Yuki Uchiyama

Effects of Arm Bracing on Expiratory Flow Limitation and Lung Volume in Elderly COPD Subjects.

BACKGROUND: Although it is useful for COPD patients to relieve their dyspnea by bracing their arms, the relationships between the arm bracing posture and expiratory flow limitation (EFL) and lung volume are unknown. Whether arm bracing affects dyspnea, EFL, and lung volume in elderly COPD patients was investigated. METHODS: Sixteen elderly subjects (median [interquartile range] age 81 [77–85] y) with stable COPD (percent-of-predicted FEV1 50.9 [31.3–64.9] %) and 16 age-matched healthy subjects were studied. Breathing patterns, EFL, lung volume, SpO2, and heart rate during quiet breathing were randomly evaluated in 3 standing postures: erect, leaning forward, and arm bracing. Dyspnea was also assessed for each posture with a Borg dyspnea score at the end of the test. RESULTS: Lung volume was significantly higher with arm bracing than with the other postures in both groups (P < .05). Breathing patterns, SpO2, and pulse rate were not significantly different among the 3 postures in both groups. However, EFL and Borg dyspnea scores were significantly lower with arm bracing than with the other postures in COPD subjects (P < .01). CONCLUSIONS: The decreased EFL in the arm bracing position may be caused by breathing at a higher lung volume than in the erect position, which may be one of the factors relieving dyspnea in elderly COPD patients.

Measurements of chest wall volume variation during tidal breathing in the supine and lateral positions in healthy subjects.

PURPOSE To study the feasibility and the laterality of measurements of chest wall volume variation during tidal breathing in the lateral position in healthy subjects. METHODS Eighteen normal subjects were studied. Chest wall volume changes were measured by optoelectronic plethysmography in the supine and right and left lateral positions during quiet breathing. The accuracy of measuring lung volume was also examined using hot wire spirometry in 10 of the subjects. RESULTS The measurement errors between lung volume changes and chest wall volume changes were not significantly different in all positions. There was no significant difference between right and left compartmental volume changes in the supine position. However, chest wall volume changes were lower on the dependent side in the lateral position than on the non-dependent side because of the decrease in abdominal rib cage and abdomen volume changes. CONCLUSION Chest wall volume measurements during quiet breathing in the lateral position have high measuring accuracy and show laterality.

Examination of Factors Related to the Effect of Improving Gait Speed With Functional Electrical Stimulation Intervention for Stroke Patients

Functional electrical stimulation (FES) for patients with stroke and foot drop is an alternative to ankle foot orthoses. Characteristics of FES responders and nonresponders have not been clarified.

Utility of Fractional Anisotropy in Cerebral Peduncle for Stroke Outcome Prediction: Comparison of Hemorrhagic and Ischemic Strokes

BACKGROUND Diffusion-tensor fractional anisotropy (FA) has been used for predicting stroke outcome. However, most previous studies focused on patients with either hemorrhagic or ischemic stroke. The aim of this study was to assess the correlation between FA and outcome for patients with hemorrhagic stroke and those with ischemic stroke, and then compare their correlation patterns. METHODS This study sampled 40 hemorrhagic and 40 ischemic stroke patients from our previously published reports. Diffusion-tensor images were obtained on days 14-21, and FA images were generated, after which the ratio of FA within the cerebral peduncles of the affected and unaffected hemispheres (rFA) was calculated. Outcome was assessed using Brunnstrom stage (BRS), motor component of the functional independence measure (FIM-motor), and total length of hospital stay (LOS) at discharge from our affiliated rehabilitation hospital. The data were then compared between the hemorrhage and the infarct groups. Correlation analyses between rFA and outcome assessments were performed separately for both groups and then were compared between the groups. RESULTS The hemorrhage group exhibited significantly more severe BRS, longer LOS, and lower rFA than the infarct group. The correlations between rFA and outcome measures were all statistically significant for both the hemorrhage and the infarct groups. The correlation patterns for BRS and LOS were very similar between the hemorrhage and the infarct groups. However, such similarity was not evident for FIM-motor. CONCLUSIONS FA in the cerebral peduncles may be used to predict extremity functions and LOS for both types of stroke.

Clinimetric properties of the Fugl-Meyer assessment with adapted guidelines for the assessment of arm function in hemiparetic patients after stroke

Abstract Background: Against the background of linguistic and cultural differences, there is a need for translation and adaptation from the English version of the Fugl-Meyer Assessment (FMA) to Japanese. In addition, there is no study of inter-rater reliability of FMA all domains for affected upper extremities with appropriate sample size based on the intraclass correlation coefficient (ICC) focusing on non-simultaneous assessment. Objective: This study aimed (1) to translate the English version of the FMA and its administration/scoring manual; and (2) to investigate the psychometric properties of the Japanese version of the FMA in patients with stroke. Methods: A prospective single-center study involving 30 patients was conducted. The FMA and the Action Research Arm Test, the Box-and-Block Test, and the Motor Activity Log were employed. The inter-rater/intra-rater reliability, the internal consistency, the validity, and the floor/ceiling effects were assessed. Results: Regarding the non-simultaneous and simultaneous inter-rater reliability, ICC ranged from 0.809–0.983 (P<0.001) and 0.991–0.999 (P<0.001), respectively. Regarding the simultaneous intra-rater reliability, ICC ranged from 0.994–0.999 (P<0.001). The Cronbach’s alpha was 0.973 in the non-simultaneous evaluation and 0.981 in the simultaneous evaluation. Regarding the validity, Spearman’s rhos were higher than 0.92 for the FMA all domains and motor domain. The patients who showed the highest score and the lowest score of the FMA (all domains and motor domain) were 10% and 0%, respectively. Conclusions: The Japanese version of the FMA motor domain and all domains can reliably assess the affected upper extremities in patients with mild-to-severe hemiparesis after stroke for both non-simultaneous and simultaneous assessment.

Reliability of remote evaluation for the Fugl–Meyer assessment and the action research arm test in hemiparetic patients after stroke

ABSTRACT Background Blinding for outcome assessors is considered less possible in rehabilitation treatment trials than in pharmacologic trials. This problem can be solved in part by the standardized remote evaluation system, in which researchers video-record patients for centralized assessment using prospectively standardized shooting procedures, and then outside assessors evaluate the videos using prospectively standardized methods. Objective To assess the inter-rater reliability of remote evaluation for the Fugl–Meyer assessment (FMA) and the action research arm test (ARAT) in hemiparetic patients after stroke. Methods A prospective, cross-sectional, single-center study involving 30 patients with mild-to-severe hemiparesis was conducted (Clinical Trial Registration—URL: http://www.umin.ac.jp/. Unique identifier: UMIN000022192). Two assessments (direct observation and video observation) were performed for each participant by trained assessors. The direct observation assessment was video-recorded for the video observation assessment. In the current study, a standardized guidebook for test administration and scoring was used, along with prospectively standardized shooting procedures. Results Regarding the sum scores of the total/subtests of the FMA and ARAT, the intraclass correlation coefficient ranged from 0.992 to 0.998 (95% confidence interval [CI], 0.960–0.999; p < 0.0001) and Spearman’s rho ranged from 0.949 to 1.000 (95% CI, 0.985–1.000; p < 0.0001). Regarding the individual item scores of the outcome measures, weighted kappa (median of the sum scores of total/subtests) ranged from 0.921 to 1.000. Conclusions Remote evaluation of the FMA and ARAT reliably assesses the affected upper extremities in patients with mild-to-severe hemiparesis after stroke.

Botulinum Toxin Type A Treatment Combined with Intensive Rehabilitation for Gait Poststroke: A Preliminary Study

GOAL To examine the effects of botulinum toxin type A (BoNT-A) treatment combined with intensive rehabilitation for gait compared with intensive rehabilitation alone in patients with chronic stroke. MATERIALS AND METHODS A comparative case series design was used. Subjects were 19 patients with chronic stroke and spastic hemiplegia. In 9 patients (group I), BoNT-A was injected into spastic muscles of the affected lower limbs, followed by a 4-week inpatient intensive rehabilitation program. In the other 10 patients (group II), a 4-week inpatient intensive rehabilitation program alone was first provided (control period) followed by the same treatment protocol in group I. The Modified Ashworth Scale (MAS) scores, range of motion (ROM), gait speed in the 10-Meter Walking Test, 6-Minute Walking Distance Test (6MD) scores, Timed Up and Go Test (TUG) scores, and Berg Balance Scale scores were evaluated every 4 weeks following baseline assessments. RESULTS All results except for the MAS score of knee flexor and the ROM of knee flexion improved in group I and the gait speed, 6MD, and TUG scores improved in group II. Intergroup comparisons at week 4 showed significantly greater improvements in the MAS score of ankle plantar flexor, ROM of ankle dorsiflexion, and 6MD in group I than in group II (P = .016, .011, and .009, respectively). CONCLUSIONS BoNT-A treatment for lower-limb spasticity, combined with intensive rehabilitation, was effective in improving spasticity and the 6MD compared with intensive rehabilitation alone in patients with chronic stroke.

Assessment of the Efficacy of ReoGo-J Robotic Training Against Other Rehabilitation Therapies for Upper-Limb Hemiplegia After Stroke: Protocol for a Randomized Controlled Trial

Background: Stroke patients experience chronic hemiparesis in their upper extremities leaving negative effects on quality of life. Robotic therapy is one method to recover arm function, but its research is still in its infancy. Research questions of this study is to investigate how to maximize the benefit of robotic therapy using ReoGo-J for arm hemiplegia in chronic stroke patients. Methods: Design of this study is a multi-center parallel group trial following the prospective, randomized, open-label, blinded endpoint (PROBE) study model. Participants and setting will be 120 chronic stroke patients (over 6 months post-stroke) will be randomly allocated to three different rehabilitation protocols. In this study, the control group will receive 20 min of standard rehabilitation (conventional occupational therapy) and 40 min of self-training (i.e., sanding, placing and stretching). The robotic therapy group will receive 20 min of standard rehabilitation and 40 min of robotic therapy using ReoGo®-J device. The combined therapy group will receive 40 min of robotic therapy and 20 min of constraint-induced movement therapy (protocol to improve upper-limb use in ADL suggests). This study employs the Fugl-Meyer Assessment upper-limb score (primary outcome), other arm function measures and the Stroke Impact Scale score will be measured at baseline, 5 and 10 weeks of the treatment phase. In analysis of this study, we use the mixed effects model for repeated measures to compare changes in outcomes between groups at 5 and 10 Weeks. The registration number of this study is UMIN000022509. Conclusions: This study is a feasible, multi-site randomized controlled trial to examine our hypothesis that combined training protocol could maximize the benefit of robotic therapy and best effective therapeutic strategy for patients with upper-limb hemiparesis.

Physical activity combined with resistance training reduces symptoms of frailty in older adults: A randomized controlled trial

INTRODUCTION Increased physical activity (PA) is a crucial factor in the prevention of physical deterioration, and resistance training (RT) is also a common and effective intervention for older adults. However, the effects of PA as an adjunct to RT on frailty status remains unclear; therefore, we clarified the effect of a PA intervention with feedback, as an adjunct to resistance strength training, on the physical and mental outcomes of frail older adults. MATERIALS AND METHODS We employed a randomized controlled trial. Community-dwelling frail older adults in Japan were recruited to participate. Forty-one participants (mean age 81.5) were randomly assigned to engage in a resistance training with PA (RPA group) or RT group for six months. Frailty status and frailty scores, which were measured according to the Cardiovascular Health Study criteria-muscle strength, mobility, instrumental activities of daily living, and health-related quality of life-were assessed. RESULTS Participants in the RPA group exhibited a significant increase in light-intensity PA, the number of steps taken daily (p < 0.05), and lower-limb muscle strength (p < 0.05) and a significant decrease in frailty scores. However, pre- and postintervention frailty status, instrumental activities of daily living, and health-related quality of life did not differ significantly. CONCLUSIONS Implementation of a PA intervention as an adjunct to RT is feasible, as it reduced frailty scores and increased lower-limb muscle strength and mobility in older adults with frailty symptoms.