Kazuaki Iokawa

Propensity-matched analysis of the gap between capacity and actual performance of dressing in patients with stroke

[Purpose] Dressing is an activity of daily living for which stroke patients often show discrepancies between capacity and actual performance. The aim of this study was to elucidate the physical function and unilateral spatial neglect in stroke patients that reduce their level of actual performance despite having the capacity for dressing independently. [Subjects and Methods] This retrospective study included 60 first-time stroke patients judged by occupational therapists as able to dress independently. The patients were divided into two groups according to their FIM® instrument scores for dressing the upper and lower body: an independent group with both scores ≥6 and an assistance group with one or both scores ≤5. After adjusting for confounding factors through propensity score matching, the groups were compared by using Stroke Impairment Assessment Set items, the Simple Test for Evaluating Hand Function of both upper limbs, and the Berg balance scale. [Results] The assistance group had a significantly lower score for the Berg balance scale than the independent dressing group (31.0 ± 12.3 vs. 47.8 ± 7.4). [Conclusion] The results of the present study suggested that the balance function has an effect on the discrepancy between dressing capacity and performance.

A path analysis model for grooming performance in stroke patients

Abstract Purpose: The aim of this study was to clarify the relationships between various types of functions and grooming performance and describe their hierarchical structure in survivors of stroke. Method: This was a retrospective observational study on 75 individuals with first stroke. A hypothetical path model, created based on previous studies, was examined for goodness of fit between the data and the model using path analysis. We hypothesized that in survivors of stroke, grooming performance is influenced by age, motor and sensory functions of the affected limbs, trunk function, grip and knee extensor strength, visuospatial perception, intellectual function, motivation, affected and unaffected upper limb function, and balance. Results: A revised path model was created that achieved goodness-of-fit index criteria. Balance, affected and unaffected upper limb function, and motivation were found to have a direct effect and balance and unaffected upper limb function were found to have especially stronger effect on grooming performance. The order of the standardized total effects of each function was as follows: balance, unaffected upper limb function, motivation, and affected lower limb function. Conclusions: Our results suggest that interventions targeting balance and unaffected upper limb function could be effective in rehabilitation to improve grooming performance in survivors of stroke. Implications for rehabilitation Balance and unaffected upper limb function have a strong effect on grooming independence in survivors of stroke. Balance is most influenced by affected lower limb function, and unaffected upper limb function is equally influenced by balance, visuospatial perception, and grip strength. Interventions targeting balance and unaffected upper limb function can improve grooming performance in survivors of stroke.

Cardiovascular Responses Associated with the Moving Beans Task: Influence of Psychological Characteristics

BACKGROUND AND OBJECTIVE High blood pressure (BP) after stroke is associated with a poor outcome. However, exercise training or speech therapy for patients with stroke can raise the BP. The aim of this study was to examine cardiovascular responses during the moving beans task (MBT) used in occupational therapy and to study the influence of psychological characteristics on cardiovascular responses during this task in healthy subjects. MATERIALS AND METHODS In 34 healthy volunteers, the BP and the heart rate (HR) were continuously measured during the baseline period, the 5-minute MBT, and the 1-minute cold pressor test (CPT). All subjects completed self-reported questionnaires, including the Center for Epidemiologic Studies Depression Scale (CES-D), the State Trait Anxiety Inventory Y-2, and the Japanese version of the 20-item Toronto Alexithymia Scale (TAS-20). RESULTS The systolic blood pressure (SBP), the diastolic blood pressure (DBP), and the mean blood pressure (MBP) significantly increased during the MBT and the CPT compared with the baseline values. SBP, DBP, and MBP responses during the MBT significantly correlated with the TAS-20 scores. Moreover, DBP response during the MBT correlated with the CES-D scores. CONCLUSIONS The MBT significantly raised BP without increasing the HR. BP responses during this task were influenced by the psychological characteristics of depression and alexithymia.

Relationship between Grooming Performance and Motor and Cognitive Functions in Stroke Patients with Receiver Operating Characteristic Analysis

BACKGROUND This study aimed to elucidate the relationship between grooming performance of stroke patients and various motor and cognitive functions and to examine the cognitive and physical functional standards required for grooming independence. METHODS We retrospectively analyzed the data of 96 hospitalized patients with first stroke in a rehabilitation hospital ward. Logistic regression analysis and receiver operating characteristic curves were used to investigate the related cognitive and motor functions with grooming performance and to calculate the cutoff values for independence and supervision levels in grooming. RESULTS For analysis between the independent and supervision-dependent groups, the only item with an area under the curve (AUC) of .9 or higher was the Berg Balance Scale, and the calculated cutoff value was 41/40 (sensitivity, 83.6%; specificity, 87.8%). For analysis between the independent-supervision and dependent groups, the items with an AUC of .9 or higher were the Simple Test for Evaluating Hand Function (STEF) on the nonaffected side, Vitality Index (VI), and FIM® cognition. The cutoff values were 68/67 for the STEF (sensitivity, 100%; specificity, 72.2%), 9/8 points for the VI (sensitivity, 92.3%; specificity, 88.9%), and 23/22 points for FIM® cognition (sensitivity, 91.0%; specificity, 88.9%). CONCLUSIONS Our results suggest that upper-extremity functions on the nonaffected side, motivation, and cognitive functions are particularly important to achieve the supervision level and that balance is important to reach the independence level. The effective improvement of grooming performance is possible by performing therapeutic or compensatory intervention on functions that have not achieved these cutoff values.

Quantifying lower extremity and trunk function for dressing in stroke patients: a retrospective observational study

Abstract Background Dressing performance relates strongly with balance function, and it is mainly influenced by the motor functions of the affected and unaffected lower extremity and trunk function in stroke patients. For the remedial approach to be effective, ascertaining the degree of function needed in the affected and unaffected lower extremities and trunk to achieve balance function requisite for dressing is necessary. Objectives This study aimed to elucidate standards of lower extremity and trunk function necessary for stroke patients to gain balance requisite for dressing. Methods The study included 105 first-time stroke patients, who were classified by Berg Balance Score ≥44 or not and ≥32 or not which are previously reported standard indicators for independent and supervision level in dressing. Receiver operating characteristic curves were determined for the stroke impairment assessment item of sensory and motor function of affected lower extremity, abdominal muscle strength, and knee extension muscle strength. Results Area under the curve was ≥0.7 for all variables. In BBS 44-point analyses, the calculated cut-off values were 4 points for SIAS hip flexion, 4 points for SIAS knee extension, 2 points for SIAS foot pat on the affected side, 3 points for SIAS tactile and position sensation of the affected lower extremity, 3 points for SIAS abdominal muscle strength, and 3 points for SIAS knee extension muscle strength on the unaffected side. Conclusions These cut-off values can be used as targets for motor functions, when using the remedial approach for achieving dressing independence.

Functional and cognitive variables predicting successful use of chopsticks or a spoon by the paretic upper extremity in patients following stroke: a cross-sectional study

ABSTRACT Background: The factors necessary for successful use of chopsticks or a spoon, by patients with a paretic upper extremity (UE) following stroke are unknown. Objectives: We identified the functional capacities and interactions related to chopsticks or spoon use in patients with right hemiplegia following stroke. Methods: Participants were 139 stroke patients with right hemiplegia who required rehabilitation, divided into the following three categories: able to use chopsticks, able to use a spoon, or unable to use a spoon. We collected sociodemographic data, medical data, physical and cognitive function data, and functional grades associated with chopsticks or spoon use by the paretic dominant UE while eating. We identified a complex interaction of variables relating to functional use of chopsticks or a spoon using a classification and regression tree analytic process. Results: Patients with UE Brunnstrom recovery stage (BRS) >IV, and a Hasegawa Dementia Scale – Revised (HDS-R) score >16 had a 91.3% probability of being able to use chopsticks. Moreover, patients with a UE BRS of >IV, and the HDS-R score ≤16 had a 66.7% probability of being able to use a spoon. By contrast, patients with a UE BRS of ≤IV had a 90.5% probability of not being able to use a spoon. Conclusions: The interaction of BRS as a measure of UE function and HDS-R score as a measure of cognitive function affect the ability of patients with stroke histories to functionally use the paretic UE to operate chopsticks or a spoon.