Purpose: This follow- up study by questionnaire aimed to identify factors associated with social activity levels of stroke patients by investigating their activities between 1 and 3 years after discharge.

Materials and Methods: Participants included 191 people with stroke who were living in their home. Their social activity levels at 1 and 3 years post-discharge were investigated using the Frenchay Activities Index (FAI: an index for evaluating social activities such as housework, leisure, and work). Factors associated with inactivity at 3 years post-discharge, and with a decline in activity levels from 1 to 3 years post-discharge were analyzed by logistic regression analysis.

Results: The median FAI was 23 points after 1 year; however, it declined significantly to 19 points after 3 years. Cognitive dysfunction [odds ratio (OR) = 11.61, p < .001] and dependency in activities of daily living (ADLs) [OR = 8.46, p < .001] were identified as factors associated with inactivity after 3 years. Moreover, dependence in ADLs (OR = 0.10, p = .027) was identified as a factor associated with a decline in activity level from 1 to 3 years post-discharge.

Conclusions: Patients with stroke living at home tend to be inactive in the long term; this could be attributed to cognitive dysfunction and ADL dependency. Therefore, occupational therapists need to pay more attention to the social activities of patients with stroke in the community; providing activities tailored to the patient's abilities is vital. Furthermore, interventions are needed to prevent long-term decline in social activities in patients with stroke living at home, who show independence in ADL.

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Stroke is a disease that requires long–term seamless linkage between medical care, nursing care, and welfare, including rehabilitation, life support, and support for returning to work. Therefore, it is necessary to build a one–stop information provision and consultation support system at stroke center. At the stroke consultation / support desk, a stroke specialist is in charge, and each professional who is familiar with stroke, such as certified nurses, medical social workers, physical therapists, occupational therapists, speech therapists, pharmacists, registered dietitians, and clinical psychologists (certified public psychologists), collaborate as counselors for stroke care and support. Those team provide information and support to stroke patients and their families on medical care, welfare, nursing care, etc., and share information with collaborating medical institutions.

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目的：「脳卒中後疲労のセルフマネジメント」の概念を明らかにした．

方法：PubMed，CINAHL，APA PsycINFO，医学中央雑誌から抽出した24文献をRodgers（2000）の概念分析法で分析した．

結果：脳卒中後疲労のセルフマネジメントとは，脳卒中後疲労への適応，改善を果たすために【知識の獲得】【脳卒中後疲労の受け入れ】【ライフスタイル・価値観の変更】【セルフモニタリング】【エネルギーの消耗抑制】【活動意欲の保持】【活動予定の立案と柔軟な調整】【適正な生活習慣】【活動・休息バランスの保持】【生活環境調整】【他者からの理解・支援の要請】【教育・専門家支援の要請】という対処法を用いて，脳卒中後疲労に対処する【主体的な問題解決】のプロセスであった．

結論：脳卒中後疲労のセルフマネジメントは，脳卒中後疲労に対処する主体的な問題解決のプロセスであり，それを支援する介入の開発が期待される．

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In recent years, reports on young people and children who take care of their own parents and grandparents in their homes are getting picked up in the media. Based on the Ministry of Internal Affairs' Employment Structure Basic Survey (2014), it is reported that in Japan there are nearly 180,000 people who have such a role. It has been noted that such young people and children are at high risk of suffering various influences on academic work, employment and even mental health, in connection with engaging in care for their families, the necessity of support has been pointed out from the previous research including the UK. Even in Japan, there are some aspects that are gradually being clarified from the media reports and the interview survey for the parties as mentioned above, but the number of empirical studies is very limited. In this study, we proceeded empirical research on young people and children (hereinafter referred to as Young carer) who provide nursing care and care to such families of diseased and disabled adults, and developed a psychological scale that can be index to contribute to accumulation of useful knowledge for its support. Items were prepared through Japanese translation of the content of young carer of Inventory Revised (YCOPI-R) by Cox et al (2014) and back translation. Using the Internet survey, we analyzed the responses of 174 people (including 59 Young carers) from the obtained data. As a result of factor analysis, the same structure as Cox et al (2014) was observed. It was also shown that reliability and validity are sufficient .It was considered that it is necessary to empirically investigate mental health, relationship with family function and structure, adaptability fulfilled by maturity perceived by the parties, in the future research using the developed scale.

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　前交通動脈瘤破裂患者は，記憶障害を呈することが多く，前脳基底部との関連性が議論されている．また，実際には複数部位の脳損傷を伴うことが多く，さまざまな症状を呈することにもなる．戦略獲得訓練や代償手段の導入が考慮されるが，使用すべき残存機能の部分も障害されていることが多いため，より丁寧な対応が求められる．転帰については，発症1年を過ぎても症状が残っていることが多く，情動面と社会面に課題を残す者が多い．このように発症後時間を経た後に顕在化する情動面や社会面の課題に対しても，リハビリテーションの必要性があることが指摘されている．

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脳卒中は急性期治療のみならずその後のリハビリテーション，生活支援や復職・復学支援，介護など長期にわたる医療・介護・福祉の継続的な連携が求められる疾患である．よって，急性期病院からのワンストップでの情報提供・相談支援体制の構築が求められる．脳卒中療養相談窓口では，脳卒中専門医が責任者となり，脳卒中に精通した認定看護師や医療ソーシャルワーカー，理学療法士，作業療法士，言語聴覚士，薬剤師，管理栄養士，臨床心理士（公認心理師）等の各専門職が脳卒中療養相談士として協働し，脳卒中患者およびその家族に対して医療・福祉・介護などに関する情報提供や支援や，連携する医療機関との情報共有を行う．

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〔目的〕退院後の脳卒中患者における社会的活動と意図の関連性を明らかにする．〔対象〕脳卒中患者45名．〔方法〕退院直前（T1），退院3ヵ月後（T2），退院6ヵ月後（T3）に，社会的活動実施意図尺度（I-SAS），および社会的活動尺度（SAS）を用いて調査を行った．I-SASの変化は一元配置の分散分析，SASの変化は対応のあるt検定，I-SASとSASの関連性は階層的重回帰分析を用いて検討した．〔結果〕T2からT3にかけて，社会的活動性が低下していた．T2の社会的活動は，T1の意図によって予測されるものの，T3の社会的活動はT2の意図では予測できないことが示された．〔結語〕退院6ヵ月後には社会的活動が低下し，intention-behavior gapが生じていることが示唆された．

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  非侵襲的脳刺激 (Non-invasive brain stimulation: NBS) は, 頭蓋骨を通して大脳を刺激するために電気的・磁気的な誘導電流を用いる手法で, うつ病・脳卒中など幅広い分野における新たな治療方法として注目を集めている。近年, 高次脳機能障害患者への応用に, その研究フィールドが拡大している。その応用には, (1) 高次脳機能障害を呈するさまざまな疾患, また多彩な症状に, 有効な刺激方法の確立, (2) 安全性・有効性の証明, (3) 患者の社会復帰・社会参加のために反復性経頭蓋磁気刺激療法 (Repetitive Transcranial Magnetic Stimulation: rTMS) と併用する有効な認知リハビリテーションの確立など, いくつかの課題がある。本稿においては, 我々の研究グループでの研究や, 過去の論文より rTMS を用いた手法に関する報告を中心とし, 高次脳機能障害への適応について論じる。

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[Purpose] The aim of this study was to study manual dexterity levels provided by the type of compression garment and compression bandages of patients with breast cancer-related lymphedema (BCRL). [Methods] Twenty-six BCRL patients formed experimental group and 32 healthy volunteers who were matched to the experimental subjects were in the control group. Grip strength and manual dexterity were tested under the three conditions (the no compression condition, the garment condition, and the bandage condition) using the Nine-Hole Peg Test (NHPT), the Box and Block Test (B&BT) and a hand-held Jamar dynamometer. [Results] The comparison showed significant differences of grip strength between the experimental group and the control group under the bandage condition. Both groups’ performance abilities decreased as the thickness of the compression materials increased. The correlations between the grip strength and dexterity scores tended to be low to moderate, ranging from 0.407 (Box and Block Test) to - 0.550 (Nine-Hole Peg Test) under the bandage condition. [Conclusion] The result of this study suggest that the grip strength and manual dexterity scores in patients with BCRL are influenced by the characteristics of the compression type. A wider choice of compression materials would improve on hand function in activities of daily living.

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Objective It has been increasingly recognized in various clinical areas that self-efficacy promotes the level of competence in patients. The validity, applicability and potential usefulness of a new, simple model for assessing self-efficacy in the elderly with special reference to frailty were investigated for improving elderly patients' accomplishments.

Methods The subjects of the present study comprised 257 elderly people who were members of the New Elder Citizen Movement in Japan and their mean age was 82.3±3.8 years. Interview materials including self-efficacy questionnaires were sent to all participants in advance and all other physical examinations were performed at the Life Planning Center Clinic.

Results The internal consistency and close relation among a set of items used as a measure of self-efficacy were evaluated by Cronbach's alpha index, which was 0.79. Although no age-dependent difference was identified in either sex, gender-related differences in some factors were noted. Regarding several parametric parameters, Beck's inventory alone revealed a significant relationship to self-efficacy in both sexes. Additionally, non-parametric items such as stamina, power and memory were strongly correlated with self-efficacy in both sexes. Frailty showed a significant independent relationship with self-efficacy in a multiple linear regression model analysis and using Beck's inventory, stamina, power and memory were identified to be independent factors for self-efficacy.

Conclusion The simple assessment of self-efficacy described in this study may be a useful tool for successful aging of elderly people.

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Objective: This study aims to determine the effect of grip exercise by the non-paretic hand on venous return in the paretic arm in stroke in sitting and supine positions.

Methods: The study population included 21 stroke patients (mean age, 59.5 years). The diameter (mm) and time-averaged mean velocity (TAMV) (cm/s) of the axillary vein on the paretic side were measured by ultrasound during three distinct conditions: resting, rhythmic non-resistive grip exercise, and resistive exercise (30% of maximum grip strength) in supine and sitting positions. The venous flow volume (ml/min) was calculated using the obtained data.

Results: In the supine and sitting positions, the venous flow volume during rhythmic non-resistive and resistive exercises was increased in comparison to resting, which resulted in more increased venous flow volume by rhythmic resistive grip exercise than by non-resistive grip exercise (both, p=0.01).

Conclusion: Grip exercise by the non-paretic hand was found to be effective for increasing the venous flow volume in the paretic hand, and resistive grip exercise caused the greatest increase. Our results suggest that rhythmic handgrip exercise may be clinically useful for reducing the incidence of hand edema in stroke patients.

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Background: Functional electrical stimulation (FES) improves unilateral spatial neglect (USN). However, only few studies have reported on the relationship between FES and cognitive function. Therefore, this study aimed to investigate the effects of FES on attentional function in healthy participants using the Posner task, which is generally used to assess patients with USN.

Methods: In this interventional study, we conducted experiments on healthy participants to obtain fundamental knowledge before investigating effective ways of adapting FES to patients with USN as our final purpose. A total of 28 right-handed healthy young participants were assigned to the online-effect group or after-effect group and underwent FES simultaneously with or immediately before the Posner task, respectively. FES was applied to the extensor muscles of the left forearm to induce involuntary movement.

Results: A significant difference was observed in the effects of FES in the Posner task between the online-effect group or after-effect group in the left-valid conditions (online-effect, 26.7 ms delay; after-effect, -0.4 ms [reduction]; p = 0.01). No interaction was noted between the groups and the type of target of the Posner task presentation condition. The effects of FES differed between the online- and after-effect condition groups.

Conclusion: Performing the attention task after FES may enhance attention compared with performing the task with FES simultaneously.

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脳卒中患者のセルフマネジメントに関する研究の動向と実態を明らかにすることを目的に，文献レビューを行った。医中誌，PubMed，CINAHLにおいて，国内文献７件，国外文献98件が抽出された。研究は2000年以降に報告されており，過去５年間の国外の介入研究が増加していた。国内では，実態調査と文献レビューのみであったが，国外では，尺度開発，支援ツールの開発，介入プロトコル，介入研究，介入プログラムの評価も行われていた。セルフマネジメントのプロセス全体を評価した実態調査は十分に行われておらず，介入プログラムも開発段階であった。適切なセルフマネジメント行動により，心身機能やQOLの向上が期待できる一方で，退院後の療養支援環境が十分に整っていないことが一因となり，適切な行動がとれない患者が一定割合で存在する実態が明らかになった。プロセス全体を評価できる指標や尺度の開発，実態に基づく介入プログラムの開発が求められた。

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非侵襲的脳刺激である反復性経頭蓋磁気刺激（rTMS）は，今日までに少なくない知見が報告されてきており，リハビリテーション医療の臨床において，その安全性と実行可能な治療法であることが明らかにされている．リハビリテーション治療を併用することにより，大脳の刺激部位に留まらない，脳内の広範な神経ネットワークに影響をもたらして，大脳の再組織化を進めることが脳画像などにより示されている．刺激頻度と強度，時間，併用するリハビリテーション治療を含めたプロトコールの標準化が進むことにより，rTMSが高いエビデンスの治療法として期待される．

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Unilateral spatial neglect (USN) is defined as impaired attention to stimuli on one side, which can exist for near and far spaces combined or independently. Thus, quantifying both near- and far-space neglect is crucial. This study aims to propose an index to quantify the near/far spatial neglect ratio to describe neglect symptoms’ characteristics in each patient using virtual reality (VR). Objects were presented in a VR space and the positional data of them recognized by the patients was recorded. The near/far neglect ratio (NF_Ratio) which was calculated using proposed equation suggested that four patients tended to have greater far-space neglect, and one tended to have greater near-space neglect. Moreover, NF_Ratio was shown to vary according to height. This is the first study to propose VR system to quantify the near and far spatial neglect. However, further study is needed to assess its reliability and validity and describe its clinical usability.

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Objective: Augmentative and alternative communication (AAC) devices are crucial for amyotrophic lateral sclerosis (ALS) patients because disease progression impairs verbal speech. Although the introduction of AAC devices must be appropriately timed, no guidelines currently exist. In this study, we examined the usefulness of the ALS functional rating scale-revised (ALSFRS-R) for predicting the timing of device introduction. Methods: This study was a retrospective cross-sectional study with consecutive sampling of patients diagnosed with ALS who underwent rehabilitation at Kitasato University East Hospital between 2011 and 2018. Patients were introduced to AAC devices (writing, communication boards, switch control, and/or eye control) and underwent assessment at three timepoints: the start of rehabilitation, as each communication device was introduced, and at the end of rehabilitation. ALSFRS-R multiple comparisons were analyzed using the Kruskal-Wallis test and, as a post-test, the Steel-Dwass test was used. Receiver operating characteristic (ROC) curves and areas under the ROC curves (AUCs) based on ALSFRS-R total and sub-item scores were used to calculate cut-off values for when transitioning to a new type of device is necessary. Results: In this study, 216 patients underwent rehabilitation, and 92 met the inclusion criteria. The total ALSFRS-R scores significantly differed among the four devices, except for those between communication boards and switch control devices. The bulbar and respiratory sub-scores did not significantly differ between devices. For each device type, total or sub-item scores yielded an AUC of 0.8 or more. Conclusions: Our findings suggest that the ALSFRS-R is a useful assessment for timing the introduction of communication devices, and its utilization could help therapists, caregivers, and families to provide AAC for patients with ALS.

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  自動車運転評価を考える段階にある右半球損傷例については, 症状が軽度であるか, リハビリテーションを経て症状が改善, あるいは代償期の USN で ADL が自立している段階にあり, 自宅復帰や復職を控えた活動的な時期に至っているケースが中心になる。これらの軽度例は, 中等度・重度症例とは異なり, 机上の BIT 行動性無視検査などの静的検査では制限時間を設けるなどの方法上の工夫がない限り問題が検出されにくいことが多い。特に, 自動車運転の課題特性を踏まえた評価として, ドライビングシミュレータ上の車線追従課題や反応課題などに代表される動的評価は, 右半球損傷例の自動車運転時のリスクを予測するうえで有益な情報を提供する可能性がある。本稿では, 机上検査だけでは一見 USN の症状が見過ごされやすい右半球損傷例を対象に, 著者らが開発したドライビングシミュレータ課題の実施結果について紹介する。

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