著者
Yoshihiro Yoshimura Takahiro Bise Fumihiko Nagano Sayuri Shimazu Ai Shiraishi Makio Yamaga Hiroaki Koga
出版者
The Japanese Association of Rehabilitation Medicine
雑誌
Progress in Rehabilitation Medicine (ISSN:24321354)
巻号頁・発行日
vol.3, pp.20180011, 2018 (Released:2018-05-18)
参考文献数
53
被引用文献数
1 18

Objective: The aim of our study was to investigate how systemic inflammation relates to sarcopenia and its impact on functional outcomes in the recovery stages of stroke. Methods: A retrospective cohort study was performed in consecutive patients admitted to convalescent rehabilitation wards following stroke. Patients with acute or chronic high-grade inflammatory diseases were excluded. Systemic inflammation was evaluated using the modified Glasgow Prognostic Score (mGPS). Sarcopenia was defined as a loss of skeletal muscle mass and decreased muscle strength, with the cut-off values set by the Asian Working Group for Sarcopenia. The primary outcome was the motor domain of the Functional Independence Measure (FIM-motor). Univariate and multivariate analyses were used to determine whether mGPS was associated with sarcopenia and FIM-motor at discharge. Results: The study included 204 patients (mean age 74.1 years, 109 men). mGPS scores of 0, 1, and 2 were assigned to 149 (73.0%), 40 (19.6%), and 13 (6.4%) patients, respectively. Sarcopenia was diagnosed in 81 (39.7%) patients and was independently associated with stroke history (odds ratio [OR] 1.890, P=0.027), premorbid modified Rankin scale (OR 1.520, P=0.040), body mass index (OR 0.858, P=0.022), and mGPS score (OR 1.380, P=0.021). Furthermore, the mGPS score was independently associated with sarcopenia (OR 1.380, P=0.021) and FIM-motor at discharge (β=−0.131, P=0.031). Conclusion: Systemic inflammation is closely associated with sarcopenia and poor functional outcomes in the recovery stage of stroke. Early detection of systemic inflammation and sarcopenia can help promote both adequate exercise and nutritional support to restore muscle mass and improve post-stroke functional recovery.
著者
Tomoko Sakai Chisato Hoshino Masanobu Hirao Reiko Yamaguchi Rui Nakahara Atsushi Okawa
出版者
The Japanese Association of Rehabilitation Medicine
雑誌
Progress in Rehabilitation Medicine (ISSN:24321354)
巻号頁・発行日
vol.6, pp.20210013, 2021 (Released:2021-03-04)
参考文献数
18

Objectives: The aim of the study was to describe the characteristics and efficiency of rehabilitation for patients diagnosed with moderate-to-severe coronavirus disease (COVID-19).Methods: We retrospectively assessed the medical records of patients with COVID-19 who underwent rehabilitation for early mobilization and to maintain activities of daily living at our hospital between April 21 and August 20, 2020. The following patient data were evaluated: age, sex, diseases, and the total number of sessions completed by patients with severe COVID-19 in the intensive care unit (ICU) and by patients with moderate disease in the general COVID-19 wards. The number of daily sessions performed by physiotherapists was also evaluated.Results: Of 161 patients with COVID-19 admitted during the study period, 95 underwent rehabilitation (78 in the general COVID-19 wards and 17 in the ICU). These 95 COVID-19 patients completed 1035 rehabilitation sessions in total (882 in the general ward and 153 in the ICU). Polymerase chain reaction test results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were positive for 79 patients on the initiation of rehabilitation. Moreover, 86 sessions were supervised remotely, thereby reducing the duration of the medical staff’s stay in the SARS-CoV-2 isolation area. Patients with COVID-19 in the ICU received significantly more daily physiotherapy sessions than general ward patients (P<0.001). Each physiotherapist performed, on average, 4.6 sessions daily, with 4.3 daily sessions being performed wearing personal protective equipment (PPE).Conclusions: COVID-19 rehabilitation required more efforts as wearing PPE was necessary for most cases although tried with remote rehabilitation in some cases. Overall, a longer rehabilitation period was needed for ICU patients.
著者
Yumi Yamada Hiroshi Shamoto Keisuke Maeda Hidetaka Wakabayashi
出版者
The Japanese Association of Rehabilitation Medicine
雑誌
Progress in Rehabilitation Medicine (ISSN:24321354)
巻号頁・発行日
vol.3, pp.20180019, 2018 (Released:2018-11-20)
参考文献数
18
被引用文献数
1

Background: Sarcopenic dysphagia is caused by decreased muscle mass and muscle weakness in the swallowing muscles that occurs because of sarcopenia. The key to treating sarcopenic dysphagia is combined therapy with rehabilitation and aggressive nutrition management. However, to our knowledge, no studies based in a home medical care setting have yet been published. Case: A 72-year-old man with Parkinson’s disease developed sarcopenia and possible sarcopenic dysphagia during hospitalization for drug adjustment. At discharge, the patient’s body weight was 39.0 kg (−33.8%/4 months, body mass index: 15.3 kg/m2), the Barthel Index was 45, Functional Oral Intake Scale was level 4, and Dysphagia Severity Scale was 4. Sarcopenia was confirmed by a calf circumference of 23.8 cm, a handgrip strength of 22 kg, and a gait speed of 0.5 m/s. The patient was diagnosed with sarcopenic dysphagia, according to the consensus diagnostic criteria for sarcopenic dysphagia. After the patient was discharged, he underwent a combination of dysphagia rehabilitation, daily activity training, and aggressive nutrition management, which started from 1200 kcal/day and reached a maximum of 2800 kcal/day. Four months after discharge, the patient’s swallowing function returned to normal (Functional Oral Intake Scale: 7, Dysphagia Severity Scale: 6) and his weight increased by 31% (body mass index: 20.1 kg/m2). Increases in muscle mass (calf circumference: 32 cm), muscle strength (handgrip strength: 34 kg), physical function (gait speed: 1 m/s), and activities of daily living (Barthel Index: 90) indicated recovery from sarcopenia. Discussion: Sarcopenic dysphagia may be a complication of Parkinson’s disease, and home-based combined therapy with rehabilitation and aggressive nutrition management may be effective for treating this condition.
著者
Masahiro Iwakura Masahiko Wakasa Kazuki Okura Atsuyoshi Kawagoshi Keiyu Sugawara Hitomi Takahashi Takanobu Shioya
出版者
The Japanese Association of Rehabilitation Medicine
雑誌
Progress in Rehabilitation Medicine (ISSN:24321354)
巻号頁・発行日
vol.6, pp.20210008, 2021 (Released:2021-02-06)
参考文献数
29

Objectives: We aimed to identify the quadriceps muscle strength (QMS) thresholds below which exercise capacity is compromised in men with chronic obstructive pulmonary disease (COPD).Methods: We measured the quadriceps isometric maximum voluntary contraction (QMVC) and calculated the QMVC values normalized to weight (QMVC-BW), height squared (QMVC-H2), and body mass index (QMVC-BMI) in 113 patients with COPD. The functional exercise capacity was evaluated using the 6-minute walk distance (6MWD), and 6MWD <350 m was defined as functional exercise intolerance. Thresholds were determined for QMVC and its normalized values to achieve high specificity (>0.90) with maximal sensitivity. P-values <0.01 were considered statistically significant.Results: Data from 99 male patients (age, 74 ± 6 years; percentages of predicted forced expiratory volume in 1-s, 56.9 ± 26.4%) were analyzed; 3 women and 11 participants with the missing data were excluded. Multivariate logistic regression models identified significant associations of QMVC and QMVC-H2 with 6MWD, after adjustment for age and dyspnea. C-statistics showed that the area under the curves of all QMVC parameters were comparable. The thresholds of QMVC and QMVC-H2 for predicting compromised exercise capacity were 26.2 kg and 9.6 kg/m2, respectively.Conclusions: QMS thresholds in men with COPD could help clinicians evaluate whether QMS is insufficient to achieve 6MWD ≥350 m and thereby identify patients who should be specifically targeted for muscle strengthening training during their pulmonary rehabilitation program.
著者
Kyohei Omon Masahiko Hara Hideo Ishikawa
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.20190011, 2019 (Released:2019-05-31)
参考文献数
18
被引用文献数
2

Background: Virtual reality (VR) technology has been recently introduced in a variety of clinical settings, such as physical, occupational, cognitive, and psychological rehabilitation or training. However, the clinical efficacy of VR rehabilitation compared with traditional training techniques remains to be elucidated. Case: A 90-year-old man underwent VR-guided, dual-task, body trunk balance training in the sitting position using a newly developed medical device (mediVR KAGURA, mediVR, Inc., Toyonaka, Japan) after his physical activity level had plateaued. The patient had difficulty in walking outside the hospital even after having undergone traditional physical training. VR-guided training was performed for 40 min every weekday for 2 weeks. Trunk balance training was performed using reaching tasks, and cognitive stimulation was designed to emulate the cognitive processing involved when walking in a city or town. After the VR-guided training, the patient’s 6-min walk distance improved from 430 m to 500 m even though there had been no improvement in muscle strength of the lower extremities. Furthermore, the patient could successfully walk outside the hospital without falling or colliding with obstacles. Discussion: It is noteworthy that the patient’s walking ability improved further by the addition of VR-guided, dual-task, trunk balance training carried out in the sitting position. This finding suggests several possible new approaches to overcoming walking disability. Walking requires lower-extremity muscle strength, postural balance, and dual-task processing. Currently, no effective quantitative methods have been identified for postural balance and dual-task training with the patient in the sitting position. Herein, we discuss the possible advantages of VR-guided rehabilitation over traditional training methods.
著者
Yuki Choji Ryuji Kobayashi
出版者
The Japanese Association of Rehabilitation Medicine
雑誌
Progress in Rehabilitation Medicine (ISSN:24321354)
巻号頁・発行日
vol.5, pp.20200001, 2020 (Released:2020-01-30)
参考文献数
35

Objective: The success of a client-centred practice depends on the relationship between the client and therapist and on their ability to make constructive decisions together, particularly in the field of occupational therapy. The aim of this study was to develop a Occupational Therapy Collaborative Relationship Scale (OTCRS) to measure the quality of such interaction. Methods: This work included constructing a draft questionnaire and testing its validity and reliability. A Rasch analysis was applied to determine its validity, and several tests were used to confirm its internal consistency. Results: After reviewing more than 130 scientific papers and books, we built explicit selection criteria for issues to be addressed in this instrument, and we developed 40 questions to be included. These were analysed using a standard content validation process and a Rasch analysis to examine confirmation validity. A nine-item scale was finalised for testing (OTCRS-9). This review process revealed the validity, high internal consistency, and item/person separation reliability of OTCRS-9. Conclusion: This study presents only the initial phase of scale development. As suggested by the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN), the OTCRS-9 score should be tested further for validity and reliability and should also be conducted in subjects of other ethnicities to improve its generalizability.
著者
Masako Kishima Hidetaka Wakabayashi Hideaki Kanazawa Masataka Itoda Toshio Nishikimi
出版者
The Japanese Association of Rehabilitation Medicine
雑誌
Progress in Rehabilitation Medicine (ISSN:24321354)
巻号頁・発行日
vol.3, pp.20180020, 2018 (Released:2018-12-11)
参考文献数
12

Background: Dysphagia occurs often after oral cancer surgery. However, no case of dysphagia in combination with cerebral hemorrhage, tongue defect, and sarcopenia has been reported. We describe the case of a 70-year-old man with dysphagia associated with a cerebral hemorrhage, tongue defect, and sarcopenia who received rehabilitation nutrition and underwent glottal closure. Case: At age 48 years, the patient had the left part of his tongue removed because of cancer. Twenty-two years later, he developed dysphagia and right hemiplegia after a cerebral hemorrhage. The patient was diagnosed with sarcopenia based on a low left handgrip strength (10 kg) and reduced calf circumference (26.5 cm). The patient’s Functional Oral Intake Scale (FOIS) score was 1, and his tongue muscle mass indicated atrophy, making the maximum tongue pressure difficult to measure. Palatal augmentation prostheses (PAP) were made to increase swallowing and tongue pressures, and nutritional intake was changed from nasal tube feeding to a gastric fistula. Nutritional intake was increased to 2400 kcal/day and protein intake to 96 g/day. Although rehabilitation nutrition using PAP improved the patient’s nutritional status, the dysphagia did not improve, and therefore he underwent glottal closure. This resulted in a weight gain of 13.7 kg and increased tongue muscle strength and volume. The patient’s FOIS score increased to 7 (i.e., total oral diet with no restrictions) at 5 months after discharge. Discussion: Glottic closure surgery may be useful for improving oral ingestion, nutritional status, and activities of daily living.Background: Dysphagia occurs often after oral cancer surgery. However, no case of dysphagia in combination with cerebral hemorrhage, tongue defect, and sarcopenia has been reported. We describe the case of a 70-year-old man with dysphagia associated with a cerebral hemorrhage, tongue defect, and sarcopenia who received rehabilitation nutrition and underwent glottal closure. Case: At age 48 years, the patient had the left part of his tongue removed because of cancer. Twenty-two years later, he developed dysphagia and right hemiplegia after a cerebral hemorrhage. The patient was diagnosed with sarcopenia based on a low left handgrip strength (10 kg) and reduced calf circumference (26.5 cm). The patient’s Functional Oral Intake Scale (FOIS) score was 1, and his tongue muscle mass indicated atrophy, making the maximum tongue pressure difficult to measure. Palatal augmentation prostheses (PAP) were made to increase swallowing and tongue pressures, and nutritional intake was changed from nasal tube feeding to a gastric fistula. Nutritional intake was increased to 2400 kcal/day and protein intake to 96 g/day. Although rehabilitation nutrition using PAP improved the patient’s nutritional status, the dysphagia did not improve, and therefore he underwent glottal closure. This resulted in a weight gain of 13.7 kg and increased tongue muscle strength and volume. The patient’s FOIS score increased to 7 (i.e., total oral diet with no restrictions) at 5 months after discharge. Discussion: Glottic closure surgery may be useful for improving oral ingestion, nutritional status, and activities of daily living.
著者
Masahiko Hara Tetsuhisa Kitamura Yuichiro Murakawa Kyosuke Shimba Shimpei Yamaguchi Masatake Tamaki
出版者
The Japanese Association of Rehabilitation Medicine
雑誌
Progress in Rehabilitation Medicine (ISSN:24321354)
巻号頁・発行日
vol.3, pp.20180016, 2018 (Released:2018-10-24)
参考文献数
27
被引用文献数
2

Objective: The ability to walk is one of the most important basic functional activities of daily living, and the number of patients with walking disability who need rehabilitation is increasing worldwide. The purpose of this first-in-man study was to evaluate the safety and feasibility of an off-label, tailor-made, dual-task rehabilitation program for body trunk balance using the mediVR01 system (mediVR, Inc. Osaka, Japan), which incorporates virtual reality (VR) and three-dimensional tracking technologies. Methods: We prospectively enrolled 31 healthy volunteers to take part in the trial (Trial Registration UMIN000029659). After an assessment of body trunk balance, a tailor-made, dual-task, rehabilitation training program lasting 10–15 min was provided. The primary endpoint was the postprocedural number of simulator sickness questionnaire (SSQ) symptoms. The secondary endpoints were adverse events and satisfaction with the program. Results: The median age of participants was 68 years, with 67.7% being elderly (>65 years) and 54.8% being male. The number of SSQ symptoms immediately after the rehabilitation programs significantly increased from 0 (interquartile range 0–0) to 0 (0–1.5) (P=0.009), with a significant difference between the young and elderly participants (P-interaction<0.001). The most frequent symptom was sweating (22.6%), followed by fatigue (19.4%). All participants successfully completed the rehabilitation programs without significant adverse events such as fall or injuries. Moreover, all participants considered the VR rehabilitation programs to be enjoyable, and 93.5% of participants reported a sense of achievement. Group attendance was associated with higher levels of satisfaction (P=0.049). Conclusion: The tailor-made, dual-task rehabilitation training programs for body trunk balance using VR and three-dimensional tracking technologies were safe and feasible even for elderly participants.
著者
小口 和代 才藤 栄一 水野 雅康 馬場 尊 奥井 美枝 鈴木 美保
出版者
The Japanese Association of Rehabilitation Medicine
雑誌
リハビリテーション医学 (ISSN:0034351X)
巻号頁・発行日
vol.37, no.6, pp.375-382, 2000-06-18 (Released:2009-10-28)
参考文献数
19
被引用文献数
67 78

機能的嚥下障害スクリーニング法として,「反復唾液嚥下テスト」(the Repetitive Saliva Swallowing Test: RSST)を考案した.30秒間の平均空嚥下回数は若年者(N=30)で7.4回,高齢者(N=30)で5.9回,30秒間の平均人工唾液嚥下回数は若年者で7.7回,高齢者で6.2回であった.空嚥下,人工唾液嚥下ともに高齢者は若年者より有意に嚥下回数が少なかった.一方,若年者,高齢者それぞれの空嚥下と人工唾液嚥下の嚥下回数には有意差を認めなかった.嚥下運動の確認は喉頭挙上の触診で可能であった.高齢者の積算嚥下時間(検査開始から嚥下完了時点までの時間)上限より,RSST 2回/30秒間以下が嚥下障害のスクリーニング値として設定できた.
著者
Tomoko Sakai Chisato Hoshino Atsushi Okawa Kenji Wakabayashi Hidenobu Shigemitsu
出版者
The Japanese Association of Rehabilitation Medicine
雑誌
Progress in Rehabilitation Medicine (ISSN:24321354)
巻号頁・発行日
vol.5, pp.20200016, 2020 (Released:2020-07-29)
参考文献数
26

Objective: The aim of this study was to investigate the effect and risk management of early mobilization in the intensive care unit (ICU) with multidisciplinary collaboration and daily goal planning.Methods: Rehabilitation of ICU patients in our hospital between April 1, 2019, and September 30, 2019, was investigated retrospectively. The following factors were evaluated: age and sex of the subjects; diseases; the total number of early mobilization therapy sessions done at a lowered goal level; the clinical course of the step-down sessions; reasons for lowering goal levels that corresponded to the cancellation criteria from the officially issued guidelines of the Japanese Association of Rehabilitation Medicine, the expert consensus on ICU, or other reasons for step down; and the rate of planned goals that were achieved.Results: Of the 1908 overall rehabilitation sessions carried out during the period of investigation, 9.6% had the planned level lowered; changes in vital signs accounted for 54.6% of the reasons for lowering the level. Of the step-down sessions, 92.3% corresponded with the cancellation criteria of rehabilitation. Early mobilization in the ICU in accordance with daily goal planning via collaboration within the multidisciplinary team during rounds was accomplished in 90.4% of sessions. No serious mobilization-related adverse events were noted during the study period.Conclusion: Early mobilization should be performed with daily goal planning by a multidisciplinary team during rounds and should be governed by the cancellation criteria of rehabilitation.
著者
大高 洋平 里宇 明元 宇沢 充圭 千野 直一
出版者
The Japanese Association of Rehabilitation Medicine
雑誌
リハビリテーション医学 (ISSN:0034351X)
巻号頁・発行日
vol.40, no.6, pp.374-388, 2003-06-18 (Released:2009-10-28)
参考文献数
72
被引用文献数
9 8

Fall prevention is one of the major issues in health care in our aging society. The aim of this review is to provide useful information for researchers and practitioners who plan to start fall prevention programs for elderly persons with various risk levels and in different settings. Fifty-three randomized controlled trials (RCTs) and several meta-analyses retrieved with extensive literature search formed the basis for this review. Available evidence suggests that several preventive strategies have been proven beneficial in fall prevention. For the community-dwelling elderly, two RCTs and one meta-analysis demonstrated that an individually tailored home exercise program provided by nurses or physical therapists could reduce the rate of falls and injuries. One RCT suggested that Tai Chi Chuan might have a high potential to reduce falls. Two large RCTs indicated that programs including group exercise classes could also reduce the number of fallers. For people with known risk factors living in the community, three RCTs showed that home visits to address multiple risk factor modification were an effective way to reduce falls. One RCT with a relatively small sample showed that psychotropic withdrawal reduced falls in elderly persons taking psychotropic medication. A subgroup analysis of one RCT showed that home hazard reduction at hospital discharge reduced subsequent falls in patients with a past history of falls. However, more evidence is needed to prove its effectiveness, because this effect was also observed outside of homes. Dual chamber pacemaker for elderly persons with hypersensitive carotid sinus, who were detected when investigated for undiagnosed falls, markedly reduced subsequent falls with or without syncope. In institutional settings, two RCTs showed that comprehensive risk assessment and modification reduced the rate of falls and fractures or the number of recurrent fallers. Three RCTs performed in hospital settings failed to show any effectiveness. However, a meta-analysis of 3 controlled trials and 7 cohort studies with a historical control suggested that fall prevention program in hospitals could be promising. There are some methodological problems in fall prevention research such as the definition, measures, and monitoring method of falls, inadequate sample size and a short follow-up period. In the future, we need research based on strong and comprehensive methodological designs.
著者
Akihisa Watanabe Qana Ono-matsukubo Tomohiko Nishigami Toshiki Maitani Akira Mibu Takahiko Hirooka Hirohisa Machida
出版者
The Japanese Association of Rehabilitation Medicine
雑誌
Progress in Rehabilitation Medicine (ISSN:24321354)
巻号頁・発行日
vol.6, pp.20210019, 2021 (Released:2021-04-14)
参考文献数
45

Objectives: Subacromial pain syndrome is a common problem in primary care. Although several randomized controlled trials have shown that eccentric exercise is effective in patients with subacromial pain syndrome, its generalizability to real-world clinical practice is unknown. This study aimed to investigate, using propensity score analysis, the generalizability of eccentric exercise for patients with subacromial pain syndrome to real-world daily clinical practice.Methods: In this study, 78 patients underwent eccentric exercise in addition to traditional exercise, and 77 patients underwent only traditional exercise for 4 weeks. Outcomes measured using a visual analog scale (VAS) and American Shoulder and Elbow Surgeons Society Standardized Shoulder Assessment Form (ASES) scores were assessed at baseline and at 4 weeks.Results: In the propensity score-matched analysis, 65 patients in each group were successfully matched (130 of 155 patients, 84% overall). After 4 weeks of exercise, pain intensity was lower in the eccentric exercise group than in the traditional exercise group (VAS −14.5, 95% CI −21.2 to −7.9, P<0.001). No significant difference in the improvement in function was found between the two groups (ASES 4.1, 95% CI −2.0 to 10.2, P=0.18).Conclusions: Eccentric and traditional exercise in combination could reduce pain in patients with subacromial pain syndrome to a greater extent than traditional exercise alone. These findings have clinical relevance to primary care practitioners who provide conservative treatment for patients with subacromial pain syndrome.
著者
Emily Suzuki Tomoko Sakai Chisato Hoshino Masanobu Hirao Reiko Yamaguchi Rui Nakahara
出版者
The Japanese Association of Rehabilitation Medicine
雑誌
Progress in Rehabilitation Medicine (ISSN:24321354)
巻号頁・発行日
vol.5, pp.20200018, 2020 (Released:2020-08-13)
参考文献数
24
被引用文献数
1

Objective: The aim of this study was to describe the clinical characteristics of coronavirus disease (COVID-19) patients, including risk factors for deep vein thrombosis and pulmonary embolism, and to evaluate the need for rehabilitation to prevent pulmonary embolism.Methods: A retrospective medical record review was conducted of patients admitted to the study hospital with COVID-19 between April 2 and April 23, 2020. The clinical characteristics and blood test results of patients with no history on admission of oral anticoagulant use were evaluated to assess the importance of inflammation and clotting function as risk factors for pulmonary embolism.Results: A total of 51 patients with COVID-19 were admitted during the study period. Their median age was 54.0 years (range: 41–63 years) and 38 of 51 (74.5%) were men. The most common comorbidities in men were diabetes (9/38, 23.7%) and hypertension (13/38, 34.2%). On admission, white blood cell counts were normal in both sexes, whereas C-reactive protein and hemostatic marker levels, except for the activated partial thromboplastin time, were significantly higher in men. Moreover, C-reactive protein and hemostatic marker levels were significantly higher in patients that required invasive ventilation. Two patients were diagnosed with acute pulmonary embolism, neither of whom required invasive ventilation.Conclusions: Hypercoagulability and hyperinflammation were observed in COVID-19 patients, especially in men with high oxygen demand. We recommend anticoagulant therapy and early rehabilitation intervention to prevent pulmonary embolism in COVID-19 patients.
著者
Kiyoshi Yoshioka Tatsunori Watanabe Mizuki Yoshioka Keita Iino Kimikazu Honda Koshiro Hayashida Yuji Kuninaka
出版者
The Japanese Association of Rehabilitation Medicine
雑誌
Progress in Rehabilitation Medicine (ISSN:24321354)
巻号頁・発行日
vol.5, pp.20200009, 2020 (Released:2020-04-17)
参考文献数
19

Objective: This study aimed to characterize reaching movements of the paretic arm in different directions within the reachable workspace in post-stroke patients. Methods: A total of 12 post-stroke patients participated in this study. Each held a ball with a tracking marker and performed back-and-forth reaching movements from near the middle of the body to one of two targets in front of them located on the ipsilateral and contralateral sides of the arm performing the movement. We recorded and analyzed the trajectories of the tracking marker. The stability of arm movements was evaluated using areas and minimum Feret diameters to assess the trajectories of both the paretic and non-paretic arms. The speed of the arm movement was also calculated. Results: For the paretic arm, contralateral movement was more impaired than ipsilateral movement, whereas for the non-paretic arm, no difference was observed between the directions. The maximum speed of the contralateral movement was significantly slower than that of the ipsilateral movement in both the paretic and non-paretic arms. Conclusion: The paretic arm shows direction-specific instability in movement toward the contralateral side of the arm.
著者
寺岡 史人 西 眞歩 吉澤 忠博 百瀬 瑞穂 平島 靖江 市川 孝子
出版者
The Japanese Association of Rehabilitation Medicine
雑誌
リハビリテーション医学 (ISSN:0034351X)
巻号頁・発行日
vol.41, no.6, pp.421-428, 2004-06-18 (Released:2009-10-28)
参考文献数
38
被引用文献数
8 1

嚥下造影検査(以下VF)を行った急性期脳卒中220例について,退院時に経口摂取が可能となったか,一部でも経管栄養を要したかを帰結としてロジスティック回帰分析による予後予測を行った.対象の年齢75±10歳,脳梗塞154例,脳出血66例,平均入院期間106±62日であった.173例(79%)が経口摂取可能となり,47例(21%)では胃瘻等が必要であった.VF上の誤嚥,重度の片麻痺,画像上の両側病変が有意な予測因子として抽出された.得られた予測式で,2項目以上が良好な値であれば,経口摂取可能となる確率は90%以上と予測された.しかし,3変数とも不利な値でも,49%の患者が経口摂取可能となっていた.
著者
小口 和代 才藤 栄一 馬場 尊 楠戸 正子 田中 ともみ 小野木 啓子
出版者
The Japanese Association of Rehabilitation Medicine
雑誌
リハビリテーション医学 (ISSN:0034351X)
巻号頁・発行日
vol.37, no.6, pp.383-388, 2000-06-18 (Released:2009-10-28)
参考文献数
10
被引用文献数
55 84

131名の機能的嚥下障害患者の「反復唾液嚥下テスト」(the Repetitive Saliva Swallowing Test: RSST)と嚥下ビデオレントゲン造影(videofluorography:VF)所見を比較し,RSSTの妥当性を検討した.RSSTはVF所見と相関が高く,カットオフ値として3回/30秒間が妥当であると思われた.誤嚥の有無の判別に関する感度と特異度は,0.98,0.66と,感度が非常に高かった.摂食・嚥下障害の診断・評価としては,まずRSSTでスクリーニングを行い,3回/30秒間未満の場合はさらに詳細な病歴,身体所見をとり,必要と判断されればVFを行い,治療方針を決定するのが適当である.
著者
大高 洋平 里宇 明元 宇沢 充圭 千野 直一
出版者
The Japanese Association of Rehabilitation Medicine
雑誌
リハビリテーション医学 (ISSN:0034351X)
巻号頁・発行日
vol.40, no.6, pp.389-397, 2003-06-18 (Released:2009-10-28)
参考文献数
41
被引用文献数
2 3

The second part of the review discusses some important issues associated with fall prevention and future perspectives on fall related research. Currently, many kinds of interventions are available for the treatment of patients suffering from osteoporosis, i. e. nutritional supports, medications acting on bone metabolism and exercise. However, a series of meta-analyses showed that only alendronate and risedronate have been proven to prevent non-vertebral fractures in persons with osteoporosis. Anaerobic and weight bearing exercises are known to have a positive effect on the bone mineral density of the spine. There is, however, no reliable data for fracture prevention with exercise alone. Also, the synergistic effect of a combination of these interventions has not been clearly proven. Although there is evidence that the use of hip protectors in institutional settings reduces the rate of hip fractures, this approach faces the problem of patient acceptance and compliance. Psychosocial problems related to falls such as fear of falling, post-fall syndrome and cost-effectiveness of the prevention programs are becoming increasingly important in elderly health care, but little evidence of such has been reported in the literature. In future perspectives on fall relared research, a theory-based approach for fall prevention needs to be included to explore more effective interventions. We must also consider the double-edged effects of interventions that may increase certain fall risk factors while reducing another. Especially, the relation between activities and incidence of falls is important to consider, because increased activity itself may increase the chance of falls. When applying exercise or rehabilitative approaches, the interaction between falls, activity levels, frailty, and injury must be studied much more carefully. In addition, one has to always think about what is the true aim of a program, because the aim of fall prevention goes beyond preventing falls. Although some research has so far been conducted in Europe and the U. S. A. by researchers and practitioners in various fields, the quantity and quality of fall prevention research are still lacking and the available data is therefore insufficient to suggest appropriate decision-making in clinical practice. Especially in Japan, there have been only a few RCTs to determine the effectiveness of fall prevention programs. Because there are many differences in the characteristics of our native population and health care systems vs those of Europe and the U. S. A., it is a critical issue for us to establish fall prevention programs suited to Japanese population and health care system.
著者
二木 立
出版者
The Japanese Association of Rehabilitation Medicine
雑誌
リハビリテーション医学 (ISSN:0034351X)
巻号頁・発行日
vol.19, no.4, pp.201-223, 1982-07-18 (Released:2009-10-28)
参考文献数
53
被引用文献数
39 12

脳卒中患者のリハビリテーション後の最終自立度が,(1)患者の年齢,(2)各時期の自立度,(3)臨床的諸因子の組み合わせにより,早期にどの程度予測可能かを検討した.対象は発症後第30病日以内に入院した脳卒中患者406人で,平均年齢は67.0歳である.自立度は,屋外歩行,屋内歩行,ベッド上生活自立,全介助の4段階に分類し,臨床的諸因子としては,運動障害の他に,意識障害,痴呆,夜間せん妄等12因子を選んだ.これら諸因子を組み合わせて作製した予測基準により,入院時自立歩行不能患者のうち,7割は入院時に,8割は入院後2週時に,9割は同1月時に,最終自立度が予測可能であった.
著者
笹沼 澄子 福迫 陽子
出版者
The Japanese Association of Rehabilitation Medicine
雑誌
リハビリテーション医学 (ISSN:0034351X)
巻号頁・発行日
vol.9, no.2, pp.79-89, 1972-04-18 (Released:2009-10-28)
参考文献数
7
被引用文献数
35 35

The recovery processes of 72 out of the 269 aphasic patients studied in PART I were investigated longitudinally by means of following up the rate (and direction) of the change of each of the five factors obtained in PART I. Measurement was taken of the increase and decrease of the factor scores estimated for each patient at each of the successive re-testings. The length of the follow-up period ranged from one to 32 months after the initial evaluation.Each factor seemed to have its characteristic mode of change in time. Factor 1 (the general factor of language behavior) had a tendency to exhibit subnormal scores in the majority of subjects at the initial evaluation, but to show a greatest possibility of improvement for a longest period of time (1.5 years since onset). The rest of the factors tended to be more variable in the kinds of subjects exhibiting subnormal scores as well as in the rate and degree of improvement. The clinical types of aphasia appeared to serve as a crutial variable in predicting the overall patterns of improvement of the five factors in individual patients.The findings seemed to give a further support for the neuro-physiological interpretation of the five factors suggested in PART I. The necessity of increased specificity in our diagnostic and therapeutic procedures was emphasized, and the possible use of the factor analysis technique for this purpose was reiterated.
著者
Hiroaki Teramatsu Junichiro Shiraishi Yasuyuki Matsushima Masaru Araki Tetsuya Okazaki Satoru Saeki
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.20190018, 2019 (Released:2019-10-19)
参考文献数
50
被引用文献数
1

Objective: The aim of this study was to investigate which method of evaluating physical function could predict 1-year readmission due to worsening of heart failure (HF) in newly diagnosed HF patients. Methods: One hundred sixteen consecutive patients with HF who underwent cardiac rehabilitation at our hospital between May 2012 and September 2015 were retrospectively enrolled. Participants were divided into two groups based on whether they were readmitted for worsening HF within 1 year. Logistic regression analysis was used to evaluate whether physical function at the time of discharge was related to HF readmission within 1 year. Results: After a mean follow-up period of 327 days, 22 patients were readmitted because of worsening HF. In the readmission group, the results of the 6-Minute Walk Test (6MWT), One-Leg Standing Test, and 30-Second Chair-Stand Test at initial discharge were significantly worse than those in the non-readmission group. In a multivariable logistic regression model, after adjusting for age and sex, a lower 6MWT distance was independently associated with increased risk of readmission within 1 year (odds ratio: 0.990, 95% confidence interval: 0.985–0.996). The 6MWT showed better prognostic value (area under the receiver operating characteristic curve: 0.696) than other evaluation methods of physical function. The 1-year non-readmission rates were 90% for 6MWT ≥382.5 m, 68% for 6MWT <382.5 m, and 53% for those unable to walk 200 m independently (P <0.001). Conclusion: Physical function, particularly the 6MWT distance at time of discharge, can be used to predict the likelihood of readmission within 1 year for patients with HF.