Objective: Improvement in a subject’s motor function is clinically evaluated by comparing measurements of the motor function tests taken before and after an intervention. Consequently, it is important to increase the accuracy of the determination of the intervention effect by confirming the minimal detectable change (MDC), which is an index representing the limits of measurement errors in motor function tests. This study aimed to examine the MDC of the five-time sit-to-stand test (FTSST) and the 5-m walk test (5mWT) in patients with knee osteoarthritis (OA). Methods: In this cross-sectional study, 83 patients (63 women and 20 men, mean age: 73.7±8.0 years) with knee OA were subjected to two trials of the FTSST and 5mWT. The maximum walking speed was calculated using the walking time in the 5mWT, and the intraclass correlation coefficients (ICCs) were determined. Results: The ICCs (1,1) of the FTSST, the walking time in the 5mWT, and the walking speed were 0.90, 0.83, and 0.81, respectively. The MDC₉₅ for the FTSST time, walking time in the 5mWT, and walking speed were 1.71 s, 0.99 s, and 0.36 m/s, respectively. Conclusion: If the observed changes in the motor function tests exceed 1.71 s for FTSST time, 0.99 s for walking time in the 5mWT, or 0.36 m/s for walking speed, then an improvement in function is indicated. Such an improvement would reflect the effectiveness of the intervention. These findings may aid in clinical decision making when using motor function tests in patients with knee OA.

Introduction: Although patients commonly experience psychological disorders such as depression following cerebrovascular events, mania is extremely rare. Here we present a patient who experienced secondary mania while being hospitalized in a convalescent rehabilitation ward following cerebral infarction. Case: The patient was a 70-year-old man who was hospitalized at our hospital for convalescent rehabilitation after suffering mild right hemiplegia and higher brain dysfunction following cerebral infarction. During hospitalization, the patient experienced a progression-free course. Upon awakening on day 26 after hospitalization, the patient suddenly showed signs of mania. The symptoms included elevated mood, pressured speech, hyperactivity, insomnia, and agitation; these symptoms caused problems in his daily life at the hospital. On day 29 after hospitalization, the patient was referred to a psychiatric hospital as an outpatient. He was diagnosed with organic manic disorder and was hospitalized. The patient was administered lithium carbonate (Limas^®; 400 mg daily) and risperidone (Risperdal^®; 2 mg daily). Because the mania persisted for more than 1 week, he was diagnosed with secondary mania. His manic state gradually improved, and he was transferred to our hospital. He was able to undergo rehabilitation without any problem and with no exacerbation of mania. The patient was discharged on day 139 after readmission. Discussion: In cases where patients with cerebrovascular disorders display abnormal behavior, it becomes necessary to differentiate between secondary mania and social behavior disorder. Because mania has a negative impact on the patient’s hospitalization and convalescence, if secondary mania is suspected, early consideration of psychiatric treatment is required.

Background: Dysphagia occurs often after oral cancer surgery. However, no case of dysphagia in combination with cerebral hemorrhage, tongue defect, and sarcopenia has been reported. We describe the case of a 70-year-old man with dysphagia associated with a cerebral hemorrhage, tongue defect, and sarcopenia who received rehabilitation nutrition and underwent glottal closure. Case: At age 48 years, the patient had the left part of his tongue removed because of cancer. Twenty-two years later, he developed dysphagia and right hemiplegia after a cerebral hemorrhage. The patient was diagnosed with sarcopenia based on a low left handgrip strength (10 kg) and reduced calf circumference (26.5 cm). The patient’s Functional Oral Intake Scale (FOIS) score was 1, and his tongue muscle mass indicated atrophy, making the maximum tongue pressure difficult to measure. Palatal augmentation prostheses (PAP) were made to increase swallowing and tongue pressures, and nutritional intake was changed from nasal tube feeding to a gastric fistula. Nutritional intake was increased to 2400 kcal/day and protein intake to 96 g/day. Although rehabilitation nutrition using PAP improved the patient’s nutritional status, the dysphagia did not improve, and therefore he underwent glottal closure. This resulted in a weight gain of 13.7 kg and increased tongue muscle strength and volume. The patient’s FOIS score increased to 7 (i.e., total oral diet with no restrictions) at 5 months after discharge. Discussion: Glottic closure surgery may be useful for improving oral ingestion, nutritional status, and activities of daily living.

Background: Dysphagia occurs often after oral cancer surgery. However, no case of dysphagia in combination with cerebral hemorrhage, tongue defect, and sarcopenia has been reported. We describe the case of a 70-year-old man with dysphagia associated with a cerebral hemorrhage, tongue defect, and sarcopenia who received rehabilitation nutrition and underwent glottal closure. Case: At age 48 years, the patient had the left part of his tongue removed because of cancer. Twenty-two years later, he developed dysphagia and right hemiplegia after a cerebral hemorrhage. The patient was diagnosed with sarcopenia based on a low left handgrip strength (10 kg) and reduced calf circumference (26.5 cm). The patient’s Functional Oral Intake Scale (FOIS) score was 1, and his tongue muscle mass indicated atrophy, making the maximum tongue pressure difficult to measure. Palatal augmentation prostheses (PAP) were made to increase swallowing and tongue pressures, and nutritional intake was changed from nasal tube feeding to a gastric fistula. Nutritional intake was increased to 2400 kcal/day and protein intake to 96 g/day. Although rehabilitation nutrition using PAP improved the patient’s nutritional status, the dysphagia did not improve, and therefore he underwent glottal closure. This resulted in a weight gain of 13.7 kg and increased tongue muscle strength and volume. The patient’s FOIS score increased to 7 (i.e., total oral diet with no restrictions) at 5 months after discharge. Discussion: Glottic closure surgery may be useful for improving oral ingestion, nutritional status, and activities of daily living.

Background: Sarcopenic dysphagia is caused by decreased muscle mass and muscle weakness in the swallowing muscles that occurs because of sarcopenia. The key to treating sarcopenic dysphagia is combined therapy with rehabilitation and aggressive nutrition management. However, to our knowledge, no studies based in a home medical care setting have yet been published. Case: A 72-year-old man with Parkinson’s disease developed sarcopenia and possible sarcopenic dysphagia during hospitalization for drug adjustment. At discharge, the patient’s body weight was 39.0 kg (−33.8%/4 months, body mass index: 15.3 kg/m²), the Barthel Index was 45, Functional Oral Intake Scale was level 4, and Dysphagia Severity Scale was 4. Sarcopenia was confirmed by a calf circumference of 23.8 cm, a handgrip strength of 22 kg, and a gait speed of 0.5 m/s. The patient was diagnosed with sarcopenic dysphagia, according to the consensus diagnostic criteria for sarcopenic dysphagia. After the patient was discharged, he underwent a combination of dysphagia rehabilitation, daily activity training, and aggressive nutrition management, which started from 1200 kcal/day and reached a maximum of 2800 kcal/day. Four months after discharge, the patient’s swallowing function returned to normal (Functional Oral Intake Scale: 7, Dysphagia Severity Scale: 6) and his weight increased by 31% (body mass index: 20.1 kg/m²). Increases in muscle mass (calf circumference: 32 cm), muscle strength (handgrip strength: 34 kg), physical function (gait speed: 1 m/s), and activities of daily living (Barthel Index: 90) indicated recovery from sarcopenia. Discussion: Sarcopenic dysphagia may be a complication of Parkinson’s disease, and home-based combined therapy with rehabilitation and aggressive nutrition management may be effective for treating this condition.

Background: Giant cell myocarditis (GCM) is a rare inflammatory heart disease that, left untreated, rapidly progresses and is fatal without transplantation. Most patients with GCM die of congestive heart failure, but some survive for long periods, often after receiving immunosuppressive therapy. Although rehabilitation is crucial for improving activities of daily living (ADL) after discharge, no reports are available on the rehabilitation of patients with GCM. Here, we report the case of an elderly patient with GCM who was hospitalized for rehabilitation in the recovery phase. Case: The patient was a 78-year-old woman who was hospitalized because of the exacerbation of chronic heart failure. She was diagnosed with GCM based on the histological findings. The patient was administered immunosuppressive therapy, and intra-aortic balloon pumping, percutaneous cardiopulmonary support, and artificial respiration were performed. Cardiac function gradually improved, and the patient was transferred to our hospital for convalescent rehabilitation. Rehabilitation, including calisthenics, upper and lower limb resistance training, walking, and endurance exercise on a bicycle ergometer, improved the patient’s physical function, ADL, and cardiac function. Discussion: Rehabilitation was safely and effectively conducted in a patient with GCM. This single report might be considered inadequate for ascertaining the efficacy of rehabilitation for patients with GCM, but it could be used as a reference when considering rehabilitation for other GCM patients.

Objective: We set out to examine the effectiveness of early rehabilitation for maintaining mobility status during hospitalization in elderly patients with heart failure. Methods: Using the Japanese Diagnosis Procedure Combination inpatient database, we retrospectively examined the eligibility of 527,440 consecutive patients aged ≥60 years who were diagnosed with heart failure with New York Heart Association class ≥ II at admission between July 2010 and March 2014. Of the 146,735 eligible subjects, 39,357 underwent early rehabilitation and 107,378 underwent non-early rehabilitation. Early rehabilitation was defined as rehabilitation starting within 3 days after admission. A multivariable logistic regression analysis and an instrumental variable analysis were carried out to examine the association of early rehabilitation with changes in mobility status during hospitalization. Results: The proportion of heart failure patients with maintained or improved mobility status during hospitalization was higher in the early rehabilitation group. Multivariable logistic regression analysis revealed that the early rehabilitation group had a significantly higher proportion with maintained or improved mobility status (odds ratio, 1.32; 95% confidence interval, 1.21–1.43; P<0.001). The instrumental variable analysis showed that early rehabilitation was associated with an increased proportion of patients with maintained or improved mobility status (risk difference, 0.8%; 95% confidence interval, 0.4%–1.1%; P<0.001). Conclusions: The present study suggests that early rehabilitation is associated with an increase in the proportion of patients with maintained or improved mobility status compared with non-early rehabilitation in elderly inpatients with heart failure.

Objective: The ability to walk is one of the most important basic functional activities of daily living, and the number of patients with walking disability who need rehabilitation is increasing worldwide. The purpose of this first-in-man study was to evaluate the safety and feasibility of an off-label, tailor-made, dual-task rehabilitation program for body trunk balance using the mediVR01 system (mediVR, Inc. Osaka, Japan), which incorporates virtual reality (VR) and three-dimensional tracking technologies. Methods: We prospectively enrolled 31 healthy volunteers to take part in the trial (Trial Registration UMIN000029659). After an assessment of body trunk balance, a tailor-made, dual-task, rehabilitation training program lasting 10–15 min was provided. The primary endpoint was the postprocedural number of simulator sickness questionnaire (SSQ) symptoms. The secondary endpoints were adverse events and satisfaction with the program. Results: The median age of participants was 68 years, with 67.7% being elderly (>65 years) and 54.8% being male. The number of SSQ symptoms immediately after the rehabilitation programs significantly increased from 0 (interquartile range 0–0) to 0 (0–1.5) (P=0.009), with a significant difference between the young and elderly participants (P-interaction<0.001). The most frequent symptom was sweating (22.6%), followed by fatigue (19.4%). All participants successfully completed the rehabilitation programs without significant adverse events such as fall or injuries. Moreover, all participants considered the VR rehabilitation programs to be enjoyable, and 93.5% of participants reported a sense of achievement. Group attendance was associated with higher levels of satisfaction (P=0.049). Conclusion: The tailor-made, dual-task rehabilitation training programs for body trunk balance using VR and three-dimensional tracking technologies were safe and feasible even for elderly participants.

Objective: The objective of the current study was to evaluate the reliability and validity of the Japanese version of the Mini-Balance Evaluation Systems Test (J-Mini-BESTest) in patients with subacute stroke. Methods: Eighteen patients who had suffered a first hemiplegic stroke (mean age, 59.1 ± 27.0 years) and had been admitted to convalescent rehabilitation wards were enrolled. The J-Mini-BESTest, the Berg Balance Scale (BBS), and the functional reach test (FRT) were used to assess balance. Four physical therapists (PTs) observed and scored the J-Mini-BESTest while another PT conducted the test. The interrater reliability of the J-Mini-BESTest was assessed using intraclass correlation coefficients (ICC[2,1]) for the total and section scores, and kappa statistics for each item. Internal consistency of the five raters was assessed using Cronbach’s alpha. Concurrent validity of the J-Mini-BESTest was assessed against the BBS and FRT using Spearman’s correlation coefficients. Results: The ICC[2,1] of the total and section scores were 0.90 (95% confidence interval: 0.81–0.95) and 0.63–0.85, respectively. Cronbach’s alphas were 0.80–0.87. The kappa statistics were 0.47–1.00. The scores of the J-Mini-BESTest were significantly correlated with those of the BBS (rho=0.66, p=0.006) but not with those of the FRT (rho=–0.36, p=0.189). Conclusion: The J-Mini-BESTest showed excellent inter-rater reliability and internal consistency. Although the J-Mini-BESTest was not correlated with the FRT, it was significantly correlated with the BBS. The J-Mini-BESTest is a reliable and valid tool for evaluating dynamic balance in patients with subacute stroke.

Background: Only a few researchers have therapeutically applied transcranial magnetic stimulation (TMS) for patients with spinal cord injury. The purpose of this case study was to evaluate the safety, feasibility, and efficacy of therapeutic TMS combined with rehabilitative training for a patient with tetraparesis resulting from incomplete spinal cord injury. Case: An 82-year-old male patient with incomplete spinal cord injury was admitted to our department for long-term rehabilitation. Eighteen days prior to admission, the patient sustained the injury in a fall. At admission to our department, the patient was diagnosed as having injury of the spinal cord at the C6 level. From the 76th day after admission, when the patient was considered to have attained a plateau state of recovery, application of therapeutic TMS was initiated using a double-cone coil. Two 15-min sessions of 10-Hz TMS were scheduled for daily application. Simultaneously, rehabilitative training was continuously provided. This patient received a total of 30 sessions of TMS over 19 days. Neither adverse effects nor deterioration of neurological symptoms was recognized during the intervention period. With this application of TMS, some improvements were evident in the American Spinal Injury Association motor score, the knee muscle strength, and the calf circumference. Discussion: This case study demonstrated the safety and feasibility of TMS combined with rehabilitative training in a patient with incomplete spinal cord injury. Our protocol featuring TMS might constitute a novel neurorehabilitation intervention for such patients; however, the efficacy of the protocol should be confirmed in a large number of patients.

Objective: Gender differences in scapular kinematics during arm elevation have been reported. Because women wear brassieres (bras) daily, their scapular motion may be restricted by the garment; however, the influence of bra wearing on this motion has not been reported. Therefore, using a three-dimensional electromagnetic tracking device, we investigated the influence of bra wearing on shoulder kinematics during arm elevation. Methods: The subjects were 19 healthy women, and the shoulder on the dominant side was evaluated. Subjects performed scapular plane arm elevation while wearing or not wearing bras. Kinematic data were recorded using an electromagnetic tracking device. The glenohumeral elevation angle, scapular upward and internal rotation angles, and the posterior tilt angle were determined from the recorded data. The angles were calculated at 20°–120° arm elevation, and the data were compared between the two conditions. Results: The scapular upward and internal rotation angles and the posterior tilt angle were significantly smaller with the subjects wearing bras than not wearing bras. In contrast, the glenohumeral elevation angle was significantly greater when bras were warn. Conclusions: Bra wearing may influence shoulder kinematics. Consequently, great care should be taken to account for this factor during the evaluation of kinematics in female subjects.

Objective: The intensity of pain after surgical treatment of hip fracture has a negative effect on functional recovery. However, the effects of acute postoperative pain on the recovery of walking ability after the surgery remain unclear. This study aimed to investigate the association between acute postoperative pain and the recovery of functional gait among patients who had independent walking ability prior to hip fracture. Methods: This was an observational study that included 41 patients with a mean age of 81.3±7.3 years who underwent surgical treatment for traumatic hip fracture at a general hospital. The primary outcome was the time to recovery of independent gait postsurgery. Based on the median time to recovery, patients were classified into an early independent walking group and an independent walking group. Stepwise logistic regression analysis was performed to identify predictive factors of the time to recovery of independent walking. Results: The median time to recovery of independent gait was 24 days (range, 7–50 days). In total, 20 patients were classified in the early independent walking group and 21 in the independent walking group. On logistic regression analysis, the total pain intensity, reported during activities of daily living (ADL) on postoperative days 5 and 6, and the knee extensor strength were predictive of the time to recovery of independent walking. Conclusions: The degree of recovery of gait function of patients surgically treated for hip fracture was found to be predicted by the pain intensity measured during ADL and the knee extensor strength assessed in the acute phase. Effective management of acute pain after surgical treatment of hip fracture may help improve functional recovery of gait.

Objective: The aim of our study was to investigate how systemic inflammation relates to sarcopenia and its impact on functional outcomes in the recovery stages of stroke. Methods: A retrospective cohort study was performed in consecutive patients admitted to convalescent rehabilitation wards following stroke. Patients with acute or chronic high-grade inflammatory diseases were excluded. Systemic inflammation was evaluated using the modified Glasgow Prognostic Score (mGPS). Sarcopenia was defined as a loss of skeletal muscle mass and decreased muscle strength, with the cut-off values set by the Asian Working Group for Sarcopenia. The primary outcome was the motor domain of the Functional Independence Measure (FIM-motor). Univariate and multivariate analyses were used to determine whether mGPS was associated with sarcopenia and FIM-motor at discharge. Results: The study included 204 patients (mean age 74.1 years, 109 men). mGPS scores of 0, 1, and 2 were assigned to 149 (73.0%), 40 (19.6%), and 13 (6.4%) patients, respectively. Sarcopenia was diagnosed in 81 (39.7%) patients and was independently associated with stroke history (odds ratio [OR] 1.890, P=0.027), premorbid modified Rankin scale (OR 1.520, P=0.040), body mass index (OR 0.858, P=0.022), and mGPS score (OR 1.380, P=0.021). Furthermore, the mGPS score was independently associated with sarcopenia (OR 1.380, P=0.021) and FIM-motor at discharge (β=−0.131, P=0.031). Conclusion: Systemic inflammation is closely associated with sarcopenia and poor functional outcomes in the recovery stage of stroke. Early detection of systemic inflammation and sarcopenia can help promote both adequate exercise and nutritional support to restore muscle mass and improve post-stroke functional recovery.

Background: Acute lithium intoxication is associated with neurological manifestations such as tremor, ataxia, dysarthria, seizures, and in more severe cases encephalopathy and coma; patients experiencing such manifestations require rehabilitation. The authors present a patient who received post-acute rehabilitation for lithium toxicity-associated ataxia. Case: The patient was a man aged 30 years who had been diagnosed with bipolar disorder more than 10 years ago and had been prescribed lithium carbonate by a psychiatrist. The patient was admitted to the hospital with disturbance of consciousness, and physical therapy began on day 6 of hospitalization. Occupational therapy and speech therapy began on day 15. Physical therapy interventions focused on improving balance and coordination, and occupational therapy focused on improving stability while sitting, upper extremity control, and activities of daily living to improve the Functional Independence Measure motor subscale score. Speech therapy focused on dysarthria. On day 27 of hospitalization, the patient was able to walk 5 m with two Lofstrand crutches and could feed himself without assistance. From day 15 to day 30 of hospitalization, the Scale for the Assessment and Rating of Ataxia score improved from 28 to 19, and the Functional Independence Measure score increased from 25 to 77. On day 31, the patient was discharged to a convalescent rehabilitation hospital. Discussion: Post-acute rehabilitation for ataxia caused by acute lithium toxicity may improve ataxia and the ability to perform activities of daily living, and therefore may be of benefit.

Objective: The present study examined the association between early rehabilitation for mechanically ventilated intensive care unit (ICU) patients and oral ingestion. Method: Among 1055 consecutive patients who were transported to the study facility via ambulance, newly admitted to the ICU, and treated with rehabilitation during hospitalization, 234 were included in the current study. The patients were allocated to early rehabilitation and control groups to retrospectively examine the proportion able to orally ingest three meals per day, the period needed to achieve such independence, and course-related factors. Results: A total of 77 matched pairs were selected using propensity score matching. Analysis using the Kaplan–Meier estimator revealed that the early rehabilitation group needed a markedly shorter period to achieve oral ingestion of three meals per day. There were significant differences between the groups in the periods from hospital admission to first physical therapy and to mobilization as well as differences in the frequency of delirium. Conclusion: Early rehabilitation for mechanically ventilated ICU patients may facilitate earlier mobilization. It may also shorten the period needed to achieve oral ingestion of three meals per day by preventing complications such as delirium.

Objective: This study was conducted to clarify the ground reaction force exerted on the foot during athletic movements and to demonstrate the effects of reach balance training (RB-T) on toe grip strength as an injury prevention exercise. Methods: RB-T was undertaken for 2 weeks by 11 male college basketball players and 22 healthy male college students (including 10 participants in the control group). The vertical ground reaction forces during athletic movements were measured using ground reaction force meters. Before and after RB-T intervention, toe grip strength was measured with a toe grip strength meter, and distances of the center of pressure (COP) to the center of the foot during movement were measured using a three-dimensional motion analyzer. Results: The vertical ground reaction force during athletic movement was highest during take-off and decreased in the following order: single-leg front landing, single-leg lateral landing, and turning. The toe grip strength of the BT group and the T group increased after RB-T intervention. For the BT group, RB-T also tended to decrease the COP lateral distance on turning in the dominant leg and the COP front distance on turning and take-off in both legs. Conclusion: RB-T could improve the toe grip strength and stabilize the COP position.

Objective: The aim of the current study was to examine the relationship between the straight leg raising (SLR) repetition count and both the knee extension strength (KES) and walking independence. Methods: We enrolled 106 inpatients aged ≥20 years with collagen disease in a cross-sectional study. We measured the SLR repetition count, KES, and walking independence of each participant. The correlations between the SLR repetition count and KES/walking independence were then examined. Furthermore, patients were divided into three groups depending on their SLR repetition count (low, medium, or high), and the differences among the groups were analyzed. Results: A moderately significant correlation was found between the SLR repetition count and KES (right: r=0.46, P<0.01; left: r=0.55, P<0.01). Moreover, there was a strong correlation between the maximum SLR repetition count and walking independence (r=0.74, P<0.01). Differences in KES and walking independence were observed among the SLR repetition groups (P<0.01). KES and walking independence in the group with a low repetition count were 0.08±0.04 kgf/kg and 1 (1–4) point, whereas the values in the group with a medium repetition count were 0.25±0.08 kgf/kg and 5 (1–7) points and those in the group with a high repetition count were 0.40±0.13 kgf/kg and 7 (4–7) points. Conclusion: The SLR repetition count is related to KES and walking independence. SLR repetition counts can be used in the clinical setting for the assessment of lower limb strength and walking independence.

Background: Sternocleidomastoid anomalies are mostly discovered in cadavers during routine dissection. Such anomalies causing torticollis are rare in adults. We report a case of accessory mid-clavicular head of the sternocleidomastoid causing torticollis in an adult. Case: A previously healthy 27-year-old man presented with neck and shoulder pain following heavy manual work. On examination, he had mild restriction of left tilt of the head and right rotation of the neck. Palpation revealed a bipartite right sternocleidomastoid. There was no abnormal posturing of other body parts. The range of motion of the cervical spine was limited to rotation of 70° and tilt of 38° on the left side and rotation of 65°and tilt of 46° on the right side. Neck extension was 40°. The accessory sternocleidomastoid muscle belly was visible and inserted at the middle of the clavicle. Musculoskeletal ultrasound imaging confirmed the diagnosis. Radiological images of the cervical spine and electromyography were normal. Myectomy of the lateral accessory clavicular belly of the sternocleidomastoid was planned, but the patient declined this treatment. Currently, he uses oral analgesics and participates in occasional sessions of physical therapy. Discussion: An accessory sternocleidomastoid can result in torticollis because it causes a physical restriction preventing the neck from tilting and rotating to the opposite side. In mild cases, the anomaly may remain undiagnosed until adulthood and can be confused with cervical dystonia and fibromatosis colli. Knowledge of the anatomy and possible variants of the sternocleidomastoid muscle is of the utmost importance to medical practitioners involved in the diagnosis and management of problems in the neck area. Variants of the sternocleidomastoid can be a concern for surgeons, physicians, and anesthetists performing interventional procedures on the neck because of possible confusion of anatomical landmarks.

Objective: We developed a rehabilitation robot to assist hemiplegics with gait exercises. The robot was combined with functional electrical stimulation (FES) of the affected side and was controlled by a real-time-feedback system that attempted to replicate the lower extremity movements of the non-affected limb on the affected side. We measured the reproducibility of the non-affected limb movements on the affected side using FES in non-disabled individuals and evaluated the smoothness of the resulting motion. Method: Ten healthy men participated in this study. The left side was defined as the non-affected side. The measured hip and knee joint angles of the non-affected side were reproduced on the pseudo-paralytic side using the robot’s motors. The right quadriceps was stimulated with FES. Joint angles were measured with a motion capture system. We assessed the reproducibility of the amplitude from the maximum angle of flexion to extension during the walking cycle. The smoothness of the motion was evaluated using the angular jerk cost (AJC). Results: The amplitude reproduction (%) was 87.9 ± 6.2 (mean ± standard deviation) and 71.5 ± 10.7 for the hip and knee joints, respectively. The walking cycle reproduction rate was 99.9 ± 0.1 and 99.8 ± 0.2 for the hip and knee joints, respectively. There were no statistically significant differences between results with FES versus those without FES. The AJC of the robot side was significantly smaller than that of the non-affected side. Conclusions: A master–slave gait rehabilitation system has not previously been attempted in hemiplegic patients. Our rehabilitation robot showed high reproducibility of motion on the affected side.

Background: We report a rare case of calcific tendinopathy in the posterior tibial tendon (PTT) at the navicular insertion. Case: Conservative treatments other than extracorporeal shock wave therapy (ESWT) were ineffective. Calcium deposition disappeared from the PTT on plain radiographs at 6 months after ESWT. Discussion: In this case, a 14-year-old boy with calcific tendinopathy of the PTT who had not benefited from conservative treatments was effectively treated using ESWT.

Objective: This study examined the risk factors in the early rehabilitation therapy of critically ill patients with weakness acquired in an intensive care unit and the impact of this therapy on walking independence after discharge from the hospital. Method: Of the 764 consecutive patients transported to the study facilities by ambulance, newly admitted to the intensive care unit (ICU), and treated with rehabilitation during hospitalization, 88 were included in this study after eliminating those who met a detailed list of exclusion criteria. To retrospectively examine the rate of walking independence and the effect of differing durations of rehabilitation activity, the study patients were divided into two groups: those with ICU-acquired weakness (AW) and those without ICU-acquired weakness (non-ICU-AW) on discharge from the ICU. Results: Analysis using the Kaplan–Meier estimator revealed that the non-ICU-AW group needed a markedly shorter period to achieve walking independence. In terms of the rehabilitation activities performed in the ICU, both in-bed exercises and the total duration of rehabilitation activity were significantly shorter in the ICU-AW group than in the non-ICU-AW group. Conclusion: The two groups were compared, and the amount of daily activity time significantly influenced the quality of patient outcome.

Objective: Patients with chronic pain often have symptoms similar to neuropathic pain (NeP). Such symptoms are also frequently observed in people with knee osteoarthritis (OA). However, pain quality may be related to psychological problems such as high pain catastrophizing and/or low self-efficacy. The objective of the current study was to investigate whether pain quality is associated with pain catastrophizing and self-efficacy in individuals with symptomatic knee OA. Methods: This was a cross-sectional study in which 50 subjects with symptomatic knee OA were enrolled. NeP scores were evaluated using the painDETECT questionnaire (PDQ), the pain catastrophizing scores were evaluated using the coping strategy questionnaire, and the self-efficacy scores were evaluated using the self-efficacy scale for rheumatoid arthritis (SERA). Participants were classified as members of the unlikely NeP group (PDQ score ≤12) or the uncertain/likely NeP group (PDQ score >12). The pain catastrophizing scores and the self-efficacy scores were compared between the two groups. Results: Of the 50 participants, 17 (34%) were classified in the uncertain/likely NeP group. The pain catastrophizing score was higher for the uncertain/likely NeP group than for the unlikely NeP group (P=0.03). On the SERA scale, the self-efficacy for pain score was lower for the uncertain/likely NeP group than for the unlikely NeP group (P=0.03). Conclusion: High pain catastrophizing and low self-efficacy for pain control are significantly associated with the existence of an NeP component on PDQ in people with symptomatic knee OA.

Objective: To investigate (1) the concurrent validity of the Nursing Home Life-Space Diameter (NHLSD) and the Home-based Life-Space Assessment (Hb-LSA), (2) the correlated factors of life-space, and (3) the factors that affected the NHLSD score for the elderly in a geriatric health service facility, or Roken. Methods: This cross-sectional study included 32 participants in a Roken. Staff members, who had received essential guidance for assessment, examined the cognitive function, physical function, mood, communication ability, objective quality of life, vitality, and daily behavior of the participants. Correlation analysis between NHLSD and other measurements and multiple regression analysis with NHLSD as a dependent variable were conducted. Results: NHLSD and Hb-LSA were significantly correlated (r=0.710, P<0.01). NHLSD was significantly correlated with more measurements than Hb-LSA was; i.e., NHLSD was significantly correlated with communication ability, independence of daily living (Barthel Index; BI), maximum knee extension strength, grip strength, function in daily living, and three QOL measurements: positive affects, ability to communicate, and spontaneity and activity. A stepwise multiple regression analysis indicated that the BI total score, the maximum knee extension strength, and spontaneity and activity (one of the QOL items) were significantly correlated with the NHLSD score. Conclusions: NHLSD can measure the mobility levels of elderly persons in Roken. In addition to physical conditions and dependence of ADLs, spontaneity (or low levels of apathy) may be an important factor for promoting physical activity in Roken.