Cancer rehabilitation in the United States has gone from a small obscure rehabilitation subspecialty to an area of intense interest. American cancer rehab's recent growth can be attributed to the ever increasing number of cancer survivors. The future of cancer rehabilitation may be accelerated by the concept of exercise as cancer medicine.

Impairments resulting from stroke lead to persistent difficulties with walking. Subsequently, an improved walking ability is one of the highest priorities for people living with stroke. The degree to which gait can be restored after a stroke is related to both the initial impairment in walking ability and the severity of paresis of the lower extremities. However, there are some patients with severe motor paralysis and a markedly disrupted corticospinal tract who regain their gait function. Recently, several case reports have described the recovery of gait function in stroke patients with severe hemiplegia by providing alternate gait training. Multiple studies have demonstrated that gait training can induce "locomotor-like" coordinated muscle activity of paralyzed lower limbs in people with spinal cord injury. In the present review, we discuss the neural mechanisms of gait, and then we review case reports on the restoration of gait function in stroke patients with severe hemiplegia.

Objective: To clarify the corrected age of walking attainment in very low birth weight infants by birth weight and gestational age, and determine perinatal factors affecting the delay in walking attainment. Method: This was a longitudinal study. We investigated walking attainment and perinatal factors in 145 very low birth weight infants without neurological abnormalities (mean birth weight 1019.3 ± 299.7 g, gestational age 29.0 ± 2.9 weeks). The study infants were stratified by birth weight (group A: <1,000 g, group B: 1,000 g≤, <1,500 g) and gestational age (group I: <28 weeks, group II: 28 weeks≤, <37 weeks) and were compared using unpaired t-tests. Furthermore, we examined the perinatal factors that affect the delay in walking attainment using multiple regression analysis. Results: Of the walking attainment, infants in Group A were older than those in Group B (50th percentile, 15.8 vs. 14.7 months). Infants in Group I were older than those in Group II (50th percentile, 16.0 vs. 14.8 months). Using multiple regression analysis with walking attainment age as the dependent variable, the duration of mechanical ventilation was found to be significantly related. Conclusion: Very low birth weight infants with light weight and short gestational age have delayed walking attainment, and longer duration of mechanical ventilation increases the risk of delay.

Objective: Several strategies have been designed to improve balance after stroke. Although recent studies have suggested that the balance training in stroke should include exercises that are performed in different sensory conflict conditions, little attention has been paid to manipulation of visual input. This study aimed to compare effects of balance training on an unstable surface with balance training under visual deprivation conditions in persons with stroke. Method: Forty-five stroke patients were randomized into three groups: the visual deprivation- stable based training (VD-SBT); unstable based training (UBT); and control (C) groups. Subjects of the VD-SBT group performed balance training on a stable surface with closed eyes. The UBT group performed balance training on an unstable surface with open eyes. Patients were assessed before and after interventions for Timed Up and Go (TUG), Four Square Step (FSS) and Five Times Sit to Stand (FTSS) tests. Result: There was a significant difference in pre- post intervention time of TUG, FSS and FTSS tests in all three groups. In a comparison of three groups, the UBT and VD-SBT groups had a significant improvement in time of all tests but significant improvement in time of all tests was observed in the VD-SBT group in comparison with the UBT group. In the field of balance training, the manipulation of visual input was more effective than the manipulation of standing surface to reweighting the sensory information. Conclusion: We recommended balance rehabilitation programs after stroke performed under conditions to stimulate the use of underused sensory input.

Objective: Exercise therapy to strengthen quadriceps muscle is recommended in rehabilitation program for people with patellofemoral pain syndrome (PFPS). This study aimed to investigate the electromyography (EMG) activity of vastus medialis obliquus (VMO), vastus lateralis (VL) and VMO/VL ratio during PNF in individuals with and without PFPS. Methods: 26 persons with PFPS and 26 healthy subjects participated to study. All subjects performed PNF patterns (Flexion-Adduction-External Rotation (D₁FL), Extension-Adduction-External Rotation (D₂EX), D₁FL+ load, D₂EX+ load) and straight leg raise (SLR). The normalized EMG activity of VMO, VL and VMO/VL ratio were measured and analyzed using repeated measure ANOVA. Results: There were significant main effects of group and exercises for the both VMO and VL (p<0.05). It was found that except SLR and D₂EX, in the other motions PFPS group had lower VMO activity compared to healthy group (p<0.05). For VL except SLR, in the other motions PFPS group had lower VL activity too (p<0.05). The PNF patterns activated VMO more than SLR, however it was not significant (p>0.05). Also; there weren't any significant difference between the two groups in VMO/VL activation ratios. Also, performing the PNF patterns with load increased VMO and VL muscles activity significantly (p<0.05). It also found that in PFPS group the VMO/VL ratio values in PNF patterns were significantly more than SLR and the highest VMO/VL ratio value (0.96) was found during D₂EX. Conclusion: The PNF patterns due to provide optimal VMO/VL ratio value than SLR and proper balance between these two muscles can be recommended in rehabilitation of individuals with PFPS.

Objective: The study aimed to demonstrate the significance of early postoperative physical therapy interventions on clinical outcomes by determining the influence of the distance walked under the supervision of a physical therapist in the early postoperative period after liver cancer. Methods: All consecutive patients who underwent surgery for liver cancer between April 2018 and March 2020 were eligible for enrollment in the study. The total walking distance during physical therapy till the third postoperative day was examined. The clinical outcomes comprised duration of postoperative hospital stay, time to independent walking, and occurrence of postoperative complications. For data analysis, the patients were divided into two groups: those who walked more than the median total distance (the long-distance group) and those who walked less than the median distance (the short-distance group). We used propensity score matching to match the background characteristics between the groups. Results: Of the 65 patients who were eligible, 14 patients were included in the two groups each, after matching. The long-distance walking group had a significantly shorter hospital stay (9.0 days vs. 11.0 days, p=0.008) and a shorter time to independent walking (3.5 days vs. 7.5 days, p=0.019) than the short-distance walking group. There were no significant differences in postoperative complications between the two groups (7.1% vs. 42.8%, p=0.08). Conclusion: In the early postoperative period after liver cancer surgery, increasing the walking distance under the supervision of a physical therapist is important for improving clinical outcomes. Further prospective studies are needed to confirm the findings of this study.

Objective: Preoperative factors related to perceived leg length discrepancy (PLLD) after total hip arthroplasty (THA) are not well studied. This study aimed to examine the preoperative factors, including hip abductor modulus, related to PLLD one month after THA. Methods: The study included 73 patients diagnosed with osteoarthritis secondary to developmental dysplasia of the hip and a posterior approach to surgery. Multiple logistic regression analysis was performed using the presence or absence of PLLD as the dependent variable and preoperative hip abductor's modulus of elasticity, pain, hip abduction range of motion, hip abductor muscle strength and pelvic obliquity as the independent variable. Additionally, receiver operating characteristic curves were used for the extracted variables for calculating the cutoffs, sensitivity, specificity and area under the curve (AUC) to determine the presence or absence of PLLD. The significance level was set at p<0.05. Results: The hip abductor modulus (odds ratio=1.13; 95% confidence interval=1.06-1.21; p<0.001) was selected as a preoperative factor. The cutoff value to determine the presence or absence of a PLLD was 16.32 kPa. The sensitivity and specificity were 81.8% and 72.5%, respectively, and the AUC was 0.8137. Conclusion: The hip abductor muscle elastic modulus affected PLLD one month after THA. If the preoperative hip abductor elastic modulus is higher than the cutoff value, it may affect the appearance of PLLD at one month postoperatively.

Objective: To clarify the effect of intervention with dynamic motor control exercise (DMCE) for the lumbar region on low back pain in sedentary office workers (SOWs). Methods: The participants comprised 32 SOWs with low back pain who were randomly categorized into two groups: the DMCE group and the normal trunk exercise (NTE) group. Both groups performed each exercise for three days per week for 8 weeks. The primary endpoints were evaluated for the lumbar and hip flexion angles during trunk forward bending, effect of low back pain on activities of daily living (using the Oswestry Disability Index), and intensity of low back pain (using the Visual Analog Scale) pre- and post-intervention. The extent of changes was calculated by subtracting the pre-intervention value from the post-intervention value and was compared between the two groups using an unpaired t-test. Results: The extent of changes in the lumbar flexion and hip flexion angles at 10° of trunk forward bending were significantly greater in the DMCE group than in the NTE group, and no significant differences were noted between the two groups at other angles of trunk forward bending. The extent of changes in the Oswestry Disability Index and the Visual Analog Scale scores were significantly greater in the DMCE group than in the NTE group. Conclusion: DMCE is effective in improving motor control in the lumbar region and hip joints, thereby ameliorating low back pain in SOWs.

Objective: This study aimed to clarify the effects of pre- and postoperative physical function on the 6-minute walking distance (6MWD) in patients with peripheral arterial disease (PAD). Method: Forty-two elderly patients with PAD who were hospitalized for revascularization and able to walk independently were included in the study. The 6MWD, ankle brachial index (ABI), weight-bearing index (WBI), gait, and intermittent claudication distance (ICD) were measured before and after the surgery, and skeletal muscle index was measured only before surgery. Analyses were performed by comparing the pre- and postoperative values of each factor using a paired t-test. In addition, multiple regression analysis was performed with 6MWD as the dependent variable before and after surgery. Results: Postoperatively, pain disappeared in 22 patients, and ABI, ICD, 6MWD, and stride length improved significantly. ICD and stride length were extracted as factors related to 6MWD before and after surgery, and ABI, WBI, and stride length were extracted as factors related to 6MWD after surgery. Conclusion: The improvement of intermittent claudication associated with revascularization suggests a stronger influence of functional aspects on postoperative 6MWD.

Objective: Preoperative performance status is an important factor in thoracic surgery, but little is known about the effect of preoperative physical activity (PA) on the postoperative course. This study investigated the associations between preoperative PA and postoperative complications and clinical outcomes of lung cancer surgery. Methods: This prospective observational study included patients who underwent surgery for lung cancer at a single institution. PA was measured before hospitalization for 5 consecutive days and then after surgery until hospital discharge. The daily step count and time spent performing moderate intensity activity (> 3 metabolic equivalents) were measured with an accelerometer. We examined the correlations between PA and preoperative pulmonary function and physical fitness, and examined the relationship between postoperative complication and PA. Finally, a multivariate analysis was performed with pre-hospital PA as the dependent variable. Results: Forty-two patients were analyzed. Univariate analysis found no correlation between pre-hospital PA and preoperative pulmonary function, but found significant positive correlations between pre-hospital PA and time spent performing moderate intensity activity, in-hospital PA, preoperative 6-minute walk distance, and maximum gait speed (r > 0.5, p < 0.01). The nine patients who developed postoperative complications had significantly lower pre-hospital and postoperative step count than the patients with no complication (p = 0.04). Multiple regression analysis showed that pre-hospital PA was significantly associated with time spent performing moderate intensity activity, maximum gait speed, and postoperative complication. Conclusions: Evaluation of pre-hospital PA is useful in predicting the postoperative course after lung cancer surgery.

Objective: Anterior cruciate ligament (ACL) injury is one of the most frequent sportsinjuries, and previous studies have shown that fatigue is a risk factor for sports injuries.This study aimed to inform prevention of ACL injury by investigating how exercise and desk tasks affect trunk and lower limb alignment and ground reaction force (GRF) during one-legged landing movements. Methods: The study subjects were 12 men who performed a one-legged landing movement from a 30-cm platform before and after fatigue tasks, including lower-limb muscle fatigue, cardiopulmonary fatigue, and brain fatigue tasks. For the measurement of joint angles and moments and GRF, a three-dimensional motion analysis device and a floor reaction-force meter were used. Statistics were performed using Wilcoxon's signed rank sum test as a multiple comparison test with Bonferroni adjustment to compare the difference in effects. Results: The maximum trunk flexion angle during landing on one leg was significantly lower in the brain fatigue group than in the control group. The time to peak vertical GRF (pGRF) was significantly shorter in the leg-muscle fatigue group than in the control group. Conclusion: Brain fatigue may have altered the postural strategy before and after landing, resulting in a decrease in trunk flexion angle. Time to pVGRF was shortened in the leg muscle fatigue group, suggesting that there may be an increased risk of ACL injury. Time to pVGRF during lower extremity muscle fatigue and trunk flexion angle during brain fatigue may be more pronounced during actual sports activities.

Objective: The purpose of the study was to clarify the causal effect of toe-grasping exercises on the improvement of static or dynamic balance ability in home-based rehabilitation users. Method: Our study included 34 subjects who met the criteria and were evaluable out of 98 rehabilitation service users at home nursing stations. This study was a randomized controlled trial. The intervention group performed towel gathering exercises in addition to the regular home-based rehabilitation program. The primary outcome was one-leg standing time, and the secondary outcomes were two-step test and toe grip strength. Results: Seventeen subjects were assigned to the intervention group and seventeen to the control group by block randomization. Data from 15 and 12 subjects in the intervention group and control group, respectively, who were able to complete the initial evaluation and the evaluation after 3 months, were analyzed. We compared the amount of change after 3 months of evaluation in the intervention group with the change in the control group. The results showed that the left/right mean value of oneleg standing time in the intervention group was significantly greater than that in the control group. In terms of the amount of change in the intervention period (T2-T1) within each assessment, there were significant improvements in both the toe-grip strength and the two-step values in the intervention group. Conclusion: We found that toe-grasping exercises could improve the balance ability of home-based rehabilitation users. This suggests the clinical significance of toe function in rehabilitation programs.

OBJECTIVE: Adequate physical activity after stroke is critical for cardiovascular health. Although sex is a potential factor associated with post-stroke physical activity, its mechanism remains unclear. This study aimed to examine sex differences in human physical activity following stroke. METHOD: A cross-sectional study with 62 participants (men: 42, women: 20) was conducted. Physical activity was measured for three consecutive days using a step activity monitor. The walking durations per day in light physical activity, moderate-to-vigorous physical activity, and total physical activity were calculated. Sex differences in walking duration were compared using Welch's t-tests or Mann-Whitney U tests. RESULTS: Women had a significantly greater walking duration in light physical activity and in total than did the men. In contrast, no significant differences were found in moderate-to-vigorous physical activity. CONCLUSION: This study reported sex differences in the walking duration after stroke. Moreover, it found that women spent more time in low intensity physical activity than men. Our results will be useful for planning interventions to increase physical activity and decrease sedentary behavior after stroke.

Background: Early mobilization and rehabilitation interventions should be provided to patients who survived severe COVID-19 to improve their physical function and activities of daily living (ADL). However, their physical and mental status at discharge has not been well described in Japan. We report the intervention provided for a survivor of severe COVID-19 and his physical and mental status at discharge from an acute care hospital. Case Report: A 62-year-old man was admitted to our emergency department with a diagnosis of COVID-19 with severe acute respiratory dysfunction. He had complicated intensive care unit-acquired weakness (ICU-AW) and delirium during mechanical ventilation therapy. Rehabilitation intervention was initiated on the seventh day post-admission and was gradually performed according to his respiratory and hemodynamic status. As a result of the rehabilitation intervention, ICU-AW and cognitive function gradually improved. On hospital day 37, he independently performed basic ADL and was discharged. However, he lost approximately 9% of his body weight at discharge. In addition, his hand grip strength and six-minute walking distance were lower and shorter than the reference values, respectively. His mental component summary of the Short Form-8™ was lower than the national standard deviation for the Japanese population. Conclusion: Although survivors of severe COVID-19 who undergo early rehabilitation can be discharged from an acute care hospital, they may have several impairments in their physical and mental status, including muscle function, diffusion capacity, exercise tolerance, and health-related quality of life.

Objectives: Patients with cancer cachexia have poor adherence to treatment, which affects their prognosis. Currently, there are many studies on the effects of rehabilitation on cancer cachexia, but there is a lack of evidence on the effects of nutrition therapy alone or in combination with rehabilitation and nutrition therapy. This article describes a case in which rehabilitation nutrition care process was effective in a patient with lung cancer who developed cancer cachexia. Methods: A 68-year-old woman was hospitalized for treatment of lung adenocarcinoma. The patient had moderate malnutrition, sarcopenia, and cachexia at the time of admission, so the authors intervened according to rehabilitation nutrition care process. The physiotherapist mainly prescribed resistance training and aerobic exercise, 40-60 minutes a day, 5-6 days a week. And the dietitian provided oral nutritional supplements (100 kcal, branched-chain amino acid: 3.0 g) in addition to hospital food and adjusted the patient's energy intake to 26.96-33.05 kcal/kg/day and protein intake to 1.07-1.14 g/kg/day. Outcomes: Comparing the initial evaluation with the discharge, nutritional status, such as body mass index and skeletal muscle mass, and physical functions, such as maximum grip strength, gait speed, and functional independence measure (motor items), were improved. Conclusions: Rehabilitation nutrition care process-based interventions may improve nutritional status and physical functions more than exercise therapy alone in patients with lung cancer cachexia.

Post-polio syndrome refers to the physical and psychological sequelae caused by poliovirus infection. For this reason, according to which the emotional and sensorimotor sphere is affected, we consider a biobehavioural approach based on education and therapeutic exercise to be necessary. The aim of this case report is to evaluate the effect of a biobehavioural approach in a patient with post-polio syndrome and low back pain. We describe a 57-year-old man with post-polio syndrome and low back pain following a fall at the end of February 2020. The pain, disability and lack of functionality caused by both processes led him to contact a physiotherapy service. A therapeutic planning was carried out for 3 months, where a biobehavioural approach based on therapeutic exercise and education, with an assessment and three face-to-face sessions which were complemented by online follow-up and finalised due to the Sars-Cov-2 pandemic in a telerehabilitation approach. It was organised in two phases; the initial phase lasted 2 weeks with the aim of reducing the symptoms of the lumbar region, and the advanced phase in which the aim was to improve his physical condition. During the three-month intervention, four assessments were conducted (Pre, at 4 weeks, at 8 weeks and at 12 weeks). At follow-up, improvements in functional and psychological variables were obtained. This case suggests that a biobehavioural approach through telerehabilitation was a useful option in this reported case and could be an option of treatment to improve psychological, physical and functional variables in this patient.