses.

Conclusions: Nutritional monitoring and planning recommendation at least once a week by dietitians may correlate with positive BMI change and better functions in tube-fed stroke patients.

Takayama M, Nishioka S, Okamoto T, Urushihara M, Kiriya Y, Shintani K, Nakagomi H, Hijioka S, Watanabe M, Sugawara H, Ishikawa M, Miyai I, Sonoda S. Multicenter survey of dysphagia and nutritional status of stroke patients in Kaifukuki (convalescent) rehabilitation wards. Jpn J Compr Rehabil Sci 2018; 9: 11-21.

Objective: This study aimed to identify the current situation of nutritional status and swallowing training in stroke patients with dysphagia in Kaifukuki (convalescent) rehabilitation wards (KRWs).

Methods: We performed a retrospective study in the KRWs of 25 hospitals to investigate the swallowing function and nutritional status of stroke patients who had dysphagia at admission to the KRW. Nutritional status was assessed using the Geriatric Nutritional Risk Index (GNRI) and swallowing function was assessed by Fujishima's swallowing grade (swallowing grade).

Results: A total of 440 subjects were analyzed. Malnutrition (GNRI < 92) was found in 63.4% of the subjects at admission, and the rate was reduced significantly (p < 0.05) to 42.7% at discharge. Among the 440 subjects, 94.1% underwent indirect swallowing training while 80.9% underwent direct training. The median swallowing grade improved significantly (p < 0.05) from 2 at admission to 7 at discharge. At discharge, 53.4% of the subjects achieved oral intake of three meals.

Conclusion: This multicenter survey revealed the outcome of oral intake and nutritional status in stroke patients with dysphagia in KRWs. These data are expected to be utilized as benchmarks for the goal of further improvement of the quality of nutritional care and dysphagia rehabilitation in the future.

Tomita T, Fukui T, Takanohashi S, Goto H, Yoshida T, Sumiya K, Kohda Y, Kudo K. Effect of xanthan gum as a thickener in widely-used food thickeners on the disintegration of rapidly-disintegrating tablets. Jpn J Compr Rehabil Sci 2018; 9: 22-28.

Objective: We studied the impact of xanthan gum (XTG) as a thickener in widely-used food thickeners on the disintegration of rapidly-disintegrating tablets.

Methods: We used 0.2%, 0.4%, 0.6%, and 0.8% (w/v) aqueous solutions of XTG (XTG-Sol) for the study. The rapidly-disintegrating tablet used was magnesium oxide tablet (M-Tab). M-Tabs were immersed in XTG-Sol for 1, 5, and 10 min and then subjected to disintegration tests (purified water).

Results: The results obtained revealed that the longer the immersion time in 0.6% or 0.8% XTG-Sol, the longer the disintegration time of the M-Tabs. All the M-Tabs disintegrated in the 0.2% XTG-Sol. Additionally, when the immersion time was 5 or 10 min, the M-Tabs disintegrated in the 0.4% XTG-Sol.

Conclusion: The disintegration of the rapidly-disintegrating tablets was affected by XTG and was dependent on its concentration and the immersion time. Thus, care is needed when swallowing tablets with thickened food products containing XTG.

Ono M, Kono Y, Aoyagi Y, Tsuji Y, Ishikawa A, Sugiura T, Mori E, Tanaka Y, Kagaya H, Hirose M, Horiguchi T, Saitoh E. The clinical impact of depressive symptom on ADL score in elderly patients with respiratory disease. Jpn J Compr Rehabil Sci 2018: 9: 29-33.

Background: This study aimed to clarify the impact of depressive symptom on activities of daily living (ADL) in elderly patients with respiratory disease.

Methods: We studied 160 consecutive patients who met the criterion of no physical disability. During hospitalization, we measured physical function, respiratory function and Hospital Anxiety and Depression Scale (HADS). Firstly, we divided the patients into two groups (depression group and non-depression group) followed by presence of depressive symptom, which was defined as an HADS score of 8 points or more. Then we analyzed the association between depressive symptom and the other clinical variables mentioned above by the chi-squared test and unpaired t-test.

Results: There were 40 patients (22.7%) in the depression group. There was no statistically significant difference in age, sex, BMI, physical function or respiratory function. Although we could not find any difference in FIM motor score, the score of NRADL (The Nagasaki University Respiratory Activity of Daily Living Questionnaire), which is a disease-specific ADL score, was significantly lower in the depression group than the non-depression group (71.6 points vs 59.7 points).

Conclusion: We clarified that depressive symptom was closely related to NRADL score, but not to FIM motor score. The results also suggest that it is important to consider the impact of depressive symptom on ADL score when evaluating ADL in elderly patients with respiratory disease.

Kuramoto N, Suzuki K, Watanabe S, Hidaka K. Mealtime assistance and caregivers' frequency of checking the residents in nursing homes: a questionnaire survey. Jpn J Compr Rehabil Sci 2018; 9: 34-42.

Objective: Based on a questionnaire survey of caregivers in nursing homes, this study aimed to describe 1) the caregivers' basic characteristics, 2) the current mealtime assistance settings, and 3) the differences in the frequency of checking the residents during general care as well as before, during, and after mealtime assistance according to the caregivers' experience of attending lectures, their profession, and gender.

Methods: A questionnaire survey was distributed to 18 nursing homes in Ibaraki Prefecture in Japan and caregivers currently providing mealtime assistance answered the questions.

Results: Out of 695 distributed questionnaire surveys, 493 were answered (return rate: 70.9%). The majority of respondents were female (70.9%) and were care workers (78.7%). Most of them felt anxious about mealtime assistance. There were differences in the frequency of checking the residents according to the caregivers' experience of attending lectures, their profession (nurses or care workers), and gender.

Conclusions: To provide mealtime assistance in a safe and relaxed environment, the nursing home managers need to offer psychological support to the nursing home staff. In addition, it is important to provide lectures that take into account the caregivers' professions and genders.

Akahori R, Kagaya H, Ozeki M, Shibata S, Aoyagi Y, Onogi K, Saitoh E. Dysphagia associated with acute-phase brainstem cerebrovascular disorder. Jpn J Compr Rehabil Sci 2018; 9: 43-51.

Objective: To elucidate the details of dysphagia associated with acute-phase brainstem cerebrovascular disorders.

Methods: A total of 207 patients with brainstem cerebrovascular disorder that had developed within the past 3 days were examined at the Department of Rehabilitation Medicine. The median duration of hospital stay was 20 days. The most common lesion site was the pons in 168 patients and the lateral medulla in 25. A total of 167 patients had no history of cerebrovascular disorder in any part of the brain other than the brainstem (CVD−), and 40 patients had such a history (CVD+). A retrospective survey of these patients was conducted to identify the dysphagia severity scale (DSS) scores, eating status scale (ESS) scores, food texture, seating positions during meals, onset of pneumonia during follow-up, and functional independence measure (FIM).

Results: A total of 51% of CVD− patients and 64% of CVD+ patients had dysphagia, and DSS, ESS, food texture, and FIM scores at discharge all showed improvement at a significance level of 5%. No significant differences in DSS, ESS, and pneumonia incidence were observed between the CVD− and CVD+ patients.

Conclusions: The results of this study indicated that dysphagia can be improved even in patients with both CVD+ and CVD− acute-phase brainstem cerebrovascular disorders.

Yamagami T, Oka M, Sunagawa N, Onozuka Y, Tanaka Y, Yamaguchi H, Saito M. Influence of concomitant dementia on FIM gain in convalescent rehabilitation: Strategies to provide effective rehabilitation for patients with concomitant dementia. Jpn J Compr Rehabil Sci 2018; 9: 52-58.

Objective: The influence of the presence and severity of concomitant dementia on Functional Independence Measure (FIM) gain and strategies for rehabilitation were investigated in Kaifukuki rehabilitation wards.

Methods: The presence of dementia, and FIM gain and efficiency on admission and discharge as well as outcomes were compared among 232 patients in Kaifukuki rehabilitation wards. In addition, factors considered to be associated with a significant increase (positive) or decrease (negative) in FIM gain were investigated.

Results: Changes in FIM by the presence or absence of dementia showed a significant main effect (F=352.4, p<0.001) and interaction (F=5.382, p=0.021). FIM gain and efficiency were significantly lower in the group with dementia, but no significant difference in severity was noted between the group without dementia and the group of mildly demented elderly subjects with level II dependence in activities of daily living. Factors associated with positive FIM gain were medical and life management as well as approaches to involvement, whereas aggravation of the main disease and complications were considered negative factors.

Conclusion: FIM improved even in the presence of dementia through convalescent rehabilitation and care in consideration of dementia, suggesting that effects comparable with those for patients without dementia are possible when dementia is mild.

Okamoto S, Sonoda S, Watanabe M, Okazaki H, Yagihashi K, Okuyama Y. Relationship between Functional Independence Measure (FIM) score on admission and influence of inhibitive factors in a comprehensive inpatient stroke rehabilitation ward. Jpn J Compr Rehabil Sci 2018; 9: 59‒65.

Objective: Investigate how the influence of inhibitive factors was changed by the status of activities of daily living (ADL).

Methods: Subjects were 2,650 stroke hemiplegic patients admitted to our comprehensive inpatient rehabilitation wards. Decision tree analysis was performed in which motor subscore of the Functional Independence Measure (FIM-M) at discharge was set as the target variable. Distribution of the verticality item of the Stroke Impairment Assessment Set, age, and the cognitive subscore of the FIM were calculated for every score of the FIM-M on admission. The FIM-M gain was compared by stratifying trunk function, age, and FIM cognitive subscore with certain ranges of the FIM-M on admission.

Results: The FIM-M at discharge and the FIM-M gain were significantly low (p<0.05) in patients with decreased trunk function and low ADL score on admission. Both were significantly low (p<0.05) in patients with relatively wide-ranged ADL scores in elderly patients whose age was 68 years or older, and also significantly low (p<0.05) in low cognitive function patients who needed moderate or severe assistance.

Conclusion: These results demonstrated that the influence of inhibitive factors is not uniform but instead differs according to degree of ADL level on admission.

Sato H, Kuniyasu K, Kobara K, Okada Y, Kawashima T, Shinonaga A, Yamamoto S, Yasunaga M, Hanayama K. Verification of the accuracy of measuring the muscle cross-sectional area and muscle intensity of the rectus femoris using ultrasonography. Jpn J Compr Rehabil Sci 2018; 9: 66-72.

Objective: This study aimed to establish ultrasonography as a method of measuring the muscle cross-sectional area and muscle intensity of the rectus femoris and to assess its measurement accuracy.

Methods: Three testers measured the muscle cross-sectional area and muscle intensity of the rectus femoris using ultrasonography in 16 healthy male volunteers. Intra-rater and inter-rater reliabilities were evaluated using the intraclass correlation coefficient (ICC), and Bland-Altman (B-A) analysis was used to confirm the systematic error and measure the minimum detectable change.

Results: Intra-tester and inter-tester ICCs of the muscle cross-sectional area and muscle intensity were ≥0.9 and ≥0.7, respectively. On B-A analysis, no systematic error was observed in each measurement. The minimum testable changes were 0.39 cm² for the intra-tester cross-sectional area, 0.15 cm² for the inter-tester cross-sectional area, 6.77 for the intra-tester intensity, and 4.47 for the inter-tester intensity.

Conclusion: The muscle cross-sectional area and muscle intensity of the rectus femoris can be measured with high accuracy using this measurement method. In addition, changes larger than the minimum detectable change can be used as a true change in clinical efficacy assessments.