OTAKA YOHEI

OBJECTIVES: To investigate the prevalence of aspiration and its association with GI involvement and clinical features in systemic sclerosis (SSc). METHODS: Fifty patients with SSc who underwent the videofluoroscopic (VF) swallowing study were included. Aspiration was identified by the presence of aspiration and/or penetration defined by the Penetration-Aspiration Scale. The radiological findings including the residue in the oral cavity, pharynx and esophagus, which reflect oral, pharyngeal, and esophageal involvement, were also evaluated. RESULTS: Twenty-three patients (46%) had aspiration and/or penetration. Patients with aspiration and/or laryngeal penetration had more pharyngeal vallecular residue (None 22%, Trace 44%, Mild 56%; p = 0.072) and esophageal residue (None 0%, Mild 20%, Moderate 40%, Severe 61%; p = 0.010). Esophageal, pharyngeal, and lower GI involvement were found in 98%, 83%, and 54%, respectively. Notably, the group with esophageal and pharyngeal plus lower GI involvement had a higher frequency of aspiration and/or penetration (79% vs 28%; p = 0.003), higher FSSG scores (18.4 ± 11.8 vs 5.4 ± 5.7; p = 0.002), and higher UCLA GIT-2.0 total scores (None-to-Mild 47% vs 100%, Moderate 42% vs 0%, Severe-to-Very severe 11% vs 0%; p = 0.001) compared to those limited esophageal and pharyngeal involvement. By multivariate analysis, aspiration and/or penetration was associated with pharyngeal vallecular residue (Odds ratio (OR) 3.71; p = 0.012) and esophageal residue (OR 2.92; p = 0.011), and higher UCLA GIT-2.0 scores for diarrhea (OR 3.68; p = 0.028) and the total score (OR 4.21; p = 0.046). CONCLUSION: In our study, about half of the patients had aspiration and/or penetration in SSc. Aspiration was associated with the extent of radiographic abnormalities of pharyngeal and esophageal involvement on the VF swallowing study. Patients with lower GI have aspiration and high UCLA GIT-2.0 scores suggesting that these patients had more severe GI manifestation.

BACKGROUND: In Japan, a growing number of older adults with heart failure (HF) are experiencing physical frailty. Healthcare providers recommend multicomponent exercise program for frail patients; however, their effectiveness in older Japanese adults with HF, who differ physiologically from their Western counterparts, remains unclear. In this study, we will compare the feasibility and efficacy of a multicomponent exercise program with those of conventional exercise therapy as pilot study of the randomized controlled trial, Japanese REHAB-HF (J REHAB-HF) trial. METHODS: In this multicenter study, frail older adults hospitalized with worsening HF will be randomly assigned to participate in a program of either multicomponent or conventional exercise therapy. We developed a multicomponent exercise program to target characteristics of physical frailty: poor gait performance, balance ability, muscle strength, and exercise tolerance. The primary outcome is the total score on the Short Physical Performance Battery; additional outcome measures include feasibility and safety of the programs. CONCLUSION: The pilot study of the J REHAB-HF trial is an evaluation of whether a multicomponent exercise program enhances physical function more effectively than does conventional exercise therapy in frail older adults with HF. The findings will guide the design of the main J REHAB-HF trial and improve care for these individuals.

BACKGROUND: Robot-assisted gait training (RAGT) has proven effective in addressing gait disorders in patients with stroke. However, its efficacy in patients with acute stroke has not yet been demonstrated. This pilot study is designed to evaluate the following: (1) feasibility of conducting a randomized controlled trial on RAGT for enhancing gait postacute stroke and (2) to obtain preliminary estimates regarding the potential efficacy of RAGT for achieving gait independence during the acute phase. METHODS: We will conduct an assessor-blinded, single-center, randomized controlled pilot trial involving 32 patients with acute stroke who are unable to walk. Participants will be randomly assigned to either the RAGT or the conventional gait training (CGT) groups. Each participant will receive 180 min of daily rehabilitation, including 60 min dedicated to gait training. The RAGT group will receive 40 min of RAGT and 20 min of CGT, while the CGT group will engage in 60 min of CGT. Interventions will continue for up to 8 weeks, or until participants achieve gait independence, as indicated by a Functional Ambulation Category score of ≥ 3. Feasibility outcomes will include recruitment, enrollment, protocol adherence, and retention rates. The primary clinical outcome will be the incidence of achieving gait independence during the intervention period. Secondary clinical outcomes will include gait performance measures, assessments of physical function and activity, and intervention dose. Adverse events associated with RAGT and CGT will also be documented to evaluate the safety of both interventions. DISCUSSION: Implementing RAGT during the acute phase of stroke may facilitate earlier attainment of gait independence compared to CGT. We aim to provide valuable insights into the feasibility of the proposed study design and generate preliminary data on the potential effects of RAGT on gait independence in the acute phase of stroke, providing a framework for future larger-scale trials. TRIAL REGISTRATION: This clinical trial was registered with the Japan Clinical Trials Registry (jRCT) on 19 June 2023 (registration number: jRCTs042230040). The study protocol was initially registered as version 1.0 and has since undergone minor amendments-currently on version 4.0. This protocol was written based on the latest version (ver. 4.0) registered with jRCT.

This study aimed to determine the impact of bolus volume on UES opening. Twenty-two healthy subjects (10 males and 12 females, 23-45 years) underwent a CT scan while swallowing 3-, 10-, and 20 ml of thin liquid. Upper esophageal sphincter (UES) cross-sectional area and hyoid and laryngeal displacement were measured at every frame across three conditions. The timing of UES opening onset, UES maximum opening, and duration of UES opening were also measured. With increasing bolus volume, the UES maximum opening area increased, at the UES opening onset, at the UES maximum opening was earlier, and the duration of the UES opening prolonged. The maximum displacement of the hyoid and larynx was significantly more anteriorly and higher with a large bolus volume. However, the hyoid displacement at the timing of UES maximum opening did not change across three bolus volumes. This result suggests that the increase in the UES maximum opening area with increasing bolus volume was modulated by the bolus itself rather than by the hyoid movement.

BACKGROUND: Visuospatial function is a core domain of functional cognition in stroke. Post-stroke cognitive impairment disrupts rehabilitation practice, highlighting the importance of characterizing patients with higher-order visuospatial dysfunction to inform personalized rehabilitation strategies. Although neuroimaging offers insights into disease-related mechanisms, its clinical application remains limited. AIM: The aim of this paper was to investigate whether the residual resting-state functional connectivity supports higher-order visuospatial function after stroke and whether changes in connectivity can characterize patients with visuospatial dysfunction. DESIGN: Observational study. SETTING: Inpatient rehabilitation ward at Fujita Health University Hospital in Japan. POPULATION: Fifty-eight patients with stroke. METHODS: Visuospatial analogical reasoning was assessed using Raven's Colored Progressive Matrices (RCPM). Resting-state functional connectivity was evaluated using functional magnetic resonance imaging (fMRI). Empirical covariance matrices and group-sparse inverse covariance (GSIC) matrices were computed from the fMRI data, with the latter negated to estimate partial correlations representing direct connectivity. Correlations between connectivity measures and RCPM scores were analyzed, alongside data-driven clustering to stratify patients. RESULTS: No significant correlation was found between empirical covariance connectivity and RCPM scores. However, GSIC-based analysis revealed a significant inverse correlation between connectivity of the posteromedial and the left inferior parietal cortex and RCPM scores. Higher parietal connectivity was associated with lower RCPM performance. Patients in the highest connectivity cluster exhibited severe impairments in visuospatial analogical reasoning, particularly in tasks requiring the integration of discrete figures into spatially related wholes. The lesions in these patients were predominantly localized in the left subcortex. CONCLUSIONS: Medio-lateral parietal connectivity may underlie visuospatial analogical reasoning after stroke. CLINICAL REHABILITATION IMPACT: Clustering analysis highlighted a distinct pattern of low scores in patients with increased parietal connectivity, suggesting that parietal connectivity changes have the potential for characterizing patients with severe dysfunction.

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 define long-term changes in subjective symptoms among polio survivors in Japan. DESIGN: Prospective cohort study. PATIENTS: Sixty-five polio survivors. METHODS: Surveys were conducted on subjective symptoms including muscle weakness and limb atrophy during 2007 and 2021. The results of manual muscle tests of the upper and lower limbs on both sides during 2007 were summed and scored, and the side with lower scores was defined as the poor side. The participants were classified as younger or older groups based on the median age at the first survey (i.e., 58 years old) and the subjective symptoms were compared between the two groups. RESULTS: As a whole, muscle atrophy and weakness progressed in the lower and upper limbs while fatigue was reduced. Muscle weakness progressed especially in the lower limbs on the poor side in the younger group, and in the older group it progressed in the lower limbs on the good side and the upper limbs on the poor side. CONCLUSION: The timing of progressive muscle weakness differed between the upper and lower limbs of younger and older polio survivors.

BACKGROUND: Step count is used to quantify activity in individuals using accelerometers. However, challenges such as difficulty in detecting steps during slow or irregular gait patterns and the inability to apply this method to wheelchair (WC) users limit the broader utility of accelerometers. Alternative device-specific measures of physical activity exist, but their specificity limits cross-applicability between different device sensors. Moving standard deviation of acceleration (MSDA), obtained from truncal acceleration measurements, is proposed as another alternative variable to quantify physical activity in patients. OBJECTIVE: This study aimed to evaluate the validity and feasibility of MSDA for quantifying physical activity in patients with stroke-induced hemiparesis by comparing it with the traditional step count. METHODS: We enrolled 197 consecutive patients with stroke hemiparesis admitted to a convalescent rehabilitation ward. Using the hitoe system, a smart clothing-based physical activity measurement system, we measured the MSDA of trunk movement and step count. The correlation between MSDA and step count was examined in all participants. Based on their daily living mobility levels, measured using the Functional Independence Measure (FIM), participants were categorized into 6 subgroups: FIM1-4, FIM5 (WC), FIM5 (walking), FIM6 (WC), FIM6 (walking), and FIM7 (walking). Intersubgroup differences in MSDA were analyzed. RESULTS: A strong correlation was observed between MSDA and step count (r=0.78; P<.001), with a stronger correlation in the walking group (r=0.79; P<.001) compared with the WC group (r=0.55; P<.001). The Shapiro-Wilk test indicated no significant results for MSDA across all subgroups, supporting a normal distribution within these groups. In contrast, the step count data for the WC subgroups showed significant results, indicating a deviation from a normal distribution. Additionally, 10.2% (20/197) of participants recorded zero steps, demonstrating a floor effect in the step count data. The median MSDA values for the 6 subgroups (FIM1-4, FIM5 WC, FIM5 walking, FIM6 WC, FIM6 walking, and FIM7) were 0.006, 0.007, 0.010, 0.011, 0.011, and 0.014, respectively, reflecting their levels of independence based on the FIM mobility scores. The median step counts for these subgroups were 68, 233, 1386, 367, 2835, and 4462, respectively. FIM5 participants who walked had higher step counts than FIM6 participants using WCs, though the difference was marginally but not statistically significant (P=.07), highlighting the impact of mobility type (walking vs WC). CONCLUSIONS: The results suggest the validity of MSDA as a variable for physical activity in patients with stroke, applicable to patients with stroke irrespective of their mobility measures. This finding highlights the potential of MSDA for use in individuals with motor impairments, including WC users, underscoring its broad utility in rehabilitation clinical practice.

BACKGROUND: Dysphagia significantly impacts prognosis in individuals with multiple system atrophy (MSA). While video-based assessments are practical, their limited availability highlights the need for a simple tool such as the Dysphagia Severity Scale (DSS) in clinical practice. OBJECTIVES: To evaluate the utility of the DSS in assessing dysphagia in MSA patients and its correlations with clinical indices. METHODS: We examined 43 MSA patients using the DSS and other clinical measures, including the Unified MSA Rating Scale (UMSARS) and cerebrospinal fluid 5-hydroxyindoleacetic acid levels. As a follow-up, 11 of 43 patients underwent a secondary DSS evaluation. Spearman's correlation and linear mixed models were used to analyze cross-sectional and longitudinal relationships. RESULTS: DSS scores were significantly correlated with UMSARS Parts 1, 2, and 4, as well as disease duration and blood pressure changes. This indicates that the DSS is sensitive to MSA-related motor and autonomic dysfunctions, and that the DSS could provide a more detailed assessment of swallowing function compared with the UMSARS Part 1 swallowing subscore. Additionally, DSS score was correlated with cerebrospinal fluid 5-hydroxyindoleacetic acid levels. Our longitudinal analysis further supported the role of DSS score as a reliable marker of dysphagia progression over time. CONCLUSIONS: The DSS is a sensitive and practical tool for evaluating dysphagia. Thus, combining the DSS and UMSARS could improve dysphagia monitoring in individuals with MSA. Our data support the use of the DSS as a valuable clinical and research tool in MSA management.

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: Robot-assisted gait training (RAGT) is an effective method for treating gait disorders in individuals with stroke. However, no previous studies have demonstrated the effectiveness of RAGT in individuals with acute stroke. This study aimed to investigate the effects of RAGT initiation within 1 week after onset on degree of gait independence in individuals with hemiparetic stroke. METHODS: This retrospective cohort study used propensity-score matching. Individuals admitted to Fujita Health University Hospital after stroke onset and underwent RAGT between March 2017 and June 2023 were enrolled. Ninety-two individuals were eligible and grouped into the acute (≤ 7 days after the onset) and subacute groups (8-90 days after onset). RAGT was conducted using Welwalk, primarily comprising a knee-ankle-foot orthosis type robot worn on one paralyzed lower extremity, with training sessions lasting approximately 40 min/day, occurring 3-7 days/week. The primary outcome was the gait under supervision within 90 days of onset, which was compared between groups using the log-rank test. RESULTS: After propensity-score matching, 36 individuals were included in the analysis, including 18 each in the acute and subacute groups; the participant demographics were not significantly different between the groups. RAGT was initiated at a median of 6 and 25 days after onset in the acute and subacute groups, respectively. The Kaplan-Meier curves after the log-rank test showed a significantly higher percentage and shorter median days to achieve gait under supervision in the acute group than in the subacute group. The cumulative incidence of gait under supervision events at 90 days after onset was 82.2% and 55.6% in the acute and the subacute groups, respectively. Half of the individuals achieved gait under supervision within 49 days and 75 days in the acute and subacute groups, respectively (p = 0.038). No significant differences were observed in the dose of rehabilitation program and gait training per day from onset to achieving gait under supervision. CONCLUSION: Initiation of RAGT within 1 week after stroke onset in individuals with hemiparesis may reduce the number of days required to achieve gait under supervision and increase the percentage of gait under supervision.

OBJECTIVES: We aimed to design and implement a community-based rehabilitation (CBR) curriculum to promote community engagement by multidisciplinary teams. METHODS: Participants in this prospective interventional study at a rehabilitation institution for people aging with disabilities included learners, the chief executive officer of the institution, program auditors, and community members. A customized CBR curriculum was developed using systems thinking design. Thirty-five learners were trained through 36 instructional contact hours and 60 hours of guided self-directed learning. Learners completed pre-training self-reported questionnaires regarding knowledge and experience of CBR. During training, learners were evaluated continuously through observation, assignments, self-reported feedback questionnaires, and CBR projects. The chief executive officer was interviewed during the study. The program auditors were interviewed and wrote reports on the curriculum and observations regarding the CBR projects. Learners reported on community participation in these projects. RESULTS: Thirty-three of 35 learners completed the program, 31 (94%) of whom had no prior knowledge of CBR. Learners implemented nine community engagement CBR projects, in which 1,293 community members participated. The auditors commended the curriculum content and its positive impact on learners and the community. The chief executive officer implemented inclusive community engagement at work. A CBR curriculum was dynamically developed for multidisciplinary rehabilitation team training to promote community engagement. CONCLUSIONS: The custom-designed CBR curriculum enabled multidisciplinary teams to practice community engagement at work. Equipped with CBR knowledge and skills, teams engaged with multiple sectors of the community to enhance patients' rehabilitation potential and increase public awareness through the implemented projects.

OBJECTIVE: To determine the impact of mobilization training time during the first postoperative week on the length of hospital stay for postoperative patients admitted to an intensive care unit. DESIGN: A retrospective cohort study. PATIENTS: Consecutive patients who underwent elective surgery and stayed in the intensive care unit of a university hospital for more than 48 h between July 2017 and August 2020 were enrolled. METHODS: The total duration of mobilization training during the first postoperative week and clinical variables, including demographic information, were collected from medical records. Multivariable regression analysis was used to investigate the impact of mobilization training time on the length of hospital stay, adjusting for potentially confounding variables. RESULTS: In total, 773 patients (504 males; median age, 70 years) were enrolled. Multivariable regression analysis showed that an increase in mobilization training time during the first postoperative week was associated with a shorter length of hospital stay (β = -0.067, 95% confidence interval: -0.120, -0.017, p = 0.010), with each 1-h increase in training time associated with a 4.02-day reduction in the length of hospital stay. CONCLUSION: Increased mobilization training during the first postoperative week significantly reduced the length of hospital stay in postoperative patients.

BACKGROUND: The economic burden on individuals with stroke is a major concern, and measures to mitigate the negative effects of stroke on labor productivity are imperative. However, few studies have explored the return to work (RTW) of individuals with stroke after their discharge from rehabilitation wards. We therefore aimed to explore the proportion of patients with stroke who returned to work after discharge from a convalescent rehabilitation ward and to explore the characteristics of patients with stroke who achieve RTW compared to those who do not. METHODS: This descriptive study was conducted in a convalescent rehabilitation ward at a university hospital in Japan. It included patients with stroke in the working-age population (15-64 years) who worked before the onset and were discharged from the rehabilitation ward to their homes between January 2018 and April 2022. The participants were required to respond to a questionnaire, which was sent by mail, and the RTW status at 6 months after discharge from the rehabilitation ward was investigated. They were classified into RTW and non-RTW groups, and their characteristics were compared between the groups. RESULTS: Fifty-nine patients [mean (SD) age 53.0 (9.0) years; 42 men] among 125 who met the criteria returned the questionnaire, and their data were included in the analysis. Thirty-nine individuals [66.1%; mean (SD) age 53.0 (8.2) years; 31 men] achieved RTW. Compared to the non-RTW group, the RTW group had significantly higher total functional independence measure (FIM) scores at admission (p = 0.046) and discharge (p < 0.001), a significantly shorter duration of ward stay during hospitalization (p = 0.002), and a significantly smaller proportion of patients with aphasia (p = 0.019). CONCLUSION: Two-thirds of the patients in this study population had achieved RTW at 6 months after discharge from the convalescent rehabilitation ward. Patients who achieved RTW had better motor function and FIM scores at discharge than those who did not.

INTRODUCTION: Gait robots have the potential to analyze gait characteristics during gait training using mounted sensors in addition to robotic assistance of the individual's movements. However, no systems have been proposed to analyze gait performance during robot-assisted gait training. Our newly developed gait robot," Welwalk WW-2000 (WW-2000)" is equipped with a gait analysis system to analyze abnormal gait patterns during robot-assisted gait training. We previously investigated the validity of the index values for the nine abnormal gait patterns. Here, we proposed new index values for four abnormal gait patterns, which are anterior trunk tilt, excessive trunk shifts over the affected side, excessive knee joint flexion, and swing difficulty; we investigated the criterion validity of the WW-2000 gait analysis system in healthy adults for these new index values. METHODS: Twelve healthy participants simulated four abnormal gait patterns manifested in individuals with hemiparetic stroke while wearing the robot. Each participant was instructed to perform 16 gait trials, with four grades of severity for each of the four abnormal gait patterns. Twenty strides were recorded for each gait trial using a gait analysis system in the WW-2000 and video cameras. Abnormal gait patterns were assessed using the two parameters: the index values calculated for each stride from the WW-2000 gait analysis system, and assessor's severity scores for each stride. The correlation of the index values between the two methods was evaluated using the Spearman rank correlation coefficient for each gait pattern in each participant. RESULTS: The median (minimum to maximum) values of Spearman rank correlation coefficient among the 12 participants between the index value calculated using the WW-2000 gait analysis system and the assessor's severity scores for anterior trunk tilt, excessive trunk shifts over the affected side, excessive knee joint flexion, and swing difficulty were 0.892 (0.749-0.969), 0.859 (0.439-0.923), 0.920 (0.738-0.969), and 0.681 (0.391-0.889), respectively. DISCUSSION: The WW-2000 gait analysis system captured four new abnormal gait patterns observed in individuals with hemiparetic stroke with high validity, in addition to nine previously validated abnormal gait patterns. Assessing abnormal gait patterns is important as improving them contributes to stroke rehabilitation. CLINICAL TRIAL REGISTRATION: https://jrct.niph.go.jp, identifier jRCT 042190109.

OBJECTIVES: This study aimed to establish standardized categories of rehabilitation approaches in long-term care and evaluate their appropriateness through a Delphi survey with an expert panel. METHODS: We adopted the Delphi method using the RAND/UCLA Appropriateness Method. A panel of 15 multidisciplinary rehabilitation experts comprising physicians, physical therapists, occupational therapists, and speech-language-hearing therapists was established. We developed a questionnaire comprising 10 main categories and 58 subcategories based on the glossary review and cross-sectional survey. Panelists rated the categories on a Likert scale from 1 (extremely inappropriate) to 9 (extremely appropriate). The survey was repeated until all categories reached a consensus on "appropriate" and "agreement." RESULTS: All 15 panelists participated in three rounds of the Delphi survey. In the first round, although all categories were deemed "appropriate," one main category and six subcategories did not achieve "agreement." In the second round, all categories reached the status of "appropriate" and "agreement." However, some of the comments needed further consideration. After making minor revisions, all items ultimately reached the status of "appropriate" and "agreement." CONCLUSIONS: This study achieved consensus on the terminology for standardized categories of rehabilitation approaches in long-term care. Future research should assess their reliability and validity using real-world clinical data.

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.

This study investigated the effects of ankle dorsiflexion angle adjustments in ankle-foot orthoses (AFOs) on the gait of healthy individuals. Fifteen healthy participants engaged in treadmill walking tasks while wearing AFOs with dorsiflexion angles set at 0°, 5°, 10°, and 15°. Three-dimensional treadmill gait analysis was used to collect data during treadmill walking. The analysis focused on toe clearance and the contribution of the vertical component of limb shortening (LS), and compared them across different dorsiflexion angles. The results indicated a significant increase in toe clearance at 10° (median [interquartile change]: 5.03 [0.90] vs. 5.98 [1.18], p < 0.01) and 15° (5.03 [0.90] vs. 5.82 [1.11], p < 0.01) dorsiflexion angle conditions compared to the 0° condition. Similarly, LS demonstrated significant increases at 10° (4.89 [1.97] vs. 5.87 [1.31], p < 0.01) and 15° (4.89 [1.97] vs. 5.61 [1.65], p < 0.01) conditions when compared with the 0° condition. These findings support the notion that higher dorsiflexion angles in AFOs lead to increased toe clearance and LS, suggesting the effectiveness of dorsiflexion angle adjustments as a strategy to address reduced toe clearance.

Background/Objectives: Clinical trials have investigated the efficacy of rehabilitation robotics for various pathological conditions, but the overall impact on rehabilitation practice remains unclear. We comprehensively examined and analyzed systematic reviews (SRs) of randomized controlled trials (RCTs) investigating rehabilitative interventions with robotic devices. Methods: Four databases were searched using term combinations of keywords related to robotic devices, rehabilitation, and SRs. The SR meta-analyses were categorized into “convincing”, “highly suggestive”, “suggestive”, “weak”, or “non-significant” depending on evidence strength and validity. Results: Overall, 62 SRs of 341 RCTs involving 14,522 participants were identified. Stroke was most frequently reported (40 SRs), followed by spinal cord injury (eight SRs), multiple sclerosis (four SRs), cerebral palsy (four SRs), Parkinson’s disease (three SRs), and neurological disease (any disease causing limited upper- and lower-limb functioning; three SRs). Furthermore, 38, 21, and 3 SRs focused on lower-limb devices, upper-limb devices, and both upper- and lower-limb devices, respectively. Quantitative synthesis of robotic intervention effects was performed by 51 of 62 SRs. Robot-assisted training was effective for various outcome measures per disease. Meta-analyses offering suggestive evidence were limited to studies on stroke. Upper-limb devices were effective for motor control and activities of daily living, and lower-limb devices for walking independence in stroke. Conclusions: Robotic devices are useful for improving impairments and disabilities in several diseases. Further high-quality SRs including RCTs with large sample sizes and meta-analyses of these RCTs, particularly on non-stroke-related diseases, are required. Further research should also ascertain which type of robotic device is the most effective for improving each specific impairment or disability.

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.

OBJECTIVE: To investigate the feasibility of poststroke interventions using a motivational instructional design model with occupational therapy (OT) and swallowing therapy (ST) and the model's potential physical and mental health effects. DESIGN: An open-label, single-arm, feasibility study on the Attention, Relevance, Confidence, and Satisfaction model. SETTING: Two convalescent rehabilitation wards. PARTICIPANTS: Twenty-five patients with stroke (N=25) (19 men; mean age, 62.4±11.9y; 61.9±36.8d from the first stroke) were recruited. INTERVENTIONS: Twelve participants received a motivational approach based on the Attention, Relevance, Confidence, and Satisfaction model during OT (OT group), and 13 received it during ST (ST group). The intervention lasted 40-60 minutes daily, 5 days weekly, for 4 weeks. MAIN OUTCOME MEASURES: The primary outcomes included the dropout rate, an adverse event, and the participants' acceptability of the intervention. Paretic arm function was assessed in the OT group; swallowing ability was assessed in the ST group; and activities of daily living, depressive symptoms, and apathy were assessed in both groups. RESULTS: No participants dropped out of the intervention or experienced an adverse event. Twenty-one participants (84%) were satisfied with the intervention, and 19 (76%) hoped to continue receiving it. The OT group showed statistically significant improvements in paretic arm function and activities of daily living (Cohen's r=0.68-0.77), whereas the ST group improved in swallowing ability, activities of daily living, and depressive symptoms (Cohen's r=0.62-0.85). CONCLUSIONS: The interventions using the motivational instructional model with OT and ST were feasible and could improve poststroke paretic arm function, swallowing ability, and activities of daily living after stroke.

The efficacy of cognitive stimulation therapy (CST) in patients with vascular cognitive impairment has not been explored, and no studies investigating CST in the convalescent rehabilitation phase have been reported. This study examined the effect of CST on the cognitive function of patients with vascular cognitive impairment. A randomized controlled, assessor-blinded, single-centered trial with two parallel groups was conducted in a convalescent rehabilitation hospital. Twenty participants were randomly allocated to CST (n=10) and control (n=10) groups. Participants in the CST group underwent two CST sessions a day, five times a week for 8 weeks, in addition to conventional rehabilitation. Participants in the control group underwent conventional rehabilitation only. The primary outcome was the Mini-Mental State Examination (MMSE) score, and the outcome between the groups was compared using a generalized linear mixed model (GLMM). The mean (standard deviation) scores of MMSE increased by 3.50 (3.08) points and 4.50 (1.61) points from baseline to the end of the study (week 8) in the CST and control groups, respectively. The GLMM showed a significant effect of TIME on MMSE (F=21.121, P<0.001), whereas no significant effect on MMSE was observed for GROUP (intervention vs. control, P=0.817) or the interaction term (TIME×GROUP, P=0.649). Although a significant improvement in cognitive function was observed in each group, no significant effect of CST was evident. This result indicates that the effect may have been masked by improvements caused by natural history or rehabilitation. Future studies with a sufficient sample size are required to confirm the findings.

BACKGROUND: Meta-learning is a metacognitive function for successful, efficient learning in various tasks. While it is possible that meta-learning is linked to functional recovery in stroke, it has not been investigated in previous clinical research on metacognition. AIM: Examine if individual meta-learning ability is associated with functional outcomes. DESIGN: Cohort study. SETTINGS: Rehabilitation ward in Fujita Health University Hospital. POPULATION: Twenty-nine hemiparetic people after stroke. METHODS: The study measured individual sensorimotor adaptation rate, meta-learning (acceleration of adaptation through training), and Functional Independence Measure (FIM) motor effectiveness, an index of functional outcome measuring improvement in proficiency of activity of daily living (ADL). Participants performed visuomotor adaptation training sessions with their less-affected arm. They made arm-reaching movements to hit a target with cursor feedback, which was occasionally rotated with regard to their hand positions, requiring them to change the movement direction accordingly. Initial adaptation rate and meta-learning were quantified from pre- and post-training tests. The relationship between these indices of adaptation ability and FIM motor effectiveness was examined by multiple linear regression analyses. RESULTS: One participant was excluded before data collection in the motor task. In the remaining 28 individuals, the regression analyses revealed that FIM motor effectiveness positively correlated with meta-learning (µ=0.90, P=0.008), which was attenuated by age (µ=-0.015, P=0.005), but not with initial adaptation rate (P=0.08). Control analyses suggested that this observed association between FIM motor effectiveness and meta-learning was not mediated by patients' demographics or stroke characteristics. CONCLUSIONS: This study demonstrates that those who can accelerate adaptation through training are likely to improve ADL, suggesting that meta-learning may be linked with functional outcomes in some stroke individuals. Meta-learning may enable the brain to keep (re-)learning motor skills when motor functions change abruptly due to stroke and neural recovery, thereby associated with improvement in ADL. CLINICAL REHABILITATION IMPACT: Meta-learning is part of metacognitive functions that is positively associated with functional outcomes.

BACKGROUND: Motor impairments not only lead to a significant reduction in patient activity levels but also trigger a further deterioration in motor function due to deconditioning, which is an issue that is particularly pronounced during hospitalization. This deconditioning can be countered by sustaining appropriate activity levels. Activities that occur outside of scheduled programs, often overlooked, are critical in this context. Wearable technology, such as smart clothing, provides a means to monitor these activities. OBJECTIVE: This study aimed to observe activity levels in patients who had strokes during the subacute phase, focusing on both scheduled training sessions and other nontraining times in an inpatient rehabilitation environment. A smart clothing system is used to simultaneously measure heart rate and acceleration, offering insights into both the amount and intensity of the physical activity. METHODS: In this preliminary cohort study, 11 individuals undergoing subacute stroke rehabilitation were enrolled. The 48-hour continuous measurement system, deployed at admission and reassessed 4 weeks later, monitored accelerometry data for physical activity (quantified with a moving SD of acceleration [MSDA]) and heart rate for intensity (quantified with percent heart rate reserve). The measurements were performed using a wearable activity monitoring system, the hitoe (NTT Corporation and Toray Industries, Inc) system comprising a measuring garment (wear or strap) with integrated electrodes, a data transmitter, and a smartphone. The Functional Independence Measure was used to assess the patients' daily activity levels. This study explored factors such as differences in activity during training and nontraining periods, correlations with activities of daily living (ADLs) and age, and changes observed after 4 weeks. RESULTS: A significant increase was found in the daily total MSDA after the 4-week program, with the average percent heart rate reserve remaining consistent. Physical activity during training positively correlated with ADL levels both at admission (ρ=0.86, P<.001) and 4 weeks post admission (ρ=0.96, P<.001), whereas the correlation between age and MSDA was not significant during training periods at admission (ρ=-0.41, P=.21) or 4 weeks post admission (ρ=-0.25, P=.45). Conversely, nontraining activity showed a negative correlation with age, with significant negative correlations with age at admission (ρ=-0.82, P=.002) and 4 weeks post admission (ρ=-0.73, P=.01). CONCLUSIONS: Inpatient rehabilitation activity levels were positively correlated with ADL levels. Further analysis revealed a strong positive correlation between scheduled training activities and ADL levels, whereas nontraining activities showed no such correlation. Instead, a negative correlation between nontraining activities and age was observed. These observations suggest the importance of providing activity opportunities for older patients, while it may also suggest the need for adjusting the activity amount to accommodate the potentially limited fitness levels of this demographic. Future studies with larger patient groups are warranted to validate and further elucidate these findings.

BACKGROUND: Gait disorder remains a major challenge for individuals with stroke, affecting their quality of life and increasing the risk of secondary complications. Robot-assisted gait training (RAGT) has emerged as a promising approach for improving gait independence in individuals with stroke. This study aimed to evaluate the effect of RAGT in individuals with subacute hemiparetic stroke using a one-leg assisted gait robot called Welwalk WW-1000. METHODS: An assessor-blinded, multicenter randomized controlled trial was conducted in the convalescent rehabilitation wards of eight hospitals in Japan. Participants with first-ever hemiparetic stroke who could not walk at pre-intervention assessment were randomized to either the Welwalk group, which underwent RAGT with conventional physical therapy, or the control group, which underwent conventional physical therapy alone. Both groups received 80 min of physical therapy per day, 7 days per week, while the Welwalk group received 40 min of RAGT per day, 6 days per week, as part of their physical therapy. The primary outcome was gait independence, as assessed using the Functional Independence Measure Walk Score. RESULTS: A total of 91 participants were enrolled, 85 of whom completed the intervention. As a result, 91 participants, as a full analysis set, and 85, as a per-protocol set, were analyzed. The primary outcome, the cumulative incidence of gait-independent events, was not significantly different between the groups. Subgroup analysis revealed that the interaction between the intervention group and stroke type did not yield significant differences in either the full analysis or per-protocol set. However, although not statistically significant, a discernible trend toward improvement with Welwalk was observed in cases of cerebral infarction for the full analysis and per-protocol sets (HR 4.167 [95%CI 0.914-18.995], p = 0.065, HR 4.443 [95%CI 0.973-20.279], p = 0.054, respectively). CONCLUSIONS: The combination of RAGT using Welwalk and conventional physical therapy was not significantly more effective than conventional physical therapy alone in promoting gait independence in individuals with subacute hemiparetic stroke, although a trend toward earlier gait independence was observed in individuals with cerebral infarction. TRIAL REGISTRATION: This study was registered with the Japan Registry of Clinical Trials ( https://jrct.niph.go.jp ; jRCT 042180078) on March 3, 2019.

BACKGROUND: Upper oesophageal sphincter (UES) serves as an important anatomical and functional landmark during swallowing. However, the precise UES location before and during swallowing has not been well established. OBJECTIVE: This study aimed to determine upper oesophageal sphincter (UES) location and displacement during swallowing accounting for sex, age, and height in healthy adults using 320-row area detector computed tomography (320-ADCT). METHODS: Ninety-four healthy adults (43 males; 22-90 years) underwent 320-ADCT scanning while swallowing one trial of 10 mL honey thick barium. UES location at bolus hold and at maximum displacement and vertical displacement during swallowing were identified using the coordinates and the section classification of vertebrae (VERT scale). The differences and correlations of UES location and distance in terms of sex, age, and height were analysed using Mann-Whitney U test and Spearman's correlation coefficient. RESULTS: UES locations at bolus hold and at maximum displacement were significantly lower and UES vertical displacement was significantly larger in males than in females (p < .001). UES location at bolus hold became lower with increasing age (r = -.312, p = .002), but the negative correlation was low at maximum displacement (r = -.230, p = .026), resulting in larger vertical distance with ageing. UES locations showed high negative correlation at bolus hold with height (r = -.715, p < .001), and showed moderate negative correlation at maximum displacement with height (r = -.555, p < .001), although this effect was unclear when analysed by sex. CONCLUSION: Males showed lower UES location and larger displacement than females. The impact of age was evident with lower location before swallowing and larger displacement during swallowing. Differences observed by sex were not completely explained by using the VERT scale to adjust for height.

Dysphagia is one of the most common symptoms of stroke and can lead to other complications such as pneumonia, dehydration, and malnutrition. This retrospective cohort study evaluated the predictive value of a comprehensive swallowing assessment tool, the Mann Assessment of Swallowing Ability (MASA), in the acute phase of stroke for oral intake status at discharge. Among 1,133 consecutive patients with acute stroke, 512 patients whose swallowing function was assessed using the MASA within 24 h of admission were included. Data including demographic information, stroke severity, MASA, Oral Health Assessment Tool, body mass index, and serum albumin level were collected. Predictive factors for oral intake were analyzed using a multiple logistic regression model, and the receiver operating characteristic (ROC) curve analysis was used to determine the cutoff values of the MASA score for determining oral intake at discharge. Oral intake at discharge was established in 69.1% of the cohort (354/512). The multiple logistic regression analysis identified a higher MASA score, younger age, and higher serum albumin level as significant predictors of oral intake at discharge. The cutoff value of the MASA score for oral intake was 136.5 points, with an area under the ROC curve of 0.87. These findings suggest that the MASA is a valid tool for predicting oral intake in patients with dysphagia during the acute phase of stroke.

This study aimed to clarify the kinematics, particularly of the shoulder and hip joints, during preparation for manual wheelchair-to-bed transfer (i.e. when flipping up the arm and foot supports). This cross-sectional study included 32 able-bodied individuals. The kinematics of the shoulder and hip joints when the arm and foot supports were flipped up of manual wheelchair, were evaluated using a markerless inertial sensor-based motion capture system. We found that flipping the arm support upwards involved a large amount of abduction, internal and external rotation, flexion, and extension at the shoulder joint, whereas flipping the foot support upwards involved a large amount of flexion at the hip joint. The findings suggest that it is necessary to consider the range of motion required to flip up the arm and foot supports of manual wheelchairs, particularly in those with limited shoulder and hip range of motion such as older people, neuromuscular disorders, and orthopedic disorders.

The application of 28 GHz millimeter-wave is prevalent owing to the global spread of fifth-generation wireless communication systems. Its thermal effect is a dominant factor which potentially causes pain and tissue damage to the body parts exposed to the millimeter waves. However, the threshold of this thermal sensation, that is, the degree of change in skin temperature from the baseline at which the first subjective response to the thermal effects of the millimeter waves occurs, remains unclear. Here, we investigated the thermal sensation threshold and assessed its reliability when exposed to millimeter waves. Twenty healthy adults were exposed to 28 GHz millimeter-wave on their left middle fingertip at five levels of antenna input power: 0.2, 1.1, 1.6, 2.1, and 3.4 W (incident power density: 27–399 mW/cm²). This measurement session was repeated twice on the same day to evaluate the threshold reliability. The intraclass correlation coefficient (ICC) and Bland–Altman analysis were used as proxies for the relative and absolute reliability, respectively. The number of participants who perceived a sensation during the two sessions at each exposure level was also counted as the perception rate. Mean thermal sensation thresholds were within 0.9°C–1.0°C for the 126–399 mW/cm² conditions, while that was 0.2°C for the 27 mW/cm² condition. The ICCs for the threshold at 27 and 126 mW/cm² were interpreted as poor and fair, respectively, while those at higher exposure levels were moderate to substantial. Apart from a proportional bias in the 191 mW/cm² condition, there was no fixed bias. All participants perceived a thermal sensation at 399 mW/cm² in both sessions, and the perception rate gradually decreased with lower exposure levels. Importantly, two-thirds of the participants answered that they felt a thermal sensation in both or one of the sessions at 27 mW/cm², despite the low-temperature increase. These results suggest that the thermal sensation threshold is around 1.0°C, consistent across exposure levels, while its reliability increases with higher exposure levels. Furthermore, the perception of thermal sensation may be inherently ambiguous owing to the nature of human perception.

OBJECTIVES: To examine the functional outcomes of patients with coronavirus disease 2019 (COVID-19) who underwent a new protocol-based rehabilitation program. METHODS: In this retrospective cohort study, we enrolled patients who were hospitalised in a university hospital in Japan because of COVID-19 from 1st September, 2020-5th July, 2021. The primary outcome was the Functional Independence Measure (FIM) subtotal score for motor items at discharge. The secondary outcomes included the FIM cognitive subtotal score, length of hospital stay, rehabilitation period, total rehabilitation time, final rehabilitation protocol level, and discharge destination. RESULTS: Of the 78 enrolled patients (49 men; mean age [standard deviation], 70.3 [13.9] years), 24 died (30.8%) during hospitalisation. Disease severity was classified as mild, moderate I, moderate II, and severe in 1, 6, 41, and 30 patients, respectively. The FIM motor subtotal score differed significantly among groups for all participants (p=0.027). Post hoc analysis revealed that the FIM motor subtotal score in the severe group was significantly lower than that in the moderate II group (p=0.030). CONCLUSIONS: Disease severity significantly affected patients' functional outcome for COVID-19 at discharge. Our protocol-based program provides a benchmark for COVID-19 rehabilitation in an acute care setting.

This study evaluated the validity of pharyngeal 2D area measurements acquired from the lateral view for predicting the actual 3D volume in healthy adults during swallowing. Seventy-five healthy adults (39 females, 36 males; mean age 51.3 years) were examined using 320-row area detector computed tomography (320-ADCT). All participants swallowed a 10 mL honey-thick barium bolus upon command while seated in a 45° semi-reclining position. Multi-planar reconstruction images and dynamic 3D-CT images were obtained using Aquilion ONE software. Pharyngeal 2D area and 3D volume measurements were taken before swallowing and at the frame depicting maximum pharyngeal constriction. Pharyngeal volume before swallowing (PVhold) was accurately predicted by 2D area (R2 = 0.816). Adding height and sex to the model increased R2 to 0.836. Regarding pharyngeal volume during maximum constriction (PVmax), 2D area also exhibited acceptable predictive power (R2 = 0.777). However, analysis of statistical residuals and outliers revealed a greater tendency for prediction errors when there is less complete constriction of the pharynx as well as asymmetry in bolus flow or movement. Findings highlight the importance of routinely incorporating anterior-posterior views during VFSS exams. Future work is needed to determine clinical utility of pharyngeal volume measurements derived from 320-ADCT.

Background: The importance of being physically active and avoiding staying in bed has been recognized in stroke rehabilitation. However, studies have pointed out that stroke patients admitted to rehabilitation units often spend most of their day immobile and inactive, with limited opportunities for activity outside their bedrooms. To address this issue, it is necessary to record the duration of stroke patients staying in their bedrooms, but it is impractical for medical providers to do this manually during their daily work of providing care. Although an automated approach using wearable devices and access points is more practical, implementing these access points into medical facilities is costly. However, when combined with machine learning, predicting the duration of stroke patients staying in their bedrooms is possible with reduced cost. We assessed using machine learning to estimate bedroom-stay duration using activity data recorded with wearable devices. Method: We recruited 99 stroke hemiparesis inpatients and conducted 343 measurements. Data on electrocardiograms and chest acceleration were measured using a wearable device, and the location name of the access point that detected the signal of the device was recorded. We first investigated the correlation between bedroom-stay duration measured from the access point as the objective variable and activity data measured with a wearable device and demographic information as explanatory variables. To evaluate the duration predictability, we then compared machine-learning models commonly used in medical studies. Results: We conducted 228 measurements that surpassed a 90% data-acquisition rate using Bluetooth Low Energy. Among the explanatory variables, the period spent reclining and sitting/standing were correlated with bedroom-stay duration (Spearman’s rank correlation coefficient (R) of 0.56 and −0.52, p &amp;lt; 0.001). Interestingly, the sum of the motor and cognitive categories of the functional independence measure, clinical indicators of the abilities of stroke patients, lacked correlation. The correlation between the actual bedroom-stay duration and predicted one using machine-learning models resulted in an R of 0.72 and p &amp;lt; 0.001, suggesting the possibility of predicting bedroom-stay duration from activity data and demographics. Conclusion: Wearable devices, coupled with machine learning, can predict the duration of patients staying in their bedrooms. Once trained, the machine-learning model can predict without continuously tracking the actual location, enabling more cost-effective and privacy-centric future measurements.

INTRODUCTION: Smiling during conversation occurs interactively between people and is known to build good interpersonal relationships. However, whether and how much the amount that an individual smiles is influenced by the other person's smile has remained unclear. This study aimed to quantify the amount of two individuals' smiles during conversations and investigate the dependency of one's smile amount (i.e., intensity and frequency) on that of the other. METHOD: Forty participants (20 females) engaged in three-minute face-to-face conversations as speakers with a listener (male or female), under three conditions, where the amount of smiling response by listeners was controlled as "less," "moderate," and "greater." The amount of the smiles was quantified based on their facial movements through automated facial expression analysis. RESULTS: The results showed that the amount of smiling by the speaker changed significantly depending on the listener's smile amount; when the listeners smiled to a greater extent, the speakers tended to smile more, especially when they were of the same gender (i.e., male-male and female-female pairs). Further analysis revealed that the smiling intensities of the two individuals changed in a temporally synchronized manner. DISCUSSION: These results provide quantitative evidence for the dependence of one's smile on the other's smile, and the differential effect between gender pairs.

OBJECTIVES: Although the standard falls prevention strategy is to identify and respond to patients with high-risk conditions, it remains unclear whether falls in patients with high fall risk account for most observed falls. In this study, fall risk and number of falls were calculated based on patients' motor and cognitive abilities, and the relationship between the two was examined. DESIGN: We conducted a retrospective cohort study. SETTING AND PARTICIPANTS: We included 2518 consecutive patients with stroke who were admitted to a rehabilitation hospital. METHODS: Data on falls during hospitalization and biweekly assessed Functional Independence Measure scores were retrieved from the medical records. The average Functional Independence Measure scores for the motor and cognitive items were obtained and categorized as complete dependence, modified dependence, and independence. The fall rate (falls/1000 person-days) and number of observed falls in each combined condition were investigated. RESULTS: Modified dependence on motor ability and complete dependence on cognitive ability had the highest risk of falls, with a fall rate of 10.8/1000 person-days and 51 fall observations, which accounted for 4.3% of all falls. Independent motor and cognitive ability had the lowest risk of falls, a fall rate of 2.6/1000 person-days and 146 observed falls, accounting for 12.4% of all falls, which was 2.8 times higher than the number of falls observed in the highest risk of falls condition. CONCLUSIONS AND IMPLICATIONS: The combined motor-cognitive ability with the highest risk of falls in stroke inpatients did not have the highest number of observed falls. Rather, the combined motor-cognitive ability with the lowest risk of falls tended to have a high number of observed falls. A different strategy is needed to reduce the total number of falls.

The purposes of the present study were: (1) to investigate the relationship between hospital-associated functional decline (HAFD) and non-lying time and (2) to clarify the optimal cut-off value for non-lying time associated with HAFD in older patients undergoing transcatheter aortic valve implantation (TAVI). From January 2021 to December 2022, patients admitted to a university hospital who underwent trans-femoral TAVI were consecutively recruited. We measured short physical performance battery (SPPB) pre and post-TAVI, and non-lying time from post-operative days 3-5. HAFD was defined as at least 1 point decrease in SPPB during pre and post-TAVI. Among 75 patients (47 female, mean age of 84.5 years) enrolled, 14 patients were classified as having HAFD. Non-lying time was significantly shorter in the HAFD group than in the non-HAFD group (371 min vs. 539 min, P < 0.001). Receiver-operating characteristic analysis determined an optimal cut-off value of 477 min for differentiating the patients more likely to experience HAFD (sensitivity, 75%; specificity, 92%; area under the curve, 0.798). The non-lying time could be one of the associated factors of HAFD in older patients with TAVI. Non-lying time of about 480 min (8 h) during hospitalization may be an initial target for preventing HAFD.

OBJECTIVE: To investigate the characteristics and symptoms of patients with hip osteoarthritis that are associated with spatiotemporal gait parameters, including their variability and asymmetry. DESIGN: A retrospective, cross-sectional study. SETTING: University hospital. PARTICIPANTS: The study analyzed the gait analysis data of 155 patients (N=155) with hip osteoarthritis who were admitted to a university hospital for total hip replacement and were able to walk on a treadmill without a handrail. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The dependent variables were gait parameters during treadmill walking. These included gait speed, stride length, cadence, coefficient of variation of stride length and stride time, swing time symmetry index, and step symmetry index. Single and multiple regression analyses were conducted using independent variables of the characteristics and symptoms of the patients, including age, sex, height, pain, leg-length discrepancy, and muscle strength of the affected and normal sides measured with a hand-held dynamometer (iliopsoas, gluteus medius, and quadriceps). RESULTS: In the analysis, gait speed and stride were the dependent variables, whereas age, height, and muscle strength on the affected side were the significant independent variables (P<.05). Additionally, pain demonstrated a marginal association with gait speed (P=.053). Only the leg-length discrepancy correlated with cadence. When the coefficient of variation of the stride length was the dependent variable, age and muscle strength on the affected side were significant. For the swing time symmetry index, only the muscle strength on the affected side was significant. Furthermore, the step symmetry index only correlated with leg-length discrepancy. The muscle strength on the affected side was the only significant independent variable for the coefficient of variation of the stride time. CONCLUSIONS: The results revealed that each of the frequent clinical symptoms of hip osteoarthritis, such as pain, muscle weakness, and leg-length discrepancy, can explain different aspects of gait performance.