越﨑 弘朗

Background Most measures of rehabilitation participation rely on self-report, excluding patients with cognitive impairment or aphasia. The observational Pittsburgh Rehabilitation Participation Scale (PRPS) allows their inclusion; however, whether rehabilitation participation assessed using the PRPS modifies improvement in activities of daily living (ADL) remains unclear. Objective To determine whether rehabilitation participation assessed using the PRPS modifies the association between baseline ADL and subsequent improvement after stroke. Methods This retrospective cohort study included 137 stroke survivors in a subacute rehabilitation ward. Admission rehabilitation participation was assessed by the PRPS. ADL improvement was evaluated using the Functional Independence Measure (FIM) motor effectiveness score. Hierarchical multiple regression analysis included age, days from onset to hospital admission, admission FIM motor and cognitive scores, and admission PRPS score in Step 1, followed by the PRPS × admission FIM motor interaction term in Step 2. Prediction plots were generated for each PRPS score. Results The median admission PRPS and FIM motor effectiveness scores were 5 (interquartile range [IQR], 4–6) and 0.70 (IQR, 0.33–0.88), respectively. Adding the PRPS × FIM motor interaction term in Step 2 significantly improved the model fit (ΔR ²  = 0.057, ΔF(1,130) = 16.28, p  < .001), resulting in a final model (R ²  = 0.545, p  < .001). Prediction plots showed steeper slopes with higher PRPS scores. Conclusions Admission rehabilitation participation assessed by the PRPS modified the association between baseline ADL and ADL improvement. Observable participation should be interpreted in relation to baseline motor ADL rather than in isolation. Lower participation may indicate a need for additional clinical support.

BACKGROUND:  Body weight-supported treadmill training (BWSTT) permits patients with stroke to practice walking at higher speeds under safe conditions but is limited by cost and accessibility. A suspended body weight-supported (BWS) walker has been developed as a practical alternative, enabling higher training speeds during walker-assisted gait training. However, it is unclear whether high-speed BWS walker-assisted gait training leads to immediate improvements in gait performance and how training speed and body weight support contribute to these effects. METHODS: Twenty patients with chronic stroke participated in a crossover study. Each participant underwent two gait training sessions using the same walker device: one without BWS and one with BWS activated. Gait performance was assessed before and after each session using the 10 m walk test. Training speed during each session was recorded to evaluate its relationship with pre-to-post changes in gait performance. RESULTS: Training with BWS enabled higher training speeds and resulted in significant improvements in gait speed and affected side step time, with a significantly greater increase in gait speed than that during training without BWS. Of the participants, 70% demonstrated increased training speed accompanied by immediate improvements in gait speed during BWS walker-assisted training. Improvements in gait speed were associated with increased stride length and reduced affected side step time. CONCLUSION: Walker-assisted gait training that enables higher training speeds, particularly when combined with BWS, may contribute to immediate improvements in gait speed in patients with stroke. Reductions in affected side step time may represent one mechanism underlying this training speed-related effect.

BACKGROUND: Most studies of knee joint motion during gait in patients who experienced a stroke have focused on comparisons with healthy individuals. However, comparisons of patients with varying gait abilities have not been adequately performed. This study compared the kinematic parameters of the bilateral knee joints of patients who experienced a stroke. These patients were divided into those with fast gait speed and those with slow gait speed to determine any differences in motion. METHODS: Twenty patients who experienced a stroke were included in this study. The fast and slow gait speed groups both comprised 10 patients. Knee joint-related parameters were the timing and flexion angle at the start of the swing phase on both sides and timing and flexion angle at the peak knee joint flexion angle. The difference between timing during both phases and the difference between the knee joint flexion angle during both phases were calculated. FINDINGS: Significant differences in the timing and angle at the start of the swing phase, peak timing, and peak angle of the fast and slow groups were observed on the affected side (p < 0.05). Significant differences in the timing of the start of the swing phase, peak timing and difference between timing of the fast and slow groups were observed on the unaffected side (p < 0.05). INTERPRETATION: Clear differences in the kinematic characteristics of the knee joints on the affected and unaffected sides were observed in both groups. These valuable insights regarding knee joint motion may improve the gait speed of such patients.

INTRODUCTION: Improvements in activities of daily living are closely linked to patients' moods. While hospital art has been reported to have a positive influence on mood, its effectiveness in rehabilitation settings remains unclear. PURPOSE: This study investigates the effects of rehabilitation and hospital art on mood improvement in patients admitted to a rehabilitation ward. METHODS: Thirty patients were assessed using questionnaires and semi-structured interviews at two time points, once before admission and then one week after hospitalization. Mood was measured using a visual analog scale, and interviews explored the perceived reasons behind mood changes. RESULTS: A significant improvement in mood was observed at the one-week mark following hospitalization (p=0.0389; 95% confidence interval: 0.51 to 18.22; Cohen's d=0.44). Rehabilitation was the most frequently cited factor contributing to improved mood. Some patients also referenced aspects of the care environment, including hospital art, while responding to the questionnaire. However, analysis of the interviews suggested a little association between rehabilitation and hospital art, indicating that hospital art had only a limited effect on mood improvement. CONCLUSION: Rehabilitation emerged as the primary driver of mood improvement, although hospital art may have provided a limited supplementary effect. A positive treatment environment may enhance mood and support better functional outcomes.

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 &lt; 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 &lt; 0.01). Impeding factors were FIM-M ≤38 (hazard ratio 0.23, 95% confidence interval 0.13–0.40; p &lt; 0.01) and FAC = 0 (hazard ratio 0.184, 95% confidence interval 0.06–0.62; p &lt; 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.

BackgroundThere is increasing recognition of the effectiveness of body weight-supported (BWS) walkers for stroke patients with hemiplegia. However, it is unclear whether the effectiveness of BWS walkers is because of the walker alone or the combined effect of the walker and body weight support.ObjectiveWe aimed to determine whether there are differences between normal, walker, and BWS walker gaits in patients after cerebral infarction (CI) and intracerebral hemorrhage (ICH).MethodsTwenty-one stroke patients with hemiplegia underwent trials under three gait conditions: normal, walker, and BWS walker gait. Spatiotemporal parameters and joint kinematics during walking were calculated using a three-dimensional motion analyzer. We further examined differences in effects depending on CI and ICH.ResultsSpeed and cadence improved in the walker gait and BWS gait groups compared with the normal gait group. In addition, the percentage of the stance and swing phases was improved in BWS walker gait compared to normal gait. Both patients with CI and those with ICH showed similar trends in gait parameters by BWS Walker.ConclusionsThese results suggest that using a BWS walker improves walking in stroke patients with hemiplegia in terms of gait parameter, and is a useful tool for gait training.

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.

〔目的〕健常成人による体重免荷式歩行器（BWS歩行器）を用いた歩行と通常歩行の歩行パラメータの類似性を比較し，BWS歩行器を用いた歩行練習が通常歩行に転移し得るかを検討した．〔対象と方法〕健常成人22名を対象とし，通常歩行とBWS歩行器歩行で10 m歩行を加速度計により測定した．加速度波形から歩行速度，ケイデンス，ストライド長，ステップ時間対称性，歩行周期変動，規則性を算出した．〔結果〕BWS歩行器歩行は，速度，ケイデンス，ストライド長，規則性（前後成分）で有意に低下を認めた．〔結語〕健常成人によるBWS歩行器歩行は歩行パラメータの低下をきたしたものの，ステップ時間対称性や歩行周期変動は差がなかった．よって，BWS歩行器は通常歩行と同様の歩行様式で歩行が行える可能性を示した．

[Purpose] This study investigated gait parameter changes in hemiplegic stroke patients who walked with a body weight-supported (BWS) walker and evaluated the usefulness of using the BWS walker in a walking exercise. [Participants and Methods] Nineteen hemiplegic stroke patients hospitalized in a convalescent rehabilitation ward were enrolled in the study. Trunk acceleration was used to evaluate walking with and without a BWS walker. Gait speed, cadence, stride length, step time symmetry, stride time variability, and stride time regularity were calculated from the accelerometer waveform. [Results] Hemiplegic stroke patients had a faster gait speed, walked more symmetrically, and had less variation in their gait cycle when using the BWS walker than when not using it. [Conclusion] Using a BWS walker may help hemiplegic stroke patients learn to walk more efficiently in terms of their gait speed.