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Background: Poststroke gait disorders negatively impact activities of daily living. Rehabilitation for stroke patients is aimed at improving their walking ability, balance, and quality of life. Robot-assisted gait training (RAGT) is associated with an increased number of task-specific exercises, which may benefit poststroke motor learning. We investigated the effects of RAGT using Stride Management Assist (SMA, which increases walk ratio by inducing hip-joint flexion and extension) in subacute stroke patients with hemiplegia.Methods: We conducted a single center, open-label randomized controlled trial in hemiplegia patients who experienced a first ever stroke and were admitted to the convalescent rehabilitation ward. A total of 41 were divided into the control (20 patients) and experimental group (21 patients). A 10-day, conventional gait training program was carried out for the control group; and RAGT with SMA was used for the experimental group. The maximum walking speed and other gait parameters were compared preintervention and postintervention. The intergroup differences in the improvement ratio were compared using an intention-to-treat analysis.Results: Ten-day intervention was completed by 36 patients. There was no difference between the 2 groups regarding gait parameters at intervention initiation. The improvement ratio of the maximum walking speed was significantly higher for the experimental group. Significant improvements were observed postintervention for maximum walking speed, paralysis-side step length, symmetry, and cadence in the experimental group. No adverse events attributable to the SMA were observed.Conclusions: Ten days of RAGT with the SMA was effective for improving gait disorders of subacute stroke patients. [ABSTRACT FROM AUTHOR]

Summary Background & aims Whether malnutrition risk correlates with recovery of swallowing function of convalescent stroke patients is unknown. This study was conducted to clarify whether malnutrition risks predict achievement of full oral intake in convalescent stroke patients undergoing enteral nutrition. Methods We conducted a secondary analysis of 466 convalescent stroke patients, aged 65 years or over, who were undergoing enteral nutrition. Patients were extracted from the “Algorithm for Post-stroke Patients to improve oral intake Level; APPLE” study database compiled at the Kaifukuki (convalescent) rehabilitation wards. Malnutrition risk was determined by the Geriatric Nutritional Risk Index as follows: severe (<82), moderate (82 to <92), mild (92 to <98), and no malnutrition risks (≥98). Swallowing function was assessed by Fujishima's swallowing grade (FSG) on admission and discharge. The primary outcome was achievement of full oral intake, indicated by FSG ≥ 7. Binary logistic regression analysis was performed to identify predictive factors, including malnutrition risk, for achieving full oral intake. Estimated hazard risk was computed by Cox's hazard model. Results Of the 466 individuals, 264 were ultimately included in this study. Participants with severe malnutrition risk showed a significantly lower proportion of achievement of full oral intake than lower severity groups ( P = 0.001). After adjusting for potential confounders, binary logistic regression analysis showed that patients with severe malnutrition risk were less likely to achieve full oral intake (adjusted odds ratio: 0.232, 95% confidence interval [95% CI]: 0.047–1.141). Cox's proportional hazard model revealed that severe malnutrition risk was an independent predictor of full oral intake (adjusted hazard ratio: 0.374, 95% CI: 0.166–0.842). Compared to patients who did not achieve full oral intake, patients who achieved full oral intake had significantly higher energy intake, but there was no difference in protein intake and weight change. Conclusion Severe malnutrition risk independently predicts the achievement of full oral intake in convalescent stroke patients undergoing enteral nutrition. [ABSTRACT FROM AUTHOR]

Objective: This study aims to test the hypothesis that the Revised Version of the Ability for Basic Movement Scale (ABMSII) can predict ambulation during rehabilitation in poststroke patients.Subjects and Methods: The study included first-ever stroke patients who were admitted to the rehabilitation ward and were dependent in walking. ABMSII scores were assessed by physical therapists on admission to the hospital. Functional ambulation category (FAC) was assessed every 2 weeks during hospitalization. The primary outcome was independent ambulation, defined as 4 points or higher on the FAC.Results: After setting the inclusion criteria, data of 374 stroke patients (mean age: 70 years, 153 women) were eligible for the analysis. Of these, 193 patients achieved independent ambulation during hospitalization. The ABMSII score was significantly higher in the patients who regained independent walking ability than in those who required assistance in walking. Based on receiver operating characteristic curve analysis, an ABMSII score of 16 points or higher had a sensitivity of 93% and a specificity of 71%. Kaplan-Meier curve analysis after log-rank test demonstrated a significantly higher event rate in patients with an ABMSII score of 16 or higher compared to those with an ABMSII score lower than 16. Univariate and multivariate Cox regression analyses identified the ABMSII score as a significant and independent predictor of ambulation during rehabilitation.Conclusion: Our results suggest that the ABMSII score is a potentially useful tool to predict ambulation during rehabilitation in poststroke patients. [ABSTRACT FROM AUTHOR]

Objective To test the hypothesis that functional outcome of patients with stroke who receive 7d/wk of rehabilitation is generally better than that of similar patients who undergo 5 or 6d/wk of rehabilitation. Design Retrospective cohort study. Setting Acute hospitals. Participants From the Japan Rehabilitation Database, which includes data on 8033 patients with acute stroke collected between January 2005 and December 2013, we included 3072 patients with stroke who were admitted to the acute hospitals and received 7d/wk of rehabilitation. Intervention Seven days per week of rehabilitation was defined as rehabilitation therapy administrated by a physical or occupational therapist on every weekday, Saturday, and Sunday. Main Outcome Measure Favorable functional independence in daily living, defined as a modified Rankin Scale score of 0 to 2 at the time of discharge. Results A total of 1075 (35.0%) patients received 7d/wk of rehabilitation. Univariate analysis demonstrated a significant difference in favorable functional recovery between the 7d/wk rehabilitation group and non–7d/wk rehabilitation group (43.3% vs 37.6%, respectively; P =.002). Multivariate logistic regression analysis using the generalized estimating equations method showed that 7d/wk of rehabilitation was independently associated with favorable functional recovery. Conclusions Our cohort analysis demonstrated that 7d/wk of rehabilitation in early rehabilitation for patients with acute stroke can lead to functional recovery. [ABSTRACT FROM AUTHOR]

Background: The apparent diffusion coefficient (ADC) values and the fractional anisotropy (FA) values calculated from diffusion tensor imaging (DT1) in the acute stage of diffuse axonal injury (DAI) are mainly used for prediction of prognosis. However, neuropsychological outcome correlates more closely with magnetic resonance imaging (MRI) findings from the chronic stage than with those obtained during the acute phase. The purpose of the study was to design a protocol that will assess the spread of neural deficit and provide an accurate prognosis for patients with DAI. Methods: We compared ADC values and FA values calculated from DTI of the anterior and posterior corpus callosum in four patients (mean ± SD: 24.0 ± 4.5 years) with DAI and cognitive disorders with those of 10 normal control subjects (23.3 ± 1.3 years).All patients had chronic stage DAI with no significant MRI abnormality. Although they maintained self-care task, they were unable to adapt to social life because of cognitive disorders. Results: For the anterior corpus callosum, the FA values were higher and the ADC values were lower bilaterally in DAI patients than in the control subjects. The high FA values may be designated as pseudo FA values due to the gliosis of astrocyles around the degenerated nerve fibers in the anterior corpus callosum. Conclusions: Our results suggest a close association between pseudo-FA values and low ADC values of the anterior corpus callosum and cognitive disorders in patients with DAI who show no significant MRI abnormalities. [ABSTRACT FROM AUTHOR]