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This study examined whether the reliability of the Nine Hole Peg Test (NHPT) is improved by a modification (mNHPT) that confines the peg insertion/removal order to one way to reduce the degree of freedom of spatial strategies.Participants performed the NHPT and mNHPT three times each in two sessions with an interval of 3-5 days. Healthy adults used their non-dominant hand (n=40), while those with hemiparetic stroke used their affected (n=40) or unaffected hand (n=40). The mean value of three trials from each session was used for analyses. The reliabilities of the NHPT and mNHPT during the two sessions were assessed via intraclass correlation coefficients (ICCs) and Bland-Altman analysis.The ICCs of the NHPT and mNHPT were 0.49 and 0.66, respectively, in healthy participants, and 0.91 and 0.94, respectively, in participants with stroke, regardless of the hand used. A significant fixed bias between the sessions was observed in both tests, except for participants with stroke who used their affected hand. Proportional biases were noted in the mNHPT results of healthy participants and in the NHPT and mNHPT results of participants with stroke who used their affected hand. The limits of agreement (lower, upper) in the affected hand were -11.0 and 9.5 for the NHPT and -8.0 and 6.2 for the mNHPT.Reduced degrees of freedom in the spatial strategy improved the relative reliability and reduced measurement errors in the NHPT. However, fixed and proportional biases were still evident.

Objective The objective of the current study was to evaluate the reliability and validity of the Japanese version of the Mini-Balance Evaluation Systems Test (J-Mini-BESTest) in patients with subacute stroke. Methods Eighteen patients who had suffered a first hemiplegic stroke (mean age, 59.1 ± 27.0 years) and had been admitted to convalescent rehabilitation wards were enrolled. The J-Mini-BESTest, the Berg Balance Scale (BBS), and the functional reach test (FRT) were used to assess balance. Four physical therapists (PTs) observed and scored the J-Mini-BESTest while another PT conducted the test. The interrater reliability of the J-Mini-BESTest was assessed using intraclass correlation coefficients (ICC[2,1]) for the total and section scores, and kappa statistics for each item. Internal consistency of the five raters was assessed using Cronbach's alpha. Concurrent validity of the J-Mini-BESTest was assessed against the BBS and FRT using Spearman's correlation coefficients. Results The ICC[2,1] of the total and section scores were 0.90 (95% confidence interval: 0.81-0.95) and 0.63-0.85, respectively. Cronbach's alphas were 0.80-0.87. The kappa statistics were 0.47-1.00. The scores of the J-Mini-BESTest were significantly correlated with those of the BBS (rho=0.66, p=0.006) but not with those of the FRT (rho=-0.36, p=0.189). Conclusion The J-Mini-BESTest showed excellent inter-rater reliability and internal consistency. Although the J-Mini-BESTest was not correlated with the FRT, it was significantly correlated with the BBS. The J-Mini-BESTest is a reliable and valid tool for evaluating dynamic balance in patients with subacute stroke.

脳卒中患者の自覚的視性垂直位(SVV)偏位とバランス・ADL障害との関連が指摘されているが，立位バランスとの関連はよく分かっていない．そこでSVVと静止立位時バランスの関係を検討した．対象は脳卒中患者29 名で，被験者が垂直と思う方向と重力方向とのずれ角度を8 回測定しその平均をSVV値とし(非麻痺側正)，各回のずれの絶対値平均をSVV絶対値とした．SVV値，SVV絶対値と立位時重心動揺計の単位軌跡長，外周面積，実効値，非麻痺側下肢荷重比の関係をスピアマンの相関係数を用いて検討した．SVV値，SVV絶対値の平均は—0.3±2.3°，2.0±1.5°で，SVV値と各指標に有意な相関を認めず，SVV絶対値と単位軌跡長(r=0.44)，外周面積(r=0.41)，実効値(r=0.46)，非麻痺側下肢荷重比(r=0.40)に有意な相関を認めた．よってSVV偏位の大きさが脳卒中の立位バランスと関連している可能性が示唆された．

The second part of the review discusses some important issues associated with fall prevention and future perspectives on fall related research. Currently, many kinds of interventions are available for the treatment of patients suffering from osteoporosis, i. e. nutritional supports, medications acting on bone metabolism and exercise. However, a series of meta-analyses showed that only alendronate and risedronate have been proven to prevent non-vertebral fractures in persons with osteoporosis. Anaerobic and weight bearing exercises are known to have a positive effect on the bone mineral density of the spine. There is, however, no reliable data for fracture prevention with exercise alone. Also, the synergistic effect of a combination of these interventions has not been clearly proven. Although there is evidence that the use of hip protectors in institutional settings reduces the rate of hip fractures, this approach faces the problem of patient acceptance and compliance. Psychosocial problems related to falls such as fear of falling, post-fall syndrome and cost-effectiveness of the prevention programs are becoming increasingly important in elderly health care, but little evidence of such has been reported in the literature. In future perspectives on fall relared research, a theory-based approach for fall prevention needs to be included to explore more effective interventions. We must also consider the double-edged effects of interventions that may increase certain fall risk factors while reducing another. Especially, the relation between activities and incidence of falls is important to consider, because increased activity itself may increase the chance of falls. When applying exercise or rehabilitative approaches, the interaction between falls, activity levels, frailty, and injury must be studied much more carefully. In addition, one has to always think about what is the true aim of a program, because the aim of fall prevention goes beyond preventing falls. Although some research has so far been conducted in Europe and the U. S. A. by researchers and practitioners in various fields, the quantity and quality of fall prevention research are still lacking and the available data is therefore insufficient to suggest appropriate decision-making in clinical practice. Especially in Japan, there have been only a few RCTs to determine the effectiveness of fall prevention programs. Because there are many differences in the characteristics of our native population and health care systems vs those of Europe and the U. S. A., it is a critical issue for us to establish fall prevention programs suited to Japanese population and health care system.

The patient, a 34-year-old male, was admitted to our hospital for comprehensive rehabilitation 18 months after traumatic spinal cord injury. He was a complete C5 tetraplegia. Although he could drive a wheel chair using his right shoulder, his activity of daily living was severely restricted due to loss of pinch function. He could not switch from a spoon to a fork properly by himself at a meal, nor could he pick up a cup to drink water. He always needed a caregiver nearby him to provide care. Because of these embarrassments, he eagerly wanted to restore his pinch function. In the past, several orthoses have been developed for restoring the pinch function in spinal cord injury. However, these have not been widely used because of high cost and heavy weight. To overcome these difficulties, we developed a new electric flexor hinge splint using a commercially available motor, which is low cost and lightweight. He could use this orthosis easily and safely after relatively short training, and his activity of daily living was markedly improved with this orthosis.