Shigeru Sonoda

ADL structure for stroke patients in Japan based on the functional independence measure

Tsuji T, Sonoda S, Domen K, Saitoh E, Liu M, Chino N: ADL structure for stroke patients in Japan based on the Functional Independence Measure. Am J Phys Med Rehabil 1995;74:432—438 The difficulty patterns of FIM (Functional Independence Measure) in Japan were determined and compared with patterns found in the United States to assess whether FIM can be used for worldwide comparisons of ADL (the activities of daily living). The FIM was measured for 190 stroke patients in several hospitals throughout Japan. The scores at admission and discharge were converted to an interval scale by Rasch analysis. Right and left brain lesion patients were analyzed separately. The FIM items were divided into two groups: motor items and cognitive items to minimize misfit. A degree of misfit was acceptable, except for bowel and bladder management, stairs, bathing, and expression. Motor items, eating, and bowel and bladder management were the easiest; stairs, bathing, and tub/shower transfers were the most difficult. The difficulty patterns of patients with left and right hemisphere lesions were almost identical. Bathing and tub/shower transfer were more difficult for Japanese patients than for those studied in the United States. Concerning the cognitive items, expression was easiest for patients with right hemisphere lesions but most difficult for those with left hemisphere lesions. Social interaction was easier for Japanese patients with left hemisphere lesions than the other patients. The item difficulty patterns in Japan differs slightly from those in the United States because of cultural differences. As countries show different patterns of difficulty, we must be careful when making international comparisons of FIM data converted by Rasch analysis.

Changes in impairment and disability from the third to the sixth month after stroke and its relationship evaluated by an artificial neural network

Functional recovery in a rather late stage after stroke was examined in 70 stroke patients using the Stroke Impairment Assessment Set (SIAS) and the Functional Independence Measure (FIM). The SIAS and the FIM were administered at three and six months after the onset of stroke. Motor items and the abdominal manual muscle testing item improved in more than 30 percent of patients. The motor subscore of the FIM changed from 60.8 to 73.4, and the cognitive subscore changed from 28.4 to 30.4. The relationship between impairment and disability was evaluated using the neural network method with the software, Skiltran. The change of the FIM motor subscore from three months to six months was used as an output variable, and the change in the SIAS items and the FIM motor subscore were included as input variables. As a result of the connection weight obtained from this network, the change in the fifth motor item (one of the tone items, abdominal manual muscle testing) and the unaffected side grip as well as the FIM at three months had a strong connection to the change of the FIM. It is compatible with ordinary experience that function of both the affected and unaffected side influences the level of disability. Contribution of the impairment to the disability indicates the importance of taking into consideration the impairment for predicting prognosis and selecting adequate treatment when we carry out stroke rehabilitation. In conclusion, we described the relationship between the SIAS and the FIM using the neural network in stroke patients and proved the importance of the impairment to predict the outcome of disability.

Extent of pyramidal tract Wallerian degeneration in the brain stem on MRI and degree of motor impairment after supratentorial stroke

The relationship between Wallerian degeneration in the brain stem and degree of motor impairment is discussed. Using MRI we studied 172 supratentorial stroke patients, whose motor impairment was graded according to Brunnstrom stage. Wallerian degeneration was represented by a T2 high-intensity area in the brain stem, and its cross-sectional extent was measured at the cerebral peduncle level. Wallerian degeneration was detected in 99 patients (57.6%). The area of T2 high intensity was significantly correlated with Brunnstrom stage. Multiple regression analysis showed that the upper extremity stage contributed most to the visualization of Wallerian degeneration. This is partly because the pyramidal tract participates in fine and precise movement. The extent of the area of Wallerian degeneration is found to be helpful in making a prognosis with respect to motor impairment in the upper extremity.

Reproducibility of dual-energy X-ray absorptiometry in the upper extremities in stroke patients

Bone mineral loss after stroke in affected extremities can increase the prevalence of fractures that interrupt the rehabilitation programme and lower the level of activity. In stroke rehabilitation, precise bone mineral measurement is needed in order to assess the risk of fractures. We defined five regions-of-interest of the upper extremity (proximal humerus, distal forearm, distal radius, distal ulna and hand) consistently, so that the position was comfortable for hemiplegic patients to maintain during the measurement. The aim of this study was to determine whether our method using dual-energy X-ray absorptiometry is useful in hemiplegic patients. Ten normal subjects and 15 hemiplegic patients were studied. In normal subjects the reproducibility of our method was evaluated by repeated measurements of both the right and left sides. In hemiplegic patients the reproducibility was evaluated by repeated measurements of the affected side. The coefficient of variation (CV) values were obtained for BMD (0.7-1.7%) and BMC (0.7-2.3%) in normal subjects, and BMD (1.3-2.1%) and BMC (1.7-5.4%) in hemiplegic patients. The CV for the side-to-side BMD and BMC ratios in the normal subjects ranged from 1.1% to 2.2% and from 1.8% to 3.1%, respectively. Our study shows that the reproducibility of our method is sufficient for application to hemiplegic patients.

Clinical application of the modified medially-mounted motor-driven hip gear joint for paraplegics.

Purpose: This paper describes a motor-driven orthosis for paraplegics which has been developed. This orthosis is composed of a medially-mounted motor-driven hip joint and bilateral knee-ankle-foot orthosis. With the gear mechanism, the virtual axis of the hip joint of this orthosis is almost as high as the anatomical hip joint. Method: A paraplegic patient with an injury level of T10/11 walked using bilateral lofstrand crutches and this new orthosis with or without the motor system. The motor is initiated by pushing a button attached at the edge of the grab of the crutches. Result: Faster cadence and speed and smaller rotation angle of the trunk was obtained in motor walking compared with nonmotor walking. The patient did not feel fearful of falling. Conclusion: The benefit of motor orthosis is that it can be used even in patients with lower motor lesions and that it provides stable regulation of hip flexion movement in spastic patients. In conclusion, this motor orthosis will enhance paraplegic walking.