MIYASAKA HIROYUKI

Practicing walking in a safety suspension device allows patients to move freely and without excessive reliance on a therapist, which requires correcting errors and may facilitate motor learning. This opens the possibility that patients with subacute stroke may improve their walking ability more rapidly. Therefore, we tested the hypothesis that overground gait training in a safety suspension device will result in achieving faster supervision-level walking than gait training without the suspension device. Twenty-seven patients with stroke admitted to the rehabilitation ward with functional ambulation categories (FAC) score of 2 at admission were randomly allocated to safety suspension-device group (SS group) or conventional assisted-gait training group (control group). In addition to regular physical therapy, each group underwent additional gait training for 60 min a day, 5 days a week for 4 weeks. We counted the days until reaching a FAC score of 3 and assessed the probability using Cox regression models. The median days required to reach a FAC score of 3 were 7 days for the SS group and 17.5 days for the control group, which was significantly different between the groups (P < 0.05). The SS group had a higher probability of reaching a FAC score of 3 after adjusting for age and admission motor impairment (hazard ratio = 3.61, 95% confidence interval = 1.40-9.33, P < 0.01). The gait training with a safety suspension device accelerates reaching the supervision-level walking during inpatient rehabilitation. We speculate that a safety suspension device facilitated learning by allowing errors to be experienced and correct in a safe environment.

Neuromuscular electrical stimulation (NMES), specifically functional electrical stimulation (FES) that compensates for voluntary motion, and therapeutic electrical stimulation (TES) aimed at muscle strengthening and recovery from paralysis are widely used in stroke rehabilitation. The electrical stimulation of muscle contraction should be synchronized with intended motion to restore paralysis. Therefore, NMES devices, which monitor electromyogram (EMG) or electroencephalogram (EEG) changes with motor intention and use them as a trigger, have been developed. Devices that modify the current intensity of NMES, based on EMG or EEG, have also been proposed. Given the diversity in devices and stimulation methods of NMES, the aim of the current review was to introduce some commercial FES and TES devices and application methods, which depend on the condition of the patient with stroke, including the degree of paralysis.

Purpose: Electrical stimulation therapy is used for training of the upper limbs in hemiplegic patients. It has been reported that this therapy can improve the functions of the paralyzed upper limb while suppressing spasticity. In this study, we applied integrated volitional control electrical stimulation (IVES) therapy for rehabilitation of the paralyzed upper limbs of sub-acute hemiplegic patients. Methods: Our objective was to investigate the carry-over effect of this method during stroke rehabilitation in patients. IVES therapy was conducted for 20 minutes per day for one week. To investigate the carry-over effect, we measured the active wrist dorsiflexion angles at 0, 30, 60, 90, and 120 minutes after daily rehabilitation sessions. Compared to the resulted obtained before the start of rehabilitation, the active wrist dorsiflexion angles had improved. Results: The SIAS and MAS also showed improvement. However, the differences were not significant. While active wrist dorsiflexion angles at 30, 60, 90, and 120 minutes after the daily sessions were decreased compared to those before rehabilitation, the active dorsiflexion angles were only significantly different for 60, 90, and 120 minutes. The dorsiflexion angle at one week after the start of rehabilitation was significantly improved at 90 and 120 minutes after daily sessions, compared with the angle at the start of rehabilitation.Conclusions: Our findings revealed the long-term therapeutic effects of IVES.

Miyasaka H, Kondo I, Kato H, Takahashi C, Uematsu H, Yasui C, Tani A, Miyata M, Wada N, Teranishi T, Wada Y, Sonoda S. Assessment of the content validity of Functional Skills Measure after Paralysis with nominal group discussion and revision of its content. Jpn J Compr Rehabil Sci 2011; 2: 24-30<br>Purpose: The purposes of this study were to assess the content validity of Functional Skills Measure after Paralysis (FSMAP) and to revise its content to make it appropriate for use in the clinical setting.<br>Methods: Eight occupational therapists (OTs) participated in the questionnaire study. Nominal Group Technique (NGT) was used to measure the content validity. Before using the NGT, we set an 80% agreement as the criterion for consent. If the agreement for an item did not reach this level and the item’s content validity was not high enough, we revised its content. We repeated the same assessment for the revised FSMAP by using a questionnaire.<br>Results: In the first assessment, 8 out of 15 items (including the subitems and descriptions) did not reach the predetermined agreement level. In the second assessment, 1 out of 15 items did not reach the agreement level. We finished the assessment process because we judged that the content validity of FSMAP reached a satisfactory level after the revision of this item.<br>Discussion: We think that FSMAP should be revised to make it appropriate for use in the clinical setting after assessing its content validity.

省スペースの定常環境下にて多数歩採取が容易となるトレッドミルを用いて三次元動作解析を行い,歩行中の足部内外反運動の計測を試み,その計測方法と分析結果について検討した.整形および中枢疾患の既往歴のない健常成人男性5例を対象とした.平均歩数は,12.2歩であった.歩行周期の内外反運動は,踵接地では内反位を呈し,立脚中期に正中および軽度外反位,立脚中期から遊脚期にかけて内反になる運動パターンの傾向を示し,5例ともほぼ同じ傾向であった.トレッドミル歩行分析では,多数歩にて正規化後加算平均処理が容易となるため,歩行周期の足部内外反運動を明確に示すことが可能になった.また,標準偏差,変動係数といった統計学的検討も可能となるため,臨床の歩行分析において非常に有用な指標になると思われた