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Using the reliable change index (RCI), we aimed to examine the effect of a multicomponent exercise program on the individual level.Overall, 270 adults (mean age, 78 years) completed a multicomponent physical exercise program (strength, aerobic, gait, and balance) for 40 min, 1-2 times per week, continued up to 1 year at a daycare center. Effectiveness was assessed using grip, ankle, knee, and hip strength; Timed UpGo (TUG); Berg Balance Scale (BBS); gait speed; and 6-min walking distance. These were measured at baseline and every 3 months thereafter. We calculated the RCI using the data between two-time points (baseline and at 3, 6, 9, or 12 months) in each participant and then calculated the mean RCI value across the participants. A paired t-test was also employed to evaluate the effect of the intervention as an average-based statistics.The highest mean RCI values were on ankle plantar-flexion strength, followed by gait speed, hip abduction strength, BBS, knee extensor strength, 6-min walk distance, grip strength, and finally TUG. Paired t-test also revealed significant improvement with moderate effect sizes for ankle plantar-flexion strength (0.504), gait speed (0.413), hip abduction strength (0.374), BBS (0.334), knee extensor strength (0.264), and 6-min walk distance (0.248). Significant but small effect size was seen on TUG (0.183).The RCI is a convenient method of comparing the effect between different assessments, especially at an individual level. This index can be applied to the use of personal feedback.

Visual vertical (VV), visually perceived direction of gravity, is widely measured to assess the vestibular function and visuospatial cognition. VV has been assessed by comparing orientation and variability of measured values separately between subject groups. However, changes in orientation and variability often differ in patients with unilateral spatial neglect (USN). Here, we developed a novel classification of VV that combines orientation and variability and characterized the effects of USN on VV. Forty-three subacute stroke patients with or without USN (USN+, n = 17; USN-, n = 26) and 33 age-matched controls were included in the study. In darkness, a luminous line, initially tilted at 30° either to the left or right, gradually rotated towards the vertical. The VV was defined as the deviation of the subjectively-perceived vertical from the true vertical. The new classification demonstrated that, while the majority of USN + patients (14/17) exhibited large variability, nine showed normal orientation and five showed greater contra-lesional deviation of orientation, suggesting different underlying mechanisms for orientation and variability. Further analyses revealed VV deviation to the initial tilt in all groups. However, the deviation in USN + was larger and more variable, indicating attentional disorders. Such characterization would contribute to individually specified clinical rehabilitation.

[Purpose] We report our experience with a patient with a central spinal cord injury who showed improved finger and upper limb functions after long-term treatment with a combination of rehabilitation and botulinum toxin type A. [Participants and Methods] The patient had spasms and pain that gradually became more profound and was given botulinum toxin type A at 1 year 3 months after sustaining a spinal cord injury. We administered 14 botulinum toxin type A injections periodically for 7 years 4 months after the injury. We administered the injections at an average interval of 5.6 months. Splints that allowed extension and improved finger muscle tone and contracture were made for the patient. [Results] The patient experienced gradual alleviation of the spasms in the proximal upper limb muscles and improved range of motion after receiving five doses of botulinum toxin type A. The spasms and range of motion in the fingers gradually improved around 4 years after the injury through splint therapy and a combination of botulinum toxin type A administration and rehabilitation. [Conclusion] The combination of botulinum toxin type A, splint, and rehabilitation therapies can lead to positive improvements in finger spasticity and range of motion and is recommended for hypertonia cases with severe contractures.

To clarify the difference in the longitudinal effects of physical exercise on health-related outcomes according to the baseline frailty status (frail or non-frail) in community-dwelling older adults.Participants included 177 adults aged ≥65 years who carried out multicomponent physical exercises (strength, aerobic, gait and balance) for 40 min, one to three times per week, for 1 year at a day-care center. Bodyweight, comfortable walking speed, 6-min walking distance and Mini-Mental State Examination were measured at baseline and every 3 months. For longitudinal trend, we analyzed the change in scores from baseline for each outcome using the linear mixed effects model. Fixed effects included "group" (frail or non-frail), "time" (4 time points every 3 months, from 3 to 12 months) and "interaction between group and time."The effect sizes from baseline showed almost all positive values for each outcome. The linear mixed effects model showed significant effects on "interaction between group and time" in changes in bodyweight (P = 0.033), "group" in changes in walking speed (P = 0.013) and "time" in changes in the Mini-Mental State Examination (P 0.001). Bodyweight showed a decreasing trend in the non-frail group after 3 months, unlike in the frail group. For walking speed, moderate effect sizes (d = 0.67-0.74) were sustained over time in the frail group, as did lesser effect sizes (d = 0.26-0.40) in the non-frail group.Exercise-based multicomponent interventions were effective for both groups. The longitudinal effects on walking speed and bodyweight were greater in the frail group. Geriatr Gerontol Int 2022; 22: 213-218.

The motor modules during human walking are identified using non-negative matrix factorization (NNMF) from surface electromyography (EMG) signals. The extraction of motor modules in healthy participants is affected by the change in pre-processing of EMG signals, such as low-pass filters (LPFs); however, the effect of different pre-processing methods, such as the number of necessary gait cycles (GCs) in post-stroke patients with varying steps, remains unknown. We aimed to specify that the number of GCs influenced the motor modules extracted in the consideration of LPFs in post-stroke patients. In total, 10 chronic post-stroke patients walked at a self-selected speed on an overground walkway, while EMG signals were recorded from the eight muscles of paretic lower limb. To verify the number of GCs, five GC conditions were set, namely, 25 (reference condition), 20, 15, 10, and 5 gate cycles with three LPFs (4, 10, and 15 Hz). First, the number of modules, variability accounted for (VAF), and muscle weightings extracted by the NNMF algorithm were compared between the conditions. Next, a modified NNMF algorithm, in which the activation timing profiles among different GCs were unified, was performed to compare the muscle weightings more robustly between GCs. The number of motor modules was not significantly different, regardless of the GCs. The difference in VAF and muscle weightings in the different GCs decreased with the LPF of 4 Hz. Muscle weightings in 15 GCs or less were significantly different from those in 25 GCs using the modified NNMF. Therefore, we concluded that the variability extracted motor modules by different GCs was suppressed with lower LPFs; however, 20 GCs were needed for more representative extraction of motor modules during walking in post-stroke patients.

Background/Aim. Improving walking ability, especially the step-to-step transition control, is important in individuals after stroke. Although walking is a continuous skill, the discrete skills of gait, defined as movements with a clear beginning and end, may effectively modify walking performance. This pilot study shows the immediate effects of a discrete skill-based step training on ground reaction forces (GRFs) during gait in individuals with chronic hemiplegia following stroke.Methods. Twenty-two community-dwelling patients with chronic hemiplegia participated in this study. Eight participants performed only discrete-skill step training during the loading response phase, focusing on paretic hip extension movement (LR group). Another eight performed only discrete-skill step training during the preswing phase, focusing on paretic swing movement (PSw group). The remaining six were trained using both training methods, with at least 6 months in each group to washout the influence of previous training. Therefore, the final number of participants in each group was 14. The braking and propulsive forces of GRFs were measured during gait before and after 30 repetitions of the discrete-skill step training.Results. Although both groups showed a significant increase in stride length, walking speed was increased only in the LR group. The PSw group showed an increase in braking forces of both sides without any change in propulsion. In the LR group, paretic braking impulse did not change, while nonparetic propulsion increased.Conclusion. The discrete-skill step training during loading response phase induced an increase in nonparetic propulsion, resulting in increased walking speed. This study provides a clear understanding of immediate effects of the discrete-skill step training in patients with chronic stroke and helps improve interventions in long-term rehabilitation.

The aim of this study was to analyze individual muscle contributions to knee angular acceleration using a musculoskeletal simulation analysis and evaluate knee extension mechanics in the early stance phase in patients with knee osteoarthritis (OA). The subjects comprised 15 patients with medial knee OA and 14 healthy elderly individuals. All participants underwent gait performance test using 8 infrared cameras and two force plates to measure the kinetic and kinematic data. The simulation was driven by 92 Hill-type muscle-tendon units of the lower extremities and a trunk with 23° of freedom. We analyzed each muscle contribution to knee angular acceleration in the 5%-15% and 15%-25% periods of the stance phase (% SP) using an induced acceleration analysis. We compared accelerations by individual muscles between the two groups using an analysis of covariance for controlling gait speed. Patients with knee OA had a significantly lesser knee extension acceleration by the vasti muscles and higher knee acceleration by hip adductors than those in controls in 5-15% SP. In addition, knee OA resulted in significantly lesser knee extension acceleration by the vasti muscles in 15-25% SP. These results indicate that patients with knee OA have decreased dependency on the vasti muscles to control knee movements during early stance phase. Hip adductor muscles, which mainly control mediolateral motion, partly compensate for the weak knee extension by the vasti muscles in patients with knee OA.

Background Little is known about the relationship between vertical ground reaction force (vGRF) and muscle strength while climbing stairs after total hip arthroplasty (THA). Methods We investigated the relationship between muscle strength and vGRF during stair climbing in 21 women with THA. Differences in the time required to climb stairs and side-to-side differences in muscle strength and vGRF during climbing were examined at 6 and 12 months. The relationship between climbing time and vGRF variables and that between vGRF and muscle strength were analyzed using Spearman's rank correlation coefficient at 6 and 12 months. First peak force (Fz1) was defined as the peak vGRF at heel strike normalized by body weight. Findings Climbing time was related to the time to Fz1 at 6 and 12 months post-THA (r = 0.50–0.64). At 6 months, time to Fz1 was related to the strength of muscles involved in hip extension in the operated limb (r = −0.46). At 12 months, time to Fz1 was related to the strength of muscles responsible for knee extension in the operated limb (r = −0.45). Interpretation At 6 months, climbing stairs depended on muscle strength in the hip extensors. Conversely, at 12 months, the functional recovery of knee extensors was important for transferring weight upward while climbing stairs. Therefore, to improve the climbing function of patients with THA, it is important to not only focus on the recovery of muscle strength in the hip extensors but also improve muscle strength in the knee extensors.

This paper introduces an approach that robotizes an ankle-foot orthosis (AFO). In particular, toward post-stroke gait rehabilitation, we robotize a double-bar AFO, which is widely used in rehabilitation facilities, by newly designing a modular joint, a pneumatic actuator, and a Bowden cable force-transmission system. Our modular joint system, called the Modular Exoskeletal Joint (MEJ), has a hollow shaft for simple attachment to an AFO's pivot. We designed MEJ to compactly house an encoder that is built in a bearing in a pulley. We adopted Bowden cables to transmit contraction forces from an actuator to the MEJ. As an actuation scheme, we developed the Nested-cylinder Pneumatic Artificial Muscle (NcPAM) system. Even though PAMs are mechanically compliant and lightweight, they can still generate a large force. Therefore, they can provide an ideal actuation system for exoskeletal robots. The nested-cylinder in NcPAM houses a cable-tensioning spring to properly maintain small cable tension for passive movements and a cable stopper to connect the PAM and the cable for properly transmitting the large force generated by PAM. We show the ankle-joint trajectory tracking performances of this integrated system using iterative learning control.

Many individuals with knee osteoarthritis (OA) generate low forward center of mass (COM) acceleration during the late stance phase, consequently making it difficult to walk fast. This study analyzed individual muscle contributions to forward COM acceleration and the muscle potential (i.e., acceleration by unit force) to clarify whether reduced acceleration was related to decreased muscle potential of forward progression by the triceps sure. Twelve individuals with knee OA and 12 healthy age-matched individuals participated in this study. All participants underwent kinetic measurements during normal gait. The simulation involved 92 Hill-type muscle-tendon units with 23 degrees of freedom. We analyzed how each muscle contributed to forward COM acceleration during the 70-100% stance phase using an induced acceleration analysis. Next, the muscle potential of forward COM acceleration was calculated. Our results showed that individuals with knee OA had significantly lower forward COM acceleration with the soleus, gastrocnemius, and iliopsoas muscles compared with controls. Lower muscle potential in the soleus was found in those with knee OA. These findings implied that improving the contribution of the soleus to forward body progression would be effective for increasing the gait speed of those with knee OA during the late stance phase.

Background The Barthel Index (BI) is a measure of independence in activities of daily living (ADL). In the modified Barthel Index (MBI), a five-point system replaced the original two or three or four point rating system. Based on this modified measure, the performance evaluation tool MBI (PET-MBI) was developed in Japan. Although the reliability and validity of PET-MBI have been verified for older people, the use of this tool in stroke patients has not been evaluated. This study investigated the validity and reliability of PET-MBI for stroke patients. Methods Ten raters independently determined the BI and PET-MBI scores of stroke patients by direct observation. These patients’ ADL were videotaped, and 10 other raters then evaluated the videos privately and assigned PET-MBI scores twice, one month apart. The criterion-related validity of the PET-MBI against the BI was evaluated using the correlation coefficients for their total scores. Furthermore, to assess inter- and intra-rater reliabilities from the results of the first and second sessions, Fleiss’ intraclass correlation coefficients (ICCs) were calculated for the total scores, with the lower limits of the 95% confidence interval (95%CI), along with weighted kappa (κw) coefficients for agreement in individual tasks of this evaluation tool. ICC and κw coefficients of 0.81–1.00 were considered to be “almost perfect” agreement. Results The mean age of the 30 patients (23 men, 7 women) was 71.9 (standard deviation 10.5) years. One patient had diplegia, 14 had right hemiplegia, and 15 had left hemiplegia. For the total scores obtained by direct evaluation, Pearson’s and Spearman’s correlation coefficients of the BI versus the PET-MBI were both 0.95 (lower limit of the 95%CI, 0.90). The ICC representing inter-rater reliability for the first session was 0.99 (lower limit of the 95%CI, 0.98]. For intra-rater reliability, the mean value of the ICCs was 0.99 (range, 0.99–1.00). For individual tasks of the PET-MBI, inter-rater κw coefficients for the first session ranged from 0.77 to 0.94, with intra-rater κw coefficients from 0.85 to 0.96. Conclusions PET-MBI showed strong criterion-related validity against the BI, with high reliabilities. This scoring system may become a convenient tool allowing anyone to assess ADL.

Objective Pedaling is widely used for rehabilitation of locomotion because it induces muscle activity very similar to locomotion. Afferent stimulation is important for the modulation of spinal reflexes. Furthermore, supraspinal modulation plays an important role in spinal plasticity induced by electrical stimulation. We, therefore, expected that active pedaling combined with electrical stimulation could induce strong after-effects on spinal reflexes. Design Twelve healthy adults participated in this study. They were instructed to perform 7 min of pedaling. We applied electrical stimulation to the common peroneal nerve during the extension phase of the pedaling cycle. We assessed reciprocal inhibition using a soleus H-reflex conditioning-test paradigm. The magnitude of reciprocal inhibition was measured before, immediately after, 15 and 30 min after active pedaling alone, electrical stimulation alone and active pedaling combined with electrical stimulation (pedaling + ES). Results The amount of reciprocal inhibition was significantly increased after pedaling + ES. The after-effect of pedaling + ES on reciprocal inhibition was more prominent and longer lasting compared with pedaling or electrical stimulation alone. Conclusions Pedaling + ES could induce stronger after-effects on spinal reciprocal inhibitory neurons compared with either intervention alone. Pedaling + ES might be used as a tool to improve locomotion and functional abnormalities in the patient with central nervous lesion.

Objectives Few studies have assessed short intracortical inhibition (SICI) in the affected hemisphere (AH) in a large number of patients with chronic stroke. In this study, SICI was assessed in chronic stroke patients with severe hemiparesis, and its relationship to clinical parameters was examined. Methods The participants were 72 patients with chronic hemiparetic stroke. SICI of both the AH and the unaffected hemisphere (UH) was assessed. The relationships between SICI and the location of lesion, time from onset, and finger function were studied. Motor function of the paretic finger was assessed with the Stroke Impairment Assessment Set (SIAS) and the Fugl-Meyer test upper extremity motor score. To compare the results with those of healthy subjects, SICI was assessed in seven age-matched control subjects. Results MEPs of the UH were evoked in all 72 subjects, and MEPs of the AH were evoked in 24 subjects. SICI of the AH was inversely correlated with paretic finger motor function and time from stroke onset. SICI of the UH was not correlated with either one. SICI of the UH was higher in the cortical lesion group than in the control group. Conclusions The state of intracortical inhibitory neuron activity depends on the state of motor function and lesion site even in chronic stroke patients with severe hemiparesis. Significance The inhibitory system of the AH is involved in functional recovery of the paretic hand even in the chronic stage of stroke.

Electroencephalogram-based brain-computer interface (BCI) has been developed as a new neurorehabilitative tool for patients with severe hemiparesis. However, its application has been limited because of difficulty detecting stable brain signals from the affected hemisphere. It has been reported that transcranial direct current stimulation (tDCS) can modulate event-related desynchronization (ERD) in healthy persons. The objective of this study was to test the hypothesis that anodal tDCS could modulate ERD in patients with severe hemiparetic stroke. The participants were six patients with chronic hemiparetic stroke (mean age, 56.8 ± 9.5 years; mean time from the onset, 70.0 ± 19.6 months; Fugl-Meyer Assessment upper extremity motor score, 30.8 ± 16.5). We applied anodal tDCS (10 min, 1 mA) and sham stimulation over the affected primary motor cortex in a random order. ERD of the mu rhythm (mu ERD) with motor imagery of extension of the affected finger was assessed before and after anodal tDCS and sham stimulation. Mu ERD of the affected hemisphere increased significantly after anodal tDCS, whereas it did not change after sham stimulation. Our results show that anodal tDCS can increase mu ERD in patients with hemiparetic stroke, indicating that anodal tDCS could be used as a conditioning tool for BCI in stroke patients.

The sensorimotor cortex activity measured by scalp EEG shows coherence with electromyogram (EMG) activity within the 15- to 35-Hz frequency band (β-band) during weak to moderate intensity of isometric voluntary contraction. This coupling is known to change its frequency band to the 35- to 60-Hz band (γ-band) during strong contraction. This study aimed to examine whether such contraction level-related modulation of corticomuscular coupling differs between muscles with different muscle compositions and functions. In 11 healthy young adults, we quantified the coherence between EEG over the sensorimotor cortex and rectified EMG during tonic isometric voluntary contraction at 10–70% of maximal voluntary contraction of the tibialis anterior (TA) and soleus (SOL) muscles, respectively. In the TA, the EEG-EMG coherence shifted from the β-band to the γ-band with increasing contraction level. Indeed, the magnitude of β-band EEG-EMG coherence was significantly decreased, whereas that of γ-band coherence was significantly increased, when the contraction level was above 60% of maximal voluntary contraction. In contrast to the TA, the SOL showed no such frequency changes of EEG-EMG coherence with alterations in the contraction levels. In other words, the maximal peak of EEG-EMG coherence in the SOL existed within the β-band, irrespective of the contraction levels. These findings suggest that the central nervous system regulates the frequency of corticomuscular coupling to exert the desired levels of muscle force and, notably, that the applicable rhythmicity of the coupling for performing strong contractions differs between muscles, depending on the physiological muscle compositions and functions of the contracting muscle.

Hase K, Suzuki E, Matsumoto M, Fujiwara T, Liu M. Effects of therapeutic gait training using a prosthesis and a treadmill for ambulatory patients with hemiparesis. Objective To examine the short-term effects of a newly developed hemiparetic gait training in which patients walk with a prosthesis applied to the nonparetic leg in the flexed knee position. Design Pre-post nonrandomized controlled trial. Setting Rehabilitation center and gait laboratory of a university hospital. Participants Community-dwelling ambulatory volunteers (N=22) with chronic hemiparesis caused by a unilateral stroke. Intervention Study subjects participated in a gait training program using either a below-knee prosthesis or a treadmill. Treadmill gait training was performed at a speed approximating the maximum gait velocity for each patient. The 3-week program consisted of a 5-minute gait training session 2 to 3 times a day. Main Outcome Measures The ground reaction forces, stance time, step length and cadence during walking at a comfortable speed, and maximum gait speed, as well as the Berg Balance Score, were estimated before and after each training program. Results In comparison with changes after the treadmill gait training, analyses of covariance demonstrated a significant increase of the fore-aft ground reaction forces during the paretic propulsion phase and a significant increase in the relative durations of the paretic and nonparetic single stance involved in a gait cycle after the prosthetic gait training ( P Conclusions Prosthetic gait training would have different effects on a hemiparetic gait than treadmill gait training. The gait-related task inducing the dominant use of the paretic leg to support the body may be useful as a rehabilitative treatment to improve the kinetic abilities in the paretic stance period.

Background and objective. Unilateral spatial neglect (USN) can interfere with rehabilitation processes and lead to poor functional outcome. The purpose of this study was to determine whether prism adaptation (PA) therapy improves USN and functional outcomes in stroke patients in the subacute stage. Methods. A multicenter, double-masked, randomized, controlled trial was conducted to evaluate the effects of a 2-week PA therapy on USN assessed with the Behavioral Inattention Test (BIT), the Catherine Bergego Scale (CBS), and activities of daily living (ADL) as evaluated with the Functional Independence Measure (FIM). A total of 38 USN patients with right-brain damage were divided into prism (n = 20) and control (n = 18) groups. Patients were divided into mild and severe USN groups according to BIT behavioral test (mild ≥ 55 and severe

Background and objective. Hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy was devised to facilitate the use of the hemiparetic upper extremity in daily life by combining assistive neuromuscular electrical stimulation, referred to as the integrated volitional electrical stimulator (IVES), with a splint. The aim of this study is to assess the effectiveness of HANDS therapy for patients with subacute stroke. Methods. The participants were 24 inpatients receiving rehabilitation for hemiparetic stroke within 60 days of onset. Entry criteria included inability to individuate finger extension. Patients were randomly assigned to 2 groups. The HANDS group (n = 12) used the IVES combined with a wrist splint for 8 hours a day for 3 weeks, and the control group (n = 12) wore a wrist splint alone. All patients received the same daily dose and length of standard poststroke multidisciplinary rehabilitation. Outcome measures were the upper extremity portion of the Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Motor Activity Log-14 (MAL). Results. In all, 10 patients in each group completed the interventions. Compared with the control group, the HANDS group showed significantly greater gains in distal (wrist/hand) portion of the FMA ( P < .01) and improvement of the ARAT ( P < .05). The gains in the MAL did not differ. No adverse effects occurred and the HANDS therapy was well accepted. Conclusion. HANDS therapy in addition to conventional therapy may improve hand function in patients with moderate to severe hand impairment during early rehabilitation.

The purpose of this study was to verify the influence of lower limb orthoses on muscle synergy control during gait in stroke patients with hemiparesis. In four subjects with acute stroke, surface EMG signals from eight muscles of the paretic lower limb were measured during gait in two conditions (ankle foot orthosis; AFO or knee ankle foot orthosis; KAFO). The number of modules, muscle weightings and activation timing profile of each module were analyzed using non-negative matrix factorization. In two subjects (Fugl Meyer Assessment; FMA > 20) who walked with mild assistance, three modules were identified during gait with KAFO, whereas two modules were identified with AFO. The third module was composed of triceps surae activities in the late stance phase of the gait cycle. In two subjects (FMA

Saccadic eye movements (SEM) are used as a biomarker for psychiatric disorders. However, the relationship between SEM and higher brain function has not been fully elucidated. Therefore, we examined SEM during the Trail Making Test part A (TMT-A), a neuropsychological test of visual attention and processing speed, and assessed the correlation between the frequency of SEM during TMT-A and neuropsychological test results. The eye movements of 43 elderly subjects (>65 y/o, mean 72.4 y/o), with no history of neuropsychiatric disorders, were measured using eye tracking glasses (SensoMotoric Instruments, Germany). Eye movements of more than 1.6 degrees/s were judged to be SEM. We found a significant inverse correlation between the frequency of SEM during TMT-A and the time required to complete TMT-A (r = −0.402, p = 0.008). We found a positive correlation with the Backward block-tapping span (r = 0.371, p = 0.015), a neuropsychological test of spatial working memory, and the Japanese version of the Montreal Cognitive Assessment (r = 0.301, p = 0.021). The lower frequency of SEM during TMT-A reflected lower processing speeds and spatial working memory, which may lead to poorer performance on neuropsychological tests. This result indicates that the frequency of SEM during TMT-A might be an informative biomarker for attention and cognitive function in the elderly.

The rehabilitation strategies for bipedal locomotion have been developed with a variety of gait tasks inducing sensory-motor integration. Whereas the observational gait analyses are applied to planning treatments or evaluating interventions, standardized assessment tools are not commonly used in the usual clinical settings for rehabilitation treatments. The use of assessment tools improves the analyses and helps avoid omissions of important gait issues. Also, to enhance the effects of motor learning, the feedback should be given as focusing on sensory information to be controlled. To achieve these purposes, the instrumented motion analyses were performed with standardized observational gait assessments as well as gait trainings. The 3-D motion analysis system with a custom-made software automatically evaluated most of the Gait Assessment and Intervention Tool items. To develop this system, the normative data of age-matched elderly people had to be established. This analysis system provides quantitative assessments of changes in a gait pattern and may contribute to identifying benefits from rehabilitation treatments. In addition, the instrumented motion analyses including wearable sensors during gait trainings should be utilized to optimize the use of a paralytic lower limb.

Objective: To study the activities of daily living (ADL) structure of patients with Duchenne muscular dystrophy (DMD).Design: Cross-sectional survey.Subjects: Seventy-two patients with DMD (mean [SD] age, 17.2 [8.1] years), recruited in 160-bed regional center for neuromuscular disease.Methods: We assessed 72 participants with the Functional Independence Measure (FIMSM), and determined the difficulty order of the FIMSM items with the percentage of patients who were independent (6 or 7) for each FIM item (% independence).Results: The ADL of patients with DMD had an order in terms of difficulty. For the motor subscale, the most difficult item was stairs, and the easiest item was locomotion. On the cognitive subscale, problem solving was the most difficult item. When we compared item difficulty between patients

To investigate swallowing problems in patients with Duchenne muscular dystrophy (DMD) using a questionnaire and videofluorography (VF).A questionnaire survey was performed of swallowing-related symptoms and VF in 31 male patients with DMD (mean age 19.9 years, range 9 - 26 years). The relationships among age, frequency of symptoms and VF abnormalities were analysed using Spearman's rank correlation. The differences in VF abnormalities among different food textures were analysed with the Kruskal - Wallis test.Symptoms related to pharyngeal phase dysfunction were more frequent than those related to oral and oesophageal phases. Coughing while eating was seen in 71% of the patients, choking while eating in 32% and the need to clear the throat in 26%. VF abnormalities were observed in 30 patients (96.8%). Common VF abnormalities included pooling in the valleculae (90.3%) and in the pyriform sinus (90.3%). Pharyngo-oral regurgitation was seen in 35.5% of the patients. Pooling in the pyriform sinus after repeated swallowing seen in VF correlated significantly with symptoms related to the pharyngeal phase (Spearman's rho 0.356 - 0.544).Because oropharyngeal dysphagia in DMD was evident in teenage patients as well as those without clinical symptoms, VF is recommended in patients with DMD.

To develop a short version of the motor Functional Independence Measure (FIM) for use in long-term care settings.For model construction, the participants were 398 community-dwelling persons with disability (mean age 79.3 years (SD 10.3)) who were receiving visiting nurse services. For cross-validation, 169 patients with stroke (mean age 78.0 years (SD 11.2)) in the chronic phase and 187 patients with stroke (mean age 63.4 years (SD 12.7)) in the recovery phase.Model construction and cross-validation study.The second power of correlation coefficient (R2) was used for agreement analysis between the short and the full version. Cross-validation of the models was estimated with the intraclass correlation coefficient (ICC).Five to 7 motor FIM items were selected for the models based on Rasch calibration and consideration of internal consistency. Total motor FIM was estimated with the 6-item and 7-item models with regression analysis, which yielded high correlations with the original 13-item motor FIM score (R20.95). Regression formulas derived from the models could estimate total motor FIM scores accurately in the 2 cross-validation samples (ICC0.98).The short version of the motor FIM developed is a useful measure of functional status, not only in long-term care but in the recovery phase rehabilitation settings.

Objective: To identify a most useful and simple clinical screening tool to predict videofluoroscopic aspiration in patients with stroke. Design: Factor analysis of multiple dysphagia variables and sensitivity and specificity testing with chi-square test. Patients: Sixty-one consecutive stroke patients with symptoms suggestive of dysphagia admitted to a university hospital and its 4 affiliated hospitals in Japan. Methods: Factors were extracted from 6 oromotor examinations (lip closure, tongue movement, palatal elevation, gag reflex, voice quality and motor speech function), 2 swallow screen tests (saliva swallowing test and our modified water swallowingtestusing30 mlofwater)and4parameters evaluated with a videofluoroscopic swallow study. Sensitivity and specificityofeachdysphagia-relatedvariablewasdetermined against aspiration in a videofluoroscopic swallow study. Results: Factor analysis revealed that cough/voice change in the water swallowing test and aspiration on videofluoroscopic swallow study belonged to the same factor. Chi-square analysis showed that cough/voice change in the water swallowing test was the only variable that was significantly associated with aspiration on videofluoroscopic swallow study, with a sensitivity of 72% (95% CI: 61‐83%) and a specificity of 67% (CI: 55‐79%) as a predictor of aspiration (p < 0.05). Conclusion: We recommend our modified 30 ml waterswallowing test as a useful single task-screening tool to detect aspiration.

Although electromyography and electrodiagnosis (EMG-EDX) is one of the most fundamental skills in rehabilitation medicine, the number of residency programs that can provide comprehensive postgraduate EMG-EDX training is still limited in Japan. Under these circumstances, we started a 2-day primer course in EMG-EDX at Keio University Hospital in 1998. To review our 7-year experience with the course, we analyzed the number and specialty of the participants, their appraisal of the lectures and practical sessions, and the score distribution of the final examination. The number of participants totaled 288 during the past 7 years, and the mean number for each year was 41. The distribution by specialty for the whole period was 64.0% for rehabilitation medicine, 25.4% for orthopedic surgery, 5.1% for neurology, 1.0% for pediatrics, 0.5% for gerontology and 4.1% for physical therapists and occupational therapists. The difficulty levels of the lectures were judged as appropriate by 81 to 95.5% of the participants, and the presentation was judged as good by 34 to 67% of them. For the practice sessions, the difficulty levels were judged as appropriate by 88% of the participants, and the quality of the supervisors was judged as good by 64% of them. The mean score for the final examination was 56.0 (SD 15.2, median 60). In conclusion, our course has played an important role to promote EMG-EDX in our country by providing compact introductory exposure to EMG-EDX for beginners. A follow-up system for the course graduates is planned to support their EMG-EDX practice.