藤村 健太

Objective: To identify factors associated with earlier independence in “real-life walking” during hospitalization in subacute stroke patients.Design: Retrospective cohort study.Subjects/Patients: Two hundred and six hemiplegic patients.Methods: Functional Independence Measure (FIM) walking items were measured biweekly from admission to discharge. Patients were grouped by achieving independent “real-life walking” (FIM-walking score ≥6). Time to independence, stratified by age, FIM motor score (FIM-M), FIM cognitive score (FIM-C), and Functional Ambulation Categories (FAC) scores were compared using Kaplan–Meier plots and log-rank tests. Hazard ratios were calculated via multivariable Cox proportional hazard models.Results: The median time to independence was 4 weeks, with significant differences (p < 0.05) by age, FIM-M, FIM-C, and FAC stratification. Age ≤64 years (hazard ratio 1.92, 95% confidence interval 1.21–3.06), FIM-C ≥25 (hazard ratio 2.42, 95% confidence interval 1.52–3.86), and FAC ≥3 (hazard ratio 1.98, 95% confidence interval 1.22–3.21) significantly affected earlier walking independence (all p < 0.01). Impeding factors were FIM-M ≤38 (hazard ratio 0.23, 95% confidence interval 0.13–0.40; p < 0.01) and FAC = 0 (hazard ratio 0.184, 95% confidence interval 0.06–0.62; p < 0.01).Conclusion: Early improvement in “real-life walking” was associated with younger age, greater cognitive function, and greater “test-setting walking” ability on admission. Low activities of daily living independence and “test-setting walking” ability hindered early progress.

Objective: To demonstrate the long-term efficacy of repeated botulinum toxin A injections into the same muscles for ameliorating lower limb spasticity and gait function.Design: Single-case studyPatient: A 36-year-old woman with right cerebral haemorrhage received her first botulinum toxin A injection 1,296 days after onset. The patient underwent 30 treatments over 12 years after the first injection to improve upper and lower limb spasticity and abnormal gait patterns. The mean duration between injections was 147 days.Methods: The Modified Ashworth Scale, passive range of motion, gait velocity, and degree of abnormal gait patterns during treadmill gait were evaluated pre-injection and at 2, 6, and 12 weeks after every injection.Results: The follow-up period showed no injection-related adverse events. Comfortable overground gait velocity gradually improved over 30 injections. The Modified Ashworth Scale and passive range of motion improved after each injection. Pre-injection values of the degree of pes varus, circumduction, hip hiking, and knee extensor thrust improved gradually. However, the degree of contralateral vaulting, excessive lateral shift of the trunk, and insufficient knee flexion did not improve after 30 injections.Conclusion: Repeated botulinum toxin A injections effectively improve abnormal gait patterns, even when a single injection cannot change these values.

BACKGROUND: The impact of different stroke types on specific activities of daily living (ADL) is unclear. OBJECTIVE: To investigate how differences between intracerebral hemorrhage (ICH) and cerebral infarction (CI) affect improvement of ADL in patients with stroke within a hospital by focusing on the sub-items of the Functional Independence Measure (FIM). METHODS: Patients with first-stroke hemiplegia (n = 212) were divided into two groups: ICH (86 patients) and CI (126 patients). Primary assessments included 13 motor and 5 cognitive sub-items of the FIM assessed at admission and discharge. Between-group comparisons and multiple regression analyses were performed. RESULTS: Upon admission, the ICH group exhibited significantly lower FIM scores than those of the CI group across various activities, including grooming, dressing (upper body and lower body), toileting, bed/chair transfer, toilet transfer, walking/wheelchair, and stairs. Age and FIM motor scores at admission influenced both groups' total FIM motor scores at discharge, whereas the duration from onset affected only the CI group. CONCLUSION: Several individual FIM motor items were more adversely affected by ICH than by CI. Factors related to ADL at discharge may differ depending on stroke type. Recognizing these differences is vital for efficient rehabilitation practices and outcome prediction.