Yoshitake Hirano

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.

Prognosis and Classification of Severely Hemiplegic Stroke Patients in aRehabilitation Hospital

Objective: When carrying out rehabilitation during convalescence, the prognosis must be considered before treatment, and guidance needs to be provided to patients and their families. However, predicting the prognosis and final outcomes of patients with severe hemiplegia is challenging since the condition is influenced by various factors in a complex manner. The aim of this study was to identify prognosis factors for the outcomes of severely hemiplegic stroke patients on the basis of evaluations conducted at the time of admission to rehabilitation. Methods: The subjects were 80 first-time stroke patients presenting with severe hemiplegia. They were divided into groups by their properties and physical function on admission. The groups were compared by their properties, physical function on admission, and outcomes. Results: According to these factors, the patients were divided into 3 groups: “good cognitive function and good muscle strength in the lower extremity on the non-paralyzed side (A group),” “poor cognitive function and poor motor function (B group),” and “good cognitive function and good motor function(C group)” by cluster analysis. At the end of the rehabilitation period, the patients in the B group had a significantly worse ability to walk and to perform ADL than the patients in the A and C groups, and only a few patients from the B group were able to return home. Conclusion: We concluded that the classification of severely hemiplegic stroke patients is useful to predict prognosis in a rehabilitation hospital.

Development of a prognostic scale for severely hemiplegic stroke patients in a rehabilitation hospital

OBJECTIVES For patients with severe hemiplegia in a rehabilitation hospital, early prediction of the functional prognosis and outcomes is challenging. The purpose of this study was to create and verify a prognostic scale in severely hemiplegic stroke patients and allowing for prediction of (1) the ability to walk at the time of hospital discharge, (2) the ability to carry out activities of daily living (ADL), and (3) feasibility of home discharge. PATIENTS AND METHODS The study was conducted on 80 severely hemiplegic stroke patients. A prognostic scale was created as an analysis method using the following items: mini-mental state examination (MMSE) at the time of admission, modified NIH stroke scale (m-NIHSS); trunk control test (TCT); and the ratio of the knee extensor strength on the non-paralyzed side to the body weight (KES/BW-US). We verified the reliability and validity of this scale. RESULTS We established a prognostic scale using the MMSE, m-NIHSS, TCT, and KES/BW-US. A score of 56.8 or higher on the prognostic scale suggested that the patient would be able to walk and that assistance with ADL would be unnecessary at the time of hospital discharge. In addition, a score of 41.3 points indicated that the patients return home was feasible. The reliability and the results were in good agreement. These findings showed that the ability or inability to walk was predictable in 85%, the need of assistance with ADL in 82.5%, and the feasibility of home return in 76.3% of cases. CONCLUSION At the time of admission, four evaluation items permitted the prediction of three outcomes at time of discharge. Our formula predicts three outcomes with an accuracy of more than 76%.