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The coronavirus disease 2019 (COVID-19) pandemic has had a major impact on society and our lives. Many older people and those with underlying medical conditions have refrained from social activities and become housebound, increasing the risk of frailty. Therefore, we developed the Home Exercise Program for Older People, a multidisciplinary program that makes it easier for older people to exercise at home. We also provide outpatient rehabilitation for not only those affected by COVID-19, but also older people with frailty who have become confined under the COVID-19 pandemic. In this chapter, we overview the situations and lives of older people in Japan under the COVID-19 pandemic and discuss preventive strategies.

Aim Executive dysfunction is pathognomonic for dementia and impedes the activities of daily living (ADL). This study aimed to examine the relationship of dementia severity with executive dysfunction and ADL in mild cognitive impairment and dementia. Methods This single-center study enrolled 86 patients (men, 40; women, 46; mean age, 76.1 ± 7.5 years) referred for cognitive and physical rehabilitation between October 2015 and September 2020. The Clinical Dementia Rating (CDR) was 0.5, 1, and ≥2 in 45, 30, and 11 patients, respectively. The presence and severity of executive dysfunction were assessed using the Behavioral Assessment of the Dysexecutive Syndrome-Japanese version (BADS). The ADL and instrumental ADL (IADL) were assessed using the Barthel Index and Frenchay Activities Index (FAI), respectively. We examined the relationship between CDR severity and overall BADS profile score and its sub-items, and that between the overall BADS profile score and IADL. Results The cognitive and executive functional assessment scores differed significantly depending on the CDR severity. The CDR severity and overall BADS profile score exhibited significant correlations. The BADS found cognitive impairment in 31%, 70%, and 100% of patients with CDR0.5, CDR1, and CDR≥2, respectively. The FAI score differed according to the CDR severity in women but not in men. The overall profile and age-adjusted BADS scores were strongly correlated with the IADL in women but not in men. Conclusions The greater the severity of executive dysfunction, the greater the difficulty in performing ADL. This effect was more pronounced in women and may predict dementia progression. Geriatr Gerontol Int 2021; ••: ••-••.

Background Rare neuromuscular diseases such as spinal muscular atrophy, spinal bulbar muscular atrophy, muscular dystrophy, Charcot-Marie-Tooth disease, distal myopathy, sporadic inclusion body myositis, congenital myopathy, and amyotrophic lateral sclerosis lead to incurable amyotrophy and consequent loss of ambulation. Thus far, no therapeutic approaches have been successful in recovering the ambulatory ability. Thus, the aim of this trial was to evaluate the efficacy and safety of cybernic treatment with a wearable cyborg Hybrid Assistive Limb (HAL, Lower Limb Type) in improving the ambulatory function in those patients. Results We conducted an open-label, randomised, controlled crossover trial to test HAL at nine hospitals between March 6, 2013 and August 8, 2014. Eligible patients were older than 18 years and had a diagnosis of neuromuscular disease as specified above. They were unable to walk for 10 m independently and had neither respiratory failure nor rapid deterioration in gait. The primary endpoint was the distance passed during a two-minute walk test (2MWT). The secondary endpoints were walking speed, cadence, and step length during the 10-m walk test (10MWT), muscle strength by manual muscle testing (MMT), and a series of functional measures. Adverse events and failures/problems/errors with HAL were also evaluated. Thirty patients were randomly assigned to groups A or B, with each group of 15 receiving both treatments in a crossover design. The efficacy of a 40-min walking program performed nine times was compared between HAL plus a hoist and a hoist only. The final analysis included 13 and 11 patients in groups A and B, respectively. Cybernic treatment with HAL resulted in a 10.066% significantly improved distance in 2MWT (95% confidence interval, 0.667–19.464; p = 0.0369) compared with the hoist only treatment. Among the secondary endpoints, the total scores of MMT and cadence at 10MWT were the only ones that showed significant improvement. The only adverse effects were slight to mild myalgia, back pain, and contact skin troubles, which were easily remedied. Conclusions HAL is a new treatment device for walking exercise, proven to be more effective than the conventional method in patients with incurable neuromuscular diseases. Trial registration: JMACTR, JMA-IIA00156

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.

[Purpose] To examine the olfactory identification abilities and specify the difficult-to-identify odors in community-dwelling individuals with mild cognitive impairment (MCI) and Alzheimer's disease (AD). [Participants and Methods] We included, 12 and 17 patients with MCI (MCI group) and AD (AD group), respectively, and 30 community-dwelling older adults with no history of MCI or a dementia diagnosis (control group). Scores on the Japanese odor stick identification test (OSIT-J), an olfactory identification ability test, were compared among the three groups with intergroup differences examined accordingly. Next, we performed intergroup comparisons of the ratios of correct responses for each odor, and the difficult-to-identify odors were examined. [Results] OSIT-J scores of the MCI and AD groups were significantly lower than those of the control group. There were no intergroup differences in the correct identification of pungent odors. No patients in the AD group could identify the odor of cooking gas. The ability to identify food-related odors was reduced in the MCI and AD groups. [Conclusion] Patients with MCI and AD had reduced olfactory identification abilities in comparison to community-dwelling older adults without cognitive decline. These findings suggest the importance of olfactory evaluation before providing patients with dementia with therapeutic interventions associated with olfactory stimuli.

The recovery of aphasia occurs immediately after the onset of the disease and lasts for several months or more. The speed and degree of improvement in aphasia vary depending on the time since onset, severity of aphasia, and each language modalities. It is assumed that there is a difference in the mechanism of aphasia recovery. The recovery process of the central nervous system observed in the first few days to weeks after the onset of aphasia is thought to involve the disappearance of cerebral edema, the absorption of necrotic tissue, angiogenesis, the development of the collateral circulation, and the resolution of hematomas, leading to the repair of damaged tissue. In the chronic phase, 1) recovery of damaged functional areas, 2) reconstruction of functions in the residual areas, and 3) compensatory functions by the contralateral hemisphere or activation of the contralateral cortex are assumed. In recent years, there have been many reports supporting the effectiveness of speech and language therapy interventions. Speech and language therapy should not only promote improvement of aphasia, but also take a comprehensive approach to improve the QOL of aphasia patients, such as acquisition of compensatory means of communication and family guidance.

With the rapid spread of the new coronavirus, COVID-19, many universities switched to online classes to promote social distancing and reduce the risk of infection. The Ministry of Education, Culture, Sports, Science and Technology, however, requested universities hold face-to-face classes whenever possible. Therefore, after the national emergency was lifted, our university, the Kinjo University in Hakusan, launched the “Kinjo Infection Control Team” to help prevent infection on campus. Our university was one of the first universities in the Hokuriku region to resume face-to-face classes. Infection control teams were originally organized at hospitals and other medical facilities by professionals specializing in infection prevention and control. Although our university did not have an affiliated hospital, we had medical professionals, including doctors and nurses, as well as virology researchers, who conducted environmental patrols, hand hygiene education and monitoring, and infection education for students and faculty. The most important countermeasures against the spread of infectious disease in universities are the maintenance of the campus environment and the behavioral changes of students. To maintain a safe learning environment during a pandemic, it is necessary to consider the best measures to prevent infection from various aspects so that we can avoid spreading infectious diseases, and also maintain maximum student activity and provide a safe learning environment at all times.

Universities are the centers of society’s intellectual activities and are places where highly skilled professionals are trained. For managers and businesses, universities are a valuable resource for revitalizing and promoting communities and industries. Achieving this requires multifaceted cooperation and collaboration with universities. In 2017, our university concluded a “comprehensive cooperation agreement” with the city of Hakusan, where the university is located. Last year, the university signed an agreement with Dai-ichi Life Insurance Co., and this year it signed one with Eon Mall Co., Ltd. A variety of projects are currently being planned to be carried out at Eon Mall Hakusan, a major supermarket in the community. The main purpose of these agreements is to help the community develop by solving local problems and fostering new professionals.

In 2020, Japan had nearly three million students enrolled in 795 universities, representing 54.4% of the student population—the highest in the nation’s history. However, the number of private universities has grown dramatically, while the population of 18-year-olds has dropped due to Japan’s declining birthrate; as a result, one-third of private universities are now under-enrolled, making it difficult for many of them to operate. Universities have a long and storied history, and their function and mission have changed over time. Amid competing visions for what a university’s primary focus should be, the roles universities are expected to play are also changing. To meet the demands of local communities and society, as well as the diverse needs of students, universities should provide an education that draws on students’ individuality. Recently, universities’ contributions to the development of society have started being emphasized; together with research and education, social contribution needs to be perceived as the so-called third mission of the university, and analysts are calling for more industry-academia-government collaborations. This chapter focuses on universities’ social contribution, and describes the connection between local communities and the social contribution activities that universities have carried out for the past 20 years.

[Purpose] We investigated whether olfactory identification ability may be useful for early detection of cognitive decline. [Participants and Methods] The study included 55 community-dwelling older individuals without a history of mild cognitive impairment or dementia, who were capable of living independently. Cognitive function was evaluated using the Japanese versions of the Mini-Mental State Examination and the Montreal Cognitive Assessment tools. The olfactory identification ability was evaluated using the Odor Stick Identification Test for the Japanese. We also investigated the association between olfactory identification ability and cognitive function. [Results] Based on the Japanese version of the Mini-Mental State Examination, all participants were categorized into the noncognitive decline group, and based on the Japanese version of the Montreal Cognitive Assessment tool, 21 participants were categorized into the cognitive decline group. With regard to olfactory discrimination ability, we observed a significant difference between participants with and without cognitive decline based on the Japanese version of the Montreal Cognitive Assessment scores. Furthermore, we observed a significant positive correlation between the Japanese version of the the Montreal Cognitive Assessment scores and the Odor Stick Identification Test for the Japanese scores, although no significant correlation was observed between the Japanese version of the Mini-Mental State Examination and the Odor Stick Identification Test for the Japanese scores. [Conclusion] Olfactory identification ability may be useful to detect early-stage cognitive decline in community-dwelling older individuals.

[Purpose] To consider the effective rehabilitation approaches for locomotive syndrome (LS) and pre-frailty, we examined the characteristics of physical function and health-related quality of life (HRQoL) in community-dwelling older adults. [Participants and Methods] Eighty-three individuals (age 71.8 ± 5.5 years, 29 males and 54 females) were divided into robust (R), LS, and locomotive syndrome with pre-frailty (LSP) groups. We compared the subscale and summary scores of the 36-Item Short-Form Health Survey (SF-36) as HRQoL indices. The grip strength, five-chair stand up test (SS-5), and normal walking speed were the physical function indices. [Results] The LS group had lower two-step scores and normal walking speed but there was no significant difference in the SF-36. The two-step score and 25-question geriatric locomotive function scale, SS-5, seven SF-36 subscales, and mental component summary (MCS) scores were lower in the LSP group. Compared to that of the LS group, the LSP group did not show significant difference in physical function but showed lower values in overall health, vitality, mental health, and MCS in the SF-36 subscales. [Conclusion] The subjective evaluation of one's health was lower than that of the deterioration of physical function as a characteristic of the LSP.

Cerebral infarction is one of the most common cerebrovascular diseases and can result in severe residual functional disabilities that permanently affect patients’ activities of daily living and quality of life. Rehabilitation plays a significant role in reintegrating these people into society and enabling them to return home. Due to the growing aging population in Japan, the financial and societal impacts of cerebrovascular diseases are expected to increase. Here, we review the rehabilitation process in Japan through the acute, recovery, and daily living stages while considering the pathological conditions of patients with cerebral infarction. In particular, we discuss the pathology of cerebral infarction and rehabilitation interventions, the timing and purpose of rehabilitation, the use of walking aids such as canes, braces, and walking assistive robots, the benefits of providing support and guidance to family members and caregivers, the use of telestroke and telerehabilitation, the services provided by rehabilitation facilities, and recent legal changes in Japan.

Dementia is characterized by the deterioration of working memory (WM). The backward digit span (DS) task and reading span test (RST) are measures of WM. DS task and RST have not been directly compared in assessing dementia. This study aimed to compare the performance of individuals with dementia in forward and backward DS tasks to that in RST. We investigated the ability of forward/backward DS tasks to discriminate dementia severity. Forward/backward DS tasks and RST were performed in 15 elderly Japanese individuals with dementia. Twenty-six and 20 elderly individuals for the DS task and RST, respectively, were included as controls. Clinical Dementia Rating scale (CDR) was used to evaluate dementia severity. DS task scores were significantly correlated with RST scores. Both types of DS tasks correlated with RST, only the RST distinguished dementia severity based on CDR. Our findings indicate that the backward DS task may detect WM decline in dementia, but the RST is more suitable for assessing dementia severity. The backward DS task may be an effective screening measure for dementia signs in the elderly and may be used to identify patients requiring further assessments such as the RST to evaluate dementia severity based on WM performance.

Background In stroke rehabilitation, the most important concern of the patients and their families is whether the patients can walk independently and whether they need braces after discharge. Aim This study aims to investigate the relationship between several types of putaminal hemorrhage and walking independence and orthotic therapy in patients with hemiplegia. Design Observational study. Setting Inpatients rehabilitation department, Fujita Health University Nanakuri Memorial Hospital, Japan. Population Total 264 patients with putaminal hemorrhage admitted to our hospital. Methods Neurological and cognitive functions were examined as per the stroke scale of the National Institutes of Health and the Mini-mental state examination, respectively. The hematomas were classified into five types, and the volume was measured using computed tomography (CT). Walking ability was evaluated by Functional Ambulation Category (FAC), and walking independence was defined as FAC ≥4. The relationship between the types of hematomas and walking independence and orthotic therapy in patients with hemiplegia with putaminal hemorrhage was also analyzed. Results We observed differences within the hematoma types in volume, neurological symptoms, and cognitive function but not in age, sex, and lesion side aspects of these patients-143 of whom could walk independently (FAC≥4) and 121 non-independently. Walking independently and the need for orthosis were closely related to the type of hematoma. Conclusions CT imaging at stroke onset can provide useful information when examining walking independence and indicate necessity for an orthosis at the time of discharge to the rehabilitation ward. Clinical rehabilitation impact This study might help to better understand the role of neuroimaging in stroke rehabilitation.

Stroke impairs episodic memory, while retaining immediate and remote memory. Cerebral hemorrhage/infarction in the Papez and Yakovlev circuits (episodic memory) manifests as memory loss. Extensive medial temporal lobe damage impairs retrieval of old memories. Hippocampal damage causes anterograde amnesia. Damage to the hippocampus and parahippocampal gyri causes severe retrograde amnesia. Retrosplenial lesions may cause memory loss if the fibrous communication between the hippocampus and anterior thalamic nucleus is impaired. Basal forebrain amnesia impairs recall but the aspect providing retrieval clues remains relatively intact. Corpus striatum and basal forebrain damage results in serious memory loss. Other cognitive functions require evaluation using intelligence (WAIS-IV) and executive function tests, along with memory loss assessments. The WMS-R can evaluate memory after stroke. The RBMT elucidates the nature of memory loss, especially in the elderly. Cognitive rehabilitation with repetitive training and internal-memory strategies aims to activate the memory processes. External strategies and environmental adjustments provide effective clues and replicate the environment. Rehabilitation protocols should directly solve problems encountered in daily life. This chapter provides an overview of the anatomical basis of memory, pathophysiology of underlying memory loss, and assessment for stroke.

Unilateral spatial neglect refers to a condition where patients do not react to various environmental stimuli originating from the contralateral side of a brain lesion, in the absence of other sensory or motor deficits. Consequently, activities of daily living can be adversely affected. Cerebral hemorrhage or infarction is often the cause, and approximately 80% of patients with right hemisphere injury from acute stroke show unilateral spatial neglect. The presence of unilateral spatial neglect is determined through a number of different tests. However, even cases that are not apparent from typical tests are often associated with symptoms of neglect in activities of daily living. Stroke-mediated unilateral spatial neglect may improve or disappear during rehabilitation; however, in most cases, it remains. Cerebral hemorrhage, bleeding site, level of hematoma, and age are closely related with prognosis. Treatment approaches include conscious behavioral changes and activation of higher-order central nerves by stimulation from the periphery. Several mechanisms have been proposed to explain the onset of unilateral spatial neglect. Therefore, treatment strategies should be formulated only after careful examination and determination of the causative mechanism specific to each patient. This will enable the rehabilitation team to provide the most appropriate support.

Background The cube-copying test is used to assess cognitive function. It is one of the methods used to distinguish healthy older individuals from those with cognitive impairment based on its 3 mm vertex criterion and parallel line errors. We sought to assess how: (1) precisely elderly community-dwelling individuals draw cubes based on two different vertex criteria; and (2) they keep the parallelism of lines. Methods The cross-sectional design study population comprised 121 adults ((outlier analysis excluded the results of three, resulting in 118 participants) ≥ 65 years (21 men and 100 women) who participated in an annual physical fitness circuit and who lived independently in their communities. We recorded the participants' ages, years of education, and the scores they obtained in the Japanese version of the Montreal Cognitive Assessment. Participants were instructed to draw the cube as precisely as possible. Cube drawings were assessed based on the correct position of the vertices using 1 and 3 mm criteria and parallel line errors. Results Eighty-nine percent of the participants were able to draw vertices within 3 mm distance from the correct position but found it difficult to draw them within 1 mm distance. Using the 3 mm vertex criterion, the mean score for correct vertices was six (out of a maximum of eight). Most of the participants made a maximum of one out of six possible parallel line errors. Conclusions Almost 90% of the elderly in our study drew the vertices within 3 mm of the correct position, and the parallel line errors were few. The 3 mm vertex and parallel line criteria by cube-copying seem to be cleared by most community-dwelling elderly. Further research should determine if participants aged ≥85 years with less than 6 years of education show different results.

Objectives: The aim of this study was to investigate the clinical usefulness of the Cube Copying Test (CCT) for quantitative assessment of visuo-spatial function in patients with Alzheimer’s disease (AD). Methods: The CCT, Raven’s Colored Progressive Matrices (RCPM), and other neuropsychological tests were administered to 152 AD outpatients. For the quantitative assessment of CCT, we scored the points of connection (POC) and the number of plane-drawing errors (PDE) and categorized the pattern classification (PAC). We also measured Functional Assessment Staging (FAST) to assess the severity of AD. The relationships among CCT, RCPM, and FAST were then analyzed. Results: The mean POC and PDE scores were 2.7 and 3.6, respectively, and the median PAC score was 6.0. PDE and PAC showed a linear relationship, but POC and PDE, and POC and PAC did not. Each component of CCT showed a significant correlation with RCPM scores. PDE and PAC had closer correlations with RCPM scores than POC did. The PDE and PAC results were significantly different among most of the FAST stages. Conclusions: Quantitative assessment using CCT may be effective for the quick determination of the visuo-spatial function in AD patients.

Background Aphasia often appears in persons living with dementia; however, aphasia and the mirror phenomenon are rarely present at the same time. Case presentation Here, we report a case of fluent conversation with a person in a mirror or a magazine, and examine the underlying mechanism using brain imaging and neuropsychological findings. We found that the appearance of the mirror phenomenon may be associated with a visuospatial dysfunction caused by a decreased function of the posterior region of the right temporal and parietal lobe. Moreover, active talking to a person in a mirror or a person in a magazine could be associated with disinhibition caused by a decline in bilateral frontal lobe function. Conclusions This case represents a very valuable and interesting presentation because it is the first report of a long-term follow-up of the course of dementia using neurological imaging, and of the neuropsychological analysis of the mechanism of conversation with a mirror image combined with aphasia.

Computed tomography (CT) is used for initial assessment of patients with suspected stroke. Motor outcome prediction using the initial CT image is important for clinical rehabilitation. However, there is inconsistency in the results reported by the few publications on hematoma volume and motor outcomes in patients with putaminal hemorrhage. To clarify the direction of hematoma and relationship between the hematoma volume and motor outcomes in patients with putaminal hemorrhage using an initial CT image, we evaluated the volume of direction of hematoma in 170 patients in the subacute phase after putaminal hemorrhage using CT at stroke onset.The patients were divided into 5 groups according to the direction of the hematoma. For each group, Spearman's correlation coefficients were calculated to investigate the relationship between hematoma volume and motor outcomes. Motor outcomes were assessed using the motor items of Stroke Impairment Assessment Set, which are impairment indexes for the distal and proximal functions of the upper and lower extremities after stroke.Hematoma volume was significantly correlated with all the motor items in the group whose hematoma extended to the posterior limb of the internal capsule alone (Bonferroni corrected P.05). On the other hand, significant correlations between hematoma volume and motor outcomes could not be found in almost all the other groups.Motor outcome after putaminal hemorrhage can be predicted by evaluating the progression of hematoma to the corticospinal tract and its volume using CT images at stroke onset.

Objective To assess quantitatively the efficacy of oral baclofen for spasticity poststroke. Methods The participants were 29 persons poststroke with increased resistance to passive ankle dorsiflexion and ankle clonus on clinical assessment. Baclofen was administered at 20 mg/day for 1 week. The ankle joint was passively dorsiflexed at either 5°/s (slow stretch) or 90°/s (fast stretch) by a custom-built device. The ankle joint angle and resistive torque were measured during the ramp-and-hold stretch, with gastrocnemius electromyogram. The main outcome measures were the numbers of ankle clonus during hold, and the torques at 10° of ankle dorsiflexion in slow stretch (T-slow) and fast stretch (T-fast). Moreover, the velocity-dependent torque (ΔT = T-fast - T-slow) was compared between before and after oral baclofen. Results The numbers of ankle clonus, T-slow, T-fast, and ΔT for all participants did not exhibit significant differences between before and after baclofen administration. However, reduction in the number of ankle clonus of five or more was accompanied with a reduction in ΔT (4.0 ± 1.8 Nm) in three participants (the responders). Conclusion Although the responder rate was low, some participants responded to oral baclofen. Thus, a short-term trial of oral baclofen, and quantitative and electrophysiological assessments of muscle tone and ankle clonus are recommended.

Objective: We aimed to clarify the relationship between aphasia and hematoma type/volume in patients with left putaminal hemorrhage admitted to a rehabilitation facility. Methods: We evaluated the relationship between the presence, type, and severity of aphasia and hematoma type/volume in 92 patients with putaminal hemorrhage aged 29-83 years. Hematoma type and volume were evaluated on the basis of CT images obtained at stroke onset. The Standard Language Test for Aphasia was conducted as part of the initial assessment. Results: Aphasia was observed in 79 of 92 patients. A total of 31 patients had fluent aphasia, while 48 had non-fluent aphasia. Non-fluent aphasia often involved hematoma on the anterior limb of the internal capsule, while fluent aphasia often involved hematoma on the posterior limb of internal capsule. When the hematoma volume exceeded 20 mL, patients experienced difficulty in repeating spoken words. When hematoma volume exceeded 40 mL, non-fluent aphasia was observed in all patients. Conclusion: Our findings suggest that hematoma type and volume not only influence the development of aphasia following putaminal hemorrhage but also play a major role in determining the patient's fluency and repetition ability.

Background Quantification of increased muscle tone for patients with spasticity has been performed to date using various devices to replace the manual scales, such as the modified Ashworth scale or the Tardieu scale. We developed a device that could measure resistive plantar flexion (PF) torque of the ankle during passive dorsiflexion (DF) as an indicator of muscle tone of ankle plantar flexors. Methods The primary objective was to explore the test–retest intrarater reliability of a custom-built device. Participants were 11 healthy subjects (7 men, 4 women; mean age 47.0 years) and 22 patients with poststroke hemiplegia (11 hemorrhagic, 11 ischemic; 14 men, 8 women; mean age 57.2 years). The device was affixed to the ankle. Subjects were seated with knees either flexed or extended. The ankle was passively dorsiflexed from 20° of PF to more than 10° of DF at 5°/second (slow stretch) or 90°/second (fast stretch). Angle and torque were measured twice during the stretches. The intraclass correlation coefficients (ICCs) of torque at 10° of DF (T10) in the 4 conditions—slow and fast stretches with knee flexed or extended—were calculated. Results The T10 ICCs of the 4 conditions were .95-.99 in both groups. The healthy subjects showed significantly higher T10 of knee extension than of knee flexion during slow and fast stretches. The patients showed increased velocity-dependent torque during fast stretches. Conclusions Excellent reliability was observed. The device is suitable for measuring resistive PF torque during passive stretch in a flexed knee condition.

Background Dysphagia occurs frequently during the acute phase of cerebral hemorrhage; however, there are few reports of dysphagia associated with cerebral hemorrhage in the subacute and chronic phase. We focused on putaminal hemorrhage at a rehabilitation hospital and evaluated the relationships between the frequencies of dysphagia, focus, and hematoma volume and type. Methods A hundred patients with putaminal hemorrhage referred to our rehabilitation hospital were evaluated. Bedside swallowing assessments (BSAs) were conducted and results were evaluated relative to the information obtained on computed tomography imaging, including hematoma type and volume, and oral intake at the time of admission/discharge from the hospital. Results A regular diet was provided to 48 patients, dysphagia diet to 44 patients, and enteral feeding to 8 patients. There were significant feeding group differences in age, hematoma volume and type, existence of ventricle rupture, neurological manifestation, cognitive function, existence of unilateral neglect and aphasia, initial BSA, activities of daily living (ADL) score using the Functional Independence Measure at the time of admission/discharge from the hospital, and length of stay. At discharge, we provided a regular diet to 81 patients and dysphagia diet to 19 patients. Age and ADL score had the greatest influence on oral intake at the time of discharge from the hospital. Conclusion The prognosis of dysphagia caused by putaminal hemorrhage is good, with no patient requiring enteral feeding, although putaminal hemorrhage often causes dysphagia. Patient age and ADL score on admission are used to predict the residual factors of dysphagia.