Effects of gait exercise assist robot (GEAR) on subjects with chronic stroke: A randomized controlled pilot trial.

OBJECTIVE: The aim of this study was to investigate whether gait training using the Gait Exercise Assist Robot (GEAR) is more effective for improving gait ability than treadmill gait training in chronic stroke subjects. DESIGN: Subjects were randomly assigned to either the GEAR group (n = 8) or treadmill group (n = 11). Both groups received a training program of 20 sessions (5 days/week). The 10-m walk test, Timed Up and Go (TUG) test, 6-min walk test, the Medical Outcome Study 8-item Short Form Health Survey (SF-8), and Global Rating of Change (GRC) scales were administered at baseline (week 0), completion of training (week 4), 1-mo follow-up (week 8), and 3-mo follow-up (week 16). RESULTS: Gait speed was significantly increased at completion of training and 1-mo follow-up compared with baseline in the GEAR group. Mean changes in TUG and 6-min walk were significantly greater in the GEAR group than in the treadmill group at completion of training compared to baseline. Furthermore, GRC scales were significantly increased at completion of training, 1-mo follow-up, and 3-mo follow-up compared with baseline in the GEAR group. CONCLUSION: This study suggests that gait training using GEAR was more effective for improving gait ability than treadmill among subjects with chronic stroke. REGISTRATION OF CLINICAL TRIALS: This study was registered with the University Hospital Medical Information Network (No. UMIN000028042).

Rehabilitation Treatment of a Patient With Total Humeral Endoprosthetic Replacement.

Total humeral endoprosthetic replacement (THR) is a rare surgery for malignant humeral bone tumors. Studies focusing on its surgical methods and functional status are limited. Furthermore, rehabilitation treatment after THR has not been reported. Therefore, this case report aimed to investigate its postoperative rehabilitation treatment and reinstatement. A 69-year-old woman was diagnosed with chondrosarcoma of her left humerus. THR was performed the day following patient admission. The wide resection caused the loss of her left shoulder motor function. She had a left ulnar nerve disorder and carpal tunnel syndrome. Rehabilitation treatments such as joint range of motion training were initiated on postoperative day (POD) 1. We designed a shoulder abductor brace to maintain her left shoulder in an abducted and flexed position so she could use her left hand effectively. The manual muscle testing scores for elbow joint movements gradually improved. On POD47, she was transferred to a convalescent rehabilitation hospital to receive training in activities of daily living and barber work. The patient was discharged on POD107. The Disabilities of the Arm, Shoulder, and Hand score improved from 86.2 (POD7) to 17.2 (POD107). She continued outpatient rehabilitation and reinstated work on POD143. The use of a brace and seamless rehabilitation from the acute phase to convalescence and community-based rehabilitation enabled the patient with THR to return to work. This study suggests that precise assessment of the disorders and consecutive rehabilitation treatment with a brace should be considered after THR.

Heart Failure Management Capability and Exacerbation of Heart Failure　- A 6-Month Prospective Cohort Study.

Background: In households with older individuals, where a patient is experiencing heart failure (HF), effective cooperation between patients and caregivers is crucial for disease management. However, there is limited evidence regarding the impact of cooperative HF management on the incidence of exacerbation. Therefore, the aim of this 6-month prospective cohort study was to investigate the association between HF management capability and exacerbations. Methods and Results: The study enrolled outpatients (age ≥65 years) with chronic HF from a cardiology clinic and their caregivers. Self-care capabilities among patients and caregivers were evaluated using the Self-Care of Heart Failure Index (SCHFI) and Caregiver Contribution-SCHFI, respectively. Total scores were calculated using the highest score for each item. During the follow-up period, 31 patients experienced worsening HF. The analysis revealed no significant association between the total HF management score and HF exacerbation among all eligible patients. However, in patients with preserved left ventricular ejection fraction (LVEF), high HF management capability of the family unit was associated with a reduced risk of HF exacerbation, even after adjusting for the severity of HF. Conclusions: In older patients with HF and preserved LVEF, effective HF management may contribute to a lower risk of exacerbations.

Web-Based Questionnaire Survey on Heart Failure in Elderly Patients Using Outpatient Rehabilitation　- Actual Conditions of Cardiac Rehabilitation in Long-Term Care Insurance Systems.

Background: The purpose of this study was to investigate the actual conditions of cardiac rehabilitation (CR) for elderly patients with heart failure (HF) in outpatient rehabilitation (OR) facilities using long-term care insurance systems. Methods and Results: This was a cross-sectional web-based questionnaire survey conducted at 1,258 facilities in the Kansai region (6 prefectures) of Japan from October to December 2021. In all, 184 facilities responded to the web-based questionnaire (response rate 14.8%). Of these facilities, 159 (86.4%) accepted patients with HF. Among the patients with HF, 94.3% were aged ≥75 years and 66.7% were classified as New York Heart Association functional class I/II. Facilities treating patients with HF generally provided exercise therapy, patient education, and disease management, which were components of CR. Many facilities not currently treating patients with HF responded positively stating they will accept HF patients in the future. However, a few facilities responded by stating that they are waiting for clearer evidence demonstrating the beneficial effect of OR on patients with HF. Conclusions: The present results show the possibility that outpatient CR can be performed for elderly patients with HF in other than medical insurance.

Prosthetic walking after bilateral transfemoral amputation in a patient with dilated cardiomyopathy: a case report.

In this study, we present a case of a 14-year-old adolescent boy who developed rhabdomyolysis and underwent bilateral transfemoral amputation after cardiopulmonary resuscitation for cardiac arrest because of dilated cardiomyopathy (DCM). Patients with bilateral transfemoral amputation have slower walking velocity and greater oxygen consumption during walking. Rehabilitation of such patients may be demanding especially if they have DCM, one of the major causes of advanced heart failure. The patient was admitted to our hospital on postoperative day (POD) 206. At first, we started with residuum compression. Simultaneously, resistance training and range-of-motion exercise were performed. He started the walking training with short stubbies prostheses on POD 262. Then, we used two types of knee joint prostheses, microprocessor-controlled prosthetic knee (MPK) and non-MPK. We chose MPK for his bilateral knee joints because it was easier for him to walk with MPK than with non-MPK. MPK also has the advantage of high stability and less burden on the heart. He achieved to walk with the prosthesis using T-canes with both hands on POD 374. Furthermore, he was able to return to school after discharge. In patients with transfemoral amputations and DCM with exercise restrictions, MPK is preferred because it reduces cardiac load during physical activity.

Improving abnormal gait patterns by using a gait exercise assist robot (GEAR) in chronic stroke subjects: A randomized, controlled, pilot trial.

BACKGROUND: Although the Gait Exercise Assist Robot (GEAR) has been reported to effectively improve gait of hemiplegic patients, no study has investigated its use in chronic stroke patients. It is possible to facilitate gait reorganization by gait training with less compensation using the GEAR even in chronic stroke patients. RESEARCH QUESTION: What are the effects of GEAR training on the abnormal gait patterns of chronic stroke subjects? METHODS: Subjects were randomly assigned to either the GEAR group (n = 8) or the treadmill group (n = 11). Each group underwent 20 sessions (40 min/day, 5 days/week). The changes in the 10 types of abnormal gait patterns were evaluated using a three-dimensional motion analysis system and the Global Rating of Change (GRC) scale before and after the intervention, and at 1-month and 3-month follow-up assessment. RESULTS: In the GEAR group, hip hiking at a 1-month follow-up assessment was markedly lesser than that before the intervention, and the excessive hip external rotation at 3-month follow-up assessment was notably lesser than that after the intervention, but the change in excessive hip external rotation was in the normal range. In the treadmill group, knee extensor thrust at a 1-month follow-up assessment was strikingly lesser than that before the intervention, but the difference was in the normal range. In the GEAR group, the GRC scale scores were considerably higher after the intervention, at a 1-month, and 3-month follow-up assessment than those before the intervention. But, in the treadmill group, only the GRC scale score at a 1-month follow-up assessment was visibly higher than that before the intervention. SIGNIFICANCE: Gait training using the GEAR may be more effective than treadmill-training in improving the swing phase in chronic stroke subjects.

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

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.