Shoji Kinoshita

Effects of ankle-foot orthoses on functional recovery after stroke: a propensity score analysis based on Japan rehabilitation database.

Objectives The purpose of the present study was to investigate potential effects of ankle–foot orthoses (AFOs) on the functional recovery of post-acute stroke patients following rehabilitation. Subjects and Methods This study is a retrospective cohort study. Participants were in-hospital stroke patients registered in the Japan Rehabilitation Database between 2005 and 2012. A total of 1862 patients were eligible after applying exclusion criteria. Propensity score analysis was applied to adjust for potential bias and to create two comparable groups. An additional subset analysis focused on Functional Independence Measure (FIM) scores on admission. Results In this sample, 30.7% of 1863 eligible patients were prescribed AFOs. Propensity score matched analysis showed that patients with AFOs had significantly higher scores than those without them for discharge FIM (mean: 91.3 vs 85.8; p=0.02), FIM gain (mean: 28.9 vs 23.5; p<0.001), and FIM efficiency (mean: 0.27 vs 0.22; p<0.001). Inverse probability weighting analysis showed similar results. In the subset analysis, patients with AFOs had significantly higher discharge FIM compared with those without them in the low admission FIM subgroup only. In addition, patients with AFOs performed independent exercise more than those without them (p<0.001). Conclusions These data suggest that stroke survivors may have better functional recovery if they are prescribed an AFO than if they are not prescribed an AFO. The use of AFOs is considered to be a feasible option to improve functional recovery of stroke rehabilitation patients.

Association Between 7 Days Per Week Rehabilitation and Functional Recovery of Patients With Acute Stroke: A Retrospective Cohort Study Based on the Japan Rehabilitation Database

OBJECTIVE To test the hypothesis that functional outcome of patients with stroke who receive 7d/wk of rehabilitation is generally better than that of similar patients who undergo 5 or 6d/wk of rehabilitation. DESIGN Retrospective cohort study. SETTING Acute hospitals. PARTICIPANTS From the Japan Rehabilitation Database, which includes data on 8033 patients with acute stroke collected between January 2005 and December 2013, we included 3072 patients with stroke who were admitted to the acute hospitals and received 7d/wk of rehabilitation. INTERVENTION Seven days per week of rehabilitation was defined as rehabilitation therapy administrated by a physical or occupational therapist on every weekday, Saturday, and Sunday. MAIN OUTCOME MEASURE Favorable functional independence in daily living, defined as a modified Rankin Scale score of 0 to 2 at the time of discharge. RESULTS A total of 1075 (35.0%) patients received 7d/wk of rehabilitation. Univariate analysis demonstrated a significant difference in favorable functional recovery between the 7d/wk rehabilitation group and non-7d/wk rehabilitation group (43.3% vs 37.6%, respectively; P=.002). Multivariate logistic regression analysis using the generalized estimating equations method showed that 7d/wk of rehabilitation was independently associated with favorable functional recovery. CONCLUSIONS Our cohort analysis demonstrated that 7d/wk of rehabilitation in early rehabilitation for patients with acute stroke can lead to functional recovery.

Repetitive Peripheral Magnetic Stimulation With Intensive Swallowing Rehabilitation for Poststroke Dysphagia: An Open-Label Case Series

The purpose of this pilot study was to determine the safety and feasibility of a six‐day protocol of in‐hospital repetitive peripheral magnetic stimulation combined with intensive swallowing rehabilitation (rPMS‐ISR) for poststroke dysphagia.

Noninvasive brain stimulation for dysphagia after acquired brain injury: a systematic review

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.

Effect of baseline brain activity on response to low-frequency rTMS/intensive occupational therapy in poststroke patients with upper limb hemiparesis: A near-infrared spectroscopy study

Abstract Background: The beneficial effects of the combination therapy of low-frequency repetitive transcranial magnetic stimulation of nonlesional hemisphere and intensive occupational therapy (LF-rTMS/OT) on upper limb hemiparesis have been well established in poststroke patients. However, there is no information on the effect of brain activity on LF-rTMS/OT treatment outcome. Method: A total of 59 poststroke patients with upper limb hemiparesis received 15-day LF-rTMS/OT. Motor function of the affected upper limb was evaluated before and after the treatment. We also conducted functional near-infrared spectroscopy (fNIRS) before the treatment and calculated the laterality index (LI) based on the change in oxy-hemoglobin in the primary sensorimotor cortex and supplementary motor cortex. The correlation between LI before LF-rTMS/OT and observed improvement in upper limb motor function was analyzed. Results: Motor recovery was significantly more pronounced in patients with unaffected hemisphere dominance in both hemispheres (LI of −1 to 0) than in those with affected hemisphere dominance in the lesional hemisphere (LI of 0 to 1). There was a significant negative correlation between LI and improvement in upper limb motor function. Discussion: The results demonstrated that patients with a shift in brain activity to the noninjured cerebral cortex exhibited better motor recovery following LF-rTMS/OT. The findings suggest that evaluation of brain asymmetry before LF-rTMS/OT with fNIRS can help predict the response to LF-rTMS/OT.

Low-Frequency rTMS and Intensive Occupational Therapy Improve Upper Limb Motor Function and Cortical Reorganization Assessed by Functional Near-Infrared Spectroscopy in a Subacute Stroke Patient

There is still no agreement on the most suitable time and modality for application of repetitive transcranial magnetic stimulation (rTMS) to improve motor recovery in subacute stroke patients. The underlying mechanism of motor recovery following low-frequency rTMS is considered to be modulation of the interhemispheric asymmetry. On the other hand, the cortical balance of brain activity during the acute to chronic phase of stroke is reported to be unstable. Therefore, we conducted this study to clarify the time course of the interhemispheric asymmetry and the effect of application of low-frequency rTMS combined with occupational therapy on motor recovery and cortical imbalance of brain activity in a subacute stroke patient. The interhemispheric asymmetry in this patient with new-onset subcortical cerebral infarction and upper limb hemiparesis was evaluated longitudinally using functional near-infrared spectroscopy with finger tasks. A nonlesional hemisphere-dominant activation pattern was observed on day 28 after onset. On day 56 after onset, a bilaterally eminent activation pattern was observed. Low-frequency rTMS was applied on day 109 after stroke onset when the cortical activity shifted to the nonlesional hemisphere. The treatment resulted in improvement in motor function of the affected upper limb and a shift in brain activation to the lesional hemisphere. Our report is the first to describe the therapeutic benefits of low-frequency rTMS as assessed by longitudinal neuroimaging for functional recovery and interhemispheric asymmetry in a subacute stroke patient.

Utility of the Revised Version of the Ability for Basic Movement Scale in Predicting Ambulation during Rehabilitation in Poststroke Patients

OBJECTIVE This study aims to test the hypothesis that the Revised Version of the Ability for Basic Movement Scale (ABMSII) can predict ambulation during rehabilitation in poststroke patients. SUBJECTS AND METHODS The study included first-ever stroke patients who were admitted to the rehabilitation ward and were dependent in walking. ABMSII scores were assessed by physical therapists on admission to the hospital. Functional ambulation category (FAC) was assessed every 2 weeks during hospitalization. The primary outcome was independent ambulation, defined as 4 points or higher on the FAC. RESULTS After setting the inclusion criteria, data of 374 stroke patients (mean age: 70 years, 153 women) were eligible for the analysis. Of these, 193 patients achieved independent ambulation during hospitalization. The ABMSII score was significantly higher in the patients who regained independent walking ability than in those who required assistance in walking. Based on receiver operating characteristic curve analysis, an ABMSII score of 16 points or higher had a sensitivity of 93% and a specificity of 71%. Kaplan-Meier curve analysis after log-rank test demonstrated a significantly higher event rate in patients with an ABMSII score of 16 or higher compared to those with an ABMSII score lower than 16. Univariate and multivariate Cox regression analyses identified the ABMSII score as a significant and independent predictor of ambulation during rehabilitation. CONCLUSION Our results suggest that the ABMSII score is a potentially useful tool to predict ambulation during rehabilitation in poststroke patients.

Responsiveness of the functioning and disability parts of the International Classification of Functioning, Disability, and Health core sets in postacute stroke patients

To study the responsiveness of the International Classification of Functioning, Disability, and Health (ICF) core set with respect to human functioning and disability in stroke patients. Postacute stroke patients who were admitted to the convalescent rehabilitation wards were included in this observational cohort study. The comprehensive ICF core set for neurological conditions for postacute care and the ICF rehabilitation set were evaluated at admission and discharge using five-grade qualifiers. Extension indexes were calculated for entire two ICF core sets. Responsiveness was measured as change in the extension indexes in the ICF core sets. The correlation between changes in ICF core sets and improvement in the Functional Independence Measure (FIM) was analyzed using Spearman’s correlation coefficient. The study included 108 poststroke patients (49 women, mean age 70.8 years, mean FIM score improvement: 23.0). The mean percentage of categories that showed changes with at least one qualifier level was 19.5% in the comprehensive ICF core set for neurological conditions for postacute care and 35.9% in the ICF rehabilitation set. Effect sizes in each ICF core set were moderate to large (0.79–0.80). Improvement in the two ICF core sets correlated significantly with changes in the FIM score. Our results indicate that functioning and disability parts of these two ICF core sets can detect changes in functioning and disability in patients who receive an inpatient rehabilitation program for postacute stroke.

Combination Treatment of Low-Frequency Repetitive Transcranial Magnetic Stimulation and Intensive Occupational Therapy for Ataxic Hemiparesis due to Thalamic Hemorrhage

Background: Both low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) and intensive occupational therapy (OT) are clinically beneficial for post-stroke patients with upper-limb hemiparesis. However, the usefulness of LF-rTMS and intensive OT for ataxic hemiparesis (AH) is unknown. Methods: The study subjects included 7 patients with AH. All patients had ataxia and mild hemiparesis without a sensory disturbance that was due to thalamic hemorrhage. Each patient was scheduled to receive 20-min rTMS at 1 Hz at the contralesional cerebral hemisphere followed by 120-min intensive OT, daily for 21 sessions. The primary outcome was the motor function of the affected upper limb that was evaluated by using the Fugl-Meyer Assessment (FMA). In addition, the International Cooperative Ataxia Rating Scale (ICARS) score was determined to assess the severity of ataxia. Results: All patients completed the protocol without any adverse effects. The FMA score significantly increased after treatment. Notably, the ICARS score also significantly decreased. Conclusions: Our proposed combination treatment is a safe and feasible neurorehabilitative intervention for patients with AH due to thalamic hemorrhage. Our results demonstrate the possibility that rTMS in combination with intensive OT could improve motor function and alleviated ataxia in patients with AH.