著者

Ryo Momosaki Shoji Kinoshita Wataru Kakuda Naoki Yamada Masahiro Abo

出版者

徳島大学医学部

雑誌

The Journal of Medical Investigation (ISSN:13431420)

巻号頁・発行日

vol.63, no.3.4, pp.153-158, 2016 (Released:2016-09-17)

参考文献数

26

被引用文献数

8

---

The purpose of this study was to review the best available evidence of noninvasive brain stimulation, including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) for dysphagia after acquired brain injury. We searched randomized controlled trials that compared noninvasive brain stimulation with control used to improve dysphagia after acquired brain injury. We assessed dysphagia severity rating scales and penetration-aspiration scale as outcomes immediately after intervention. We calculated the pooled estimate of the standardized mean difference (SMD) to combine individual results. We included 8 published studies. Two heterogenous trials of 48 patients showed that rTMS was associated with a significant improvement in the dysphagia severity rating scale score (SMD 2.95). Three homogeneous trials of 88 patients showed a significant effect of rTMS on the penetration-aspiration scale score (SMD 0.77). Two homogeneous trials of 34 patients showed that tDCS was associated with a significant improvement in the dysphagia severity rating scale score (SMD 1.20). The review provided low-quality evidence for the effectiveness of noninvasive brain stimulation in improving dysphagia after acquired brain injury. Further trials of larger sample sizes are needed to determine the most appropriate noninvasive brain stimulation protocol. J. Med. Invest. 63: 153-158, August, 2016

著者

Takashi Asakawa Mieko Ogino Naomi Tominaga Naoto Ozaki Jin Kubo Wataru Kakuda

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.8, pp.20230035, 2023 (Released:2023-10-03)

参考文献数

32

---

Objectives: One of the causes of death in patients with multiple system atrophy (MSA) is aspiration pneumonia caused by cough dysfunction. This study aimed to identify an effective approach to improve coughing and to explore the establishment of criteria for the use of gastrostomy based on cough and respiratory dysfunctions.Methods: Eighteen probable MSA patients participated in the study. They were categorized into air stacking and non-air stacking groups. First, we investigated how the inspiration volume changes by applying maximum insufflation capacity (MIC). Second, peak cough flow (PCF) was measured by different cough augmentation methods: 1) spontaneous coughing (SpC); 2) SpC with MIC (SpC + MIC); 3) SpC with manually assisted cough (MAC) (SpC + MAC); and 4) SpC with MIC and MAC (SpC + MIC + MAC). Among these four conditions, PCF values were compared to determine the most effective approach for cough augmentation. Receiver operating characteristic analysis was performed on percent forced vital capacity (%FVC) to determine an index for discriminating PCF below160 L/min, which indicates a high risk of suffocation, involving SpC and SpC + MIC.Results: Inspiration volume increased significantly with MIC in both groups (P < 0.05), and PCF increased significantly with MIC in the air stacking group (P < 0.01). PCF could not be maintained at 160 L/min when %FVC fell below 59%, even when MIC was applied.Conclusions: PCF increases with MIC in patients with MSA. It may be meaningful to consider the timing of gastrostomy introduction based on the severity of cough and respiratory dysfunction.

著者

Tomohiro Kakehi Masashi Zenta Takuya Ishimori Naoki Tamura Hiromu Wada Masahiko Bessho Wataru Kakuda

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.8, pp.20230046, 2023 (Released:2023-12-29)

参考文献数

44

---

Objectives: To evaluate caregivers’ fear of post-fracture patients falling, we previously developed the Caregivers’ Fear of Falling Index (CFFI). In this study, we investigated the relationship between patient performance in activities of daily living (ADLs) and CFFI.Methods: We surveyed 55 patients receiving home-visit rehabilitation after fall-related fracture and their primary caregivers. Participants (patient and caregiver pair) were divided into two groups based on patient performance in basic ADLs (BADLs) and instrumental ADLs (IADLs). ROC analysis was conducted to assess the usefulness of CFFI and Falls Efficacy Scale-International (FES-I) in determining declines in performance in BADLs and IADLs. Multivariate logistic regression analysis was performed to examine the association between CFFI and declining performance in BADLs and IADLs.Results: ROC analysis showed that CFFI exhibited a higher accuracy than FES-I (AUC: 0.73 in BADLs, 0.77 in IADLs) as an indicator of reduced ADL performance. Multivariate logistic analysis adjusted for age, sex, and physical function showed that CFFI was associated with a decline in patients’ performance in IADLs (odds ratio, 0.92; 95% confidence interval, 0.85–0.99).Conclusions: Caregivers’ fear of post-fracture patients falling was associated with a decline in patients’ performance in IADLs. These findings may serve as a guide for supporting caregivers of post-fracture patients.

著者

Tsuyoshi Hara Eisuke Kogure Akira Kubo Wataru Kakuda

出版者

The Society of Physical Therapy Science

雑誌

Journal of Physical Therapy Science (ISSN:09155287)

巻号頁・発行日

vol.33, no.3, pp.299-306, 2021 (Released:2021-03-17)

参考文献数

30

---

[Purpose] This study aimed to evaluate the effectiveness of pre-operative physical rehabilitation on the postoperative course of the patients with gastrointestinal cancer undergoing surgery. [Participants and Methods] A rehabilitation physician examined and educated 33 patients (42% of whom were male with a mean age of 65.2 ± 10.9 years) who were scheduled to undergo elective surgery for gastrointestinal cancer. They received instructions for performing exercise from a physical therapist 17.0 ± 7.3 days prior to surgery. We divided the participants into three groups (improvement, maintenance, and deterioration) based on the changes in their ability to walk prior to surgery. This study compared the results of the 6-min walk test, hospital anxiety and depression scale, and 36-Item Short-Form Health Survey version 2 for the three groups at baseline, following rehabilitation prior to surgery, and 4 weeks following surgery. [Results] In the improvement group, the decrease in the ability to walk between the baseline and 4 weeks after surgery was not significant. Conversely, the deterioration group exhibited a significant decrease in the ability to walk 4 weeks after surgery. [Conclusion] Improvement in walking ability by rehabilitation training prior to surgery leads to the preservation of physical function in the patients with gastrointestinal cancer undergoing surgery.

著者

Yasuhisa Fukawa Wataru Kakuda Seiya Yoshida Masashi Zenta Osamu Itano Risa Kiko Hiroaki Tani Akira Kubo

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.4, pp.20190005, 2019 (Released:2019-02-06)

参考文献数

20

被引用文献数

2

---

Background: The clinical importance of postoperative rehabilitation for cancer patients has recently attracted much attention. However, it remains uncertain whether early rehabilitation can prevent infectious complications in patients undergoing gastrointestinal cancer surgery. Methods: The study group consisted of 259 patients who underwent laparoscopic or open surgery for gastrointestinal cancer at our institution between December 2012 and November 2016. Our department proposed a new early rehabilitation protocol for such patients to encourage physical activity after surgery. The protocol was clinically introduced on July 21, 2015. We divided the study subjects into two groups: those who were admitted before the introduction of the new protocol and those admitted after. The frequency of infectious complications, including respiratory infections, and the length of hospital stay after surgery were compared between the two groups. Results: No adverse cardiovascular event associated with the early rehabilitation protocol was experienced. After the protocol was introduced, more than 80% of patients started exercising on the first day after surgery. For patients undergoing open surgery, the frequency of infectious complications was significantly reduced with the introduction of the protocol (p<0.05). Moreover, when open surgery was performed, the protocol significantly shortened the length of hospital stay (p<0.05). Conclusion: Our proposed early rehabilitation protocol for patients who have undergone gastrointestinal cancer surgery was considered to be safe and feasible. The protocol may prevent infectious complications and shorten the hospital stay after such surgery.

著者

Wataru Kakuda Ryo Momosaki Naoki Yamada Masahiro Abo

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.55, no.23, pp.3515-3519, 2016-12-01 (Released:2016-12-01)

参考文献数

20

被引用文献数

2 11

---

Structural and functional abnormalities of the prefrontal cortex seem to correlate with fatigue in patients with chronic fatigue syndrome (CFS). We consecutively applied facilitatory high-frequency repetitive transcranial magnetic stimulation (rTMS) to the dorsolateral prefrontal cortex (DLPFC) of seven CFS patients over three days. Five patients completed the 3-day protocol without any adverse events. For the other two patients, we had to reduce the stimulation intensity in response to mild adverse reactions. In most of the patients, treatment resulted in an improvement of fatigue symptoms. High-frequency rTMS applied over the DLPFC can therefore be a potentially useful therapy for CFS patients.