Daisuke Nishio

Efficacy of a hybrid assistive limb in post-stroke hemiplegic patients: a preliminary report

BackgroundRobotic devices are expected to be widely used in various applications including support for the independent mobility of the elderly with muscle weakness and people with impaired motor function as well as support for nursing care that involves heavy laborious work. We evaluated the effects of a hybrid assistive limb robot suit on the gait of stroke patients undergoing rehabilitation.MethodsThe study group comprised 16 stroke patients with severe hemiplegia. All patients underwent gait training. Four patients required assistance, and 12 needed supervision while walking. The stride length, walking speed and physiological cost index on wearing the hybrid assistive limb suit and a knee-ankle-foot orthosis were compared.ResultsThe hybrid assistive limb suit increased the stride length and walking speed in 4 of 16 patients. The patients whose walking speed decreased on wearing the hybrid assistive limb suit either had not received sufficient gait training or had an established gait pattern with a knee-ankle-foot orthosis using a quad cane. The physiological cost index increased after wearing the hybrid assistive limb suit in 12 patients, but removal of the suit led to a decrease in the physiological cost index values to equivalent levels prior to the use of the suit.ConclusionsAlthough the hybrid assistive limb suit is not useful for all hemiplegic patients, it may increase the walking speed and affect the walking ability. Further investigation would clarify its indication for the possibility of gait training.

The effect of voluntary training with family participation on early home discharge in patients with severe stroke at a convalescent rehabilitation ward.

Background: The purpose of this study was to clarify the effects of voluntary training with family participation in addition to conventional rehabilitation for stroke patients. Methods/Design: The subjects were 49 first-time stroke patients with severe hemiplegia. They were divided into two groups: a family participation group, in which voluntary training was performed with family members (21 patients), and a nonfamily participation group, in which voluntary training was performed with a physical therapist (28 patients). The groups were compared by background, cognitive and physical function, postadmission course, and outcome. Results: There were shortened lengths of stay and higher rates of home discharge in family participation group, but no differences in functional recovery. Conclusions: Voluntary training with family participation was effective in shortening the length of hospital stay and in improving the rate of home discharge in a convalescent rehabilitation ward.

Prediction of Independent Walking Ability for Severely Hemiplegic Stroke Patients at Discharge from a Rehabilitation Hospital

BACKGROUND It is important to predict walking ability for stroke patients, because rehabilitation programs are planned on such predictions. We therefore examined predictive factors that are available before discharge from a rehabilitation hospital. METHODS Seventy-two consecutive patients with a first attack of stroke with severe hemiplegia were included in this study. We retrospectively evaluated background factors (age, gender, time from stroke onset, paresis side, and stroke type). Other neurological and physical parameters were collected by means of the modified National Institutes of Health Stroke Scale, the Mini-Mental State Examination, the Trunk Control Test (TCT), and the knee extension strength/body weight ratio on the unaffected side (KES/BW-US) at the time of admission. We divided the patients into 2 groups, the independent group (n = 49) and the dependent group (n = 23), on the basis of the Barthel Index of mobility at the time of discharge. We then compared the 2 groups with respect to the aforementioned parameters. We also performed stepwise discriminant analyses to ascertain which parameters are the best predictors of walking ability at the time of discharge. RESULTS Age, TCT score, and the KES/BW-US ratio were significantly different between the groups. Discriminant analysis revealed that younger age and a higher KES/BW-US ratio were significantly associated with walking ability at discharge, which could be precisely predicted using the following formula: Y = .093 × (age) - 4.316 × (KES/BW-US) - 4.984. CONCLUSIONS At the time of admission, age and the KES/BW-US ratio permit the prediction of independent walking ability at the time of discharge. Our formula predicts walking ability with an accuracy of more than 91%.

Factors Influencing the Burden on Caregivers of Stroke Patients with Hemiplegia Living at Home

Objective: The purpose of this study was to clarify the factors influencing burden on the caregivers of stroke patients with hemiplegia who live at home under their family’s care. Methods: From July 2009 to July 2013, 20 hemiplegic stroke patients who provided written informed consent and met the following criteria were included in the study: Brunnstrom recovery stage<4, living at home at 6 months after discharge, and Barthel index<95 at 6 months after discharge. Age, sex, number of caregivers, Barthel index, frequency of using nursing-care services, and frequency of voluntary standing or walking training were evaluated as independent variables. Results of the Zarit Burden Interview, which reflects the burden for caregivers, were evaluated as dependent variables. Variables were analyzed with a stepwise regression analysis. Results: Factors that influenced the burden on caregivers were frequency of using nursing-care services, number of caregivers, sex of patients, and frequency of voluntary training. Conclusion: In stroke patients with a high dependence on nursing-care services, the burden on caregivers was large. Caution must be used in extending the findings of this study to general practice, but our study suggests that a higher frequency of voluntary training and a larger number of caregivers reduces the burden on caregivers of stroke patients after discharge.