kanada yoshikiyo

We compared falls in community-dwelling older adults during the previous year using six items from the new physical fitness test created by the Japanese Ministry of Education and Science. The participants comprised females (mean age±standard deviation, 73.6±8.3 years) who understood the purpose of the study and provided their consent. The new test is composed of the following measures: grip strength; sit-ups; a sit-and-reach test; single leg standing; a 10-m obstacle walking test; and a 6-minute walking test. The participants were divided into two groups (fallers or non-fallers) based their number of falls in the year prior to the study. Differences between the groups were evaluated using the Mann-Whitney U test. The odds ratio (OR) of falling was evaluated using a logistic regression model with significantly different items (p＜0.05) as the independent variable and falling or non-falling during the past year as the dependent variable. Moreover, the receiver operating characteristic curve was used to evaluate the sensitivity, specificity, area under the curve (AUC), and cut-off point of fall predictions. Significant differences were observed between groups in single leg standing, the 10-m obstacle walking test, and the 6-minute walking test. After converting these items to independent variables based on the logistic regression model, the only significant difference observed between the groups was the 10-m obstacle walking test (OR: 1.473; 95% confidence interval: 1.127-1.924; p=0.005). The 10-m obstacle walking test results were: AUC=0.763; cut-off point=8.7 seconds; sensitivity=100%; and specificity=57.8%. These results suggest that the 10-m obstacle walking test is a useful predictor of falls in community-dwelling older adults.

[Purpose] The difficulty levels of level-2 OSCE (examination and measurement skills) items were examined, with a view to providing reference data for the determination of students' skills. [Subjects] A total of 284 graduates of physical (PT) and occupational (OT) therapy classes of 2011 (59 and 40), 2012 (46 and 36), and 2013 (61 and 42, respectively) were studied, with PT or OT faculty members as OSCE examiners and a simulated patient. [Methods] Scores for 11 level-2 OSCE items were compared between before and after clinical training. [Results] Scores markedly increased after clinical training. On comparison among the items, scores for sensory examination were the highest, and those for interviews were the lowest. [Conclusion] The results of this study indicate the necessity of considering an appropriate combination of different difficulty levels when adopting OSCE-based educational approaches.

Neuromuscular electrical stimulation (NMES) can be used as treatment for spasticity. The present study examined differences in time-dependent effects of NMES depending on stimulation frequency. Forty healthy subjects were separated into four groups (no-stim, NMES of 50, 100, and 200 Hz). The un-conditioned H-reflex amplitude and the H-reflex conditioning-test paradigm were used to measure the effectiveness on monosynaptic Ia excitation of motoneurons in the soleus (SOL) muscle, disynaptic reciprocal Ia inhibition from tibialis anterior (TA) to SOL, and presynaptic inhibition of SOL Ia afferents. Each trial consisted of a 30-min period of NMES applied to the deep peroneal nerve followed by a 30-min period with no stimulation to measure prolonged effects. Measurements were performed periodically. Stimulation applied at all frequencies produced a significant reduction in monosynaptic Ia excitation of motoneurons in the SOL muscle, however, only stimulation with 50 Hz showed prolonged reduction after NMES. NMES frequency did not affect the amount of disynaptic reciprocal Ia inhibition and presynaptic inhibition of Ia afferents. The results show a frequency-dependent effect of NMES on the monosynaptic Ia excitation of motoneurons. This result has implications for selecting the optimal NMES frequency for treatment in patients with spasticity.

[Purpose] The aim of this study was to examine the applicability of the Objective Structured Clinical Examination (OSCE) to postgraduate education systems for novice and mid-career therapists in workplaces. [Subjects] Physical and occupational therapists with 1 to 5 years of clinical experience took the OSCE to assess their learning, with a physical or occupational therapy faculty member and a clinical supervisor as examiners. Another clinical supervisor acted as a simulated patient. [Methods] A Wilcoxon signed-rank test was performed to compare skills between before and after OSCE-based learning, and a Mann-Whitney U test was used to compare them between therapists with 1 to 2 years (novice) and 3 to 5 years (mid-career) of clinical experience. [Results] While no experience-related differences were observed in behavioral aspects, mid-career therapists exhibited markedly higher scores compared with novices in technical aspects, such as skills to guide patients for standing up, transfer, and dressing. [Conclusion] The OSCE may be sufficiently applicable to postgraduate education systems in workplaces.

[Purpose] To examine agreement rates between faculty members and clinical supervisors as OSCE examiners. [Subjects] The study subjects were involved physical and occupational therapists working in clinical environments for 1 to 5 years after graduating from training schools as OSCE examinees, and a physical or occupational therapy faculty member and a clinical supervisor as examiners. Another clinical supervisor acted as a simulated patient. [Methods] The agreement rate between the examiners for each OSCE item was calculated based on Cohen's kappa coefficient to confirm inter-rater reliability. [Results] The agreement rates for the behavioral aspects of the items were higher in the second than in the first examination. Similar increases were also observed in the agreement rates for the technical aspects until the initiation of each activity; however, the rates decreased during the middle to terminal stages of continuous movements. [Conclusion] The results may reflect the recent implementation of measures for the integration of therapist education in training schools and clinical training facilities.

[Purpose] To examine the effects of intervention combining individualized and group rhythm (To-balance) exercises on the mental and physical functions of the elderly requiring low level care. [Subjects] A total of 29 elderly persons requiring level 2 assistance to level 2 who were and using outpatient care services participated in this study. [Methods] The participants were randomly allocated to 2 groups: To-balance, and Sitting. The former group performed individualized and To-balance group exercises, while the latter group performed individualized exercise, as well as group exercise while sitting on a chair. The effects were evaluated through somatometric, physical fitness, and mental function measurements before and 3, 6, and 9 months after the initiation of the intervention. [Results] The lower-limb muscle strength and mental function significantly improved in both groups. Particularly, in the To-balance group, early improvement in balance and gait ability were observed. [Conclusion] The To-balance exercise may be useful for quickly improving the elderly's static balance ability.

[Purpose] To investigate the necessary conditions for wheelchair user stroke patients to be discharged to home from a recovery stage rehabilitation ward. [Subjects] The subjects were 68 wheelchair user stroke patients who were discharged to home (Home group), or a facility or a convalescence ward (FacCon group). [Methods] The Home (28 persons) and FacCon (40 persons) groups were compared, and factors related to the discharge destination were extracted using logistic regression analysis. [Results] In logistic regression analysis, “eating” and “toileting” were identified as discharge destination factors. Furthermore, we found a tendency for the discharge destination intention on hospital admission to be reflected in the final discharge destination. [Conclusion] The requirements for discharge to home of wheelchair user stroke patients were found to be toileting and eating, and it also important for both the patients and their family to share the desire of return to home from the time of hospital admission.

BACKGROUND: Motor dysfunction after stroke might be improved by neuromuscular electrical stimulation (NMES) combined with 1 Hz repetitive transcranial magnetic stimulation (rTMS) in patients with moderate and severe motor dysfunction. OBJECTIVE: This preliminary study tested the effect of this treatment combination. METHODS: Fifteen patients (60.5 +/- 10.3 years old) participated in the study. All patients had been affected by cerebral artery infarction or hemorrhage and had moderate or severe motor dysfunction in their affected hand. The patients received NMES at paretic wrist extensor muscles combined with rTMS over the unaffected M1 hemisphere twice a day, six days/week over two weeks. All participants underwent the following battery of tests to evaluate the motor function of the affected hand: Upper limb Fugl-Meyer Assessment (UFMA), Wolf Motor Function Test (WMFT), and Box and Block Test (BBT). RESULTS: UFMA, WMFT, and BBT scores improved significantly after the study. CONCLUSIONS: These results suggest that NMES combined with rTMS could be useful for recovery of moderate and severe motor function after stroke.

Objectives: To develop effective electrical stimulation treatment to reduce spasticity, we examined the optimal stimulus point of the common peroneal nerve. Materials and Methods: The locations of selective stimulus points for the deep peroneal nerve or superficial peroneal nerve fiber were examined in 25 healthy subjects in both legs (50 legs) using the ratio of the tibialis anterior (TA) to the peroneus longus (PL) M-wave amplitude (TA/PL ratio). In addition, we measured reciprocal Ia inhibition in ten healthy subjects. The amount of inhibition was determined from short-latency suppression of the soleus (Sol) H-reflex by conditioning stimuli to the deep or superficial peroneal nerve. The paired t-test was used for statistical analysis. Results: The mean TA/PL ratio during deep peroneal nerve stimulation was significantly different from superficial peroneal nerve stimulation (p < 0.001). The mean stimulus point for the deep peroneal nerve was located 7 +/- 5mm distal and 3 +/- 6mm anterior from the distal edges of the head of fibula and was markedly different from the stimulus point for the superficial peroneal nerve (20 +/- 7mm distal and 12 +/- 8mm posterior). During deep peroneal nerve stimulation, the mean conditioned H-reflex was depressed to 83.8 +/- 10.7% of the unconditioned value of the H-reflex. In contrast, during superficial peroneal nerve stimulation, the mean conditioned H-reflex increased to 105.3 +/- 5.2%. These values were significantly different (p < 0.001). Conclusions: In the present study, we revealed a stimulus area of the deep peroneal nerve. Also, we observed the inhibitory effects of stimulation upon the deep peroneal nerve at individual stimulus point. Our results appear to indicate that localized stimulation of the deep peroneal nerve is more useful for the reduction of ankle spasticity.

[Purpose] We investigated the ADL outcomes necessary for very elderly stroke patients to be discharged to home from a recovery stage rehabilitation ward. [Subjects] The subjects were 71 stroke patients aged over 85 who were discharged to home, or a facility or long-term care. [Method] We divided the subjects into a Home group (n=41) and a Facility group (n=30), and compared the basic characteristics of the two groups and their FIM scores at discharge. We also performed logistic regression analysis on the each of the FIM scores, which were found to be significantly different, to determine the receiver operating curve and cut-off values. [Results] Age, time from stroke onset to entering the recovery ward, and transfer items were found to be significantly different between the two groups. The cut-off value of the FIM mobility items' score was 39. [Conclusion] As an additional ADL outcome, a FIM mobility items' total score below 39 at discharge indicates discharge to home would be a difficult situation for very elderly stroke patients.

The case report describes the effects of 5 Hz repetitive transcranial magnetic stimulation (rTMS) combined with transcutaneous electrical stimulation (TES) in a patient with severe stroke. The patient was a 69-year-old male who was affected by a left middle cerebral artery infarction. The patient had no movement in his right hand. To assess the effects, cerebral blood flow and motor function were measured before and after treatment. This treatment delivered rTMS over the affected M1 with TES at the paretic wrist extensor muscles for 10 days. The regional cerebral blood flow (rCBF) in the entire brain was measured by positronemission tomography. To evaluate the motor function, the Fugl-Meyer assessment (FMA) was used. After treatment, the rCBF was increased (except for the stimulated region), and the FMA score was slightly improved. These results suggest the potential therapeutic use of rTMS combined with TES for recovery in severe stroke.

The purpose of present study is to estimate the optimal stimulus intensity envelope for drop foot rehabilitation based on a kinetic perspective. The voluntary and electric-stimulated elicited dorsiflexion torque responses of 11 healthy subjects were measured. During dorsiflexion, we recorded the tibialis anterior (TA) electromyography (EMG) or the stimulation intensity at four angles of the ankle joint. From these measurements, we derived two approximate equations that estimate dorsiflexion produced by either voluntary contraction or by electrical stimulation using a sigmoid function and a stepwise-regression analysis. We then tested the predictive capability of the model using Pearson correlation. Both equations indicated high correlation coefficients. Finally, we derived a relation between the TA EMG amplitude and stimulation intensity. From the obtained equation, we determined the optimal stimulus amplitude. We assume that the derived stimulus intensity envelope, calculated from EMG amplitude and angle of ankle joint, satisfies kinetic demand. © 2012 Informa UK, Ltd.

[Purpose] In this study, in order to establish the clinical path for Activities of Daily Living (ADL) training, and utilizing Functional Independence Measure (FIM) we estimated the predictable goals (independence levels) of individual items of ADL and the time it would take to achieve them. [Subjects] The subjects were 1,479 hospitalized stroke patients admitted to a rehabilitation ward in the recovery period. [Method] Based on the totals of the FIM motor item scores on admission (FIMM), the patients were divided into 9 groups, and for each group, for each of the individual items of FIMM, we calculated the percentage of patients achieving independence, and analyzed the times needed to achieve independence. [Results] The degree of disability in ADL on admission shows characteristics of achievement of independence and time to achieve independence [Conclusion] These results suggest that knowing a combination of these could serve as an index for ADL training of hospitalized hemiplegic stroke patients in rehabilitation wards in the recovery period.

Purpose: We examined the effect on physical and mental function of elderly persons of a group rhythm exercise designed with "safety, enjoyment, and length" as the primary considerations for elderly persons certified under the less severe grades of the long-term care insurance. Subjects: The subjects were 20 persons (average age, 79.5± 7.2) certified between Need Support level 2 and Need Care level 2 who were attending a day-care service facility. [Method] The subjects were randomly allocated to an intervention and a control group. The intervention group performed an individual exercise program and the group rhythm exercise the control group performed only the individual exercise program. To assess the effect, before the intervention and at 3 and 6 months afterwards, participants received a physical examination, performed strength tests and answered a questionnaire. Results: In both groups a significant improvement in lower limb strength was seen. Furthermore, in the intervention group, significant improvements in mental function, walking ability and balance ability were also seen. Conclusion: The results suggest that the group exercise could possibly become a beneficial exercise therapy for improving the mental and physical functions of elderly persons.

[Purpose] In this study, in order to establish the clinical path for Activities of Daily Living (ADL) training, and utilizing Functional Independence Measure (FIM) we estimated the predictable goals (independence levels) of individual items of ADL and the time it would take to achieve them. [Subjects] The subjects were 1,479 hospitalized stroke patients admitted to a rehabilitation ward in the recovery period. [Method] Based on the totals of the FIM motor item scores on admission (FIMM), the patients were divided into 9 groups, and for each group, for each of the individual items of FIMM, we calculated the percentage of patients achieving independence, and analyzed the times needed to achieve independence. [Results] The degree of disability in ADL on admission shows characteristics of achievement of independence and time to achieve independence [Conclusion] These results suggest that knowing a combination of these could serve as an index for ADL training of hospitalized hemiplegic stroke patients in rehabilitation wards in the recovery period.

We performed sensory evaluation of 11 modalities and SEP for 166 stroke patients. Contralateral central SEP patterns were evaluated by SEP classification. Furthermore, SEP type III was classified in three subtypes. And we studied sensory disturbance relations to SEP. As a result, the following were suggested. 1) A correlation coefficient was high in the SEP classification and the sensory disturbance of Lemniscus medialis. 2) When a discriminative element was included in protopathic sensations evaluation, Lemniscus medialis may contribute. 3) The SEP subclassification was regarded as a utility as objective sensory evaluation of the stroke patients having aphasia and higher cortical function disorder.

[Purpose] This Study was performed to clarify the relationship between respiratory muscle strength and exercise tolerance. [Subjects and Methods] Nine healthy adult male subjects (mean age 20.9 +/- 0.3 years) were instructed to perform a ramp load exercise using a cycle ergometer. As measures of inspiratory muscle strength, maximal expiratory mouth pressure (PEmax) and maximal inspiratory mouth pressure (PImax) were measured before exercise and immediately, 15 minutes and 30 minutes after exercise. As measures of respiratory response, minute ventilation, respiratory frequency, tidal volume and oxygen uptake were measured using an exhaled gas analyzer. Heart rate was calculated from R-R intervals on an electrocardiogram as a measure of heart rate response. [Results] The results revealed significant Correlations between PEmax and maximal exercise load, PImax and maximal exercise load, PEmax and peak (V) over dotO(2) and PImax and peak (V) over dotO(2). PEmax measured immediately after exercise was lower than that measured immediately before exercise. [Conclusion] These findings suggest a correlation between respiratory muscle strength, especially expiratory muscle strength, and exercise performance.

We performed sensory evaluation for 166 stroke patients and we studied the influence that presence of dysesthesia gave to sensory function. And then, the sensory evaluation tried for quantification as much as possible. In addition, we studied focal presence in tractus thalamocorticalis lesions by CT and relations of dysesthesia. As a result, the following were suggested. 1) Stroke patients were easy to produce dysesthesia. 2) Regardless of focal presence in tractus thalamocorticalis lesions, dysesthesia occurs. 3) Sensory function except vibration sense is disordered whether it is not disordered. 4) High degree of difficulty discrimination senses, such as two-point discrimination sense and graphasthesia and stereognosis, it was thought that there were easy to become disorder by dysesthesia.

【目的】 過去の報告ではADLと難易度についての報告はみられているが、FIM運動項目の中での介助量研究報告は少ない。ADL訓練を行う際の着眼点をみつけることを目的とし今回の研究を行った。 【対象】 研究期間は2009年4月から2009年6月の間に当院に入院していた脳血管障害患者55名（男性：19名 女性：36名）とした。疾患内訳は脳梗塞 41名 脳出血 9名 その他 5名であった。平均年齢は74.9±13.1歳であった。 【方法】 今回、FIM運動項目を評価する際に含まれる内容をさらにFIMに準じて「自立」から「全介助」までの7段階評価（食事では「準備」「口まで運ぶ」「咀嚼、嚥下」「食べ残しを集める」の４項目でFIMは採点を行う。今回はこの4項目それぞれFIMに準じて7段階評価した）を行った。そして、「自立」「修正自立」を自立群、「監視」を監視群、「最小介助」から「全介助」までを介助群とし、自立群、監視群の割合を調査した。 【結果】 食事は「摂食、嚥下」「口に運ぶ」の自立度が高いが、「準備」の自立度が低かった。移乗動作は「立ち上がり」の自立度は高いが、「方向転換」の自立度が低かった。更衣動作(上衣、下衣)は「片腕を通す」など開始動作の自立度が高く、開始動作ができないと残りの項目は自立度が低かった。トイレ動作は「拭く」ことの自立度は高いが、「服の上げ下げ」の自立度は低かった。清拭は遠位にいくほど自立度が低下した。 【考察】 今回の結果では食事の自立度が最も高かった。しかし、食事の項目で「口に運ぶ」ことが出来ない場合は、他のFIM項目の自立度も低下していた。 更衣はFIM3点と4点では「片腕を通す」など開始動作の自立度が変わってくる。これは開始動作がその後の動作に影響したものだと考える。移乗動作はFIM3点と4点では「立ち上がり」の自立度が変わってくる。4点になるかどうかは「立ち上がり」の影響が考えられる。今回の結果から、FIM3点と4点ではポイントとなる項目があった。また、食事で「口に運ぶ」ことが行えないとADLに影響を及ぼすことが示唆された。