sonoda shigeru

The Medical Outcome Study 36-Item Short Form Health Survey (SF-36) is a widely used method to evaluate health-related quality of life and has been applied for patients with stroke. However, because it is a self-assessment tool, there is a risk in using results of the survey because of lack of information on patients who cannot answer the questionnaire. For this report, 38 patients with stroke hospitalized in the rehabilitation department filled out the SF-36 and motor items of the Functional Independence Measure (FIM) and the Stroke Impairment Assessment Set. We then examined characteristics of patients who could not be evaluated by the SF-36. Of the 38 patients, 19 patients could and 19 patients could not be evaluated by the SF-36. There was no remarkable relationship among capacity or incapacity for evaluation by the SF-36, motor subscores on the FIM, and motor items on the Stroke Impairment Assessment Set. All 10 patients having a communication subscore on the FIM of 10 points or less and/or a social cognition subscore on the FIM of 13 points or less could not be evaluated by the SF-36. The remaining unevaluable patients were not cooperative. Studies in which the entry criteria include the ability to answer the SF-36 questionnaire neglect patients with poor cognition. Therefore, when administering the SF-36 for patients with stroke, we recommend using an interview setting. © 2008 National Stroke Association.

The aim of this study is to validate the effect of a nutrition support team's (NST) interventions in convalescent stroke rehabilitation using the Functional Independence Measure (FIM). Three hundred and four patients were retrospectively divided into an NST-nourishment group, an NST-losing-weight group and a non-NST group. We then compared the FIM gain, the FIM efficiency and the change of body mass index during admission among these three groups. The FIM gain was 17.3 ± 15.9 in the NST-nourishment group and 16.7 ± 12.5 in the non-NST group and there was no significant difference. The FIM efficiency in the NST-nourishment group (0.20 ±0.19) was significantly lower than the one in the non-NST group (0.27 ± 0.19). Patients with an FIM of 53 or less showed no significant difference in FIM gain and FIM efficiency between the two groups. Since those patients who received NST intervention would tend to have a poor prognosis in general, we assumed that our "no difference" results indicated the effectiveness of the NST intervention. There was no evident relationship between FIM gains and changes in the body mass index.

近年、脳卒中患者に対してトレッドミル歩行訓練が積極的に行われるようになってきたが、個々の歩行能力や回復過程を考慮にいれた訓練介入方法は確立されていないのが現状である。今回、個々に応じた介入方法立案の手がかりとすべく、脳卒中片麻痺患者19名にトレッドミル歩行を行ってもらい、歩行周期に占める両側の単脚支持時間と両脚支持時間の割合を算出し、歩行速度、歩行自立度、歩行形態との関連について検討した。結果、手すりを用いた監視下トレッドミル歩行の適応となるのは歩行自立度(歩行FIM)4点以上の症例であり、歩行周期パターンからみた適応のポイントは「回復初期(入院後2週程度)」で平地快適歩行速度が「1.0km/h以下」かつ歩行形態が「3動作歩行」の患者であると考えられた。

Stroke rehabilitation is effective in some patients, however not so effective in others. Our ultimate aim is to use the clinical laboratory assessment as a tool for effectiveness discrimination in rehabilitation. Subjects were 15 stroke patients (68.1 +/- 12.7 years old) who were admitted to our convalescent rehabilitation wards. Fasting blood samples were analyzed for serum concentrations of hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF) and insulin-like growth factor-I (IGF-I) which are considered to be involved in hypermyotrophy using ELISA methods on admission and at discharge. Sixteen healthy control subjects (63.0 +/- 7.6 years old) were also employed. As accuracy control of these analyses, decrease of serum HGF after keeping at -20 degrees C for 499 days were measured. The concentration was 0.66ng/mL from 0.71 ng/mL and residual ratio was 94.0%. Reaction specificity to MW 60 kDa HGF antibody using the Western blot method was confirmed. Average HGF and VEGF were higher in stroke patients than those in control subjects. Average IGF-I was lower in stroke patients. The correlations between HGF, VEGF, and IGF-I and the score of activities of daily living expressed by the Functional Independence Measure (FIM) were calculated. Highest correlation coefficient of 0.67 (p < 0.01) was obtained between HGF at discharge and the FIM efficiency (the gain of the FIM during hospitalization divided by length of stay). The correlation coefficients related to VEGF or IGF showed lower value. High FIM efficiency denotes rapid recovery with vigorous exercise. HGF at discharge would reflect the result of high activity.

The purpose of this study was to determine the relationship between patients' Functional Independence Measure (FIM) scores, Functional Assessment Measure (FAM) scores and age and their usefulness to predict the outcome of traumatic brain injury in 109 patients. We classified the outcomes of patients in five groups. They either returned to work or school (5), returned home without any help (4), went to a welfare center for further training (3), returned home with help (2), or went to another hospital (1). The number of patients in each group was 5:5, 4:29, 3:21, 2:15, and 1:39. Admission and discharge FIM scores were 52±28 and 63±27 in the motor subscore and 19±9 and 22±8 in the cognitive subscore. The FAM adjustment to limitations subscores were 2.1±1.7 and 3.3±2.1. Using a regression analysis we determined that 42.1% of the variance of the outcome could be accounted for by the admission FIM motor subscore. On the other hand, discharge data had a predictive accuracy of 55.0% when we used classification and regression tree (CART) analyses to predict outcome. Results of the CART analyses indicate that it is possible to be in outcome groups 5 or 4 if the discharge FIM motor subscore is 73 or more and the FAM adjustment to limitation subscore is 4 or more. Thus, not only does physical ability (FIM motor) contribute to the outcome of traumatic brain injury patients, but cognitive (FIM cognitive) and awareness (FAM adjustment to limitations) abilities might also be important.

We carried out three experimental trials to determine antidiabetic effects of Aloe arborescens Miller components. Firstly, ICR mice which received frequent injections of streptozotocin (Sz) in small doses (low-dose Sz-induced diabetes mice) were fed ad libitum with basal diets supplemented with components of Aloe arborescens Miller var. natalensis Berger (Kidachi aloe) and Aloe vera Linne from 31 days before to 73 days after the Sz injections. Variation in blood glucose levels, incidence rates of insulitis and blood insulin levels were examined during the trial. As a result, groups receiving diets supplemented at the rate of 2% with whole leaf of Kidachi aloe and 10 KDa fraction powder (a fraction with less than 10 KDa molecular weight derived from Kidachi aloe leaf skin juice by ultra filtration) significantly suppressed the elevation of blood sugar as compared to a control group receiving basal diet. In contrast, there was no significant effect with Aloe vera leaf pulp powder. Insulitis emerged at the rate of 87% in the basal diet group. On the contrary, the whole aloe leaf and 10 KDa fraction groups significantly decreased the incidence of insulitis and incidence rates of whole aloe leaf and 10 KDa fraction powder were 51 and 38%, respectively. While insulin levels in the basal diet group averaged at 0.05 ng, more than four times the insulin level was observed in the 10 KDa group relative to the basal diet group. Secondary, the inhibitory effects of test materials on intestinal glucose absorption were observed using the jejunum of rats. A strong inhibitory action on intestinal glucose absorption was observed in the 10 KDa fraction powder group. Thirdly, phenol compounds derived from aloe in the blood serum and organs were quantitatively measured by a HPLC following forced administration of aloe components to rats to determine absorption kinetics of aloe components inside the body. The primary component of aloe phenol compounds is the same component of the 10 KDa fraction powder and it was found in the pancreas and liver in addition to in the blood serum. The above results indicate that fore and aft when Sz injections could cause selective toxicity to B cells of islets, the dietary administration of 10 KDa fraction powder to mice would lead to the persistence of aloe phenol compound having an antioxidant activity in the pancreas and blood, which could protect islets of Langerhans from the destruction caused by methyl radical derived from Sz. The results also suggested the possibility of the 10 KDa fraction powder to alleviate the burden of insulin secretion as it has an inhibitory action on glucose absorption in the jejunum of rats. © 2005 Elsevier Ireland Ltd. All rights reserved.

We examined the modifying effect of freeze-dried whole-leaf Aloe arborescens Miller var. natalensis Berger (Kidachi aloe in Japan designated as 'ALOE') on azoxymethane (AOM)-induced intestinal carcinogenesis in rats. Male F344 rats (4 weeks old) were fed basal diet or experimental diet containing 0.2% or 1% ALOE for 28 weeks. Starting two weeks later, the animals received subcutaneous injections of AOM once weekly for 10 weeks. The incidence of colorectal adenocarcinomas in the 0.2% (but not 1%) ALOE group showed a strong tendency for decrease (p = 0.056) from the control group. Further, the adenocarcinoma incidence in the entire intestine (small and large intestines) in the 0.2% ALOE group was significantly (p = 0.024) decreased compared to the control value. However, there were no significant differences in tumor multiplicities of colorectal or entire intestines among the 3 groups. In addition, we also studied the safety of long-term ingestion of ALOE as a health food or natural thickening stabilizer. Rats were fed the basal diet or 1% ALOE diet for 35 weeks without AOM treatment. Feeding with 1% ALOE did not affect most hematological and serum biochemical parameters in the rats. These results indicate that a low level of ALOE ingestion might have a mild suppressive effect on intestinal tumor growth without harmful side effects.

OBJECTIVE: To investigate the relationship between the bisection test and the severity of behavioral hemineglect and to verify if this test can predict the behavioral hemineglect. METHODS: Thirty stroke patients with left hemiparesis were divided into 4 groups according to the Catherine Bergego Scale, which assessed the behavioral hemineglect: severe unilateral neglect (UN), moderate UN, mild UN, and lack of UN. Eleven healthy subjects served as age-matched control subjects. In the bisection test, 18 lines were presented on the left, middle, and right of an A4 paper, respectively. The subjects were asked to place a short cross mark in the exact middle point of each line on the paper using their right hand. The middle 6 lines in the above bisection test were extracted on another sheet of A4 paper for the rebisection test. The subjects were asked to divide a line into 4 segments by successive bisections. The proportion of the right part to the length of line for bisecting was calculated. RESULTS: In the bisection test, the main effect of space was significant in every group except the mild neglect group. The crossover effect of space location was found in the severe UN group, the group without UN, and the controls. In the severe UN group, the patients bisected the left and middle lines with rightward bias (<50%) but bisected the right lines with leftward bias (>50%). In the group without UN and the controls, the subjects bisected the left lines with leftward bias (>50%) but bisected the middle and right lines with rightward bias (<50%). Almost the same results were seen in the rebisection test. CONCLUSIONS: This study showed that if the spatial crossover effect occurred in the right space condition, it was strongly supported that this patient had moderate to severe behavioral hemineglect. The crossover effect of the space location was explained by a new model.

【目的】当院で実践しているFull-time Integrated Treatment （以下，FIT ）programは，空間と情報の共有・統合により，多量（毎日）で高密度（全日）のリハビリテーション（以下，リハ）を可能とする回復期リハのシステムである．このFIT programが，従来のリハに比べより短い在院日数で，より大きなADL改善をもたらすことを我々は報告してきた．また，FIT programによる治療効果の優位性が退院後に維持されている結果も得られている．今回は，FIT programによる治療効果の退院後の優位性をより長期的に調査したので報告する．<BR>【対象・方法】対象は2000年12月以降にFIT programによる治療を受け，退院後6か月および18か月の計2回の時点でFunctional Independence Measure（以下，FIM）運動項目を追跡調査できた，テント上に一側性の病変を有する初発の脳卒中片麻痺患者77名とした．入院中，訓練に支障を及ぼすような重篤な併存症を有していた症例，今回の発症以前に明らかなADL障害を有していた症例，また退院後に脳卒中を再発した症例は予め除外した．ADL調査は，退院後6か月と18か月の時点でFIM質問紙を郵送して行った．このFIM質問紙は，当院にて新たに作成されたフローチャート式の質問紙であり，その信頼性は確認済みである．返信後不備のあった場合には，電話での補足確認を加えた．経過の検討として入・退院時，退院後6か月と18か月の4期においてFIM運動項目合計（以下，FIMM）の平均点を比較，検討した．また，退院後6か月と18か月のFIM各項目の平均点変化を比較した．<BR>【結果および考察】FIMM平均点推移では，退院時と比較すると，退院後6か月と18か月では有意に低下していた．しかし，6か月後のFIMMが18か月後にさらに低下する傾向はなく，維持されていることが確認された．FIM各項目別の平均点でみても，退院後6か月と18か月を比較すると特定の項目が低下する傾向は認められず，全項目において維持されていた．<BR>これまでの先行研究ではリハビリ施行後，達成されたADLレベルを維持することは困難な場合が多いと報告されている．とりわけ，従来よりも短い在院日数で大きなADL改善の効果が得られるFIT programでは，退院後の低下が懸念されていた．今回の結果より，退院後6か月の時点でADL能力は低下するものの，退院後18か月の時点では更に低下することなく維持されていることから，ADL能力低下の要因として経時的低下ではなく，病院環境と住宅環境の差異による低下と考えられる．また，FIMM項目別の比較の結果では，特定の項目の低下を認めないことから，入院中のADLに密着した訓練により，どの項目においても十分に訓練・指導が行えていたことが示唆された．今後の課題としては，退院直後のADL能力低下を軽減するために，入院時により高いADL能力獲得を目指し，退院時のADLレベルを上げるだけではなく，在宅生活のシミュレーション訓練の強化，外泊などによる在宅生活のリハーサルの機会を増やすことが重要であると考えられる．

Objective: To validate the effectiveness of the Full-time Integrated Treatment (FIT) program that is characterized by rehabilitation 7 days/wk, encouragement of daytime activity, and enhanced communication between staff in stroke rehabilitation. Design: Since our facility changed from the conventional rehabilitation system of 5 days of treatment to the FIT program in December 2000, we compared the conventional rehabilitation program with the FIT program at our hospital. The conventional treatment group and the FIT group consisted of 48 and 58 first-stroke hemiplegics, respectively. Results: The motor subscore of the FIM(TM) instrument at admission and at discharge was 64.3 and 77.0 in the conventional group and 60.6 and 80.9 in the FIT group, respectively. The length of stay and efficiency of the FIM instrument were 80.0 days and 0.16 in the conventional group and 69.8 days and 0.30 in the FIT group, respectively. These differences between groups were statistically significant, with the exception of admission FIM data. Conclusions: Because the FIT program attained a higher discharge FIM level with a shorter length of stay, the FIT program was concluded to be an efficient and effective method of stroke rehabilitation.

Purpose To assess results of a 5year-follow-up, in terms of disability, depression, quality of life, and social network in cases of stroke patients. This report deal with results at admission and discharge (in average, from 2.5 to 6 moths of the onset) in a rehabilitation-specialzed hospital.<br/>Object and method The subjects were 87 stroke patients hospitalized in the Ibaraki Prefectural University Hospital. They were 64 men and 23 women, and their age were between 42 and 79 with an avarage of 59 years. Systematic evaluation for mental and physical functions was conducted at admission and discharge, and it is intended that the evaluation will be repeated 1, 2, 3 and 5years from the stroke onset.<br/>Results There were substantial improvements in motor functions, general intelligence, and the status of dementia during the hospitalization. Activities of daily living and degrees of job execution and satisfactory were also improved. The prevalence of depression remained 40%, and the acceptance of limb paralysis or reduced quality of life did not change. Social network scores declined.<br/>Discussion Lack of inprovement of depressive status and quality of life, and deterioration social network may increase the rist of major difficulties after discharge of stoke patients.<br/>Prevention programs at hospital may be necessary to cope with these potential problems.

Objective-The ability of 46 patients with supratentorial stroke and 15 healthy subjects to localise sounds was tested using an apparatus with headphone and sound space processor. Methods-With a binaural sound space processor, sounds were randomly presented from seven directions in the 180 degree frontal area of the subject at intervals of 30 degrees. The subject was asked to imagine a clock face through the horizontal plane passing through the subject's ears with 12 o'clock denoting a sound from directly in front of the subject. After each sound, the subject indicated the direction from which he or she thought the sound came by mentioning the corresponding hour hand on the clock face; therefore, the answer directions were also separated by 30 degrees. A total of 21 sounds with three sounds from each direction, were presented in random order. The error between the presented direction and the answered direction of each sound was calculated. Results-The mean absolute error which does not distinguish whether an error was in the counterclockwise or clockwise direction, was larger in the patients with stroke than in the healthy subjects. Overall, the patients with stroke who had right brain damage (n=29) had a larger mean absolute error than those who had left brain damage (n=17). The patients with right brain damage did not show any systematic deviation such as a rightward error or leftward error. Conclusion-A right brain lesion or left brain lesion can cause a patient to have error in sound localisation, and patients with right brain damage generally have a larger mean absolute error of sound localisation. The difference in the mean absolute error of sound localisation between patients with stroke with right brain damage and those with stroke with left brain damage may be explained by the inattention theory of hemispatial neglect.

Purpose: This paper describes a motor-driven orthosis for paraplegics which has been developed. This orthosis is composed of a medially-mounted motor-driven hip joint and bilateral knee-ankle-foot orthosis. With the gear mechanism, the virtual axis of the hip joint of this orthosis is almost as high as the anatomical hip joint. Method: A paraplegic patient with an injury level of T10/11 walked using bilateral lofstrand crutches and this new orthosis with or without the motor system. The motor is initiated by pushing a button attached at the edge of the grab of the crutches. Result: Faster cadence and speed and smaller rotation angle of the trunk was obtained in motor walking compared with nonmotor walking. The patient did not feel fearful of falling. Conclusion: The benefit of motor orthosis is that it can be used even in patients with Lower motor lesions and that it provides stable regulation of hip flexion movement in spastic patients. In conclusion. this motor orthosis will enhance paraplegic walking.

This study was designed to examine the scale quality of our newly developed short behavior scale and to identify its role in predicting the functional outcome of stroke patients. The short behavior scale consists of six items that assess cognitive function related to the daily behavioral status of a patient in activities of daily living and exercise. It can be scored quickly through observation of a patient's behavior. We assessed 190 stroke inpatients, who had a mean age of 61 years. The mean days and length of stay from onset were 47.3 and 138.2, respectively. We examined internal consistency with the Cronbach's alpha coefficient. Interrater reliability was tested by having two examiners evaluate 30 patients independently. We studied how the short behavior scale correlated with the admission Functional Independence Measure, Mini-Mental State Examination scores, and speech and visuospatial functions. We also studied how the short behavior scale contributed to the prediction of discharge Functional Independence Measure raw scores with stepwise multiple regression analysis. In another group of 116 patients, we cross-validated our predictive equation. The Cronbach's alpha coefficient was 0.88. The intraclass correlation coefficient was 0.84 for total score. The short behavior scale correlated significantly with cognitive Functional Independence Measure scores and Mini-Mental State Examination scores. We could explain 70.8% of the variance of discharge Functional Independence Measure scores from the Short Behavior Scale, days from onset to admission, age, speech scores, and admission Functional Independence Measure scores. Stability of the predictive equation was shown in cross-validation to a second sample of 116 patients. In conclusion, our newly developed short behavior scale proved reasonable and would be useful to enhance the precision of outcome prediction in stroke rehabilitation.