大高 洋平

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.

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.

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.

Radiofrequency contact current occurs when a human touches objects with different electrical potentials. For emerging wireless power transfer systems, this type of exposure is potentially more restrictive than direct exposure. The limits for contact current are prescribed in the international guidelines for human protection from electromagnetic fields, but its rationale is limited compared with that for direct field exposure. In this article, the perceptional threshold for electrostimulation and heating was evaluated based on computational dosimetry from 10 kHz to 10 MHz. First, the time course of the temperature rise was calculated until each subject perceived the contact current. Second, the perception of current was estimated considering the nerve activation modeling. The computationally estimated current threshold for nerve activation was consistent with the measured data at 100 kHz and increased linearly with increasing frequency, which was contrary to the measured threshold for perception above 300 kHz. By contrast, the estimated perceptual temperature increase was smaller at 100 kHz than at 300 kHz and above. These results indicate that the transient frequency of the threshold for stimulation and heating lies between 100 and 300 kHz, supporting the transition frequency of contact current in the international guidelines.

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.

Ankle-foot orthosis (AFO) is known to correct abnormal gait patterns and improve walking stability and speed in patients with hemiparesis. To quantify these benefits in post-stroke gait, a three-dimensional motion analysis of gait pattern was conducted. Forty patients with hemiparesis were enrolled. A three-dimensional motion analysis system was used to analyze patients' treadmill walking with/without an AFO. Outcome measures were 12 abnormal gait indices (forefoot contact, knee extensor thrust, retropulsion of the hip, flexed-knee gait, medial whip in the stance phase, circumduction gait, hip hiking, insufficient knee flexion during the swing phase, excessive lateral shifting of the trunk, contralateral vaulting, excessive hip external rotation, and posterior pelvic tilt), calculated using kinematic data and spatiotemporal indices, and the symmetry index of double-stance and single-stance time and step length. Forefoot contact (without AFO vs. with AFO: 71.0 vs. 65.8, P < 0.001), circumduction gait (65.0 vs. 57.9, P < 0.001), and contralateral vaulting (78.2 vs. 72.2, P = 0.003) were significantly reduced, whereas excessive hip external rotation (53.7 vs. 62.8, P = 0.003) significantly increased during walking with an AFO. Hip hiking (77.1 vs. 71.7) showed marginal reduction with the use of AFO ( P = 0.096). The absolute symmetry index of double-stance time (21.9 vs. 16.1, P = 0.014) significantly decreased during walking with an AFO. AFO effectively mitigates abnormal gait patterns typical of hemiparetic gait. A 3D motion analysis system with clinically oriented indices can help assess intervention efficacy for gait abnormalities.

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.

Arm reaching is often impaired in individuals with stroke. Nonetheless, how aiming directions influence reaching performance and how such differences change with motor recovery over time remain unclear. Here, we elucidated kinematic parameters of reaching toward various directions in people with post-stroke hemiparesis in the sub-acute phase. A total of 13 and 15 participants with mild and moderate-to-severe hemiparesis, respectively, performed horizontal reaching in eight directions with their affected and unaffected sides using an exoskeleton robotic device at admission and discharge. The movement time, path length, and number of velocity peaks were computed for the mild group (participants able to reach toward all eight directions). Additionally, the total amount of displacement (i.e., movement quantity) toward two simplified directions (mediolateral or anteroposterior) was evaluated for the moderate-to-severe group (participants who showed difficulty in completing the reaching task). Motor recovery was evaluated using the Fugl-Meyer Assessment.The mild group exhibited decreases in movement parameters when reaching in the anteroposterior direction, irrespective of the side of the arm or motor recovery achieved. The moderate-to-severe group exhibited less movement toward the anteroposterior direction than toward the mediolateral direction at admission; however, this direction-dependent bias in movement quantity decreased, with the movement expanding toward the anteroposterior direction with motor recovery at discharge. These results suggest that direction-dependent differences in the quality and quantity of reaching performance exist in people after stroke, regardless of the presence or severity of hemiparesis. This highlights the need to consider the task work area when designing rehabilitative training.

Background The motivation for rehabilitation is important in encouraging stroke patients to participate in rehabilitation; however, its relationship with outcomes is not well known. In addition, changes in patient motivation during hospitalization have not been examined. Aim To examine the relationship between motivation and rehabilitation outcomes for subacute stroke patients and to investigate the changes in motivation. Design Prospective cohort study. Setting Subacute rehabilitation hospital. Population The study enrolled a consecutive sample of patients (n = 201) with stroke admitted to a subacute rehabilitation ward from October 2017 to March 2019. Methods The functional independence measure and motivation in stroke patients for rehabilitation scale was evaluated at admission; at one, two, and three months after admission; and at discharge. The effectiveness and efficiency of the functional independence measure were calculated as rehabilitation outcomes. The effect of motivation on outcomes and the change in motivation in stroke patients for rehabilitation scale scores over time were analyzed using a linear mixed model. Results The median (interquartile range) converted motivation in stroke patients for rehabilitation scale scores (converted to a range of 0–100) at admission; one, two, and three months after admission; and discharge was 86 (76–95), 83 (77–94), 81 (74–95), 81 (71–93), and 84 (75–95), respectively. The median (interquartile range) of effectiveness and efficiency of the functional independence measure from admission to discharge was 0.82 (0.68–0.91) and 0.41 (0.30–0.59), respectively. Motivation in stroke patients for rehabilitation scale scores were not significantly associated with the effectiveness and efficiency of the functional independence measure (p &amp;gt; 0.05). Motivation in stroke patients for rehabilitation scale scores were significantly lower at two (β = −3.1, 95% confidence interval [−5.3, −0.9], p = 0.005) and three (β = −4.4, 95% confidence interval [−7.3, −1.6], p = 0.002) months after admission than at admission. Conclusion Motivation might not directly affect rehabilitation outcomes assessed by the functional independence measure. Furthermore, many participants remained highly motivated, although their motivation decreased at one or three months after admission. Clinical rehabilitation impact Assumptions that rehabilitation is ineffective because of low motivation may not be correct. To examine the influence on outcomes, both motivation and daily activities should be considered.

重度左片麻痺と高次脳機能障害を呈した脳卒中患者に対して,トイレ移乗動作の介入を反復して実施するも自立度の改善を認めなかったため,介入方法を見直すためにToileting Tasks Assessment Form(以下,TTAF)を用いたトイレ動作の詳細な工程分析を行った.得られた結果をもとに,段階的な難易度調整を施したトイレ移乗動作の練習を行った結果,一部の工程において自立して動作が可能となり,その他の工程の自立度も向上した.TTAFは,トイレ動作の詳細な評価に基づいた介入の立案とその効果判定を可能とし,症例の自立度の改善に貢献した可能性がある.(著者抄録)

<jats:sec><jats:title>Introduction</jats:title><jats:p>Contact electrical currents in humans stimulate peripheral nerves at frequencies of &amp;lt;100 kHz, producing sensations such as tingling. At frequencies above 100 kHz, heating becomes dominant, resulting in a sensation of warmth. When the current amplitude exceeds the threshold, the sensation results in discomfort or pain. In international guidelines and standards for human protection from electromagnetic fields, the limit for the contact current amplitude has been prescribed. Although the types of sensations produced by contact current at low frequencies, i.e., approximately 50–60 Hz, and the corresponding perception thresholds have been investigated, there is a lack of knowledge about those in the intermediate-frequency band—particularly from 100 kHz to 10 MHz.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>In this study, we investigated the current-perception threshold and types of sensations for 88 healthy adults (range: 20–79 years old) with a fingertip exposed to contact currents at 100 kHz, 300 kHz, 1 MHz, 3 MHz, and 10 MHz.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The current perception thresholds at frequencies ranging from 300 kHz to 10 MHz were 20–30% higher than those at 100 kHz (<jats:italic>p</jats:italic> &amp;lt; 0.001). In addition, a statistical analysis revealed that the perception thresholds were correlated with the age or finger circumference: older participants and those with larger finger circumferences exhibited higher thresholds. At frequencies of ≥300 kHz, the contact current mainly produced a warmth sensation, which differed from the tingling/pricking sensation produced by the current at 100 kHz.</jats:p></jats:sec><jats:sec><jats:title>Discussion</jats:title><jats:p>These results indicate that there exists a transition of the produced sensations and their perception threshold between 100 kHz and 300 kHz. The findings of this study are useful for revising the international guidelines and standards for contact currents at intermediate frequencies.</jats:p></jats:sec><jats:sec><jats:title>Clinical trial registration</jats:title><jats:p><jats:ext-link>https://center6.umin.ac.jp/cgi-open-bin/icdr_e/ctr_view.cgi?recptno=R000045660</jats:ext-link>, identifier UMIN 000045213.</jats:p></jats:sec>

Introduction We aimed to explore the effect of gait training using Welwalk on gait patterns by comparing differences in gait patterns between robotic-assisted gait training using Welwalk and gait training using an orthosis in individuals with hemiparetic stroke. Methods This study included 23 individuals with hemiparetic stroke who underwent gait training with Welwalk combined with overground gait training using an orthosis. Three-dimensional motion analysis on a treadmill was performed under two conditions for each participant: during gait training with Welwalk and with the ankle-foot orthosis. The spatiotemporal parameters and gait patterns were compared between the two conditions. Results The affected step length was significantly longer, the step width was significantly wider, and the affected single support phase ratio was significantly higher in the Welwalk condition than in the orthosis condition. The index values of abnormal gait patterns were significantly lower while using Welwalk than in the orthosis condition. The following four indices were lower in the Welwalk condition: contralateral vaulting, insufficient knee flexion, excessive hip external rotation during the paretic swing phase, and paretic forefoot contact. Discussion Gait training using Welwalk increased the affected step length, step width, and single support phase while suppressing abnormal gait patterns as compared to gait training using the ankle-foot orthosis. This study suggests that gait training using Welwalk may promote a more efficient gait pattern reacquisition that suppresses abnormal gait patterns. Trial registration Prospectively registered in the Japan Registry of Clinical Trials (https://jrct.niph.go.jp; jRCTs042180152).

BACKGROUND: There is an extensive library of language tests, each with excellent psychometric properties; however, many of the tests available take considerable administration time, possibly bearing psychological strain on patients. The Short and Tailored Evaluation of Language Ability (STELA) is a simplified, tablet-based language ability assessment system developed to address this issue, with a reduced number of items and automated testing process. OBJECTIVE: The aim of this paper is to assess the administration time, internal consistency, and validity of the STELA. METHODS: The STELA consists of a tablet app, a microphone, and an input keypad for clinician's use. The system is designed to assess language ability with 52 questions grouped into 2 comprehension modalities (auditory comprehension and reading comprehension) and 3 expression modalities (naming and sentence formation, repetition, and reading aloud). Performance in each modality was scored as the correct answer rate (0-100), and overall performance expressed as the sum of modality scores (out of 500 points). RESULTS: The time taken to complete the STELA was significantly less than the time for the WAB (mean 16.2, SD 9.4 vs mean 149.3, SD 64.1 minutes; P<.001). The STELA's total score was strongly correlated with the WAB Aphasia Quotient (r=0.93, P<.001), supporting the former's concurrent validity concerning the WAB, which is a gold-standard aphasia assessment. Strong correlations were also observed at the subscale level; STELA auditory comprehension versus WAB auditory comprehension (r=0.75, P<.001), STELA repetition versus WAB repetition (r=0.96, P<.001), STELA naming and sentence formation versus WAB naming and word finding (r=0.81, P<.001), and the sum of STELA reading comprehension or reading aloud versus WAB reading (r=0.82, P<.001). Cronbach α obtained for each modality was .862 for auditory comprehension, .872 for reading comprehension, .902 for naming and sentence formation, .787 for repetition, and .892 for reading aloud. Global Cronbach α was .961. The average of the values of item-total correlation to each subscale was 0.61 (SD 0.17). CONCLUSIONS: Our study confirmed significant time reduction in the assessment of language ability and provided evidence for good internal consistency and validity of the STELA tablet-based aphasia assessment system.

Objectives: Hyolaryngeal movement during swallowing is essential to airway protection and bolus clearance. Although palpation is widely used to evaluate hyolaryngeal motion, insufficient accuracy has been reported. The Bando Stretchable Strain Sensor for Swallowing (B4S™) was developed to capture hyolaryngeal elevation and display it as waveforms. This study compared laryngeal movement time detected by the B4S™ with laryngeal movement time measured by videofluoroscopy (VF). Methods: Participants were 20 patients without swallowing difficulty (10 men, 10 women; age 30.6 ± 7.1 years). The B4S™ was attached to the anterior neck and two saliva swallows were measured on VF images to determine the relative and absolute reliability of laryngeal elevation time measured on VF and that measured by the B4S™. Results: The intra-class correlation coefficient of the VF and B4S™ times was very high [ICC (1.1) = 0.980]. A Bland-Altman plot showed a strong positive correlation with a 95% confidence interval of 0.00-3.01 for the mean VF time and mean B4S™ time, with a fixed error detected in the positive direction but with no proportional error detected. Thus, the VF and B4S™ time measurements showed high consistency. Conclusion: The strong relative and absolute reliability suggest that the B4S™ can accurately detect the duration of superior-inferior laryngeal motion during swallowing. Further study is needed to develop a method for measuring the distance of laryngeal elevation. It is also necessary to investigate the usefulness of this device for evaluation and treatment in clinical settings.

OBJECTIVE: To examine the effect of in-bed leg cycling exercise on patients with intensive care unit-acquired weakness (ICU-AW). DESIGN: Single-center retrospective study. SUBJECTS/PATIENTS: Patients admitted to the ICU between January 2019 and March 2023 were enrolled in the ergometer group, and those admitted to the ICU between August 2017 and December 2018 were enrolled in the control group. METHODS: The ergometer group performed in-bed leg cycling exercises 5 times per week for 20 min from the day of ICU-AW diagnosis. Furthermore, the ergometer group received 1 early mobilization session per day according to the early mobilization protocol, whereas the control group received 1 or 2 sessions per day. The number of patients with recovery from ICU-AW at ICU discharge and improvement in physical functions were compared. RESULTS: Significantly more patients in the ergometer group recovered from ICU-AW than in the control group (87.0% vs 60.6%, p = 0.039). Regarding physical function, the ergometer group showed significantly higher improvement efficiency in Medical Research Council sum score (1.0 [0.7-2.1] vs 0.1 [0.0-0.2], p < 0.001). CONCLUSION: In-bed leg cycling exercise, in addition to the early mobilization protocol, reduced the number of patients with ICU-AW at ICU discharge.

This retrospective cross-sectional study is aimed at investigating the prevalence and characteristics of behavioral and psychological symptoms (BPS) in subacute stroke patients with cognitive impairment. The Neuropsychiatric Inventory-Questionnaire (NPI-Q) was used to assess BPS. A total of 358 consecutive patients with first-ever stroke admitted to rehabilitation wards and with Mini-Mental State Examination (MMSE) scores < 24 on admission were included. BPS was defined as a total NPI-Q Severity or Distress score ≥ 1. Differences between the severity and presence of BPS among patients with severe cognitive impairment (MMSE scores 0-17) and those with mild cognitive impairment (MMSE scores 18-23) were analyzed using the Mann-Whitney U test and chi-squared test, respectively. Eighty-one patients (mean (standard deviation) age, 73.5 (13.1) years) were enrolled for analysis. BPS were observed in 69.1% and 74.1% of patients when assessed with NPI-Q Severity and NPI-Q Distress, respectively. The most frequently observed BPS was apathy, followed by depression (approximately 44% and 40%, respectively). The severity and frequency of delusions, euphoria, apathy, and disinhibition were significantly higher in the severe cognitive impairment group than in the mild cognitive impairment group. However, the severity, distress, and frequency of depression were not dependent on the severity of cognitive impairment. The presence of BPS, especially apathy and depression, in subacute stroke patients with cognitive impairment is high. The severity and frequency of some BPS are higher in patients with severe cognitive impairment than in those with mild cognitive impairment. However, depression is highly prevalent among the patients regardless of the severity of cognitive impairment.

INTRODUCTION: The aim of this study was to compare the clinical applicability of the Mini-Balance Evaluation Systems Test and the Berg Balance Scale for measuring balance in inpatients with subacute stroke. METHODS: This was a prospective observational study which included 58 consecutive patients admitted to a convalescent rehabilitation hospital with a first-ever stroke and who met the inclusion/exclusion criteria. The Mini-Balance Evaluation Systems Test and the Berg Balance Scale were used to assess patient balance at admission and discharge. The ceiling and floor effects and responsiveness of each balance score were examined. In addition, receiver operating characteristic analysis based on each balance score at admission was used to examine its discriminative power to predict ambulatory independence and falls during hospitalization. RESULTS: The mean (standard deviation) change between admission and discharge for each balance scale was 4.4 (4.7) for the Mini-Balance Evaluation Systems Test and 8.3 (10.0) for the Berg Balance Scale, with standard response means, a measure of responsiveness of 0.9 (large) and 0.8 (medium), respectively. Each balance score at admission almost equally predicted gait independence and fallers during hospitalization. On the contrary, only the distribution of scores on the Berg Balance Scale at discharge showed a ceiling effect, with 25 patients (43%) obtaining a perfect score. DISCUSSION: The Mini-Balance Evaluation Systems Test may be useful as a balance measure for inpatients with subacute stroke because it is less susceptible to ceiling effects and more responsive than the Berg Balance Scale.

OBJECTIVE: To evaluate the effectiveness of a dyadic outpatient rehabilitation program focused on improving the real-life daily activities of patients with mild cognitive impairments or dementia and their caregivers. DESIGN: Retrospective study. SUBJECTS: Eight patients with mild cognitive impairments or dementia and their caregivers. METHODS: The rehabilitation program comprised eight 1-hour sessions by occupational therapists with patients and his/her caregivers. Patients were assessed for motor function, cognitive function, and quality of life, and their caregivers were assessed for depression and caregiver burden. Participants were assessed at pre-program and post-program, and 3-month follow-up. RESULTS: The scores of caregiver-assessed Quality of life in Alzheimer's disease scale in patients significantly improved at post-program (median [interquartile range], 30.0 [7.0]) compared with pre-program (27.0 [2.8], effect size = 0.77, p = 0.029). In caregivers, the Zarit Caregiver Burden Interview scores decreased significantly at post-program (16.5 [13.0]) compared with pre-program (22.0 [17.5], effect size = 0.72, p = 0.042). There were no significant differences in other assessments. CONCLUSIONS: The rehabilitation program focused on real daily activities and demonstrated to improve patients' quality of life and caregivers' depression and caring burden through patient-caregiver interaction. Future enhanced follow-up systems are warranted.