牛澤 一樹

OBJECTIVE: To determine the time course of longitudinal changes in the independence level of toileting-related subtasks in post-stroke patients. DESIGN: Single-institution, prospective cohort study. SUBJECTS/PATIENTS: A total of 101 consecutive patients with stroke admitted to subacute rehabilitation wards who urinated/defecated in bathrooms using wheelchairs upon admission. METHODS: Occupational therapists assessed the independence level of patients in each of the 24 toileting subtasks on a 3-level rating scale using the Toileting Tasks Assessment Form every 2-4 weeks from admission to the endpoint (achieving independent toileting or discharge). Patients were classified based on admission and endpoint assessment form scores using a two-step cluster analysis. RESULTS: Patients were classified into Cluster 1 (30 patients who exhibited a greater independence level in all subtasks upon admission [46.7-100% of patients performed each subtask independently] to the endpoint [73.3-100%]), Cluster 2 (41 patients who showed less independence upon admission [0-26.8%] but gained greater independence at the endpoint [34.1-73.2%]), and Cluster 3 (30 patients whose independence levels remained low in many subtasks from admission [0-26.7%] to the endpoint [3.3-26.7%]). CONCLUSION: Changes in toileting independence levels could be classified into 3 time courses. Effective intervention strategies may differ between each group.

OBJECTIVE: To clarify the percentage of stroke patients who are independent in performing tasks involved in public transportation use and problems faced while doing so. DESIGN: Single-institution retrospective study. PATIENTS: A total of 237 post-stroke patients utilized public transportation during their hospitalization in subacute rehabilitation wards. METHODS: Participants' actual performance in 14 tasks involving public transportation use was assessed using the Public Transportation Use Assessment Form. For each task, the percentage of participants who could perform the task independently was calculated and identified performance problems were categorized. RESULTS: The task with the lowest percentage of independent participants was "Walking in crowds", with 146 of 236 (61.9%) participants performing this independently, followed by "Selecting departure time and platform" (149 of 229, 65.1%), and "Getting on and off trains" (162 of 230, 70.4%). Problems faced when "Walking in crowds" included the "Risk of colliding with others" (n = 34), "Stopping abruptly" (n = 16), "Lack of attention to surroundings" (n = 14), and "Unable to walk with the flow of people" (n = 11). CONCLUSION: A significant number of patients could not perform tasks independently and faced various performance problems. These issues should be addressed during rehabilitation to enable patients to use public transportation.

BACKGROUND: Anxiety and depression in rehabilitation patients can adversely impact clinical outcomes. They may have anxieties about the differences in their physical conditions and living environments compared to before hospitalization. Although medical staff address patients' anxieties, the content of anxieties and the type of intervention have not been clarified. This study aimed to highlight the contents of anxieties and interventions for patients undergoing rehabilitation, based on medical staff's perspectives. METHODS: Seventeen medical staff were interviewed about the anxieties they perceived patients experience at the convalescent rehabilitation ward (early, middle, and late phases of hospitalization) and the corresponding interventions. Text mining and hierarchical cluster analysis were used to classify the contents of anxieties and interventions. This study was conducted based on the consolidated criteria for reporting qualitative research. RESULTS: Patients' anxieties were classified into six clusters. Among the clusters, prospects for rehabilitation plans, hospital life (e.g., unfamiliar hospital environment), and family situation (e.g., concerns about family life at home) were identified in the early to middle phases, and life at home after discharge was identified in the late phase. The prognosis of physical function and prospects of social life (e.g., return to work) were identified throughout all phases. The types of interventions for these anxieties were classified into eight clusters. The medical staff provided information about patients' prospects and helped them contact family members in the early phase. In the middle phase, feedback on patients' improvement in physical function was incorporated. In the late phase, information on social resources was provided to address anxieties about life after discharge. CONCLUSION: This study showed that patients' anxiety and interventions varied according to hospitalization phases. The findings underscore appropriate ways and the timing of interventions to keep patients in a better psychological state, potentially leading to better rehabilitation outcomes.

INTRODUCTION: Dose (number of repetitions) has been suggested as a key element in the effectiveness of rehabilitation exercises to promote motor recovery of the hemiparetic upper limb. However, rehabilitation exercises tend to be monotonous and require significant motivation to continue, making it difficult to increase the exercise dose. To address this issue, gamification technology has been implemented in exercises to promote self-engagement for people with hemiparesis in continuing monotonous repetitive movements. This study aimed to investigate how subjective perspectives, specifically enjoyability, motivation to continue, and expectancy of effectiveness, change through continuous daily exercise using a developed gamified exercise system. MATERIALS AND METHOD: Ten people with stroke suffering upper limb dysfunction underwent daily gamified exercise for seven days. The gamified exercise consisted of an electromyography (EMG)-controlled operating system that enabled users to play virtual games using repetitive finger movements. The participants performed conventional self-exercise on the same day as the control exercise, and rated their subjective perspectives on both exercises on a numerical rating scale on each exercise day. RESULTS: Ratings for enjoyability and motivation to continue consistently showed significantly higher scores for the gamified exercise than for conventional self-exercise on all exercise days. A similar trend was observed in the ratings for the expectancy of effectiveness. No changes over time were found in any of the ratings throughout the exercise period. CONCLUSIONS: Exercise using the developed EMG-controlled gamified system may have the potential to maintain motivation and enjoyment in people with stroke to continue monotonous repetitive finger movements.

OBJECTIVE: To clarify the time-course of longitudinal changes in the independence level of subtasks composing bed-wheelchair transfer among patients with stroke. DESIGN: Single-institution prospective cohort study. PATIENTS: A total of 137 consecutive post-stroke patients using wheelchair on admission to the subacute rehabilitation wards. METHODS: The independence degree in each of the 25 transfer-related subtasks was assessed using the Bed-Wheelchair Transfer Tasks Assessment Form on a three-level scale every two weeks, from admission to the endpoint (either discharge or when achieving independent transfer). Patients were classified based on admission and endpoint assessment form scores using two-step cluster analysis. RESULTS: Patients were classified into three clusters. The first cluster included 50 patients who exhibited a greater independence level in all subtasks on admission (52.0-100% of patients performed each subtask independently) and at the endpoint (64.0-100%). The second included 30 patients who showed less independence on admission (0-27.8%) but achieved greater independence levels at the endpoint (44.4-97.2%). The third included 51 patients whose independence level remained low in many subtasks from admission (0-5.8%) until the endpoint (0-29.4%). CONCLUSION: The independence level and its changing process during transfer were categorized into three time-courses, each requiring different intervention strategies.