Purpose: This study aimed to calculate cut-off values of activities of daily living independence level for stroke patient home discharge based on the number of family caregivers. Method: The subjects comprised 1442 stroke patients (26 hospitals) who were registered of the Japanese Rehabilitation Database. Receiver operating characteristic curves were used to elucidate the BI and FIM^® instrument scores necessary for home discharge. Analysis was performed for each subject according to the number of family caregivers, i.e., no caregiver, one person, two persons or more, and overall. Result: The BI cut-off points that discriminated between home discharge and other were 65/60 points overall, 75/70 points in patients with no caregiver, 65/60 points in patients with one caregiver, and 60/55 points in patients with two or more caregivers. The FIM^® instrument cut-off points were 90/89 points overall, 101/100 points in patients with no caregiver, 87/86 points in patients with one caregiver, and 87/86 points in patients with two or more caregivers. Conclusion: Our results indicated that home discharge for patients with many caregivers was possible even with low ADL independence levels, and that there was a large difference in cut-off values depending on the presence or absence of one caregiver.

Objective: To investigate the correlation between changes of contralesional cortical excitability evaluated by transcranial magnetic stimulation (TMS) and functional recovery in patients with hemiparetic stroke. Methods: Eight inpatients (mean age: 75.9±13.8 years) with mild to moderate hemiparesis were enrolled. TMS was delivered to the optimal scalp position over the contralesional (ipsilateral to the paresis) primary motor cortex (M1) to activate the unaffected flexor carpi radialis muscle (FCR) while the patient picked up a wooden block with the affected hand. The amplitude of the motor-evoked potential (MEP) was measured and then was divided by the resting MEP amplitude (MEP ratio). For evaluation of motor function, we tested grip strength (GS), performed the upper extremity motor section of the Fugl-Meyer Assessment (FMA-UE), and performed the Purdue Pegboard Test (PPT) when the patients were admitted to our hospital (T1) and 2 months after admission (T2). Results: The MEP ratio was significantly decreased at the second examination. The partial correlations between the MEP ratio and FMA-UE at T1, and PPT of an affected hand at T2 were observed while controlling for the period after stroke onset as the confounding variable. Conclusion: The reduction of contralesional cortical hyperactivity is related to the functional recovery in part, but not related with the period after stroke onset. This suggests that enhanced reduction of contralesional M1 hyperactivity contributes to functional recovery after stroke.

Objective: To identify preoperative factors that affect the medical outcome study 36-item short form health survey (SF-36) score 1 year after lumbar spinal fusion. Methods: Participants were selected from among 624 patients who underwent lumbar spinal fusion between April 1, 2009 and March 31, 2011 who were followed up for 1 year or more. The SF-36 version 2 was used to evaluate HRQOL. The following preoperative parameters were investigated: sex, age, body mass index (BMI), employment status (other than home-making), living with other family members, smoking, orthopedic disorder in another part of the body (other than lumbar spinal disease), history of lumbar spinal surgery, bladder function, and leg muscle strength. Results: 94 patients were included. None of the independent preoperative factors exhibited a high degree of correlation, and the absence of multicollinearity was confirmed before further analysis was performed. The first canonical variates were age and leg muscle strength, which had a major effect on physical functioning, role physical, and role emotional 1 year after surgery, and the second canonical variates were employment status, sex, and orthopedic disorder in another part of the body, which had a major effect on general health 1 year after surgery. Conclusions: The SF-36 score 1 year after lumbar spinal fusion was affected by the preoperative factors of age, leg muscle strength, living with other family members, employment status, sex, and orthopedic disorders in another part of the body.

Objective: Sit-to-stand motion (STS) is a dynamic motion utilized in fundamental activities of daily living and requires extensive joint movement in the lower extremities and the trunk and coordination of multiple body segments. The present study aimed to investigate whether aging affects the motor coordination of joint movements required to stabilize the horizontal and vertical movement of center of mass using the uncontrolled manifold (UCM) analysis. Method: We recruited 39 older adults with no musculoskeletal and/or neuromuscular conditions that affected STS, along with 21 healthy younger adults. All subjects performed five STS trials from a chair with the seat height adjusted to the length of their lower leg at a self-selected motion speed. Kinematic data were collected using a three-dimensional motion analysis system. We performed the UCM analysis to assess the effects of joint angle variance (elemental variable) to stabilize the horizontal and vertical movement of COM (performance variable) and calculated the joint angle variance that does not affect COM (V_UCM), the variance that affects COM (V_ORT), and the synergy index (ΔV). Results: ΔV values in the horizontal direction were higher in the older adults than in the younger adults, but ΔV values in the vertical direction were lower in the older adults than in the younger adults. Conclusion: Older adults require increasing levels of stabilization of horizontal movement of COM after buttocks-off in the STS maneuver. As a result, variance in the joint angle of the lower extremities indicated no kinematic synergy for stabilizing the vertical movement of COM.