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We retrospectively analysed large-scale, nationwide data from the Kaifukuki (convalescent) Rehabilitation Ward (KRW) survey of 2015. Patients were classified into two groups based on changes in body mass index (BMI) during their KRW stay: increased BMI and non-increased BMI. The primary outcome was motor functional independence measure (FIM) score at discharge, and the secondary outcomes were motor FIM gain and full oral intake at discharge. We analysed 4605 patients (64% women; mean age, 79.3 years). Of these patients, 1128 and 3477 were classified into the increased and non-increased groups, respectively. Multivariate analysis showed that BMI increases were independently associated with motor FIM scores at discharge (partial regression coefficient = 1.165; 95% confidence interval, 0.671-1.659) and motor FIM gains, although BMI increase was not associated with full oral intake. Thus, increasing body weight might lead to activities of daily life improvement in underweight patients undergoing post-acute rehabilitation., Author(s): Yoji Kokura [sup.1] [sup.2], Shinta Nishioka [sup.1] [sup.3], Takatsugu Okamoto [sup.4] [sup.5], Masako Takayama [sup.1] [sup.6], Ichiro Miyai [sup.4] [sup.7] Author Affiliations: (1) Nutrition Committee, Kaifukuki Rehabilitation Ward Association, [...]

Abstract Background Both low-frequency repetitive transcranial magnetic stimulation (rTMS) and intensive occupational therapy (OT) have been recently reported to be clinically beneficial for post-stroke patients with upper limb hemiparesis. Based on these reports, we developed an inpatient combination protocol of these two modalities for the treatment of such patients. The aims of this pilot study were to confirm the safety and feasibility of the protocol in a large number of patients from different institutions, and identify predictors of the clinical response to the treatment. Methods The study subjects were 204 post-stroke patients with upper limb hemiparesis (mean age at admission 58.5 ± 13.4 years, mean time after stroke 5.0 ± 4.5 years, ± SD) from five institutions in Japan. During 15-day hospitalization, each patient received 22 treatment sessions of 20-min low-frequency rTMS and 120-min intensive OT daily. Low-frequency rTMS of 1 Hz was applied to the contralesional hemisphere over the primary motor area. The intensive OT, consisting of 60-min one-to-one training and 60-min self-exercise, was provided after the application of low-frequency rTMS. Fugl-Meyer Assessment (FMA) and Wolf Motor Function Test (WMFT) were performed serially. The physiatrists and occupational therapists involved in this study received training prior to the study to standardize the therapeutic protocol. Results All patients completed the protocol without any adverse effects. The FMA score increased and WMFT log performance time decreased significantly at discharge, relative to the respective values at admission (change in FMA score: median at admission, 47 points; median at discharge, 51 points; p < 0.001. change in WMFT log performance time: median at admission, 3.23; median at discharge, 2.51; p < 0.001). These changes were persistently seen up to 4 weeks after discharge in 79 patients. Linear regression analysis found no significant relationship between baseline parameters and indexes of improvement in motor function. Conclusions The 15-day inpatient rTMS plus OT protocol is a safe, feasible, and clinically useful neurorehabilitative intervention for post-stroke patients with upper limb hemiparesis. The response to the treatment was not influenced by age or time after stroke onset. The efficacy of the intervention should be confirmed in a randomized controlled study including a control group.

Background: The beneficial effects of the combination therapy of low-frequency repetitive transcranial magnetic stimulation of nonlesional hemisphere and intensive occupational therapy (LF-rTMS/OT) on upper limb hemiparesis have been well established in poststroke patients. However, there is no information on the effect of brain activity on LF-rTMS/OT treatment outcome. Method: A total of 59 poststroke patients with upper limb hemiparesis received 15-day LF-rTMS/OT. Motor function of the affected upper limb was evaluated before and after the treatment. We also conducted functional near-infrared spectroscopy (fNIRS) before the treatment and calculated the laterality index (LI) based on the change in oxy-hemoglobin in the primary sensorimotor cortex and supplementary motor cortex. The correlation between LI before LF-rTMS/OT and observed improvement in upper limb motor function was analyzed. Results: Motor recovery was significantly more pronounced in patients with unaffected hemisphere dominance in both hemispheres (LI of −1 to 0) than in those with affected hemisphere dominance in the lesional hemisphere (LI of 0 to 1). There was a significant negative correlation between LI and improvement in upper limb motor function. Discussion: The results demonstrated that patients with a shift in brain activity to the noninjured cerebral cortex exhibited better motor recovery following LF-rTMS/OT. The findings suggest that evaluation of brain asymmetry before LF-rTMS/OT with fNIRS can help predict the response to LF-rTMS/OT. [ABSTRACT FROM AUTHOR]

Background and aim:The study aim was to investigate the validity and reliability of the Functional Independence Measure and Functional Assessment Measure (FIM + FAM), which is unfamiliar in Japan, by using its Japanese version (FIM + FAM-j) in patients with cerebrovascular accident (CVA). Material and methods:Forty-two CVA patients participated. Criterion validity was examined by correlating the full scale and subscales of FIM + FAM-j with several well-established measurements using Spearman’s correlation coefficient. Reliability was evaluated by internal consistency (tested by Cronbach’s alpha coefficient) and intra-rater reliability (tested by Kendall’s tau correlation coefficient). Results:Good-to-excellent criterion validity was found between the full scale and motor subscales of the FIM + FAM-j and the Barthel Index, National Institutes of Health Stroke Scale, modified Rankin Scale, and lower extremity Brunnstrom Recovery Stage. High internal consistency was observed within the full-scale FIM + FAM-j and the motor and cognitive subscales (Cronbach’s alphas were 0.968, 0.954, and 0.948, respectively). Additionally, good intra-rater reliability was observed within the full scale and motor subscales, and excellent reliability for the cognitive subscales (taus were 0.83, 0.80, and 0.98, respectively). Conclusion and significance:This study showed that the FIM + FAM-j demonstrated acceptable levels of validity and reliability when used for CVA as a measure of disability. [ABSTRACT FROM PUBLISHER]

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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]