Purpose: This study’s primary purpose was to verify the relationship between the cardiopulmonary response on a grocery shelving task (GST) and the motor function of the upper limbs in patients with chronic obstructive pulmonary disease (COPD). The secondary purpose was to evaluate the usefulness of the GST in the assessment of these patients’ upper-limbs motor function. Methods: We measured the respiratory gas exchange, heart rate and blood pressure and evaluated the modified Borg scale scores during both the GST and a UIULXT (unsupported incremental upper limb exercise test) in 10 COPD patients (mean age 75 ± 9 yrs) and 10 healthy elderly subjects (69 ± 10 yrs). We analyzed the relationships among the GST performance and respiratory function, respiratory muscle strength, grip strength, PFSDQ-M (pulmonary functional status and dyspnea questionnairemodified) score, m-MRC (the modified medical research council scale), and physical activity of the upper limbs and the whole body. Result: The exercise intensity achieved by the patients on the GST was 2.3 ± 1.1 METs. Their values of V˙CO₂/kg, systolic blood pressure, SpO₂, and modified Borg scale were significantly lower than their UIULXT scores. The time needed to complete the GST (GST time) was 44.1 ± 10.7 s in the COPD patients and 38.9 ± 3.7 s in the healthy elderly subjects. The GST time, grip strength and physical activity of the upper limbs were positively correlated, whereas the GST time and the values of PFSDQM and m-MRC were negatively correlated. Conclusion: Our results suggest that the GST is a relatively small-load assessment test for COPD patients and that the GST could be used to accurately evaluate the dyspnea, fatigue and physical activity of the upper limbs in COPD patients’ activities of daily living.

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Purpose: The purpose of this study was to compare the learning effects between visual and auditory feedback exercises which required voluntary weight shifts in dynamic postural balance. Methods: Twenty healthy young adults participated in this study. The subjects were equally divided into two groups randomly. The subject was required to match his or her center of pressure (COP) to visual targets, which were shown in a monitor, in the forward-backward direction at three test sessions (pre-practice, post-practice, and retention). The subjects were received an additional auditory feedback (AF) or visual feedback (VF) in conjunction with the displacements of COP during the practice session. The root mean square of the distances from the target to the COP (RMS) was calculated to determine the accuracy of the weight shifts. Results: The mean RMS at the post-practice session was reduced significantly compared to that at the pre-practice session in each group. The reduction in the mean RMS at the retention session was constant in the AF group. On the other hand, the mean RMS at the retention session was increased compared to that at the post-practice session in the VF group. Conclusion: In dynamic postural balance using the intermittent sensory feedback practices, AF is superior to the VF for the motor learning.

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Purpose: To test the reproducibility and efficacy of the Two-Square Step Test (TSST) in relation to activities of daily living (ADLs) and the ability to walk independently, and to determine the cutoff score for independently walking patients. Methods: Elderly hospitalized patients 65 years and over were studied. The reproducibility of the TSST was studied in individual patients and between patients. Then, to determine the efficacy of the TSST, we compared it with each exercise of the Four-Square Step Test (FSST) and the Functional Independence Measure (FIM) and determined the cutoff score for independent walking. Results: The correlation coefficient among individual patients and between these patients and the group of tested patients for the TSST was 0.98. There was significant correlation between the TSST and the FSST (r_s = 0.82) and between the TSST and the FIM (r_s = 0.73). The cutoff for TSST score to determine the ability to walk independently was 25.5. Conclusion: Both the reproducibility and efficacy of the TSST were excellent. We also investigated the correlation between ADLs and independent walking ability. Because the cutoff score for independent walking ability was clarified, we concluded that the TSST was applicable for clinical use.

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Purpose: This study aimed to identify factors associated with inhibition of independent ambulation and progression of rehabilitation after cardiovascular surgery in patients aged ≥80 years. Methods: This study involved 557 consecutive patients who underwent cardiovascular surgery (male: 278; mean age: 83.3 years) at 12 facilities in Japan. The patients were classified into 4 groups on the basis of the first postoperative day (POD) of 100-m independent ambulation: (1) early independence group (POD: ≤5), (2) favorable group (POD: 6–8), (3) delay group (POD: ≥9), and (4) non-independence group, and were assessed. Results: The number of patients in each group was as follows: early independence group, 271 (48.6%); favorable group, 104 (18.7%); delay group, 90 (16.2%); and non-independence group, 92 (16.5%). In all groups except the non-independence group, the mean time interval for independent ambulation was 7.0 days. Low ADL before cardiovascular surgery was the most important reason for delayed recovery and non-independence (32.4%). Multiple logistic analyses revealed that chronic kidney disease was significantly associated with delayed recovery. Conclusion: Even among very old patients, approximately 70% regained independent ambulation after cardiovascular surgery. Chronic kidney disease was a leading predictor of delayed recovery of physical activity after cardiovascular surgery.

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Purpose: The objectives of the current study were to investigate predictors of a short-term change in life-space, and to determine the diagnostic characteristics of the model among older outpatients in rehabilitation facilities. Method: A total of 82 subjects aged 60 or older took part in this study. A poor outcome was defined as deterioration or a constant low state in life-space, determined by life-space assessment measured at baseline and at a 5-month follow-up, respectively. Independent variables were a series of measurements, including physical and psychosocial functioning, comorbidities, exercise capacity, and demographic factors. A hierarchical binominal logistic regression analysis was carried out to identify independent predictors, with age, sex, body mass index, previous intervention period before baseline, and number of individual therapies entered as confounders. Finally, diagnostic properties were computed using a life-space change prediction model. Results: A low self-efficacy and grip strength were significant predictors of short-term deterioration/constant low state in life-space among the studied population. The sensitivity of this model was 82.6%, specificity 72.2%, positive likelihood ratio 2.97, and negative likelihood ratio 0.24. Conclusion: The results indicate that grip strength and self-efficacy predict a short-term change in life-space among non-active older out-patients in rehabilitation facilities.

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Purpose: The aim of this study was to evaluate the outcome of postoperative rehabilitation in patients who underwent repair for thoracic and thoracoabdominal aortic aneurysms. Method: Two-hundred and four patients (153 male, 51 female, aged 68 ± 13 years) were divided into 3 groups by the site of aortic repair: group A (ascending aorta repair), group B (aortic arch repair), and group C (descending and thoracoabdominal aorta repair). In each group, we categorized the patients into 3 grades by postoperative days to achieve 100-m unassisted walk; early (≤4 days), intermediate (5-8 days), and delayed (≥9 days) or not achieved. Based on this category, we assessed the clinical characteristics, perioperative data, progression of postoperative rehabilitation, and also the reasons for delayed or not achieved. Result: There were more patients graded as early in group A, and more patients graded as delayed or not achieved in groups B and C (p<0.05). The main reason for delayed or not achieved was cerebral vascular disease in group B, and spinal cord infarction in group C (p<0.05). Conclusion: The progression of postoperative rehabilitation tended to be delayed or unable to achieve unassisted 100-m walk in patients who underwent aortic arch repair and descending and thoracoabdominal aorta repair, and the main reason was perioperative complication of cerebral vascular disease in the former and spinal cord infarction in the latter.

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Purpose: The present study was conducted to identify the determinants of maintenance of physical activity among older adults who participated in a care prevention program. Methods: The subjects were 309 older adults who participated in a care prevention program. The subjects were divided into three groups, namely the exercise continuation group, unstable exercise continuation group, and non-exercise group, by using an action transformation stage about the exercise. We investigated the baseline characteristics, social participation, body function, and psychological factors of the subjects by administering a self-reported questionnaire and conducting physical performance tests. Results: Social participation and functional factors were related to exercise activity. Multiple logistic regression analysis revealed that a lifestyle with exercise and recovery self-efficacy were associated with maintenance of physical activity. Conclusions: In this study, we demonstrated that incorporating exercise into one’s lifestyle and enhancement of recovery self-efficacy are important factors that promote physical activity among older adults who participate in a care prevention program.

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Purpose: In this study, we aimed to investigate whether wheelchair propulsion by patients with severe Parkinson’s disease can be improved by using rhythmic auditory stimulation. Methods: Three wheelchair-bound patients (subjects A, B, and C) with stage 4 Parkinson’s disease, as assessed using the Hoehn & Yahr scale, were included in this study. The items assessed were the time required to propel the wheelchair 10 m at full exertion and the number of strokes. Each trial was divided into the following 4 phases: baseline, intervention, after intervention, and follow-up. Measurements were performed without rhythmic auditory stimulation during the baseline and follow-up, but with rhythmic auditory stimulation during and after the intervention. The intervention comprised 5 minutes of wheelchair propulsion, which was practiced twice per week for 4 weeks. Results: The time required for wheelchair propulsion and the number of strokes were markedly decreased after the intervention compared to that at baseline for subjects A (required time: 31%, number of strokes: 28% in comparison to 100% at baseline), B (37%, 26%), and C (54%, 65%). The effect was continued into the follow-up phase for subjects A and B, but not for subject C. Conclusion: This study suggests the possibility that wheelchair propulsion practice combined with rhythmic auditory stimulation is effective in improving wheelchair propulsion by patients with Parkinson’s disease.

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