Search

Background: No previous study has examined the effect of dual-task training using changes in regional cerebral blood flow (rCBF) using single-photon emission computed tomography (SPECT) as an outcome. Objective: This study aimed to examine the effects of simultaneous dual-task training of exercise and cognitive tasks on rCBF using SPECT in older adults with amnestic mild cognitive impairment (aMCI). Methods: In this non-randomized control trial, 40 older adults with aMCI participated from May 2016 to April 2018. Outpatients in the intervention group (n = 22) underwent 24 sessions (12 months) of dual-task training twice a month for 60 mins per session. Participants in the control group (n = 18) continued to have regular outpatient visits. The primary outcome was rCBF at baseline and after 12 months, which was compared in each group using the two-sample t-test. The secondary outcomes were the rate of reversion and conversion from aMCI after 12 months. Results: Of the 22 participants in the intervention group, six dropped out; therefore, 16 were included in the analysis. The intervention group showed more significant increases in rCBF in multiple regions, including the bilateral frontal lobes, compared with the control group. However, the rates of reversion or conversion from mild cognitive impairment (MCI) were not significantly different. Conclusions: Dual-task training for older adults with aMCI increased rCBF in the frontal gyrus but did not promote reversion from MCI to normal cognition. Future intervention studies, such as follow-up examinations after the intervention, are warranted to consider long-term prognosis.

Accelerations, ground reaction force data, and other quantitative data obtained from kinematic analyses of gait initiation serve as measures of dyskinesia in patients with Parkinson's disease. The objective of this study was to determine whether a separate center of pressure information could reveal new characteristics of reduced anticipatory postural adjustments in patients with Parkinson's disease.Ten healthy elderly subjects and 10 patients with Parkinson's disease participated in this study. Motions at gait initiation in response to a light signal to begin the task were analyzed. Anticipatory postural adjustments were characterized using trunk acceleration data and center of pressure displacement data.The separated center of pressure in patients with Parkinson's disease showed longer peak latency (Patients with Parkinson's disease experience asymmetry between the stance leg and stepping leg at gait initiation. These findings may help clinicians understand the changes to motor function in patients with Parkinson's disease and suggest strategies for improved rehabilitation training.

Introduction: The regional cerebral blood flow (rCBF) distribution can affect brain functioning, leading to amnestic mild cognitive impairment (aMCI) and mild Alzheimer disease (AD). This study aimed to clarify the detailed characteristics of rCBF distribution in patients with mild AD and aMCI. Methods: This cross-sectional study from April 2015 to March 2018 included 103 older adults (mean age 78.9 years; 60% females), out of a total of 302 adults, and categorized them into 3 groups according to cognitive symptoms. The normal control (NC), aMCI, and mild AD groups included 20, 50, and 33 participants, respectively. The primary outcome was rCBF, which was compared among the 3 groups using a 2-sample t test without correction for multiple comparisons. Results: In the aMCI group, the rCBF decreased in the bilateral parietal and left frontal association cortex and the bilateral premotor cortex (p < 0.01) but increased in the bilateral cerebellum (p < 0.01). In the mild AD group, the rCBF decreased in the bilateral parietal and occipital association cortex, the bilateral premotor cortex, the left temporal and frontal association cortex, and the left limbic lobe (p < 0.01). Conversely, the rCBF increased in some parts of the cerebellum, the bilateral frontal and temporal association cortex, the left occipital association cortex, and the right premotor cortex (p < 0.01). Conclusion: Based on the analysis of the values obtained, it was inferred that the rCBF undergoes reduction and elevation in aMCI and AD patients.

Background This study was focused on the gait parameters of the knee extensor and hip abductor muscle groups, which are believed to contribute to knee joint function improvement in early postoperative TKA. The associations between patient-reported outcome measures (PROMs) 6 months after total knee arthroplasty (TKA) and the early postoperative internal knee extension moment, knee extension negative joint power, and internal hip abduction moment while walking were investigated. Methods Twenty-one patients who underwent primary TKA for knee osteoarthritis were included. Three weeks after TKA, gait at a comfortable speed was measured by three-dimensional motion analysis. The lower limb joint angle, internal joint moment, and joint power parameters on the operated side while standing were calculated. The PROMs 6 months after TKA were assessed using the Japanese Knee Osteoarthritis Measure (JKOM). The relationship between each gait biomechanical parameter and the JKOM was determined. Results The maximum internal knee extension moment and maximum knee extension negative joint power during the early stance showed moderate negative correlations with the JKOM scores. The maximum internal hip abduction moment was not correlated with the JKOM scores. The maximum internal hip extension moment during the early stance and internal hip flexion moment during the late stance showed moderate negative correlations with the total JKOM scores. Conclusion The early postoperative internal knee extension moment, maximum knee extension negative joint power, and internal hip extension and flexion moment are associated with patient PROMs 6 months after TKA.

Background Pusher behavior (PB) is a posture disorder due to a subjective bias in verticality perception. However, muscle activity characteristics in this disorder and the effective treatments are not known. Objective To investigate electromyographic (EMG) activity and the effect of electrical stimulation (ES) in PB. Methods Two PB patients were enrolled. The EMG activity was measured over the upper and lower limb muscles on the non-paretic side, and over the trunk muscles on both sides during sitting. We used a modified ABA single-case design consisting of consecutive baseline, intervention, and follow-up, each phase lasting 2 d. During the intervention, together with conventional treatment, the patient received ES for 5 min/d on the muscle antagonist to the muscle where excessive activity was observed. PB was assessed before and after each phase using the scale for contraversive pushing and the Burke lateropulsion scale. Truncal balance was evaluated using the trunk control test. Results In both patients, electromyography of the non-paretic triceps brachii muscle revealed excessive activity. To inhibit the excessive activity, ES was applied to the non-paretic biceps muscle. All scores improved after the intervention and follow-up phases. Conclusion ES based on EMG activity is therapeutic for PB.

An association between respiratory muscle weakness and sarcopenia may provide a clue to the mechanism of sarcopenia development. We aimed to clarify this relationship among community-dwelling older adults. In total, 117 community-dwelling older adults were assessed and classified into 4 groups: robust, respiratory muscle weakness, sarcopenia, and respiratory sarcopenia. The respiratory sarcopenia group (12%) had a significantly higher percentage of males and had lower BMI, skeletal muscle index, skeletal muscle mass, phase angle, and oral function than the robust group (32.5%). All physical functions were significantly lower. The respiratory muscle weakness group (54.7%) had a significantly lower BMI and slower walking speed, compared with the robust group. The sarcopenia group (0.8%) was excluded from the analysis. The percent maximum inspiratory pressure was significantly lower in both the respiratory muscle weakness and respiratory sarcopenia groups, compared with the robust group. Almost all participants with sarcopenia showed respiratory muscle weakness. In addition, approximately 50% had respiratory muscle weakness, even in the absence of systemic sarcopenia, suggesting that respiratory muscle weakness may be the precursor of sarcopenia. The values indicating physical function and skeletal muscle mass in the respiratory muscle weakness group were between those in the robust and the respiratory sarcopenia groups.

Background The effects of task-specific and voluntary exercise in upright positions for pusher behavior remain unclear. In this report, we aimed to describe the effects of dynamic supported standing training using a modified standing frame to correct the alignment in a patient with severe pusher behavior. Case description A 76-year-old man with cardioembolic ischemic stroke demonstrated pusher behavior. The patient underwent 3 days of dynamic supported standing training using a modified standing frame. The Scale for Contraversive Pushing, the Burke Lateropulsion Scale, and the Trunk Control Test were used to assess changes. Outcomes Immediate improvements in sitting balance were observed after the intervention, and the effects persisted to 8 days later. Conclusion Dynamic supported standing training using a modified standing frame may improve pusher behavior with short-term training. The collapsed posture of the patient in the present case was corrected using the modified standing frame. This neutral standing position could have a positive effect on motor learning with respect to holding one's posture.

Objectives: To determine whether individual measurements of the centre of pressure for the stance and stepping legs can reveal new characteristics of reduced anticipatory postural adjustments during gait initiation in post-stroke hemiplegic patients. Methods: Subjects included 30 stroke patients and 10 healthy age-matched controls. The acceleration of the trunk, and the centre of pressure of each leg, were measured during gait initiation, 3 times each with the paretic and non-paretic legs leading. Anticipatory postural adjustments were characterized using trunk acceleration and centre of pressure displacement data. Results: Latency of the posterior displacement peak of the paretic leg centre of pressure with either the paretic or non-paretic leg leading was significantly longer in stroke patients compared with controls, and was also longer than that of the non-paretic leg. The magnitude of the posterior displacement peak of the paretic leg centre of pressure was smaller than that of the non-paretic leg. Peak latency of the paretic stepping leg centre of pressure correlated with the clinical measures of motor dysfunction, postural balance, and gait ability. Conclusion: Measurements of the latency and magnitude of centre of pressure displacement peak individually for the paretic and non-paretic legs can help elucidate the mechanism behind reduced anticipatory postural adjustments. This information will be useful in designing new treatment strategies for stroke patients. Lay Abstract Measuring the centre of pressure individually for the stance and stepping legs can reveal what happens during initiation of gait in stroke patients. The latency and magnitude of the centre of pressure displacement peak showed characteristic differences between stroke patients and control subjects, and between paretic and non-paretic legs. The peak latency of the paretic stepping leg centre of pressure correlated significantly with clinical measures of motor dysfunction, postural balance, and gait ability. These findings may contribute to the development of effective rehabilitation exercises for stroke patients.

Objective Manual ability is considered one of the factors that can predict functional independence in activities of daily living. For evaluating personal tasks such as self-care, the Pediatric Evaluation of Disability Inventory (PEDI) comprises/introduces/offers a set of useful measures that assist in enhancing the capability for self-care among children and adolescents with cerebral palsy (CP). The aim of this study was to investigate the relevant factors of self-care capability and performance in children and adolescents with spastic CP. Methods This was a cross-sectional study. Seventy-six children and adolescents with spastic CP (between 5 and 18 years of age), representing levels I to IV of the Gross Motor Function Classification System-Expanded & Revised version (GMFCS), were analyzed. Multiple linear regression analysis with forward stepwise selection was conducted to examine which determinants were related to self-care capability and performance. Independent variables were age, CP type, GMFCS, Manual Ability Classification System, Box and Block Test, and grip strength in the dominant and non-dominant hands. Dependent variables were scores for the PEDI Functional Skills Scale and the PEDI Caregiver Assistance Scale. Results Results of the multiple regression analysis showed that the PEDI Functional Skills scale scores were correlated with the Box and Block Test in the dominant hand and GMFCS (Adjusted R2 = 0.69). The PEDI Caregiver Assistance Scale scores were correlated with the Box and Block Test in the dominant hand, GMFCS, and age (adjusted R2 = 0.71). Conclusion When considering self-care of children and adolescents with spastic CP, it is necessary to consider the evaluation of upper limb dysfunction in addition to GMFCS.

Background Patient-reported outcome measures (PROMs) have recently been considered as indicating clinical outcomes after total hip arthroplasty (THA). Although various factors are reportedly associated with post-THA and PROMs, the relationship with gait parameters, which are objective assessment factors after THA, remains unclear. Research question What is the relationship between PROMs and gait biomechanical factors four weeks after THA? Methods Forty-five patients (six men and 39 women) who underwent THA were included. Three-dimensional gait analysis was performed four weeks post-THA; joint angle, internal moment, and power of the lower extremity at the first and second peaks of the vertical component of the floor reaction force were assessed for the operated side. PROMs were evaluated using the Japanese Orthopedic Association Hip Disease Evaluation Questionnaire (JHEQ). The relationship between the JHEQ score and extracted gait parameters was analyzed using gender and gait speed as control factors. Results For the JHEQ sub-domain, movement was positively correlated with the internal knee extension moment values at the first peak (r = 0.347). There was no significant correlation between JHEQ and the internal hip abduction moment value at the first peak. Mental status was negatively correlated with the hip flexion angle value at the second peak (r = −0.373), and positively correlated with the hip flexion moment value (r = 0.348). Total JHEQ scores and mental status were negatively correlated with the power of hip flexion value at the second peaks, respectively (r = −0.316, −0.444). Significance The results of this study may provide recovery guidelines to be used as an index for gait assessment in the early post-THA period. Further studies are needed to verify whether gait parameters can improve PROMs in the early post-THA period.

To investigate the intensity and effectiveness of rehabilitation in acute stroke patients according to the severity of functional impairments in them.This retrospective cohort study included 294 patients with acute hemispheric stroke admitted to three acute-care hospitals who subsequently underwent an inpatient rehabilitation program. Stroke severity was classified according to neurological deficits and trunk dysfunction. The following data were obtained from medical records: age, sex, stroke type, lesion side, hospitalization duration, initial functional status determined using the National Institutes of Health Stroke Scale, rehabilitation start date, first day out of bed after admission, total treatment duration, total number of treatment sessions, rehabilitation implementation rate between start of rehabilitation and discharge, trunk control test and Barthel Index score on the first day out of bed after admission and discharge, and post-discharge outcomes. Hierarchical cluster analysis was performed with clusters categorized using the National Institutes of Health Stroke Scale and trunk control test scores. Variables were compared using the Kruskal-Wallis test, and Dunn's nonparametric comparison test was performed for post-hoc analysis to determine differences between clusters.The National Institutes of Health Stroke Scale and trunk control test showed a significant correlation (r = -0.816, p 0.01) using which cluster analysis identified three clusters. Rehabilitation showed a ceiling effect in patients with mild stroke and a floor effect in patients with severe stroke.These results may guide the determination of rehabilitation intensity with reference to the severity of neurological deficits and trunk dysfunction.

This cohort study aimed to i) clarify the relationship between abduction of the knee joint and trunk motion during running in the stance phase, and ii) clarify the relationship between abduction of the knee joint during running in the stance phase and the amount of trunk rotation measured in a static position. Twenty-nine female collegiate middle- and long-distance runners participated. The knee abduction angle and absolute angles to the floor were calculated using a three-dimensional motion analysis device. Static trunk rotation was calculated. Trunk rotation angle to the supporting side (r = 0.525), thigh posterior tilt angle (r = -0.510), thigh adduction angle (r = 0.417), lower leg anterior tilt angle (r = -0.483), and static trunk rotation to the supporting side (r = -0.429) were significantly correlated with knee abduction angle. Trunk rotation angle to the supporting side (s = 0. 465), thigh adduction angle (s = 0.374), lower leg anterior tilt angle (s = 0.228), and static trunk rotation to the supporting side (s = -0.256) (R 2 = .556) were significantly correlated with the knee abduction angle. The increase or decrease in the knee abduction angle should consider the mutual influence of the lower limb and trunk motion.

In this study, we aim to develop a measurement system for evaluating walking ability in daily life. Health promotion is one of the most important tasks to improve quality of life and quality of community for elderly people. Disabilities related to loss of independence in performing activities of daily living can lead to their social isolation and loneliness that can induce immobility and depression, producing the vicious cycle. Various methods have been proposed to measure lower limb joint angles and positions by using wearable systems and motion capture systems. However, such systems are too expensive and big for elderly’s daily self-monitoring. This paper presents a method of lower limb joint angle estimation using a Kinect sensor. The sensor has a built-in processor to detect joint positions. However, inverse kinematics problem is required to be addressed in order to derive the joint angles. We therefore propose a hybrid approach for lower limb joint angle estimation using genetic algorithm and feed forward neural network.

It is generally accepted that proper learning of the breakfall technique during early judo training is essential for attenuating the risk of judo-related head injury. Therefore, it is critical to understand the kinematics and head injury risks of breakfall motion to design a more safe and effective judo teaching paradigm that results in reduction of injury risk. We aimed to investigate the biomechanics of judo backward breakfalls by comparing osoto-gari and ouchi-gari in novice judokas. Twelve male novice judokas (age: 21.3 years, SD = 0.6 years; height: 1.74 m, SD = 0.04 m; body weight: 71.3, SD = 6.4 kg; body mass index: 23.5, SD = 2.3) volunteered to participate in this study. The kinematic data of the breakfall motion for both osoto-gari and ouchi-gari were collected using a three-dimensional motion analysis technique (200 Hz). We observed significant differences between the movement patterns for the two techniques, especially in the lower extremity movements. In addition, a significantly greater peak extension momentum (osoto-gari: 1.29, SD = 0.23 kg m

[Purpose] The final purpose of the present study was to propose easy and quick mental rotation task. Since subjects can easily understand mental rotation task that they have to do, the task is considered to be available in particular children. However, existing mental rotation task using specific software asked subjects more than ten trials per one pictured stimulus, meaning that relatively long time is required to accurately measure. Thus, children have difficulty to keep their attention during the existing task and to demonstrate their ability accurately. To address the purpose of the present study, the performance of mental rotation task using paper was investigated whether the performance has similar characteristics to an existing mental rotation task using specific software, in order to verify the usability of the task using paper. [Subjects and Methods] Sixty-three elementary school participants were asked to determine whether a rotating hand picture was left or right as quickly as possible and indicate it by writing a diagonal line on the paper. The total time required judgment of 16 pictures and the number of judgment errors were counted. [Results] The number of judgment errors increased with an increasing stimulus rotation angle. Also, the mental rotation time improved with age. [Conclusion] These results suggest that the performance of mental rotation using paper has the same characteristics as the existing method using specific software. Therefore, the mental rotation using paper would be practical method for subjects having difficulty to keep attention relatively long time, such as elementary school children.

[Purpose] This study evaluated the effects of repetitive peripheral magnetic stimulation of the soleus muscle on spinal cord and peripheral motor nerve excitability. [Subjects and Methods] Twelve healthy adults (mean age 22 years) who provided written informed consent were administered repetitive peripheral magnetic stimulation for 10 min. Pre-and post-stimulation latencies and amplitudes of H- and M-waves of the soleus muscle were measured using electromyography and compared using paired t-tests. [Results] Pre- and post-stimulation latencies (28.3 ± 3.3 vs. 29.1 ± 1.3 ms, respectively) and amplitudes (35.8 ± 1.3 vs. 35.8 ± 1.1 mV, respectively) of H-waves were similar. Pre-stimulation latencies of M-waves were significantly higher than post-stimulation latencies (6.1 ± 2.2 vs. 5.0 ± 0.9 ms, respectively), although pre- and post-stimulation amplitudes were similar (12.2 ± 1.4 vs. 12.2 ± 1.3 mV, respectively). Motor neuron excitability, based on the excitability of motor nerves and peripheral nerve action, was increased by M-waves following magnetic stimulation. [Conclusion] The lack of effect of magnetic stimulation on the amplitude and latency of the H-reflex suggests that magnetic stimulation did not activate sensory nerve synapses of α motor neurons in the spinal cord. However, because motor nerves were stimulated together with sensory nerves, the increased H-wave amplitude may have reflected changes in peripheral rather than in α motor nerves.

[Purpose] This study examined characteristics of dynamic standing balance, with an without an insole, in patients with spastic diplegia cerebral palsy (CP). [Participants and Methods] This cross-sectional study used a crossover design. Eleven patients with spastic diplegia CP and gross motor levels between I and III with spastic diplegia CP (according to the Gross Motor Function Classification System expanded and revised version) were randomly allocated to either the barefoot or insole groups. The Index of postural stability (IPS) was evaluated while each patient was barefoot and while wearing insoles. The Pediatric Evaluation of Disability Inventory (PEDI) was used to measure functional self-care and mobility domains. [Results] While wearing the insoles, the center movement distance between right and left positions was significantly higher. While barefoot, IPS and area of postural sway correlated with the PEDI subscales for mobility and self-care. [Conclusion] Insoles promote standing balance and dynamic balance to move the center of pressure within the base of support. Such improvements may enhance activities of daily living in patients with spastic diplegia CP.

Previous studies suggest that increasing the skill level of judokas will decrease the number of head injuries sustained during judo. However, the kinematics are poorly understood, making it difficult to establish an effective breakfall teaching programme. Therefore, we studied the kinematic parameters of breakfall for osoto-gari to identify the risk of judo-related head injuries by comparing experienced and novice judokas. This information will provide insight into developing a better prevention plan for judo-related head injuries. A total of 10 experienced and 12 novice judokas volunteered to participate in this study. The kinematic data of the breakfall motion for osoto-gari were collected using a three-dimensional motion analysis technique (200 Hz). We observed a significantly higher peak neck extension momentum in the novice group than in the experienced group. This suggests that neck extension momentum during breakfall is associated with the risk of head injuries during judo. In addition, the novice judokas demonstrated a significantly greater flexed pattern in the trunk and hip movement than the experienced judokas (P 0.05). The results suggest that the trunk and lower extremity motion are important kinematic parameters that determine the skill level in performing the breakfall for osoto-gari.

[Purpose] The aim of this study was to translate the Selective Control Assessment of the Lower Extremity (SCALE) tool from English to Japanese and to assess the reliability and validity of the Japanese version of the SCALE (SCALE-J) tool in Japanese patients with spastic cerebral palsy. [Subjects and Methods] The SCALE tool was translated into Japanese in accordance with the published guidelines. In total, 55 patients with spastic cerebral palsy were enrolled in the present study. Reliability by internal consistency (Cronbach's α), intrarater reliability, inter-rater reliability, and convergent validity by comparing Gross Motor Function Classification System (GMFCS) scores were examined. [Results] The Cronbach's α value of the SCALE-J tool was 0.97-0.98, whereas that of the intrarater and inter-rater reliability ranged from 0.93 to 0.96. The Spearman correlation coefficient revealed a good relationship between the SCALE tool and the GMFCS. [Conclusion] The SCALE-J tool was found to be reliable and valid; therefore, the SCALE tool may be useful for evaluation in clinical practice.