鈴村 彰太

<p>Purpose Detailed reports of the assessments used in rehabilitation wards are lacking. This study aimed to examine the common evaluations used in rehabilitation wards and discuss the necessary assessments for treatment plans and patient management. Methods We conducted a comprehensive literature search of PubMed, Web of Science, MEDLINE, and Ichushi Web for articles published between June 2013 and June 2023. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered with PROSPERO. Data extraction and blind selection were performed, and a consensus was reached among experts in case of conflicts. Results We identified 220 studies, 31 meeting the inclusion criteria post-screening. The Functional Independence Measure was the most used assessment (96.8%), followed by grip strength (32.3%) and the 10-m walk test (9.7%). Other assessments included the Stroke Impairment Assessment Set, Short Physical Performance Battery, and Timed Up and Go Test. Although fall-related incidents are frequent, significantly affecting patient outcomes in rehabilitation units, balance assessments were underutilized. Conclusions Although the FIM is an extensively used assessment in rehabilitation wards, balance assessments critical for fall prevention are significantly underused. Therefore, these assessment tools should be evaluated in future research and clinical practice.</p>

Background: Because dementia is a long-term condition, the appropriate involvement of health-care professionals is considered important. However, little is known about the factors associated with changes in family caregiver burden. Objective: To clarify changes in family caregiver burden and associated factors during follow-up at a memory clinic. Methods: A retrospective cohort study was conducted, enrolling 495 pairs of patients with dementia or mild cognitive impairment and their family caregivers. A total of 120 pairs completed the second evaluation. The caregiver burden was assessed using the Zarit Burden Interview (ZBI). Data at the initial visit and after an average follow-up of about 2 years were compared and analyzed. Results: At initial visit, the patients’ mean age, Mini-Mental State Examination (MMSE) and ZBI scores were 78.6±5.6 years, 23.3±3.5, and 22.6±16.7, respectively. At follow-up, MMSE scores decreased (21.4±4.5, p &lt; 0.001), but ZBI scores remained similar (22.5±13.6). When the difference in ZBI scores between the two time points was defined as ΔZBI, and the related factors were analyzed by multiple regression analysis, ZBI scores at the initial visit, start of psychotropic drug, and decrease of neuropsychiatric symptoms were identified as significant factors (p &lt; 0.001, p = 0.003, p &lt; 0.001, respectively). A significant negative correlation was found between ZBI scores at the initial visit and ΔZBI (r = –0.588, p &lt; 0.001). Conclusions: These findings suggest the importance of assessing changes in the burden experienced by family caregivers during the disease follow-up.

BACKGROUND: Home-based rehabilitation involves professional rehabilitation care and guidance offered by physical, occupational, and speech therapists to patients in their homes to help them recuperate in a familiar living environment. The effects on the patient's motor function and activities of daily living (ADLs), and caregiver burden for community-dwelling patients are well-documented; however, little is known about the immediate benefits in patients discharged from the hospital. Therefore, we examined the effects of continuous home-based rehabilitation immediately after discharge to patients who received intensive rehabilitation during hospitalization. METHODS: We retrospectively reviewed 150 patients [mean (standard deviation, SD) = 81 (9) years] discharged from the convalescent rehabilitation and community-based integrated care wards undergoing tailored home-based rehabilitation for 6 months (provided by physical or occupational therapists: 1-2 sessions of 40-60 min each per week). The outcome measures at baseline and after 3 and 6 months were compared. RESULTS: The participants included in this study had orthopedic (n = 76), cerebrovascular (n = 50), neuromuscular (n = 11), cardiovascular (n = 5), respiratory (n = 3), cancer (n = 3) and other diseases (n = 2). The mean (SD) time from discharge to the start of rehabilitation was 4 (4) days. One-way analysis of variance and post-hoc comparisons showed significant improvements at 3 months from baseline in grip strength (p = 0.002), 5-repetition sit-to-stand test (p < 0.001), Standing test for Imbalance and Disequilibrium test (p = 0.025), Functional Independence Measure (p < 0.001), modified Frenchay Activities Index (p < 0.001). Additionally, a statistically significant improvement was observed in the Japanese Zarit Caregiver Burden Interview score at 6 months from baseline (p < 0.001). CONCLUSIONS: Home-based rehabilitation improves motor function, ADLs, and instrumental ADLs even after intensive inpatient rehabilitation and decreases the burden of the caregiver in the long term. Hence, tailored home-based rehabilitation should be continuously implemented after the completion of intensive inpatient rehabilitation.

高齢化社会の進行により、認知症の患者は年々増加している。我々は、認知症の患者の手指機能を定量的に評価する磁気センサ型指タッピング装置をマクセル株式会社と共同で開発をした。その機器を用いて、アルツハイマー型認知症44名、軽度認知障害患者20名に対して、手指機能と認知機能との関連を検証した。その結果、認知機能の低下に伴い手指機能の低下を認める可能性が示唆された。(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.

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.

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.

高齢化社会の進行により、認知症の患者は年々増加している。我々は、認知症の患者の手指機能を定量的に評価する磁気センサ型指タッピング装置をマクセル株式会社と共同で開発をした。その機器を用いて、アルツハイマー型認知症44名、軽度認知障害患者20名に対して、手指機能と認知機能との関連を検証した。その結果、認知機能の低下に伴い手指機能の低下を認める可能性が示唆された。(著者抄録)

Abstract Background Aging is the most significant risk factor of dementia. Alzheimer’s disease accounts for approximately 60%–80% of all dementia cases in elderly individuals. This study aimed to examine the relationship between finger movements and brain function in patients with Alzheimer’s disease, using VSRAD, and explore the relationship between VSRAD and cognitive function (MoCA-J). Methods Patients diagnosed with AD, at the Center for Comprehensive Care and Research on Memory Disorders, were included in the study. The diagnostic criteria were based on the National Institute on Aging-Alzheimer’s Association. Patients were excluded based on set criteria. A finger-tapping device was used for all measurements. Participants performed the following task, in order: non-dominant hand, dominant hand, simultaneously, and alternate hands. Movements were measured for 15 s each. The relationship between distance and output was measured. MRI measurements were performed, after which VSRAD was performed using sagittal section 3D T1-weighted images. The Z-score was used to calculate the degree of atrophy. Pearson’s product-moment correlation coefficient was used to analyze the relationship between the Z-score and mean values of the parameters in the finger-tapping movements. Statistical significance was set at p &lt; 0.05. Results Sixty-two patients were included in the study. Z-scores for MoCA-J analysis, percentage of total brain atrophy in the white matter, and other VSRAD parameters showed varying negative correlations (r = -0. 28, p = 0. 035, r = -0. 31, p = 0. 020, and r = -0. 52, p &lt; 0. 001), respectively. Varying positive correlations between Z-score and the SD of distance rate of velocity peak in extending movements in the non-dominant hand were observed. Conclusion The SD of distance rate of velocity peak in extending movements and the Z-score showed a significant relationship. An association between neuropsychological tests and overall degree of brain atrophy was also observed.

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.

OBJECTIVES: This study aimed to clarify the impact of the coronavirus disease 2019 outbreak on the levels of activity among older patients with frailty or underlying diseases. A total of 175 patients (79.0±7.0 years) undergoing outpatient or home-based rehabilitation, stratified into groups, based on frailty status. The percentage of patients who went out at least once a week decreased after the outbreak from 91% to 87%, from 65% to 46%, and from 47% to 36% in the non-frail, frail, and nursing care requirement groups, respectively. The proportion of older patients participating in exercise during the outbreak was 75%, 51%, and 41% in the non-frail, frail, and nursing care requirement groups, respectively. The proportion of older patients participating in voluntary exercise after instruction was lowest in the frail group (35%). Older patients with frailty are susceptible to the negative effects of refraining from physical activity and require careful management.