Progress in Rehabilitation Medicine
Online ISSN : 2432-1354
ISSN-L : 2432-1354
Current issue
Displaying 1-27 of 27 articles from this issue
  • Maki Itokazu, Yuji Higashimoto, Masami Ueda, Kazushi Hanada, Saori Mur ...
    2022 Volume 7 Article ID: 20220027
    Published: 2022
    Released on J-STAGE: May 18, 2022
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    Objectives: Advances in cancer treatment have led to extended survival, and, as a result, the number of patients with bone metastases is increasing. Activities of daily living (ADL) decrease with bone metastasis and the need for rehabilitation is increasing. This study examined the effects of rehabilitation in patients with bone metastases.

    Methods: We retrospectively reviewed data of cancer patients with bone metastasis who received rehabilitation between 2016 and 2018. Efficacy of rehabilitation was evaluated in 92 patients as the change in the Functional Independence Measure (FIM) score divided by rehabilitation days (FIM change/day) and assessed by different metastatic sites.

    Results: Overall FIM scores significantly improved after rehabilitation. Moreover, FIM change/day improved in patients with pelvic metastases (n=44) more than in patients with other metastatic sites (n=48) (P=0.015). In FIM motor components, improvements in toilet, tub/shower, walk/wheelchair, and stairs were significantly greater in patients with pelvic metastasis than in those with other metastasis sites.

    Conclusions: Rehabilitation improved ADL status to a greater extent in patients with pelvic metastases than in those with other metastasis sites. Patients with pelvic metastases may fear fractures, limiting their ADL, but rehabilitation could eliminate this fear and improve FIM.

  • Teruhito Yoshitaka, Yasunori Shimaoka, Issei Yamanaka, Akira Tanida, J ...
    2022 Volume 7 Article ID: 20220026
    Published: 2022
    Released on J-STAGE: May 18, 2022
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    Objectives: Hip fracture is a common injury occurring in elderly people and often impairs their activities of daily living (ADL). This study aimed to identify and analyze factors associated with ADL following hip fracture treatment.

    Methods: A total of 371 consecutive patients with hip fractures who were surgically treated in our hospital were enrolled. Among these, 103 patients who underwent acute- to recovery-phase postoperative rehabilitation at our hospital and whose motor scale of the functional independence measure (mFIM) score was ≥70 before the fracture were finally included in this study. Single and multiple regression analyses were performed to identify the factors correlated with ADL. The mFIM at hospital discharge was set as the outcome variable, and various clinical factors, such as fracture type, surgical technique, serum and biological data, mini-mental state examination (MMSE) score, and serial mFIM scores, were used as explanatory variables.

    Results: Only MMSE and preinjury mFIM scores were significantly correlated with mFIM at discharge, and MMSE had the larger effect on the outcome. Receiver operating characteristic curve analysis revealed an MMSE cutoff value of 20/21. Patients with an MMSE score of ≤20 showed a relatively poor recovery of mFIM from 2–3 weeks postoperatively compared with those with an MMSE score of ≥21.

    Conclusion: Cognitive impairment and the preinjury ADL level were correlated with short-term ADL outcomes following hip fracture. Cognitive impairment was the most important factor affecting ADL; treatment and postoperative rehabilitation should be carefully considered for cognitively disturbed patients from the acute phase after hip fracture.

  • Yoshihiro Yoshimura, Ayaka Matsumoto, Ryo Momosaki
    2022 Volume 7 Article ID: 20220025
    Published: 2022
    Released on J-STAGE: May 14, 2022
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    Pharmacotherapy is important in older patients undergoing rehabilitation because such patients, especially those with frailty and physical disabilities, are susceptible to drug-related functional impairment. Drug-related problems include polypharmacy, potentially inappropriate medications (PIMs), and potential prescription omissions. These problems are associated with adverse drug events such as dysphagia, depression, drowsiness, falls and fractures, incontinence, decreased appetite, and Parkinson’s syndrome, leading to impaired improvement in activities of daily living (ADL), quality of life (QOL), and nutritional status. Moreover, the anticholinergic burden is associated with impaired physical and cognitive functions. Therefore, pharmacist-centered multidisciplinary pharmacotherapy should be performed to maximize rehabilitation outcomes. Pharmacotherapy includes a review of all medications, the assessment of drug-related problems, goal setting, correction of polypharmacy and PIMs, monitoring of drug prescriptions, and reassessment of drug-related problems. The goal of pharmacotherapy in rehabilitation medicine is to optimize drug prescribing and to maximize the improvement of ADL and QOL as patient outcomes. The role of pharmacists during rehabilitation is to treat patients as part of multidisciplinary teams and as key members of nutritional support teams. In this review, we aim to highlight existing evidence regarding pharmacotherapy in older adults, including drug-related functional impairment and the association between pharmacotherapy and functional, cognitive, and nutritional outcomes among patients undergoing rehabilitation. In addition, we highlight the important role of pharmacists in maximizing improvements in rehabilitation outcomes and minimizing drug-related adverse effects.

  • Kaori Muraoka, Yoshiyuki Takimoto, Eisuke Nakazawa, Tetsuya Tsuji, Mei ...
    2022 Volume 7 Article ID: 20220024
    Published: 2022
    Released on J-STAGE: May 13, 2022
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    Objectives: The purposes of the present study were to describe stroke survivors’ experiences and to identify their support needs when faced with decisions about rehabilitation.

    Methods: Based on the Ottawa Decision Support Framework needs assessment, semi-structured interviews were conducted with 15 stroke survivors. The degree of participation in decision-making and anxiety were assessed quantitatively. All interview transcripts describing their experiences and emotions were qualitatively analyzed.

    Results: All participants had hemiplegia but could perform their daily activities unassisted. Most participants played an active role in decision-making, but 13 patients felt some anxiety when choosing chronic-phase rehabilitation programs. Qualitative analysis identified 19 codes, of which 13 were categorized into the four factors of knowledge, values, certainty, and support. The codes related to patient feelings of anxiety and insecurity about making decisions were “lack of information about options,” difficulty in “selecting appropriate information,” and “lack of support” from medical staff. Trustworthy specialist support and prior knowledge of rehabilitation were identified as factors that could help patients feel more secure about making decisions.

    Conclusions: To support stroke survivors in their decision-making about rehabilitation, each patient should be given a long-term perspective on stroke rehabilitation and sufficient information on rehabilitation options tailored to their individual needs. Decision aids for stroke survivors built on these findings will be used in clinical practice, and their efficacy will be verified in future studies.

  • Kensuke Matsuda, Takashi Ariie, Ryota Okoba, Nozomi Hamachi, Akari Suz ...
    2022 Volume 7 Article ID: 20220023
    Published: 2022
    Released on J-STAGE: May 12, 2022
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    Objectives: This cross-sectional study sought to examine gender dissimilarities in factors and structures associated with life-space mobility (LSM) in community-dwelling older people.

    Methods: This study included a total of 294 older people living in Okawa, Fukuoka Prefecture, Japan. The subjects’ body mass index (BMI) and skeletal muscle mass index (SMI) were evaluated. Furthermore, the age, gender, and LSM of the participants were assessed. LSM was assessed using a framework based on social isolation, fall self-efficacy, mobility, cognitive function, and lower limb muscle strength. Path analysis was performed to assess LSM-associated factors and their respective effect sizes (ESs), and male and female LSM models were established.

    Results: Path analysis identified SMI and social isolation as direct factors and cognitive function as an indirect factor associated with LSM in both men and women. In the male LSM model, the direct factors in descending order of ES were BMI, social isolation, SMI, and lower limb muscle strength. In the female model, the direct factors in descending order of ES were age, fall self-efficacy, mobility, social isolation, and SMI; age was noted as having an indirect effect on the remaining associated factors.

    Conclusions: This study clarified the gender differences in factors influencing LSM and the underlying structure of LSM mediation by these factors. Therefore, gender differences should be considered when planning interventions aimed at improving the LSM and general well-being of older people, particularly for community-dwelling individuals.

  • Maki Kobayashi, Ryo Yoshikawa, Risa Harada, Anri Date, Yoshimichi Koba ...
    2022 Volume 7 Article ID: 20220022
    Published: 2022
    Released on J-STAGE: April 29, 2022
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    Background: Advances in cancer treatment have led to an increase in the number of cancer survivors and, likewise, cancer patients in convalescent rehabilitation wards. It is difficult for patients with bone metastases to recover their motor functions and be discharged. However, cancer treatments, such as anti-cancer drug therapy and radiation therapy, are not generally provided in convalescent rehabilitation wards.

    Cases: This study retrospectively reviewed six cases of bone metastases in our convalescent rehabilitation ward from April 2018 to October 2019. The ages of the patients ranged from 58 to 85 years, and all patients were male. The primary cancers were lung cancer (two cases), renal cancer (one case), esophageal cancer (one case), prostate cancer (one case), and double lung and kidney cancer (one case). Bone metastases were observed in the spine (six cases), pelvis (two cases), and femur (one case). All patients were admitted to our convalescent rehabilitation ward for postoperative management of imminent fracture risk and rehabilitation of pathological fracture or spinal cord compression caused by bone metastasis. None of the patients received treatment for primary cancer or bone metastases during their hospitalization. Two patients had new bone metastases in load-bearing bones. Five patients were transferred to acute care hospitals for the treatment of cancer or infection.

    Discussion: Before transferring patients with bone metastases to convalescent rehabilitation wards, clinicians should assess the risk of skeletal-related events and the rate of progression of their cancer. Indications for hospitalization should be carefully determined in cooperation with acute care hospitals.

  • Hiroaki Furuta, Katsuhiro Mizuno, Kei Unai, Hiroki Ebata, Keita Yamauc ...
    2022 Volume 7 Article ID: 20220021
    Published: 2022
    Released on J-STAGE: April 23, 2022
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    Objectives: Using Functional Independence Measure (FIM) records, this study used latent class analysis (LCA) to clarify the structure of activities of daily living (ADL) status in patients following stroke.

    Methods: In this retrospective, single-center study, we extracted the medical records of patients with stroke who were admitted to a rehabilitation hospital in Japan between April 2018 and March 2020. LCA was used to determine classes of ADL status based on response patterns in FIM items converted from the original seven levels to three levels: Complete Dependence, FIM1–2; Modified Dependence, FIM3–5; Independence, FIM6–7. We compared the length of stay and discharge destinations among subgroups of patients with different ADL status at admission.

    Results: From 373 patients, 1592 FIM records were analyzed. These were classified into six ADL status classes based on “Complete Dependence,” “Modified Dependence,” and “Independence” in the motor and cognitive domains. Significant differences were observed among the six admission ADL subgroups for the length of stay (median values in patient subgroups based on admission ADL status: 126, 146, 90, 65, 44, and 29 days in the Motor Complete/Cognitive Complete, Motor Complete/Cognitive Modified, Motor Modified/Cognitive Modified, Motor Modified/Cognitive Independent, Motor Independent/Cognitive Modified, and Motor Independent/Cognitive Independent groups, respectively) and discharge destinations (patients discharged home: 27%, 62%, 81%, 92%, 95%, and 98%, respectively, and to acute care hospitals: 18%, 14%, 8%, 8%, 2%, and 2%, respectively).

    Conclusions: LCA successfully stratified ADL status in patients with stroke undergoing rehabilitation and may aid in determining an appropriate treatment regimen.

  • Masato Sato, Yukio Mikami, Fumihiro Tajima
    2022 Volume 7 Article ID: 20220020
    Published: 2022
    Released on J-STAGE: April 13, 2022
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    Background: There are no reports on the therapeutic application of perceptive exploration activity in patients with unilateral spatial neglect (USN). This study monitored the course of acute occupational therapy using perceptive exploration activities in a patient with USN who had difficulty in manipulating tools for daily living after a stroke.

    Case: A 70-year-old man was admitted to our hospital for conservative treatment of hemiparesis and USN caused by stroke. He was previously diagnosed with cerebral infarction due to middle cerebral artery occlusion. His main symptoms were hemiparesis, egocentric spatial neglect in personal space and peripersonal space, and allocentric neglect, which made it difficult to use tools for daily living. Within 24 h of admission, perceptive exploration activities were initiated as the main therapy in addition to preparatory therapies, such as the facilitation of selective movement of limbs affected by paralysis. These therapies were provided over a 30-day period in 40-min sessions, 5 days a week. This treatment resulted in improved test results for the Fugl-Meyer Assessment, Bisiach’s body neglect and anosognosia scales, and the Behavioral Inattention Test. The Functional Independence Measure scores also improved with the improvement of neglect symptoms.

    Discussion: This case study monitored the improvements of egocentric spatial neglect and allocentric neglect during therapy using perceptive exploration activities in a patient with USN who had difficulty manipulating tools for daily living. The effectiveness of the therapy should be confirmed by increasing the sample size in future studies.

  • Yoshihiro Yoshimura, Ai Shiraishi, Yuri Tsuji, Ryo Momosaki
    2022 Volume 7 Article ID: 20220019
    Published: 2022
    Released on J-STAGE: April 12, 2022
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  • Tetsuo Hagino, Satoshi Ochiai, Shinya Senga, Takashi Yamashita, Masano ...
    2022 Volume 7 Article ID: 20220018
    Published: 2022
    Released on J-STAGE: April 08, 2022
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    Objectives: We investigated the clinical situation of fractures that occurred in patients in the severely disabled patients’ ward of our hospital. The study aimed to identify risk factors for the occurrence of long bone fractures in the extremities, which pose problems in nursing care.

    Methods: We retrospectively studied fractures that occurred between April 2015 and March 2021 among a total of 126 patients in the severely disabled patients’ ward of our hospital. The fracture site, frequency of occurrence, cause of injury, and other parameters were investigated. We statistically compared the fracture group and non-fracture group with respect to age, sex, body position before fracture, motor function, food intake status, body mass index, use of anti-epileptic drugs, hip dislocation, and maximum extension angle and range of motion of elbow/knee joints.

    Results: Among 126 patients, a total of 35 fractures occurred in 28 patients (22%). There were 19 long bone fractures of the extremities in 17 patients. Multiple logistic regression analysis using the occurrence of long bone fractures of the extremities as the objective variable identified the following significant independent variables: age [odds ratio (OR)=1.087, P=0.008], maximum extension angle of the elbow joint (OR=1.039, P=0.023), range of motion of the elbow joint (OR=0.940, P=0.003), and range of motion of the knee joint (OR=0.972, P=0.034).

    Conclusions: This study reveals that older age and flexion contracture of elbow and knee joints are risk factors for the occurrence of long bone fractures in severely disabled patients.

  • Tomoyo Taketa, Yuki Uchiyama, Norihiko Kodama, Tetsuo Koyama, Kazuhisa ...
    2022 Volume 7 Article ID: 20220017
    Published: 2022
    Released on J-STAGE: April 07, 2022
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    Background: Esophageal cancer is increasing in incidence in Japan and is usually treated by radical surgery. However, pulmonary complications are a major cause of perioperative mortality. Here we report a case in which bilateral pneumothorax after thoracoscopic esophagectomy was managed successfully by a combination of chest physiotherapy, mobilization, and delayed oral intake.

    Case: The patient was a 72-year-old man with a diagnosis of lower thoracic esophageal cancer and a medical history that included chronic obstructive pulmonary disease. He underwent thoracoscopic and laparoscopic subtotal esophagectomy and two-field lymphadenectomy. On postoperative day (POD) 1, he was diagnosed as having bilateral pneumothorax. An additional drainage tube was inserted in the right chest. Chest physiotherapy was started using a combination of methods, including diaphragmatic breathing, respiratory muscle stretching, and postural drainage. Mobilization was started on POD 2 but was limited to sitting upright and standing. On POD 5, gentle walking training (Borg Scale score, 9–11) was started when air leakage from the drain was observed only during expiration. Oral food intake was resumed on POD 9, by which time the pneumothorax had resolved completely. The patient was discharged on POD 27 with near-complete independence in activities of daily living.

    Discussion: We successfully managed the rehabilitation of a patient diagnosed with bilateral pneumothorax after esophagectomy. In a tailored strategy, we took the following measures to avoid worsening the pneumothorax and other surgery-related pulmonary complications: chest physiotherapy, avoiding procedures that increase intrathoracic pressure; delayed mobilization and reduced intensity of exercise; and delayed oral intake.

  • Yusuke Takahashi, Kazuki Okura, Shin Minakata, Motoyuki Watanabe, Kazu ...
    2022 Volume 7 Article ID: 20220016
    Published: 2022
    Released on J-STAGE: April 07, 2022
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    Objectives: Wearable devices such as fitness trackers have become popular in the healthcare field. Tracking heart rate and respiratory rate, in addition to physical activity, may provide an accurate picture of daily health. We believe that a combination of two types of devices can simultaneously measure and record physical activity, heart rate, and respiratory rate. However, the measurement accuracies of these two types of devices are not clear. This study aimed to determine the measurement accuracies of two wearable devices for heart and respiratory rate measurements.

    Methods: Ten healthy men performed incremental load tests (ILTs) and constant load tests (CLTs) on a cycle ergometer. The heart and respiratory rates were measured using wrist-worn (Silmee W22, TDK, Japan, Tokyo) and respiratory tracking devices (Spire Stone, Spire Health, San Francisco, CA, USA), respectively. A 12-lead electrocardiograph and the breath-by-breath method were used as external standards for heart and respiratory rates, respectively.

    Results: Bland–Altman analysis showed that heart rate had a fixed bias at rest and during ILT and CLT and had a proportional bias during CLT. The standard error values of the regression at rest and during CLT were less than 10 bpm for heart rate and less than 5.0 /min for respiratory rate. During ILT, the standard error was greater than 10 bpm for heart rate and approximately 5.0 /min for respiratory rate.

    Conclusions: The heart and respiratory rate measurements obtained using wearable devices were accurate within the practical margin of error.

  • Tomoko Sakai, Chisato Hoshino, Megumi Nakano, Yu Fujiwara, Atsushi Oka ...
    2022 Volume 7 Article ID: 20220015
    Published: 2022
    Released on J-STAGE: March 31, 2022
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    Objectives: This study aimed to describe the rehabilitation characteristics of patients with acute stage coronavirus disease managed with extracorporeal membrane oxygenation (ECMO) in the intensive care unit.

    Methods: This retrospective study enrolled coronavirus disease patients who underwent rehabilitation following ECMO between April 21, 2020, and August 20, 2021. The following patient data were evaluated: age, sex, weaning, peak C-reactive protein, lowest albumin level, white blood cell count, use of steroids and muscle relaxants, duration of respiratory management, ECMO management and rehabilitation, Medical Research Council (MRC) score, and Barthel index after sedation and at discharge.

    Results: ECMO was performed in 20 patients, and 16 were weaned successfully. The median durations of ECMO and respiratory management in survivors were 14.5 and 38 days, respectively. The median MRC scores after sedation and after rehabilitation therapy were 18 and 45, respectively. The median rehabilitation duration after sedation was 14 days. The MRC score after sedation showed significant correlations with the durations of ECMO and intubation. The median Barthel index values after sedation and at discharge were 0 and 30, respectively.

    Conclusions: Rehabilitation was important for patients with severe coronavirus disease because muscle weakness advanced in proportion with the durations of ECMO and ventilation management in the intensive care unit.

  • Takeshi Mochizuki, Aiko Kurata, Koichiro Yano, Katsunori Ikari, Ken Ok ...
    2022 Volume 7 Article ID: 20220014
    Published: 2022
    Released on J-STAGE: March 29, 2022
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    Objectives: This study investigated the effects of locomotion training on physical functions and quality of life in patients with rheumatoid arthritis (RA).

    Methods: Thirty-five patients with RA underwent locomotion training for 6 months. Health data collected from the subjects at baseline and after 6 months were the Health Assessment Questionnaire Disability Index (HAQ-DI), pain Visual Analog Scale, 10-m walking test, Timed Up-and-Go (TUG) test, single-leg standing test, Short Form-8 score with physical and mental component summaries, and 25-question Geriatric Locomotive Function Scale. The primary endpoint was a change in HAQ-DI at 6 months.

    Results: In terms of the primary outcome, the HAQ-DI significantly improved from 0.48 ± 0.69 at baseline to 0.27 ± 0.36 at 6 months (P=0.011). The significant secondary outcomes were a change in TUG test for comfortable walking from 9.8 ± 2.1 s at baseline to 8.9 ± 2.0 s at 6 months (P=0.002) and increased single-leg standing times for the right and left legs from 24.7 ± 23.5 s and 22.6 ± 22.8 s at baseline to 30.9 ± 22.1 s and 32.4 ± 24.1 s at 6 months (P=0.004, P <0.001), respectively.

    Conclusions: The findings suggest that locomotion training for 6 months may improve the HAQ-DI in patients with RA.

  • Shinichi Watanabe, Keibun Liu, Yasunari Morita, Takahiro Kanaya, Yuji ...
    2022 Volume 7 Article ID: 20220013
    Published: 2022
    Released on J-STAGE: March 23, 2022
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    Objectives: This study investigated the effect of early mobilization [EM; physical rehabilitation with the intensity needed to sit on the edge of the bed started within 5 days of intensive care unit (ICU) admission] in relation to improvements in gait independence and other clinical outcomes.

    Methods: This retrospective single-center study evaluated patients aged at least 18 years who stayed in the ICU for at least 48 h and were categorized into EM and late mobilization (LM; physical rehabilitation started more than 5 days after ICU admission) groups. Outcomes were compared after adjusting for 20 background factors by propensity score matching and inverse probability of treatment weighting. The primary outcome was independent gait at discharge. The secondary outcomes were medical costs, 90-day survival, and durations of ICU and hospital stays.

    Results: Of 177 patients, 85 and 92 were enrolled in the EM and LM groups, respectively. Propensity score matching created 37 patient pairs. There was no significant difference in the 90-day survival rate (P=0.308) or medical costs (P=0.054), whereas independent gait at discharge (P=0.025) and duration of hospital stay (P=0.013) differed significantly. Multivariate logistic regression analysis showed that EM was independently associated with independent gait at discharge (P=0.011) and duration of hospital stay (P=0.010) but was not associated with 90-day survival (odds ratio: 2.64, 95% confidence interval: 0.67–13.12, P=0.169).

    Conclusions: Early mobilization in the ICU did not affect 90-day survival and did not lower medical costs but was associated with independent gait at discharge and shorter hospital stays.

  • Yoshihisa Masakado, Andrzej Dekundy, Shohei Tateishi, Ryuji Kaji
    2022 Volume 7 Article ID: 20220012
    Published: 2022
    Released on J-STAGE: March 08, 2022
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    Background: Botulinum toxin type A is an effective treatment widely used to address post-stroke spasticity. Long-term repeated treatment with botulinum toxin type A may result in reduced efficacy due to the induction of neutralizing antibodies. Based on data from a phase 3 study of incobotulinumtoxinA for post-stroke upper limb spasticity, we describe the therapeutic response to botulinum toxin type A treatment in two neutralizing antibody-positive patients previously treated with other preparations of botulinum toxin type A.

    Case: Two patients (a 65-year-old woman and a 36-year-old woman) with post-stroke upper limb spasticity were previously treated with onabotulinumtoxinA, and neutralizing antibodies were detected in their sera at baseline using the mouse hemidiaphragm assay. After onabotulinumtoxinA had been discontinued for at least 16 weeks, incobotulinumtoxinA (400 U) was administered in three or four injection cycles. Good therapeutic responses, manifested by a reduction of 1–2 points on the modified Ashworth scale, were noted after each injection. The patients’ sera remained positive for neutralizing antibodies throughout the incobotulinumtoxinA treatment period.

    Discussion: These patients, who were previously treated with onabotulinumtoxinA and were neutralizing antibody positive throughout the clinical study period, showed stable therapeutic responses following incobotulinumtoxinA treatment. IncobotulinumtoxinA could be initiated for patients with neutralizing antibodies induced by onabotulinumtoxinA.

  • Takahiro Asai, Eisuke Sakuma, Tetsuya Mizutani, Yohei Ishizaka, Koji O ...
    2022 Volume 7 Article ID: 20220011
    Published: 2022
    Released on J-STAGE: March 05, 2022
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    Objectives: A precise anatomical understanding of the morphology of the spine is indispensable for neck and low back pain therapy including rehabilitation. However, few studies have directly addressed spinal morphology with a focus on the height of the vertebral body and discs. The aim of the current study was to analyze sex- and age-related changes in the spine by measuring the distance between adjacent centers of the intervertebral disc spaces from the posterior aspect in cadavers and by using magnetic resonance imaging (MRI) measurements at the cervical and lumbar vertebral levels.

    Methods: In the cadaveric study, the posterior distance between the adjacent centers of the disc spaces was measured for 58 spinal canals. The equivalent distances were examined using MRI in 370 and 660 subjects who presented with neck pain and back pain, respectively.

    Results: The distance between the adjacent centers of the intervertebral disc spaces in male cadavers was larger than that in female cadavers from C3 to L5/S1. The MRI results showed that the distance between the adjacent centers of the intervertebral disc spaces decreased with age in all spinal areas in men and women. Cadaveric values were significantly lower than the MRI values in men, whereas in women, no significant differences were observed.

    Conclusions: These results suggest that age-related changes in the cervical and lumbar spine are associated with differences between men and women in the degrees of progressive vertebral body and disc degeneration.

  • Shogo Okuji, Yukio Mikami, Yuta Sakurai, Shohei Araki, Takayuki Matsud ...
    2022 Volume 7 Article ID: 20220010
    Published: 2022
    Released on J-STAGE: March 01, 2022
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    Background: Middle-aged and older individuals with spinal cord injury (SCI) often require long-term care even after receiving rehabilitation treatment, making it difficult for them to return home. We retrospectively investigated our active rehabilitation treatment for patients with SCI.

    Case: Included in this case series were ten patients with SCI who were admitted to our general hospital (located in the southern part of Wakayama Prefecture) and who underwent active rehabilitation treatment. The participants were investigated retrospectively by access to electronic medical records. The Barthel index scores for discharged patients were determined at an outpatient clinic, and the community phase of rehabilitation management was recorded. The average age of the 10 patients was 67.4 ± 13.4 years, and the average period from onset to transfer to our hospital was 102.6 ± 69.9 days. The Barthel index scores significantly improved from 39.0 ± 30.9 at admission to 65.0 ± 28.2 at discharge (P<0.05). Among the seven patients who were discharged to their homes, six had cervical SCI. Some patients with American Spinal Injury Association impairment scale grades A and B at admission could be discharged home, and their Barthel index scores were maintained after discharge.

    Discussion : Even in a remote rural hospital, the activities of daily living of patients with SCI improved, and seven of the ten patients were discharged home. The activities of daily living of the discharged patients were maintained. To achieve these results, active rehabilitation treatment conducted by rehabilitation specialists is important.

  • Eiji Sasaki, Takayuki Kasai, Ryo Araki, Tomoyuki Sasaki, Yuji Wakai, K ...
    2022 Volume 7 Article ID: 20220009
    Published: 2022
    Released on J-STAGE: February 23, 2022
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    Background: While total knee arthroplasty (TKA) and total hip arthroplasty (THA) lead to excellent clinical outcomes, some patients experience residual surgical site pain and reduced satisfaction. This prospective observational study investigated the prevalence of preoperative and postoperative residual central sensitization (CS) after TKA and THA. The influence of residual CS on the improvement in quality of life (QOL) was also investigated.

    Methods: The participants were 40 patients who underwent TKA and 47 patients who underwent THA. CS was measured using the central sensitization inventory (CSI) questionnaire. Knee symptoms were evaluated using the Knee Injury and Osteoarthritis Outcome Scales (KOOS), and hip symptoms were evaluated using the Japanese Orthopedic Association Hip-disease Evaluation Questionnaires (JHEQ). General QOL was evaluated using EuroQOL (EQ-5D-5l). Regression analysis was performed to estimate factors related to low QOL after surgery.

    Results: Preoperatively, 47.5% of TKA patients and 66.0% of THA patients were CS positive (P=0.083), which reduced to 10.0% (P=0.042) and 25.5% (P=0.202), respectively, 3 months after surgery. Although the improvements in KOOS subscales and EQ-5D-5l scores in TKA patients with residual CS were significantly lower than in those without residual CS, residual CS status had no effect on JHEQ subscales and EQ-5D-5l scores in THA patients. Regression analysis indicated that EQ-5D-5l was negatively correlated with CSI in the TKA group (P=0.017). In contrast, CSI was not correlated with EQ-5D-5l in the THA group (P=0.206).

    Conclusion: Postoperative QOL improvement was achieved 3 months after THA regardless of residual CS status. In contrast, preoperative CS was negatively associated with the improvement in QOL after TKA.

  • Nobuyuki Arai, Hiromasa Abe, Haruhiko Nishitani, Shimon Kanemaru, Masa ...
    2022 Volume 7 Article ID: 20220008
    Published: 2022
    Released on J-STAGE: February 23, 2022
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    Objectives: This study retrospectively investigated the prevalence and clinical features of trephine syndrome, which is a late complication of craniectom, in patients who underwent craniectomy decompression.

    Methods: Trephine syndrome was defined as an increase of ≥2 points in the functional independent measure (FIM) score at 7 days after cranioplasty compared with that 3 days before cranioplasty. Patients who underwent craniectomy at Kawasaki Medical School Hospital between January 1, 2010, and March 15, 2020, were included in the study.

    Results: During the observation period, 102 patients underwent craniectomy decompression; 71 of them later underwent cranioplasty. In total, 12 and 59 patients were assigned to the trephine and non-trephine syndrome groups, respectively. The patients in the trephine syndrome group were significantly younger than those in the non-trephine syndrome group (P<0.05). The mean durations±standard deviations (in days) from craniectomy decompression to cranioplasty were 57.1±38.9 and 83.6±69.3 for the trephine and non-trephine syndrome groups, respectively (P<0.05). Improvements in the FIM motor scores were greater than the improvements in the cognitive scores for all but one case (P<0.05). The frequency with which patients experienced exacerbation (worsened consciousness and sudden anisocoria) after hospitalization was significantly higher in the trephine syndrome group than in the non-trephine syndrome group (P<0.05).

    Conclusions: Performing cranioplasty as early as possible in young patients may lead to functional improvement. In the trephine syndrome group, the improvement in motor FIM score was greater than that of the cognitive score. Moreover, post-hospitalization exacerbation was more frequent in the trephine syndrome group.

  • Yuki Yoshimatsu, Kazunori Tobino, Saori Nishizawa, Kohei Yoshimine, Yo ...
    2022 Volume 7 Article ID: 20220007
    Published: 2022
    Released on J-STAGE: February 17, 2022
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    Objectives: Swallowing function is affected in patients with chronic obstructive pulmonary disease (COPD), putting them at risk of exacerbation of COPD. We previously reported the effectiveness of the repetitive saliva swallowing test (RSST) in screening for patients at risk of COPD exacerbation. However, evidence on how to improve swallowing function in this population is extremely limited. Interferential current transcutaneous electrical sensory stimulation (IFC-TESS) stimulates the larynx and pharynx, thereby improving their sensory function. IFC-TESS is an emerging tool to enhance airway protection and increase swallowing frequency; however, its safety and efficacy in patients with COPD is unknown. Therefore, we performed a preliminary prospective study focusing on stable COPD patients.

    Methods: Patients with stable COPD who were hospitalized for yearly evaluation were recruited. Patients were included if their RSST was 5 or less. Nurses carried out IFC-TESS twice daily for 10 days. Swallow screening results were compared before and after the 10-day intervention.

    Results: Ten patients were included in the study. The IFC-TESS intervention was performed safely. Patients and nurses reported no discomfort or concerns regarding the intervention. The EAT-10 and RSST scores improved significantly after the intervention, and tongue pressure also tended to improve.

    Conclusions: IFC-TESS may be a promising intervention to improve swallowing in patients with COPD who are easily fatigued and struggle to perform swallowing exercises.

  • Takuya Fukushima, Tetsuya Tsuji, Noriko Watanabe, Takuro Sakurai, Aiko ...
    2022 Volume 7 Article ID: 20220006
    Published: 2022
    Released on J-STAGE: February 10, 2022
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    Supplementary material

    Objectives: The aim of the present study was to clarify the current state of outpatient cancer rehabilitation and coordination systems provided by designated cancer hospitals in Japan.

    Methods: A questionnaire was sent to 427 designated cancer hospitals in Japan to investigate the status of outpatient cancer rehabilitation and whether it was sufficiently conducted. The status of regional coordination with post-discharge rehabilitation facilities was surveyed.

    Results: Responses were received from 235/427 facilities (55.0%). Outpatient cancer rehabilitation was implemented in 92 (39.1% of responding facilities), and of these facilities, 83.7% answered that the provision of rehabilitation was insufficient. The reasons were ineligibility for reimbursement of medical fees, a lack of human resources, a lack of awareness of the need, and a lack of education. Regional coordination was conducted by 39.1% of responding facilities, yet a regional alliance path had been established in only 9.8% of centers. The absence of coordination was associated with large facility size, the absence of physiatrists, and few rehabilitation professionals who had completed the training program; an insufficient framework for regional coordination was also given as a reason.

    Conclusions: To provide adequate outpatient cancer rehabilitation, sufficient human resources, the reimbursement of medical fees in the outpatient setting, and education and a framework to promote regional coordination are necessary.

  • Shota Mashimo, Takahisa Ogawa, Nobuto Kitamura, Junya Kubota, Stuart G ...
    2022 Volume 7 Article ID: 20220005
    Published: 2022
    Released on J-STAGE: February 08, 2022
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    Objectives: The aim of the current study was to investigate the validity, the responsiveness, and the predictive ability for discharge to own home of the Japanese version of the Cumulated Ambulation Score (CAS-JP). This was achieved by analyzing the CAS-JP after hip fracture surgery at multiple time points until patient discharge.

    Methods: Patients who underwent hip fracture surgery were evaluated using CAS-JP, the Barthel Index, and walking ability on postoperative day (POD) 1, 7, and 14 and at discharge. Floor and ceiling effects, responsiveness, and correlations between CAS-JP and other functional outcomes were assessed at each time point. The predictive ability of CAS-JP for discharge to own home was also analyzed using the area under the curve (AUC) of the receiver operating characteristic.

    Results: A total of 121 patients were included in this study. On POD7, POD14, and at discharge, strong correlations were observed between CAS-JP and the Barthel Index (r=0.81, 0.82, and 0.87, respectively), and between CAS-JP and walking status (r=0.82, 0.81, and 0.76, respectively). CAS-JP had a large effect size (1.64–2.25) and standardized response mean (1.49–1.81). The predictive ability of CAS-JP for discharge to own home, as indicated by the AUCs, were 0.73 (95% CI: 0.62–0.83) on POD7 and 0.74 (95% CI: 0.62–0.86) on POD14.

    Conclusions: CAS-JP has sufficient validity and responsiveness as a mobility assessment tool in postoperative hip fracture patients. Furthermore, this study showed that early postoperative mobility status evaluation using CAS-JP can sufficiently predict discharge to own home.

  • Shoichi Masaki, Tadashi Takahashi, Toshinori Sahara, Ryo Endo, Masayos ...
    2022 Volume 7 Article ID: 20220004
    Published: 2022
    Released on J-STAGE: February 04, 2022
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    Background: COVID-19 is associated with an increased risk of venous thromboembolism (VTE), and prophylactic anticoagulation is recommended for the prevention of VTE in COVID-19 patients. We encountered a patient with COVID-19 who developed iliopsoas hematoma (IPH) that was likely caused by prophylactic anticoagulation against VTE; we report the case here because IPH is an important risk in rehabilitation treatment.

    Case: The patient was a 73-year-old man with severe COVID-19 who received anticoagulation therapy from the time of admission (day 0). On day 22, decreased hemoglobin levels, muscle weakness in the left lower extremity, and pain on passive movement of the left hip joint were noted. On day 29, computed tomography (CT) was performed and revealed a mass lesion suspicious of a hematoma in the left iliopsoas muscle. On day 36, magnetic resonance imaging (MRI) was carried out to re-evaluate the mass lesion and revealed a multicystic lesion that could also have been an abscess. CT-guided puncture drainage was performed, but no pus-like material was collected; this finding led to a diagnosis of IPH. Subsequent exercise loads were gradually increased while the status of the hematoma was assessed.

    Discussion: The prevalence of IPH in COVID-19 patients has been reported to be 7.6 cases per 1000 admissions, and the use of anticoagulation is likely to increase the risk of IPH. Because rehabilitative interventions can lead to the discovery or aggravation of IPH, the possibility of IPH should be kept in mind when providing rehabilitation treatment for COVID-19 patients.

  • Hideki Arai, Naoya Ikegawa, Masafumi Nozoe, Kuniyasu Kamiya, Satoru Ma ...
    2022 Volume 7 Article ID: 20220003
    Published: 2022
    Released on J-STAGE: January 29, 2022
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    Objective: The aim of the current study was to investigate the association between the skeletal muscle mass index (SMI) and the convalescent rehabilitation ward achievement index (CRWAI) in older patients with functional impairment.

    Methods: We conducted a retrospective cohort study at a single rehabilitation center in Japan to include patients admitted to the convalescent rehabilitation ward because of neurological disease, motor disorder, or disuse syndrome. Patients with missing SMI data, those who died or were transferred to other hospitals due to comorbidities, those aged less than 65 years, and those hospitalized for <7 days were excluded from the study. We divided patients into two groups based on their SMI – the high SMI group (SMI ≥7.0 kg/m2 in men and SMI ≥5.7 kg/m2 in women) and the low SMI group (SMI <7.0 kg/m2 in men and SMI <5.7 kg/m2 in women); we then evaluated the association between SMI and the CRWAI score.

    Results: Of the 319 recruited patients, 84 (26%) were in the high SMI group. The medians and interquartile ranges of the CRWAI scores in the high SMI and low SMI groups were 38.6 (23.1–61) and 31.8 (10.1–57.5), respectively (P=0.029). A high SMI was independently and negatively associated with the CRWAI score (β=− 0.16, P=0.014).

    Conclusions: Our study showed that a high SMI was an independent factor negatively influencing the CRWAI score in older patients in a convalescent rehabilitation ward.

  • Tsuyoshi Hara, Eisuke Kogure, Shinno Iijima, Yasuhisa Fukawa, Akira Ku ...
    2022 Volume 7 Article ID: 20220002
    Published: 2022
    Released on J-STAGE: January 25, 2022
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    Objectives: Postoperative complications (PCs) in patients with gastrointestinal cancer (GIC) lead to reduced lifespan and poor quality of life. The aim of this study was to investigate the correlation between preoperative exercise-related factors, together with other contributory factors, and the frequency of PCs in patients with GIC.

    Methods: This was a cross-sectional, three-institution study. We enrolled 299 patients who were scheduled for elective surgery for GIC (182 men and 117 women; age, 65.7 ± 11.0 years). PCs were graded using the Clavien–Dindo classification based on the medical records 1 month postoperatively. Exercise-related factors (the skeletal muscle index, the isometric knee extension torque, and the 6-min walk test [6 MWT] distance) were measured before surgery. Based on previous studies of factors contributing to complications, data on age, sex, clinical cancer stage, comorbidities, neoadjuvant therapy, type of surgery, surgery duration, blood loss, blood transfusion, laboratory data, respiratory function, body mass index, and visceral fat area were collected.

    Results: The frequency of PCs was positively correlated with surgery duration (β=0.427) and C-reactive protein (CRP) level on postoperative day 3 (β=0.189). The 6 MWT was negatively correlated with the frequency of PCs through CRP level on postoperative day 3 (β=–0.035). This model demonstrated an acceptable fit to the data (goodness-of-fit index, 0.979; adjusted goodness-of-fit index, 0.936; comparative fit index, 0.944; and root mean square error of approximation, 0.076).

    Conclusions: Preoperative walking capacity was correlated with PCs in patients undergoing GIC surgery. Prevention of PCs in patients with GIC requires the monitoring of both surgical parameters and postoperative inflammation.

  • Junichi Inoue, Ryota Kimura, Yoichi Shimada, Kimio Saito, Daisuke Kudo ...
    2022 Volume 7 Article ID: 20220001
    Published: 2022
    Released on J-STAGE: January 22, 2022
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    Objective: We have developed a robot for gait rehabilitation of paraplegics for use in combination with functional electrical stimulation (FES). The purpose of this study was to verify whether the robot-derived torque can be reduced by using FES in a healthy-person pseudo-paraplegic model.

    Methods: Nine healthy participants (22–36 years old) participated in this study. The robot exoskeleton was designed based on the hip–knee–ankle–foot orthosis for paraplegia. Participants walked on a treadmill using a rehabilitation lift to support their weight. The bilateral quadriceps femoris and hamstrings were stimulated using FES. The participants walked both with and without FES, and two walking speeds, 0.8 and 1.2 km/h, were used. Participants walked for 1 min in each of the four conditions: (a) 0.8 km/h without FES, (b) 0.8 km/h with FES, (c) 1.2 km/h without FES, and (d) 1.2 km/h with FES. The required robot torques in these conditions were compared for each hip and knee joint. The maximum torque was compared using one-way analysis of variance to determine whether there was a difference in the amount of assist torque for each gait cycle.

    Results: Walking with the exoskeleton robot in combination with FES significantly reduced the torque in hip and knee joints, except for the right hip during extension.

    Conclusions: In the healthy-participant pseudo-paraplegic model, walking with FES showed a reduction in the robot-derived torque at both the hip and knee joints. Our rehabilitation robot combined with FES has the potential to assist paraplegics with various degrees of muscle weakness and thereby provide effective rehabilitation.

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