Transitional and Long-Term Care System in Japan and Current Challenges for Stroke Patient Rehabilitation.

In Japan, the national medical insurance system and long-term care insurance (LTCI) system cover rehabilitation therapy for patients with acute, convalescent, and chronic stroke. Medical insurance covers early and multidisciplinary rehabilitation therapy during acute phase hospitalizations. Patients requiring assistance in their activities of daily living (ADL) after hospitalization are transferred to kaifukuki (convalescent) rehabilitation wards (KRW), which the medical insurance system has also covered. In these wards, patients can receive intensive and multidisciplinary rehabilitation therapy to improve their ADL and transition to a smooth home discharge. After discharge from these hospitals, elderly patients with stroke can receive outpatient (day-care) rehabilitation and home-based rehabilitation using the LTCI system. The Japanese government has proposed building a community-based integrated care system by 2025 to provide comprehensive medical services, long-term care, preventive care, housing, and livelihood support for patients. This policy aims to promote smooth coordination between medical insurance services and LTCI providers. Accordingly, the medical insurance system allows hospitals to receive additional fees by providing patient information to rehabilitation service providers in the LTCI system. A comprehensive database on acute, convalescent, and chronic phase stroke patients and seamless cooperation between the medical care system and LTCI system is expected to be established in the future. There are only 2,613 board-certified physiatrists in Japan, and many medical schools lack a department for rehabilitation medicine; establishing such a department at each school is encouraged to teach students efficient medical care procedures, to conduct research, and to facilitate the training of personnel in comprehensive stroke rehabilitation.

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.

Validation of the "Activity and participation" component of ICF Core Sets for stroke patients in Japanese rehabilitation wards

OBJECTIVE: To validate the International Classification of Functioning, Disability and Health (ICF) Core Set for stroke in the assessment of functional status and disability in Japanese stroke patients. METHODS: The study included stroke patients admitted to the Kaifukuki (convalescent) rehabilitation wards. The comprehensive ICF Core Set for neurological conditions for post-acute care and the ICF rehabilitation set were evaluated with qualifiers assessed by the physiatrists at admission. The "activity and participation" (d) component was divided to sub-components (cognition-related activity, motor-related activity and participation). The correlations between numbers of problem categories in the entire "d" component and these sub-components in each ICF Core Set and the Functional Independence Measure (FIM) score were assessed using Spearman's correlation coefficient. RESULTS: A total of 117 post-stroke patients (mean age 70.1 ± 14.2 years, 53 women) were included. Correlation analysis identified significant and strong correlations between the values of the entire "d" component and sub-components (cognition-related activity and motor-related activity) of the 2 ICF Core Sets and FIM score. A significant, but weak, correlation between FIM and the participation sub-component was identified. CONCLUSION: The "d" component of these 2 ICF Core Sets reflects functional status and disability and could be a valid measure in post-acute stroke patients in the rehabilitation setting.

Gait analysis in Down syndrome pediatric patients using a sheet-type gait analyzer: Pilot study.

BACKGROUND: Children with Down syndrome (DS), who are likely to suffer from a large number of musculoskeletal problems, tend to have a unique pattern of walking in clinical settings. Despite such apparent uniqueness, few studies have empirically investigated gait development pattern in DS children, especially at an earlier age. We therefore conducted gait analysis in young DS children who are prescribed insoles, to explore how their gait patterns develop, using the gait parameters identified by Sutherland et al. as determinants of gait maturity of typical children. METHODS: Participants consisted of 63 DS children (31 boys) aged 1-6 years (mean, 4 years 1 month) with a diagnosis of flat feet who were prescribed orthotic insoles. A 2.4 m sheet-type gait analyzer was used to analyze gait pattern. We measured the following variables: walking velocity (cm/min), cadence (steps/min), step length (cm), and single-limb stance phase ratio (%), and examined their relationship with age on regression analysis. RESULTS: Walking velocity and step length were significantly and positively related to age. Cadence was also significantly, but negatively associated with age. In contrast, SLS phase ratio did not have a statistically significant relationship with age. CONCLUSION: Down syndrome children have unique gait development patterns. Although walking velocity, cadence, and step length were found to develop with age, as in typical children, SLS phase ratio did not change with age in DS children. Further studies with a larger sample are necessary to replicate these findings.

Assessment of feeding and swallowing in children: validity and reliability of the Ability for Basic Feeding and Swallowing Scale for Children (ABFS-C).

OBJECTIVE: The purpose was to devise a dysphagia scale for disabled children that could be applied by various medical professionals, family members, and personnel in treatment and education institutions and facilities for disabled children and to assess the validity and reliability of that scale, "Ability for Basic Feeding and Swallowing Scale for Children" (ABFS-C). METHODS: Subjects were 54 children (aged 2months to 14years and 7months, median 14months) who visited the National Center for Child Health and Development from January 2012 to December 2013. They were examined using the Fujishima's Grade of Feeding and Swallowing Ability (Fujishima's Grade), the Functional Independence Measure for Children (WeeFIM) and the ABFS-C composed of 5 items (wakefulness, head control, hypersensitivity, oral motor and saliva control). Validity was evaluated according to correlations of the ABFS-C with Fujishima's Grade or WeeFIM. To assess interrater reliability, 17 children were assessed by a doctor and occupational therapist independently. RESULTS: The ABFS-C scores and Fujishima's Grade were correlated using Spearman rank correlation coefficients. Fujishima's Grade was significantly correlated with saliva control (R=0.470) and the total ABFS-C scores (R=0.322) but not with wakefulness (R=-0.014), head control (R=0.122), hypersensitivity (R=-0.009), or oral motor (R=0.139). In addition, the total ABFS-C scores had a significant correlation with the total score of the WeeFIM (R=0.562), motor WeeFIM (R=0.451), cognitive WeeFIM (R=0,478), and the eating subscore of the WeeFIM (R=0.460). Interrater reliability was demonstrated for all items except hypersensitivity. CONCLUSIONS: There were significant correlations between the total ABFS-C scores and Fujishima's Grade and WeeFIM, which suggested the need for comprehensive assessments rather than assessments of individual feeding and swallowing functions. To improve the reliability for hypersensitivity, the assessment process for hypersensitivity should be reviewed.

Evaluation of ability for basic movement scale for children type T (ABMS-CT) for disabled children.

BACKGROUND: The objective of this pilot study was to test the validity and reliability of a new scale, the Ability for Basic Movement Scale for Children Type T (ABMS-CT). METHODS: Forty-nine pediatric patients with disabilities (aged 1.00-15.17years; 29 males and 20 females) participated in this prospective study. To prove the validity and reliability of the ABMS-CT, subjects were administered the ABMS-CT by two physicians. In addition to the ABMS-CT score, data on age, diagnosis, and results of the Functional Independence Measure for Children (WeeFIM) were recorded. RESULTS: Spearman's rank correlation coefficient analysis showed that the ability to perform basic movements according to the individual scores for each item on the ABMS-CT and the total scores of the ABMS-CT correlated significantly with the total scores of the motor and cognitive WeeFIM, respectively (r=0.753-0.892, p=0.0001). The five items on the ABMS-CT had appropriate internal consistency (Cronbach's α=0.966). Inter-rater reliability analysis indicated that the "oral and facial area", "hands and fingers", "one leg", "both legs", and "stairs" items on the ABMS-CT had almost perfect reliability (κ=0.854-0.925). CONCLUSION: This study provides evidence for the validity and reliability of the ABMS-CT with regard to assessment of the functional ability for complex movements in disabled pediatric patients even if they can walk independently.

Validity and reliability of Ability for Basic Movement Scale for Children (ABMS-C) in disabled pediatric patients.

The objective of this pilot study was to test the validity and reliability of a new scale, the Ability for Basic Movement Scale for Children (ABMS-C). A total of 45 pediatric patients with disabilities (aged 0.1-8.8 years; 29 males, 16 females) participated in this prospective study. To prove the validity and reliability of the ABMS-C, subjects were administered the ABMS-C at a 2-week interval. In addition to the ABMS-C score, data on age, diagnosis, and results of the Gross Motor Function Classification System (GMFCS) were recorded. Spearman's rank correlation coefficient analysis showed that the ability to perform basic movements according to the scores for each item and the total scores of the ABMS-C correlated significantly with the levels of the GMFCS (r=-0.628-0.784, p<0.001). The five items on the ABMS-C had appropriate internal consistency (Cronbach's α=0.944). Test-retest reliability analysis indicated that the "head control", "sitting", "locomotion on flat surface", "standing" and "walking" items on the ABMS-C had almost perfect reliability (κ=0.865-1.000). This study provides evidence for the validity and reliability of the ABMS-C with regard to assessment of functional ability in disabled pediatric patients.

Adaptive mutations in the genomes of enterovirus 71 strains following infection of mouse cells expressing human P-selectin glycoprotein ligand-1.

We recently identified human P-selectin glycoprotein ligand-1 (PSGL-1) as a functional enterovirus 71 (EV71) receptor and demonstrated PSGL-1-dependent replication for some EV71 strains in human leukocytes. Here, we report that four out of five PSGL-1-binding strains of EV71 replicated poorly in mouse L929 cells stably expressing human PSGL-1 (L-PSGL-1 cells). Therefore, we compared the replication kinetics and entire genomic sequence of five original EV71 strains and the corresponding EV71 variants (EV71-LPS), which were propagated once in L-PSGL-1 cells. Direct sequence comparison of the entire genome of the original EV71 strains and EV71-LPS variants identified several possible adaptive mutations during the course of replication in L-PSGL-1 cells, including a putative determinant of the adaptive phenotype in L-PSGL-1 cells at VP2-149. The results suggest that an adaptive mutation, along with a PSGL-1-binding phenotype, may facilitate efficient PSGL-1-dependent replication of the EV71 strains in L-PSGL-1 cells.