金田 嘉清

BACKGROUND AND OBJECTIVES: This study aimed to examine the development of clinical competence of novice physical therapists (PTs) during their first year of employment, following the implementation of an original in-house educational program. The educational program was designed to offer diverse training opportunities at an early stage, during the first year of employment. METHODS: Thirty-eight novice PTs (21 males and 17 females, mean age 23.4 ± 3.2 years) participated in this study. All participants underwent educational programs and a self-assessment using the Clinical Competence Evaluation Scale in Physical Therapy (CEPT) on the first day of employment (entry-level) and after 1, 3, 6, and 12 months of employment. The total score and CEPT component-wise scores-"knowledge," "clinical reasoning," "skill," "communication," "attitude," "self-education," and "self-management"-at the 4 assessment points (1, 3, 6, and 12 months) were compared with values on the first day. RESULTS: The total scores at 3, 6, and 12 months of employment were significantly higher than those on the first day of employment (P < .05). Among the total scores on the 7 components, those for "knowledge," "clinical reasoning," "skill," and "communication" at 3, 6, and 12 months after employment were also significantly higher than those on the first day of employment (P < .05). The scores for "attitude" and "self-education" 12 months after employment were significantly higher than those on the first day of employment. However, the "self-management" scores at 1, 3, 6, and 12 months after employment did not significantly change compared with those on the first day of employment. CONCLUSIONS: The total score was significantly higher after 3 months. The participant's clinical competence may have improved because they participated in an educational program related to "knowledge," "clinical reasoning," "skills," and "communication" at an earlier stage in the first year. However, their progress was comparatively slower in other areas, suggesting that the content might not have been sufficient. This study revealed the effectiveness of the educational program on novice PTs' clinical competence at a single institution in Japan. Positive outcomes were obtained for several parameters. Furthermore, the results reveal the need for content modifications within the educational program to improve PTs' performance across all evaluated items.

BACKGROUND: The COVID-19 pandemic has affected physical and occupational therapist education in various ways. OBJECTIVE: This study investigated whether the pandemic changed clinical placement, thus influencing the clinical competence of physical and occupational therapists at a hospital in Japan. METHODS: Eleven therapists (seven physical and four occupational) participated in this study in April 2021. Clinical placement teaching methods were surveyed using an online questionnaire. The Objective Structured Clinical Examination (OSCE), comprising attitudinal and technical items, was used to examine clinical competence. The results were calculated as the sum of the attitudinal and technical scores, and the ratios of these scores to the full score were compared using a paired-sample Wilcoxon signed-rank test. RESULTS: During the pandemic, some schools implemented shortened practical clinical placements. The substituted classes included online-only classes and combined online and face-to-face classes. Regarding clinical competence, scores on the OSCE were mostly high. The median proportion of the total attitudinal score to the perfect score was 100% for all three items (range-of-motion test, muscle strength test, Stroke Impairment Assessment Set). The median proportion of the total technical score to the perfect score ranged from 56.7% to 76.7% for the three items. The ratio of the total attitudinal score to the full score was significantly higher than that of the total technical score to the full score (p = 0.001). CONCLUSIONS: Most clinical placements were canceled or partially administered through online learning during the pandemic. This decrease in clinical placements did not affect newly recruited physical and occupational therapists’ clinical competence.

Introduction Qualitative information in the form of written reflection reports is vital for evaluating students’ progress in education. As a pilot study, we used text mining, which analyzes qualitative information with quantitative features, to investigate how rehabilitation students’ goals change during their first year at university. Methods We recruited 109 first-year students (66 physical therapy and 43 occupational therapy students) enrolled in a university rehabilitation course. These students completed an open-ended questionnaire about their learning goals at the time of admission and at 6 and 12 months after admission to the university. Text mining was used to objectively interpret the descriptive text data from all three-time points to extract frequently occurring nouns at once. Then, hierarchical cluster analysis was performed to generate clusters. The number of students who mentioned at least one noun in each cluster was counted and the percentages of students in each cluster were compared for the three periods using Cochran’s Q test. Results The 31 nouns that appeared 10 or more times in the 427 sentences were classified into three clusters: “Socializing,” “Practical Training,” and “Classroom Learning.” The percentage of students in all three clusters showed significant differences across the time periods (p &amp;lt; 0.001 for “Socializing”; p &amp;lt; 0.01 for “Practical Training” and “Classroom Learning”). Conclusion These findings suggest that the students’ learning goals changed during their first year of education. This objective analytical method will enable researchers to examine transitional trends in students’ reflections and capture their psychological changes, making it a useful tool in educational research.

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.

BACKGROUND: The impact of different stroke types on specific activities of daily living (ADL) is unclear. OBJECTIVE: To investigate how differences between intracerebral hemorrhage (ICH) and cerebral infarction (CI) affect improvement of ADL in patients with stroke within a hospital by focusing on the sub-items of the Functional Independence Measure (FIM). METHODS: Patients with first-stroke hemiplegia (n = 212) were divided into two groups: ICH (86 patients) and CI (126 patients). Primary assessments included 13 motor and 5 cognitive sub-items of the FIM assessed at admission and discharge. Between-group comparisons and multiple regression analyses were performed. RESULTS: Upon admission, the ICH group exhibited significantly lower FIM scores than those of the CI group across various activities, including grooming, dressing (upper body and lower body), toileting, bed/chair transfer, toilet transfer, walking/wheelchair, and stairs. Age and FIM motor scores at admission influenced both groups' total FIM motor scores at discharge, whereas the duration from onset affected only the CI group. CONCLUSION: Several individual FIM motor items were more adversely affected by ICH than by CI. Factors related to ADL at discharge may differ depending on stroke type. Recognizing these differences is vital for efficient rehabilitation practices and outcome prediction.

Background Upper limb motor paresis is a major symptom of stroke, which limits activities of daily living and compromises the quality of life. Kinematic analysis offers an in-depth and objective means to evaluate poststroke upper limb paresis, with anticipation for its effective application in clinical settings. Objective This study aims to compare the movement strategies of patients with hemiparesis due to stroke and healthy individuals in forward reach and hand-to-mouth reach, using a simple methodology designed to quantify the contribution of various movement components to the reaching action. Methods A 3D motion analysis was conducted, using a simplified marker set (placed at the mandible, the seventh cervical vertebra, acromion, lateral epicondyle of the humerus, metacarpophalangeal [MP] joint of the index finger, and greater trochanter of the femur). For the forward reach task, we measured the distance the index finger’s MP joint traveled from its starting position to the forward target location on the anterior-posterior axis. For the hand-to-mouth reach task, the shortening of the vertical distance between the index finger MP joint and the position of the chin at the start of the measurement was measured. For both measurements, the contributions of relevant upper limb and trunk movements were calculated. Results A total of 20 healthy individuals and 10 patients with stroke participated in this study. In the forward reach task, the contribution of shoulder or elbow flexion was significantly smaller in participants with stroke than in healthy participants (mean 52.5%, SD 24.5% vs mean 85.2%, SD 4.5%; P&lt;.001), whereas the contribution of trunk flexion was significantly larger in stroke participants than in healthy participants (mean 34.0%, SD 28.5% vs mean 3.0%, SD 2.8%; P&lt;.001). In the hand-to-mouth reach task, the contribution of shoulder or elbow flexion was significantly smaller in participants with stroke than in healthy participants (mean 71.8%, SD 23.7% vs mean 90.7%, SD 11.8%; P=.009), whereas shoulder girdle elevation and shoulder abduction were significantly larger in participants with stroke than in healthy participants (mean 10.5%, SD 5.7% vs mean 6.5%, SD 3.0%; P=.02 and mean 16.5%, SD 18.7% vs mean 3.0%, SD 10.4%; P=.02, respectively). Conclusions Compared with healthy participants, participants with stroke achieved a significantly greater distance via trunk flexion in the forward reach task and shoulder abduction and shoulder girdle elevation in the hand-to-mouth reach task, both of these differences are regarded as compensatory movements. Understanding the characteristics of individual motor strategies, such as dependence on compensatory movements, may contribute to tailored goal setting in stroke rehabilitation.

OBJECTIVES: The purpose of this study was to capture the lifestyle characteristics of traumatic brain injury (TBI) patients by administering the Frenchay Activities Index (FAI), a self-assessment questionnaire used for assessing life-related activities, among TBI patients. METHODS: This study was conducted using the revised FAI Self-Assessment Form, administering an interview-based questionnaire survey to TBI patients and healthy participants. The target group comprised 60 traumatic brain injury patients who had progressed from at least 1 year since the injury, with a comparison group of 788 healthy participants. RESULTS: A comparison of FAI scores between TBI patients and healthy participants by questionnaire revealed that TBI patients exhibited significantly higher FAI scores than healthy participants for outdoor walking and transportation use (Mann-Whitney U test, P<0.01). A comparison by occupation revealed that TBI patients were significantly less among the unemployed and other categories (Mann-Whitney U test, P<0.01). For office workers, government employees, high school students, and college students, scores were higher among TBI patients compared with healthy participants, although the differences were not significant. CONCLUSIONS: Although TBI patients were less active than healthy participants in life-related activities, their scores for cleaning up after meals and cleaning and putting things in order were close to those of healthy participants, indicating that TBI patients cannot be considered to be inactive. The findings also revealed differences in TBI patients' engagement in life-related activities and frequency of activities depending on their social position.

OBJECTIVES: This study investigates how online frame-of-reference (FOR) training of raters of the objective structured clinical examination (OSCE) for physical therapy students affects assessment accuracy. METHODS: The research was conducted in a 1-month-long randomized controlled trial. PARTICIPANTS: The participants were 36 physical therapists without experience assessing clinical skills using the OSCE. The training group completed the FOR training online, which was conducted once a week in two 90-minute sessions. The control group self-studied the rubric rating chart used in the assessment. As a measure of accuracy, weighted kappa coefficients were used to check the agreement between correct score and those assessment by the participant in the OSCE. RESULTS: The scores of the training group were higher than those of the control group in both post- and follow-up assessments, showing significant differences. No significant difference was found based on the assessment time and group for the high-agreement groups. Furthermore, scores of the low-accuracy training group were higher in the post- and follow-up assessments than those in the pre-assessment, showing significant differences. CONCLUSIONS: Online FOR training of the raters of the OSCE for physical therapists improved the assessment accuracy of the raters who had low accuracy in the pre-assessment; this improvement was maintained.

When walking with wearable robotic exoskeletons (WRE) in people with spinal cord injury, the distance between the user and the walker is one of the most important perspectives for ensuring safety. The purpose of this study was to clarify the distance between WRE users and four-wheeled walkers (4WW) while walking on level and sloping surfaces. To eliminate the effects of variation in neurological conditions, 12 healthy subjects participated. All participants ambulated using the WRE and the 4WW on level and sloping surfaces. The outcomes were the mean distances between the WRE users and the 4WWs in the level and slope conditions. To examine the influence of uphill and downhill slopes on distance, comparisons were conducted between the uphill or downhill conditions and the respective transitional periods. In the uphill condition, the mean distances were significantly greater than that in the level condition. Conversely, the mean distance moving downhill was significantly shorter than that in the level condition. Changes in the distance between the WRE user and the 4WW might increase the risk of falling forward on an uphill slope and backward on a downhill slope. This study’s results will assist in developing a new feedback system to prevent falls.

目的:本研究の目的は,理学療法士・作業療法士教育における臨床教育者の指導経験が診療参加型臨床実習に及ぼす影響について検証することである。方法:対象は藤田医科大学の教育病院において臨床実習を経験した理学および作業療法専攻の学生とし,臨床教育者の診療参加型臨床実習指導経験が無い群(CE未経験群)48名と有る群(CE経験群)49名の2群に分け,臨床実習中の学生のストレス状態,基本的姿勢,睡眠状態を比較した。結果:CE経験群では,CE未経験群と比較し,臨床実習中の対人関係,適性度,イライラ感のストレスが減少し,実習の満足度が増加していた。また,基本的姿勢の評価の点数は高かった。一方で,睡眠状態は,CE未経験群に比較してCE経験群では「不眠症なし」と判定された割合は減少し,「軽度不眠症」と判定された割合は増加していた。結論:指導経験ある臨床教育者による実習では,学生のストレスは軽減し,基本的姿勢の評価は向上するものの,睡眠状態に関しては,一定数の睡眠障害のある学生は残存し,心理面のサポートとともに,自宅での学習状況や睡眠時間を留意しながら指導する必要性が示唆された。(著者抄録)

The number of post-graduate rehabilitation therapists (novice therapists) is increasing due to the growing demand for rehabilitation services in Japan. This study investigated the acquisition status of Japanese novice therapists’ basic clinical skills to clarify their quality and characteristics. Eleven participants’ basic clinical skills (eight physical and three occupational therapists) were assessed using an Objective Structured Clinical Examination. Tasks included exercises of joint range of motion, muscle strengthening, getting up, standing up and sitting down, and transferring between wheelchair and bed. Assessment items were subdivided into categories: attitude, preparation, intervention, safety management, and feedback. One-way ANOVA and Friedman test were used for statistical analysis to compare the data between tasks and categories. The scores for each task’s achievement rate were not statistically significant. However, the achievement rate of each category including tasks was 92.6% (SD 4.0%) for attitude, 81.4% (SD 11.1%) for preparation, 77.9% (SD 14.7%) for intervention, 87.6% (SD 17.3%) for safety management, and 64.0% (SD 14.2%) for feedback. There were significant differences between attitude and feedback (p &lt; 0.001), and between safety management and feedback (p = 0.012). Post-graduate training programs should focus on improving the quality of clinical skills, especially in skills related to feedback.

Background Aging is the most significant risk factor for dementia. Alzheimer’s disease (AD) accounts for approximately 60–80% of all dementia cases in older adults. This study aimed to examine the relationship between finger movements and brain volume in AD patients using a voxel-based reginal analysis system for Alzheimer’s disease (VSRAD) software. Methods Patients diagnosed with AD at the Center for Comprehensive Care and Research on Memory Disorders were included. The diagnostic criteria were based on the National Institute on Aging-Alzheimer’s Association. A finger-tapping device was used for all measurements. Participants performed the tasks in the following order: with their non-dominant hand, dominant hand, both hands simultaneously, and alternate hands. Movements were measured for 15 s each. The relationship between distance and output was measured. Magnetic resonance imaging measurements were performed, and VSRAD was conducted using sagittal section 3D T1-weighted images. The Z-score was used to calculate the severity of medial temporal lobe atrophy. Pearson’s product-moment correlation coefficient analyzed the relationship between the severity of medial temporal lobe atrophy and mean values of the parameters in the finger-tapping movements. The statistical significance level was set at &lt;5%. The calculated p-values were corrected using the Bonferroni method. Results Sixty-two patients were included in the study. Comparison between VSRAD and MoCA-J scores corrected for p-values showed a significant negative correlation with the extent of gray matter atrophy (r = -0. 52; p&lt; 0.001). A positive correlation was observed between the severity of medial temporal lobe atrophy and standard deviation (SD) of the distance rate of velocity peak in extending movements in the non-dominant hand (r = 0. 51; p&lt; 0.001). Conclusions The SD of distance rate of velocity peak in extending movements extracted from finger taps may be a useful parameter for the early detection of AD and diagnosis of its severity.

Aim A testing method for early diagnosis of Mild cognitive dementia (MCI) that can be easily applied in clinical practice was investigated in this study. We examined whether MCI risk can be determined through finger movements. Methods Between 2013 and 2020, 1097 individuals were screened. After applying propensity-score matching to adjust for variability between the groups, 173 individuals each in the mild cognitive impairment and control groups were selected. Thereafter, differences between groups in mean values of parameters extracted from finger tap movements were determined using unpaired t-test and effect size. Furthermore, area under the curve, sensitivity, and specificity were calculated from the receiver operating characteristic curve for parameters with significant difference. Results A significant difference was observed, especially in the number of taps in the MCI group compared with that in the control group ( p &lt; .001; 95% CI, −12.7 to −8.8; r = 0.51). A cut-off value of 30 taps was applied (sensitivity, 0.77; specificity, 0.67; AUC, 0.79). Significant differences were also observed in rhythm-related parameters. Conclusions These parameters might be useful for capturing MCI risk. Finger taps are easily measured and may be suitable for screening large populations. This tool might be used as a supplemental method to increase the sensitivity of traditional cognitive tests.

Objectives: To determine if a simulated medical information system can improve the level of understanding of healthcare information technology students. Methods: The study involved 40 healthcare information technology students. All the students took the healthcare information technology course using the simulated medical information system. The primary outcome was a measure of their level of understanding assessed with a questionnaire using a five-point Likert-type scale. The questions were all included in the required knowledge for the Specific Behavioral Objectives for Healthcare Information Technologists (2016) and Senior Healthcare Information Technologists (ver. 1.1, 2017). To measure the level of understanding, median with 10th–90th percentile CI values for both sets of questionnaires were calculated for all the students. The Wilcoxon signed-rank test was used to compare level of understanding before and after the training. Results: Some students were excluded because they failed to complete the questionnaires. For both Healthcare Information Technologists (n=37) and Senior Health Information Technologists (n=34), the level of understanding was significantly different before (median [10th–90th percentile]: 1175 [935–1271], 416 [302–513]) and after (1200 [1016–1472], 469.5 [351–527]) the training (p<0.05). Conclusions: A simulated medical information system may be an effective tool for students to learn about healthcare information technology.

Background: Spasticity is defined as a velocity-dependent increase in tonic stretch reflexes and is manually assessed in clinical practice. However, the best method for the clinical assessment of spasticity has not been objectively described. This study analyzed the clinical procedure to assess spasticity of the elbow joint using an electrogoniometer and investigated the appropriate velocity required to elicit a spastic response and the influence of velocity on the kinematic response pattern. Methods: This study included eight healthy individuals and 15 patients with spasticity who scored 1 or 1+ on the modified Ashworth Scale (MAS). Examiners were instructed to manually assess spasticity twice at two different velocities (slow and fast velocity conditions). During the assessment, velocity, deceleration value, and angle [described as the % range of motion (%ROM)] at the moment of resistance were measured using an electrogoniometer. Differences between the slow and fast conditions were evaluated. In addition, variations among the fast condition such as the responses against passive elbow extension at <200, 200-300, 300-400, 400°/s velocities were compared between the MAS 1+, MAS 1, and control groups. Results: Significant differences were observed in the angular deceleration value and %ROM in the fast velocity condition (417 ± 80°/s) between patients and healthy individuals, but there was no difference in the slow velocity condition (103 ± 29°/s). In addition, the deceleration values were significantly different between the MAS 1 and MAS 1+ groups in velocity conditions faster than 300°/s. In contrast, the value of %ROM plateaued when the velocity was faster than 200°/s. Conclusion: The velocity of the passive motion had a significant effect on the response pattern of the elbow joint. The velocity-response pattern differed between deceleration and the angle at which the catch occurred; the value of deceleration value for passive motion was highly dependent on the velocity, while the %ROM was relatively stable above a certain velocity threshold. These results provide clues for accurate assessment of spasticity in clinical practice.

BACKGROUND: In this study, we investigated subjective geriatric complaints (SGCs) as conditions regarding health concerns in community-dwelling older people and analyzed their frequencies with aging and relationships with other factors. METHODS: This cross-sectional study enrolled 10,434 older people living in a community with a representative aging population in Japan. A questionnaire was sent by mail to those who had not applied for formal care needs certification. The presence of and concern for symptoms common in old age were asked as SGCs, as were physical function levels, multimorbidity, and depression. Categorical principal component analysis (CATPCA) of the symptoms was performed, and the association between the obtained components and other factors was analyzed. RESULTS: The mean age of the participants was 73.7 ± 6.1 years, and 52.5% were women. On average, they had 1.72 ± 1.57 SGCs, which showed a gradual increase with age. The results of the CATPCA revealed four components: SGC1, excretory/circulatory/swallowing complaints; SGC2, audiovisual complaints; SGC3, neurological complaints; and SGC4, musculoskeletal complaints. All SGC components were independently associated with physical function, multimorbidity, and depression. CONCLUSIONS: Each SGC showed various frequencies and differences along with aging, and SGCs were classified into four components that were thought to share a common background. These findings could contribute to the planning of better health management strategies for older people.

BACKGROUND: Ankle-foot orthoses are used to improve gait stability in patients with post-stroke gait; however, there is not enough evidence to support their beneficial impact on gait stability. AIM: To investigate the effects of ankle-foot orthoses on post-stroke gait stability. DESIGN: An experimental study with repeated measurements of gait parameters with and without orthosis. SETTING: Inpatients and outpatients in the Fujita Health University Hospital. POPULATION: Thirty-two patients (22 males; mean age 48.3±20.0 years) with poststroke hemiparesis participated in the study. METHODS: Three-dimensional treadmill gait analysis was performed with and without ankle-foot orthosis for each participant. Spatiotemporal parameters, their coefficient of variation, and margin of stability were evaluated. Toe clearance, another major target of orthosis, was also examined. The effect of orthosis in the patients with severe (not able to move within the full range of motion, defying gravity) and mild ankle impairment (able to move within the full range but have problem with speed and/or smoothness of the ankle movement) was compared. RESULTS: In the total group comparison, the decrease in the coefficient of variation of step width (P=0.012), and margin of stability on the paretic side (P=0.023) were observed. In the severe ankle impairment groups, the decreased in the coefficient of variation of the non-paretic step length (P=0.007), stride length (P=0.037), and step width (P=0.033) and margin of stability on the paretic side (P=0.006) were observed. No significant effects were observed in the mild ankle impairment group; rather, the coefficient of variation of non-paretic step length increased with the use of orthosis in this group (P=0.043); however, toe clearance increased with the use of ankle-foot orthosis (P=0.041). CONCLUSIONS: Ankle-foot orthoses improved gait stability indices; however, the effect was either not significant or showed possible worsening in the patients with mild ankle impairment, while the effect on toe clearance was significant. These results suggest that the effects of using orthoses in patients with mild impairment should be carefully evaluated. CLINICAL REHABILITATION IMPACT: Understanding the effects of ankle-foot orthoses on the stability of post-stroke gait and their relationship with ankle impairment severity may support clinical decision-making while prescribing orthosis for post-stroke hemiparesis.

BACKGROUND AND PURPOSE: There are no reports regarding the effect of Lee Silverman Voice Treatment® BIG (LSVT® BIG) on standing balance ability evaluated using quantitative assessment. This case report aimed to describe and evaluate the influence of LSVT® BIG on the center of pressure (COP) trajectory in a patient with Parkinson's disease (PD). METHODS: Although this paper focused on one case, quantitative assessment on the effect of LSVT® BIG on standing balance ability was performed. A 67-year-old woman patient diagnosed with PD at age 59, with a Hoehn and Yahr stage 3 disability severity, underwent a 4-weeks supervised LSVT® BIG program. The total distances of the COP trajectory (two-dimensional [2D] horizontal plane, anterior-posterior [AP] direction, and medial-lateral [ML] direction), and the mean COP velocity for each direction, postural stability, and posture subsections of the Unified Parkinson's Disease Rating Scale (UPDRS) Part 3 were assessed at pre- and post-intervention. RESULTS: The total distances of the COP trajectory, mean COP velocities, and scores of postural stability and posture subsections of the UPDRS Part 3 improved after intervention (from 124.6 to 76.6 cm [2D], 89.4 to 57.7 cm [AP], 77.4 to 38.5 cm [ML]; 4.0 to 2.6 cm/s [2D], 3.0 to 1.9 cm/s [AP], 2.6 to 1.3 cm/s [ML]; and 3 to 0, and 3 to 2, respectively). DISCUSSION: LSVT® BIG may be effective in improving the total distance of the COP trajectory, mean COP velocity, and both postural stability and posture subsections of the UPDRS Part 3 in the presented PD case.

BACKGROUND: There are no reports regarding the long-term retention of effects of Lee Silverman Voice Treatment® BIG (LSVT® BIG) on improvements in quality of life (QOL) among patients with Parkinson's disease (PD). OBJECTIVE: This study aimed to evaluate the short-term effect of LSVT® BIG on QOL improvement and its retention in a patient with PD. Motor symptoms, walking ability, and walking speed were evaluated as factors associated with QOL. METHODS: A 63-year-old woman who was diagnosed with PD received a 4-week LSVT® BIG program under the supervision of certified LSVT® BIG physical therapists. The participant's disease severity was classified as Hoehn and Yahr stage 2. The Parkinson's Disease Questionnaire-39 (PDQ-39), Movement Disorder Society-sponsored Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part 3, timed up-and-go test (TUG), and 10 m walk test (10 MWT) were evaluated before, after, and 1-year after the intervention. RESULTS: The results indicated short-term improvements in the PDQ-39, MDS-UPDRS part 3, TUG, and 10 MWT which were retained for up to 1 year. CONCLUSIONS: This case report suggests the possibility of 1-year retention of improvements in QOL, motor symptoms, walking ability, and walking speed resulting from LSVT® BIG intervention in a patient with mild PD.

Introduction: Lee Silverman Voice Treatment® BIG (LSVT® BIG) is widely used to improve motor symptoms in patients with mild-to-moderate Parkinson's disease (PD).Objective: To describe the effect of LSVT® BIG on the motor symptoms of a patient with severe PD.Case Description: A 77-year-old woman who was diagnosed with PD received a 4-week LSVT® BIG program under the supervision of certified LSVT® BIG physical therapists. Her disease severity was classified as Hoehn and Yahr stage 4. The unified Parkinson's disease rating scale (UPDRS) part 3, 10-m walk test (10MWT), timed up-and-go test (TUG), Berg balance scale (BBS), and 30-s chair stand test (30-s CST) were used for assessment before and after intervention.Outcomes: The UPDRS part 3, 10MWT, TUG, BBS, and 30-s CST improved after intervention (33 to 26, 0.51 to 0.69 m/s, 38.1 to 23.2 seconds, 11 to 34, and 3 to 9 times, respectively). All improvements exceeded the Minimal Clinically Important Difference or Minimal Detectable Change values (2.5, 0.16 m/s, 3.5 seconds, 5, and 3 times, respectively).Conclusions: These results indicated that LSVT® BIG appears to have improved motor symptoms in a patient with severe PD. Further studies, ideally randomized controlled trials, are needed to confirm these findings.

Background/aims There are no established methods for patients with hemiparetic stroke to practice the raising and lowering of trousers. The aim of this study was to investigate the use of different strategies by patients with hemiparetic stroke for lowering and raising trousers by using the non-paretic upper limb in the standing position, based on residual motor function in the paretic lower limb. Methods A total of 28 patients with hemiparetic stroke were included in the study (n=10, 12, and 6 with lower-limb Brunnstrom stages III, IV and V respectively). Endpoints were execution time and frequency of changing the manipulation region. Results Lower-limb Brunnstrom stages III, IV and V were associated with execution times of 24.1 ± 11.1, 18.1 ± 6.5 and 16.9 ± 9.6 seconds respectively, and the mean frequency of manipulation of trousers on the posterior paretic side was significantly lower than those of the anterior paretic, anterior non-paretic, and posterior non-paretic sides in all patients (P&lt;0.05). Conclusions Motor function of the paretic lower limb did not affect the strategies used for lowering and raising trousers with the non-paretic upper limb. Manipulation of trousers on the posterior paretic side was especially difficult.

Objectives: Wearable robotic exoskeletons (WREs) have been globally developed to achieve gait reconstruction in patients with spinal cord injury (SCI). The present study aimed to enable evidence-based decision-making in selecting the optimal WRE according to residual motor function and to provide a new perspective on further development of appropriate WREs. Methods: The current review was conducted by searching PubMed, Web of Science, and Google Scholar for relevant studies published from April 2015 to February 2020. Selected studies were analysed with a focus on the participants' neurological level of SCI, amount of training (number of training sessions and duration of the total training period), gait speed and endurance achieved, and subgroup exploration of the number of persons for assistance and the walking aid used among patients with cervical level injury. Results: A total of 28 articles (nine using Ekso, three using Indego, ten using ReWalk, one using REX, five using Wearable Power-Assist Locomotor) involving 228 patients were included in the analysis. Across all WREs, T6 was the most frequently reported level of SCI. The amount of training showed a wide distribution (number of training sessions: 2-230 sessions [30-120 min per session]; duration of the total training period: 1-24 weeks [1-5 times per week]). The mean gait speed was 0.31 m/s (standard deviation [SD] 0.14), and the mean distance on the 6-min walking test as a measure of endurance was 108.9 m (SD 46.7). The subgroup exploration aimed at patients with cervical level injury indicated that 59.2% of patients were able to ambulate with no physical assistance and several patients used a walker as a walking aid. Conclusion: The number of cervical level injury increased, as compared to the number previously indicated by a prior similar review. Training procedure was largely different among studies. Further improvement based on gait performance is required for use and dissemination in daily life. The translational potential of this article: The present review reveals the current state of the clinical effectiveness of WREs for gait reconstruction in patients with SCI, contributing to evidence-based device application and further development.

発病から15年の慢性脳血管障害者で介護保険利用の14名と非利用の14名を対象とし、能力障害(ADL)と社会参加障害(IADL)の推移を調査した。内訳は男性20名、女性8名、年齢は67.0歳±9.7であり、診断名は脳出血10名、脳梗塞16名、その他2名で、麻痺11例、片麻痺17例であった。発病から15年間のADLとIADLを追跡調査した。その結果、介護保険利用者と非利用者におけるADLの推移に特徴がみられた。本研究から抽出された地域包括ケアシステムの課題として、ADLの自立支援や介護予防、就労支援で適切な介入時期を個々に発見すること、生活期リハビリテーションにおける訪問リハビリテーションやデイケアで適切な介入プログラムを設定して社会参加を促すプランを作り、積極的に解決に向けて粘り強く進めること、があげられた。

Objectives: Objective structured clinical examinations (OSCEs) are used to assess clinical competence in medical education. Evaluations using video-recorded OSCEs are effective in reducing costs in terms of time and human resources. To improve inter-rater reliability, these evaluations undergo moderation in the form of a discussion between the raters to obtain consistency in grading according to the rubric criteria. We examined the effect of moderation related to the rubric criteria on the inter-rater reliability of a video-recorded OSCE with real patients. Methods: Forty OSCE videos in which students performed range-of-motion tests at shoulder abduction on real patients were assessed by two raters. The two raters scored videos 1 to 10 without moderation and videos 11 to 40 with moderation each time. The inter-rater reliability of the OSCE was calculated using the weighted kappa coefficient. Results: The mean scores of the weighted kappa coefficients were 0.49 for videos 1 to 10, 0.57 for videos 11 to 20, 0.66 for videos 21 to 30, and 0.82 for videos 31 to 40. Conclusions: An assessment of video-recorded OSCEs was conducted with real patients in a real clinical setting. Repeated moderation improved the inter-rater reliability. This study suggests the effectiveness of moderation in OSCEs with real patients.

Objectives: We conducted a finger tapping movement test using a finger tapping device with magnetic sensors (UB-2) and performed multiple regression analyses using a number of finger movements parameters to estimate the severity of cognitive impairment. Methods: The subjects of this study were 64 patients, including 44 diagnosed with Alzheimer's disease (AD) (mean age: 73.8±7.0 years) and 20 diagnosed with mild cognitive impairment (MCI) (mean age: 76.7±4.2 years). For the finger-tapping movement tasks, we tested single-hand (left and right) tapping, simultaneous tapping of both hands, and alternate tapping between hands. After measurement, multiple regression analysis adjusted for age and sex was performed to predict the Mini-Mental State Examination (MMSE) score from the calculated hand parameters. Results: Relatively high standardized partial regression coefficients were observed for the following two parameters: standard deviation (SD) of distance rate of velocity peak in extending movement and the SD of contact duration. The coefficients of determination (R2) ranged between 0.1 to 0.28. Conclusions: Our results suggest the possibility that these parameters may be used to assess cognitive function. We shall obtain large-scale data from older people to examine the possibility of these parameters to be used as an early diagnostic tool for dementia patients.

Introduction: Upper limb motor function and activities of daily living (ADL) are related in chronic stroke patients. This study investigated this relationship after removal of the influence of motor function of the affected lower limb, which until now has remained unclear. Methods: This retrospective cross-sectional study included 53 patients with chronic stroke. Upper and lower limb motor function and ADL were assessed using the Fugl-Meyer assessment of the upper (FMA-UL) and lower limbs (FMA-LL) and functional independence measure motor score (FIM-M). To clarify the relationship between FMA-UL and total FIM-M before and after removal of the influence of FMA-LL, Spearman’s rank correlation coefficient and partial correlation analysis were used. The relationship between FMA-UL and each item of FIM-M after removal of the influence of FMA-LL was assessed using partial correlation analysis. Results: Before the influence of FMA-LL was removed, FMA-UL was moderately to well correlated with total FIM-M. This became weak after the influence was removed. Regarding each item of FIM-M, FMA-UL was correlated with dressing (upper body), toileting, and walking or wheelchair after removal of the influence. Conclusion: The relationship between upper limb motor function and ADL is strongly influenced by lower limb motor function.

Background: The rate of force development (RFD) is an indicator of muscle strength. A previous study reported that the RFD of hip abductor muscles was increased by neuromuscular electrical stimulation (NMES) to gluteus medius (GM) during gait in healthy adults. However, the effects for patients following femoral head replacement for hip fracture are unclear. Purpose: The aim of this case report was to investigate the effects of gait training with sub-motor threshold NMES on RFD of hip abductor muscles in two patients following femoral head replacement for hip fracture compared to gait training without NMES. Case description: Two elderly patients following femoral head replacement for hip fracture received both interventions of gait training with sub-motor threshold NMES to GM and without NMES. Intervention phases involved 14 sessions each, for 28 sessions total. Outcomes: The RFD of hip abductor muscles, maximum walking speed, six-minute walk distance (6MWD), Berg Balance Scale, one-leg standing time (OLST), functional independence measure, and Numeric Pain Rating Scale (NPRS) were used as outcome measures. In both patients, RFD, 6MWD, OLST, and NPRS were improved by gait training with NMES compared to without NMES. Conclusion: Our results suggest the potential of NMES as a treatment methodology for these two patients undergoing femoral head replacement for hip fracture.

理学療法・作業療法専攻学生の教育における診療参加型臨床実習(Clinical Clerkship(CC))の効果を、臨床実習中のストレス、睡眠状態、技能習得の点で検証した。従来の臨床トレーニングを行った学生48名(従来群)とCCを行った学生48名(CC群)を対象に、職業性ストレス簡易調査票(BJSQ)、アテネ不眠尺度(AIS)、技能習得評価の成績を比較した。その結果、CC群は従来群と比較してBJSQの量的負担および質的負担の項目の点数が有意に高く、課題のコントロール度、イライラ感、疲労感、抑うつ感、身体愁訴の項目の点数は有意に低かった。またCC群では活気および指導者のサポート項目に関する点数が高かった。AISスコア中央値はCC群で有意に低かった。臨床実習成績の基本的姿勢、治療技術の項目の点数において、従来群よりもCC群で有意に高かった。以上から、当該学生のストレス、睡眠状態、ある種の技能習得に対するCCの効果が示された。

AIM: Subjective memory complaints (SMC) have attracted attention in recent years in relation to the early stages of dementia. However, it is not clear whether SMC are related to social and leisure activities. The aim of this study was to evaluate SMC in relation to activities in community-dwelling older adults. METHODS: A questionnaire inquiring about SMC and social and leisure activities was sent to 14 850 people aged ≥65 years residing in Toyoake City, as part of the Toyoake Integrated Care Study. After a preliminary analysis, we targeted respondents aged ≥70 years. Therefore, 6685 people were included in the analysis. Three question items were used detecting SMC: the feeling of a memory problem (SMC-1), memory loss pointed out by others (SMC-2) and difficulty in recalling today's date (SMC-3). Logistic regression was carried out to determine the relationship between SMC and activities. RESULTS: In response to SMC-1, 2 and 3, 45.3%, 13.3% and 23.5% participants, respectively, agreed with the statement. Social and leisure activities were negatively associated with SMC-2 and SMC-3, after controlling for confounding factors (SMC-2: odds ratio 0.76, 95% confidence interval 0.65-0.89; SMC-3: odds ratio 0.79, 95% confidence interval 0.70-0.90). However, a significant increase in participation in social and leisure activities was associated with a positive response to SMC-1 (SMC-1: odds ratio 1.24, 95% confidence interval 1.12-1.38). Conclusion A relationship was observed between SMC and social and leisure activities in community-dwelling older people, although differences in the impact of SMC were seen depending on the question asked. Geriatr Gerontol Int 2020; 20: 867-872.

OBJECTIVES: Shoulder subluxation is a common problem after stroke. It causes shoulder pain that affects activities of daily living. This study aimed to investigate the effect of repetitive peripheral magnetic stimulation on shoulder subluxation after stroke. METHODS: We enrolled 12 consecutive patients who, as a result of stroke, suffered shoulder subluxations, measuring at half of a fingerbreadth or more. All subjects underwent conventional rehabilitation, as well as repetitive peripheral magnetic stimulation of their supraspinatus, posterior deltoid, and infraspinatus muscles. We assessed the following parameters: shoulder subluxation, evaluated as the acromio-humeral interval using measurements taken from X-rays; shoulder pain, evaluated using the Numerical Rating Scale; the active range of motion of shoulder abduction; and the motor impairment of the upper extremities, evaluated using the upper extremity of the Fugl-Meyer Assessment scale. RESULTS: The acromio-humeral interval before treatment was 22.8 ± 5.7 mm (mean ± SD). It significantly decreased to 19.6 ± 7.0 mm (p = 0.004) after treatment. Shoulder pain (p = 0.039), active range of motion of shoulder abduction (p = 0.016), and total (p = 0.005), subscale A (p = 0.005), and subscale C (p = 0.008) Fugl-Meyer Assessment scores also improved significantly after treatment. CONCLUSIONS: Repetitive peripheral magnetic stimulation effectively reduced shoulder subluxations and shoulder pain caused by stroke and improved voluntary upper-limb movements in stroke patients.

BACKGROUND: Assessing abnormal gait patterns could indicate compensatory movements, which could be an index for recovery and a process of motor learning. To quantify the degree of posterior pelvic tilt, contralateral vaulting is necessary. OBJECTIVES: This study aimed to develop and evaluate the validity of quantitative indices for posterior pelvic tilt and contralateral vaulting in hemiplegic patients. METHODS: Forty-six healthy control subjects and 112 hemiplegic patients participated in this study. Of the 112 patients, 50 were selected into each abnormal gait pattern group, with some overlap. Three experienced physical therapists observed their walking and graded the severity of the two abnormalities in five levels. An index to quantify each of the two abnormal gait patterns was calculated from the three-dimensional treadmill gait analysis. The index values of patients were compared with those of healthy subjects and with the results of observational gait assessment done by three physical therapists with expertise in gait analysis. RESULTS: The index values were significantly higher in hemiplegic patients than in healthy subjects (28.0% and 44.7% for the posterior pelvic tilt in healthy subjects and patients, respectively and 0.9 and 4.7 for the contralateral vaulting, respectively). A strong correlation was observed between the index value and the median observational rating for two abnormal gait patterns (r = -0.68 and -0.72). CONCLUSIONS: The proposed indices for posterior pelvic tilt and contralateral vaulting are useful for clinical gait analysis, and thus encouraging a more detailed analysis of hemiplegic gait using a motion analysis system.

<sec><title>Background</title> Previous studies have reported a relationship between upper limb motor function and activities of daily living. However, their relationship after removing the influence of lower limb motor function has not been clarified. </sec><sec><title>Objective</title> This study aimed to investigate the relationship between Fugl-Meyer assessment upper limb and total Functional Independence Measure motor score and between Fugl-Meyer assessment upper limb and each item contained in Functional Independence Measure motor score after eliminating the influence of the motor function of the affected lower limb. </sec><sec><title>Methods</title> This retrospective cross-sectional study included 58 subacute stroke patients. To investigate the relationship between the Fugl-Meyer assessment upper limb and total Functional Independence Measure motor score before and after removing the influence of Fugl-Meyer assessment lower limb, Spearman’s rank correlation coefficient and partial correlation analysis were used. Additionally, the relationship between Fugl-Meyer assessment upper limb and each item of Functional Independence Measure motor score after removing the influence was assessed. </sec><sec><title>Results</title> Before removing the influence of Fugl-Meyer assessment lower limb, Fugl-Meyer assessment upper limb was strongly correlated with total Functional Independence Measure motor score (r = 0.74, p &lt; 0.001). However, it became weak after removing the influence (r = 0.27, p = 0.04). Regarding each item of Functional Independence Measure motor score, Fugl-Meyer assessment upper limb was correlated with grooming (r = 0.27, p = 0.04), bathing (r = 0.28, p = 0.03), dressing upper body (r = 0.33, p = 0.01), dressing lower body (r = 0.31, p = 0.02), and stair-climbing (r = 0.31, p = 0.02) after removing the influence. </sec><sec><title>Conclusion</title> These findings suggest that the relationship between the upper limb motor function and activities of daily living is strongly influenced by lower limb motor function. </sec>

在宅慢性脳卒中者における心身機能維持・改善のためのリハビリテーション(リハ)練習について、その目的や練習結果等について発病から10年間にわたり在宅調査を行った。初発脳卒中で発病半年以内に入院しリハ医療を行った40歳以上の脳卒中者125名のうち、発病10年時に在宅調査が可能であった36名(男性27名、女性9名)を対象とした。本調査は前向きコホート研究であり、同一調査員が一貫して調査し、原則在宅訪問で行った。心身機能の10年間の推移を調べたところ、入院中にADL(FIM)は有意に改善し、退院後はほぼ維持されていた。IADL(FAI)の改善は乏しく、低値で推移した。リハ練習(自主トレーニングを含む)は、36人全員が「必要」としていたが、発病2年時から「必要なし」が2人から4人とでてきた。リハ練習意欲は「十分にある」が減り、「少しある」が増え、「全くない」が発病4年時から1人、2人と出てきたが、10年時では少数にとどまった。リハ練習は、1年時は全員が行っていたが、「十分に行っている」が年々減り続け、逆に「行っていない」が徐々に増えてきた。その理由は、「良くなったから」が増える反面、「諦めた」および「面倒くさい」が増え、「その他」として仕事をあげた人が多かった。自主リハ練習は、発病1年時で83%が行っていたが、発病10年時では75%に減少した。リハ練習の結果、主観的な改善度は、発病1年時では66%が改善、34%が不変と答えていたが、10年時には、改善が30%、不変が59%、悪化が11%と答えた。

Purpose/aim of the study: An increase of hip abductor muscle strength contributes to the increase in gait speed. It is known that the rate of force development (RFD), an indicator of muscle strength, is increased by the combined use of low-intensity neuromuscular electrical stimulation (NMES) to the glutaeus medius (GM) and low-load resistance training (RT). However, it is unclear whether low-intensity neuromuscular electrical stimulation of the glutaeus medius during walking also increases the rate of force development. The aim of this study was to clarify whether NMES to the GM during gait modulates the RFD of the hip abductor muscles in healthy adults.Materials and methods: Twenty-two healthy adults randomly received both gait with sub-motor threshold NMES and gait with sham NMES conditions. The RFD was assessed at pre- and post-intervention. A two-way repeated measures analysis of variance was used to analyse the effects of time and intervention.Results: Gait with sub-motor threshold NMES condition significantly increased the RFD in shorter time interval (0-50 and 0-100 ms) compared to gait with sham NMES condition.Conclusions: These findings suggest that the adding low-intensity NMES of the GM to gait is effective in increasing the RFD of the hip abductor muscles.

Objectives: The current study sought to understand the learning outcomes experienced by students and to explain their learning process in detail using interpretive data analysis. Methods: A qualitative study examined students who participated in a multidisciplinary course in a ward. This study investigated latent meanings rather than factual information, using an interpretive paradigm. Data were collected via focus groups and analyzed using Steps for Coding and Theorization (SCAT). Results: Students in the Assembly IV trial (interprofessional education in actual medical settings) experienced a process of transition from a competing (exclusive) mode to a mutual-understanding mode when communicating with people in other professions, and they acquired the perspective of an interactive (dialectic) link between involved communication (communication that attempts to connect directly with patients) and uninvolved communication (communication with patients indirectly through data and other methods) for patient communication. This enabled students to move beyond superficial communication while deepening their connections with people in other professions, complementing each other's strengths, and learning about the possibilities inherent in the provision of collaborative medical practice. Conclusions: Students participating in interprofessional education within medical settings learned about the potential to achieve a circular realization of collaborative medical practice. A circular realization of collaborative medical practice involves incorporating diverse approaches into one's own professional work via exposure to the viewpoints of other occupations and avoiding decision-making based on assumptions that are only valid within one's own profession. This process enables the discovery of better methods and perspectives and the achievement of effective medical practice by moving beyond superficial communication.

<p>Objectives: The ability to transfer between surfaces is essential for wheelchair users' independence. We hypothesized that transfer of hemiparetic stroke patients would be improved by using surfaces at the same height with no gap or obstacle between them.</p><p>Methods: A cross-sectional study was conducted to compare the difficulty of two transfer methods as a pilot study. Thirteen hemiparetic stroke patients were transferred from a platform table to a chair (wheelchair or flat chair) and from the chair to the table using the regular and lateral transfer methods. Functional Independence Measure (FIM) transfer score in both transfer methods and Stroke Impairment Assessment Set (SIAS) score were measured.</p><p>Results: The FIM transfer score significantly increased in the lateral transfer condition compared with the regular transfer condition, indicating that the former method reduced the transfer difficulty, regardless of the SIAS scores.</p><p>Conclusions: The transfer difficulty of patients with hemiparetic stroke decreases when using the lateral transfer method. The lateral transfer method is easy, potentially helping prevent care-related injuries among caregivers.</p>

INTRODUCTION: Falling is a leading cause of injury-related death. Previous studies reported that an impairment of standing balance is one of the causative factors associated with falling. The combined use of static and dynamic stretching has been reported as a treatment method for improving standing balance. As one of the combined methods, stretching based on Mézières' concept, which has an efficacy on the improvement of body flexibility, has been used. However, it is not fully clear whether stretching based on Mézières' concept can improve standing balance. This study aimed to examine the effects of combined method of static and dynamic stretching of anti-gravitational muscles based on Mézières' concept on body flexibility and standing balance. METHODS: This study employed a quasi-randomized controlled trial design. Thirteen subjects were assigned randomly to one of two groups: stretching or control. A sit and reach test (SRT), functional reach test (FRT), and total trajectory length of center of pressure (COP) during static standing were assessed at pre- and post-intervention. An independent t-test was used to compare the rate of improvement between both groups at each assessment. RESULTS: The stretching group demonstrated a significantly larger rate of improvement in the total trajectory length of COP compared to the control group. In the SRT and FRT, the stretching group showed a trend toward improvement compared to the control group, but did not achieve statistical significance. CONCLUSIONS: The combined use of static and dynamic stretching of anti-gravitational muscles might have the potential to improve the standing balance.

BACKGROUND: Falls during transfer to and from a wheelchair are associated with numerous problems. Factors responsible for difficulty in transferring include horizontal/vertical gaps between surfaces; obstacles, such as armrests; and complicated brake/footrests configurations before transferring. Moreover, controlling a wheelchair sufficiently close to the transfer surface within the confined home space is difficult. OBJECTIVE: We described the design of the novel Lateral Transfer Assist Robot (LTAR) for solving problems during transfer. Furthermore, the effectiveness and usability of the robot were preliminary examined in healthy adults. METHOD: The transfer problems and basic designs were organized. The effectiveness of the prototype was measured by three-dimensional motion analysis and questionnaire. RESULTS: The prototype LTAR was developed. With just a push on a button, the footplate lowers to the floor and the seat and armrest lowers to the height of the seating surface to fill the gap between the surfaces. Using these features, users can transfer by simply shifting their buttocks sideways. Additionally, LTAR has omnidirectional wheels that help move it within a narrow space. The LTAR was confirmed to reduce the physical and subjective burden, except for maneuverability. CONCLUSION: The LTAR was found to be effective for home use and reducing burden of transfer.