Neural bases characterizing chronic and severe upper-limb motor deficits after brain lesion.

Chronic and severe upper-limb motor deficits can result from damage to the corticospinal tract. However, it remains unclear what their characteristics are and whether only corticospinal tract damage determines their characteristics. This study aimed to investigate the clinical characteristics and neural bases of chronic and severe upper-limb motor deficits. Motor deficits, including spasticity, of 45 patients with brain lesions were assessed using clinical scales. Regarding their scores, we conducted a principal component analysis that statistically extracted the clinical characteristics as two principal components. Using these principal components, we investigated the neural bases underlying their characteristics through lesion analyses of lesion volume, lesion sites, corticospinal tract, or other regional white-matter integrity. Principal component analysis showed that the clinical characteristics of chronic and severe upper-limb motor deficits could be described as a comprehensive severity and a trade-off relationship between proximal motor functions and wrist/finger spasticity. Lesion analyses revealed that the comprehensive severity was correlated with corticospinal tract integrity, and the trade-off relationship was associated with the integrity of other regional white matter located anterior to the posterior internal capsule, such as the anterior internal capsule. This study indicates that the severity of chronic and severe upper-limb motor deficits can be determined according to the corticospinal tract integrity, and such motor deficits may be further characterized by the integrity of other white matter, where the corticoreticular pathway can pass through, by forming a trade-off relationship where patients have higher proximal motor functions but more severe wrist/finger spasticity, and vice versa.

Influence of right versus left unilateral spatial neglect on the functional recovery after rehabilitation in sub-acute stroke patients.

Unilateral spatial neglect (USN) may lead to poor functional rehabilitation outcomes. However, studies investigating the rehabilitation outcomes of right-sided USN are lacking. We aimed to investigate (1) the clinical impacts of USN, including right-sided USN, for stroke patients in sub-acute rehabilitation, and (2) evaluate the differences in clinical characteristics and rehabilitation outcomes between right- and left-sided USN patients. We retrospectively screened the medical records of 297 inpatients at the Tokyo-Bay Rehabilitation Hospital who experienced a cerebrovascular accident with supratentorial lesions between January 1st, 2014 and December 31st, 2016. We performed independent multiple regression analysis in patients with left and right hemisphere damage. The Behavioral Inattention Test was a significant independent variable for predicting the motor, cognitive, and total functional independence measure (FIM), compared to the Stroke Impairment Assessment Set and Mini-Mental State Examination. USN affects motor FIM recovery more than cognitive FIM recovery regardless of the damaged hemisphere. Our study results confirm that both right- and left-sided USN influence the functional recovery of stroke patients. USN occurs, slightly less frequently, following a left hemisphere stroke. However, USN negatively affected rehabilitation outcomes, regardless of the neglected side. Therefore, USN treatment is necessary for patients with left and right hemisphere damage.

Relationship between initial nutritional status and functional independence measures at discharge in subacute stroke.

OBJECTIVE: This retrospective study examined the association between nutritional status at admission and functional independence measure (FIM™) at discharge. MATERIALS AND METHODS: This study included 205 patients, aged ≥ 65, discharged from a convalescent ward between April 2017 and March 2018. The primary outcome was discharge FIMTM, and the secondary outcomes were the length of stay (LOS) and FIM efficiency. The explanatory variables included demographic data, stroke type, admission FIMTM, body mass index (BMI), controlling nutritional status (CONUT), and Geriatric Nutritional Risk Index (GNRI). Patients were divided into three groups based on BMI and GNRI scores and four groups based on the CONUT score. Univariate and multiple regression analyses were performed to predict discharge FIMTM. Kruskal-Wallis and Dunn's tests were also performed for intergroup comparisons. RESULTS: In the univariate analyses, age, sex, onset-to-admission interval, admission FIMTM, GNRI, and BMI (all factors were p<0.001) were significant explanatory variables for discharge FIMTM. In the multiple linear regression analysis, admission FIMTM, LOS, age, and onset-to-admission interval were significant explanatory variables (adjusted R2 = 0.791; p<0.001). Although those with poor nutritional status required a longer hospital stay, they achieved the same FIM gain as those without poor nutritional status. CONCLUSIONS: Nutritional status on admission did not affect the FIMTM at discharge in the convalescent ward. Patients with subacute stroke require adequate rehabilitation regardless of their nutritional status.

Postural differences in the immediate effects of active exercise with compression therapy on lower limb lymphedema.

PURPOSE: Although regarded as an important treatment for lymphedema, the therapeutic effects of active exercise with compression therapy (AECT) are supported by little evidence. The purpose of this study was to determine the relative benefits of AECT with different postures for patients with lower limb lymphedema (LLL). METHODS: Eighteen women with LLL secondary to surgical treatment of gynecological cancer, completed (1) AECT in a seated position (seated AECT), (2) AECT in a supine position (supine AECT), and (3) compression-only therapy in a supine position (CT) in this randomized, controlled, crossover trial. AECT was performed on a bicycle ergometer while wearing elastic compression bandages. Each intervention was performed for 15 min, and the three conditions were separated by a 1-week washout period. Lower-limb volumes were evaluated using a PerometerTM sensor (Pero-system, Wuppertal, Germany), and symptom severity was assessed before and after each intervention using a visual analog scale (pain, heaviness) and palpation (pitting, stiffness). The effects of the interventions were estimated using linear mixed-effect models. RESULTS: The magnitude of limb volume decreases differed significantly among the interventions, with a greater decrease after supine AECT than after CT. Pre-intervention pitting severity and skin stiffness were significantly correlated with the magnitude of volume decrease after all interventions and after AECT in the supine position, respectively. CONCLUSIONS: Supine AECT using a bicycle ergometer has marked immediate effects to decrease the fluid volume of severe LLL. CLINICAL TRIAL REGISTRATION: UMIN clinical trial registry (UMIN-CTR; ID000020129) by CONSORT 2010, TRN R000023253, December 9, 2015.

Adaptation and validation of the Japanese version of the Spinal Cord Independence Measure (SCIM III) self-report.

STUDY DESIGN: Psychometric study, cross-sectional validation study. OBJECTIVES: To adapt and validate the Japanese version of the Spinal Cord Independence Measure self-report (SCIM-SR). SETTING: A spinal cord injury (SCI) rehabilitation facility in Japan. METHODS: We adapted the SCIM-SR for the Japanese population by translating and validating the questionnaire in accordance with the international guidelines. Following this, we analyzed 100 inpatients with SCI. We evaluated their independence using the Japanese SCIM-SR, and compared the data with those assessed using the SCIM III by trained ward nurses. RESULTS: Spearman's rank correlation coefficients were 0.95 for the total score, 0.89 for self-care, 0.83 for respiration and sphincter management, and 0.89 for mobility subscores. The Bland-Altman analysis revealed no significant proportional bias (-0.02; 95% CI [-0.07, 0.06]), but a significant fixed bias (2; 95% CI [0.5, 3.5]). We did not identify any specific factor that affected the differences between SCIM III and SCIM-SR scores. CONCLUSIONS: Our study validated the Japanese version of SCIM-SR as a tool for the evaluation of the independence of persons with SCI, which could substitute SCIM III and help facilitate a deeper understanding of activities of daily living among patients with SCI.

Pelvis-Toe Distance: 3-Dimensional Gait Characteristics of Functional Limb Shortening in Hemiparetic Stroke.

We aimed to investigate whether a newly defined distance in the lower limb can capture the characteristics of hemiplegic gait compared to healthy controls. Three-dimensional gait analyses were performed on 42 patients with chronic stroke and 10 age-matched controls. Pelvis-toe distance (PTD) was calculated as the absolute distance between an anterior superior iliac spine marker and a toe marker during gait normalized by PTD in the bipedal stance. The shortening peak during the swing phase was then quantified as PTDmin. The sagittal clearance angle, the frontal compensatory angle, gait speed, and the observational gait scale were also collected. PTDmin in the stroke group showed less shortening on the affected side and excessive shortening on the non-affected side compared to controls. PTDmin on the affected side correlated negatively with the sagittal clearance peak angle and positively with the frontal compensatory peak angle in the stroke group. PTDmin in stroke patients showed moderate to high correlations with gait speed and observational gait scale. PTDmin adequately reflected gait quality without being affected by apparent improvements due to frontal compensatory patterns. Our results showed that various impairments and compensations were included in the inability to shorten PTD, which can provide new perspectives on gait rehabilitation in stroke patients.

Quality of life and the prevalence of urinary incontinence after surgical treatment for gynecologic cancer: a questionnaire survey.

BACKGROUND: Although there have been a number of reports on urinary voiding symptoms associated with surgical interventions for gynecologic cancer and post-voiding symptoms, there have been few reports on urinary storage symptoms such as urinary incontinence (UI) and overactive bladder (OAB). The purpose of this study was to examine the rates and impact on quality of life (QOL) of urinary storage symptoms after gynecologic cancer surgery. METHODS: A questionnaire survey, including Japanese-language versions of the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), Overactive Bladder Symptom Score (OABSS), and Incontinence Impact Questionnaire-7 (IIQ-7), was distributed to gynecologic cancer patients who underwent hysterectomy between 2008 and 2013. RESULTS: Of the 145 patients analyzed, 49 (33.8%) had UI pre-surgery, and 76 (52.4%) had UI post-surgery, including 34 (35.4%) first-time UI patients, with a significant difference between pre- and post-surgery. Of the 49 subjects with UI pre-surgery, 43 (87.7%) had stress incontinence, while of the 76 patients with UI post-surgery, 44 (57.1%) had stress incontinence, and 24 (31.2%) had mixed incontinence. Seven (4.8%) subjects had OAB pre-surgery, whereas 19 (13.1%) had OAB symptoms post-surgery (including 15 first-time OAB patients), with a significant difference between pre- and post-surgery. IIQ-7 scores were markedly higher for patients with mixed incontinence post-surgery than for those with stress incontinence, indicating a lower QOL. Logistic regression analysis identified the number of Cesarean sections and days of urinary bladder catheterization as risk factors for postoperative UI. CONCLUSIONS: UI and OAB rates were higher after gynecologic cancer surgery than in the general female population. The mixed incontinence rate was markedly higher post-surgery; QOL was low for such patients due to the combination of urge and stress incontinence. Multiple Cesarean sections and urinary bladder catheterization post-surgery were risk factors for post-surgical UI.

Malnutrition among elderly patients with severe aortic stenosis.

BACKGROUND: Most patients with aortic stenosis (AS) are elderly. To achieve favorable outcomes after interventional treatments, careful management including adequate nutritional support is required. However, there has been a lack of knowledge about the prevalence of malnutrition and factors related to it. AIMS: To explore the prevalence of malnutrition and its related factors in patients with severe AS. METHODS: This was a single-institution, cross-sectional study. A total of 300 consecutive older patients (mean age, 83.8 ± 0.5 years) with AS were prospectively enrolled. Nutritional status was evaluated with the Mini Nutritional Assessment-Short Form (MNA-SF). Cardiac, kidney, physical, cognitive functions, instrumental activities of daily living (IADL) as measured with the Frenchay Activities Index (FAI), medical history, and comorbidities were evaluated as potentially related factors. Multiple logistic regression analysis was performed to identify factors that were significantly associated with the MNA-SF. RESULTS: The mean (SD) score of the MNA-SF was 10.9 (2.5). 34 patients (11.3%) and 127 patients (42.3%) met the criteria for malnutrition and at risk of malnutrition, respectively. On multiple logistic regression analysis, female sex (OR 3.455, 95% CI 1.045-11.42, P = 0.042), NYHA class (OR 3.625, 95% CI 1.627-8.074, P = 0.002), left ventricular ejection fraction (/10%) (OR 0.961, 95% CI 0.932-0.991, P = 0.010), and FAI score (/10 points) (OR 0.911, 95% CI 0.864-0.961, P < 0.001) were significantly related to malnutrition. CONCLUSIONS: The prevalence of malnutrition was high among older persons with severe AS, and female sex, poor cardiac function, and lower IADL were independently related to it.

Contribution of propriospinal neurons to recovery of hand dexterity after corticospinal tract lesions in monkeys.

The direct cortico-motoneuronal connection is believed to be essential for the control of dexterous hand movements, such as precision grip in primates. It was reported, however, that even after lesion of the corticospinal tract (CST) at the C4-C5 segment, precision grip largely recovered within 1-3 mo, suggesting that the recovery depends on transmission through intercalated neurons rostral to the lesion, such as the propriospinal neurons (PNs) in the midcervical segments. To obtain direct evidence for the contribution of PNs to recovery after CST lesion, we applied a pathway-selective and reversible blocking method using double viral vectors to the PNs in six monkeys after CST lesions at C4-C5. In four monkeys that showed nearly full or partial recovery, transient blockade of PN transmission after recovery caused partial impairment of precision grip. In the other two monkeys, CST lesions were made under continuous blockade of PN transmission that outlasted the entire period of postoperative observation (3-4.5 mo). In these monkeys, precision grip recovery was not achieved. These results provide evidence for causal contribution of the PNs to recovery of hand dexterity after CST lesions; PN transmission is necessary for promoting the initial stage recovery; however, their contribution is only partial once the recovery is achieved.

Factors affecting lower limb muscle strength and cardiopulmonary fitness after allogeneic hematopoietic stem cell transplantation.

PURPOSE: The aim of this study is to clarify the factors affecting physical function after allogeneic hematopoietic stem cell transplantation (HSCT). METHODS: We retrospectively analyzed 88 patients (median age, 44.5 years) who received allogeneic HSCT. Leg extension torque and peak oxygen consumption (VO2) were evaluated before and after HSCT. Patient factors (age, sex, underlying diseases, hemoglobin, serum albumin, and Karnofsky performance status score before transplant) and transplant factors (conditioning regimen, days to neutrophil engraftment, grades of acute graft-versus-host disease [GVHD], infections, and the interval between pre- and post-evaluation) were collected via chart review, and were used for correlational and comparison analyses in order to identify the variables associated with reduced post-HSCT leg extension torque and peak VO2. Stepwise multiple regression analyses for post-HSCT leg extension torque and post-HSCT peak VO2 were performed using age, sex, and the related variables with a p value < 0.2 in the correlational and comparison analyses. RESULTS: Leg extension torque and peak VO2 were significantly reduced after HSCT (p < 0.001). Pre-HSCT leg extension torque, grades of acute GVHD, age, and the interval between pre- and post-evaluation were identified as significant factors associated with reduced post-HSCT leg extension torque. However, none of these factors were significantly associated with reduced post-HSCT peak VO2, and only its pre-transplant value was identified as a significant factor. CONCLUSIONS: These findings suggest that improvements in muscle strength and cardiopulmonary fitness before HSCT are crucial for maintaining post-treatment physical function, especially in elderly individuals with acute GVHD requiring a long-term stay in a protective environment.

Using a logarithmic model to predict functional independence after spinal cord injury: a retrospective study.

STUDY DESIGN: A retrospective cohort study OBJECTIVE: To establish a logarithmic model to predict functional independence after spinal cord injury. SETTING: The National Hospital Organization, Murayama Medical Center, Japan. METHODS: Thirty-one adults with a traumatic spinal cord injury (SCI) were enrolled. The Spinal Cord Independence Measure (SCIM) III scores obtained at month 1 and 3 after admission were used to construct a simple logarithmic model to predict SCIM III scores. The validity of the predicted scores was evaluated using a linear mixed model, and agreement between the predicted and measured scores were assessed using the Bland-Altman analysis. RESULTS: In the linear mixed model, the fixed effect slope [95% CI] and the intercept [95% CI] were 1.18 [0.78, 1.58] and -1.75 [-10.3, 6.83], respectively. The scatter plot showed non-linear correlation between the predicted and actual SCIM III scores. This non-linearity became inconspicuous when Sphincter Management scores were omitted. The fixed effect slope and the intercept were 1.12 [0.89, 1.36] and -1.64 [-4.95, 1.68], respectively. A significant fixed or proportional bias was not identified on the Bland-Altman analysis of the total SCIM III score, with most scores lying between an upper limit of +15.3 and a lower limit of -19.3. CONCLUSION: The logarithmic model provided an accurate prediction of the functional independence score of individuals with SCI in our cohort which included various neurological levels and severity of the injury. Along with its simplicity, our prediction model could be useful in daily practice.

Relationship between spasticity and spinal neural circuits in patients with chronic hemiparetic stroke.

Spasticity is a common problem in patients with stroke that contributes to motor dysfunction. However, the pathophysiological mechanisms underlying spasticity are not fully understood. The purpose of the present study was to explain the relationship between features of spinal neural circuits assessed using electrophysiological techniques and the clinical manifestations of stroke. The participants were 71 patients with chronic hemiparetic stroke. To assess spinal neural circuits, Hmax/Mmax of the forearm flexor muscles and reciprocal inhibition (RI) between forearm extensor and flexor muscles with the H reflex conditioning-test paradigm were measured. The relationships between electrophysiological parameters and clinical variables (age, time from stroke onset, upper extremity functional scores, and spasticity) were then analyzed. It was found that the third phase of RI (RI-3) correlated with the modified Ashworth scores of the wrist and finger flexors. No other correlations were found between electrophysiological and clinical measures. These results suggest that RI-3 is associated with spasticity and may be helpful to understand the basis of post-stroke spasticity.

Change in Reciprocal Inhibition of the Forearm with Motor Imagery among Patients with Chronic Stroke.

We investigated cortically mediated changes in reciprocal inhibition (RI) following motor imagery (MI) in short- and long(er)-term periods. The goals of this study were (1) to describe RI during MI in patients with chronic stroke and (2) to examine the change in RI after MI-based brain-machine interface (BMI) training. Twenty-four chronic stroke patients participated in study 1. All patients imagined wrist extension on the affected side. RI from the extensor carpi radialis to the flexor carpi radialis (FCR) was assessed using a FCR H reflex conditioning-test paradigm. We calculated the "MI effect score on RI" (RI value during MI divided by that at rest) and compared that score according to lesion location. RI during MI showed a significant enhancement compared with RI at rest. The MI effect score on RI in the subcortical lesion group was significantly greater than that in the cortical lesion group. Eleven stroke patients participated in study 2. All patients performed BMI training for 10 days. The MI effect score on RI at a 20 ms interstimulus interval was significantly increased after BMI compared with baseline. In conclusion, mental practice with MI may induce plastic change in spinal reciprocal inhibitory circuits in patients with stroke.

Immediate effects of active exercise with compression therapy on lower-limb lymphedema.

PURPOSE: Active exercise with compression therapy (AECT) is a standard treatment for gynecological cancer-related lower-limb lymphedema (LLL) in clinical situations. However, there is insufficient evidence regarding the immediate effects of the use of AECT on LLL. The purpose of this study was to evaluate the immediate effects of AECT on LLL. METHODS: Participants in this randomized controlled crossover trial comprised 23 women with LLL who completed high-load AECT, low-load AECT, and compression-only therapy (CT). AECT was performed on a bicycle ergometer with short stretch bandages. Each intervention was performed for 15 min, with successive interventions separated by a 1-week washout period. Lower-limb volume was assessed using a Perometer™ sensor (Pero-system, Wuppertal, Germany). General symptoms (pain and heaviness) and skin symptoms (pitting and stiffness) were assessed using a visual analog scale and palpation, respectively. Measurements were taken before and after each intervention. Analysis of variance using linear mixed-effect modeling was used for statistical analyses. RESULTS: Volume decrement differed significantly between all three interventions (P < 0.05). Lower-limb volume was significantly reduced after high-load AECT compared to that after CT. General symptoms and skin symptoms were similar across the three interventions, but severity of pre-intervention skin symptoms correlated significantly with volume decrement after high- and low-load AECT. High-load AECT using the bicycle ergometer was more effective than CT for decreasing lower-limb volume. CONCLUSIONS: These results suggest that high-load AECT has marked effects on severe LLL.

Ipsilateral EEG mu rhythm reflects the excitability of uncrossed pathways projecting to shoulder muscles.

BACKGROUND: Motor planning, imagery or execution is associated with event-related desynchronization (ERD) of mu rhythm oscillations (8-13 Hz) recordable over sensorimotor areas using electroencephalography (EEG). It was shown that motor imagery involving distal muscles, e.g. finger movements, results in contralateral ERD correlating with increased excitability of the contralateral corticospinal tract (c-CST). Following the rationale that purposefully increasing c-CST excitability might facilitate motor recovery after stroke, ERD recently became an attractive target for brain-computer interface (BCI)-based neurorehabilitation training. It was unclear, however, whether ERD would also reflect excitability of the ipsilateral corticospinal tract (i-CST) that mainly innervates proximal muscles involved in e.g. shoulder movements. Such knowledge would be important to optimize and extend ERD-based BCI neurorehabilitation protocols, e.g. to restore shoulder movements after stroke. Here we used single-pulse transcranial magnetic stimulation (TMS) targeting the ipsilateral primary motor cortex to elicit motor evoked potentials (MEPs) of the trapezius muscle. To assess whether ERD reflects excitability of the i-CST, a correlation analysis between between MEP amplitudes and ipsilateral ERD was performed. METHODS: Experiment 1 consisted of a motor execution task during which 10 healthy volunteers performed elevations of the shoulder girdle or finger pinching while a 128-channel EEG was recorded. Experiment 2 consisted of a motor imagery task during which 16 healthy volunteers imagined shoulder girdle elevations or finger pinching while an EEG was recorded; the participants simultaneously received randomly timed, single-pulse TMS to the ipsilateral primary motor cortex. The spatial pattern and amplitude of ERD and the amplitude of the agonist muscle's TMS-induced MEPs were analyzed. RESULTS: ERDs occurred bilaterally during both execution and imagery of shoulder girdle elevations, but were lateralized to the contralateral hemisphere during finger pinching. We found that trapezius MEPs increased during motor imagery of shoulder elevations and correlated with ipsilateral ERD amplitudes. CONCLUSIONS: Ipsilateral ERD during execution and imagery of shoulder girdle elevations appears to reflect the excitability of uncrossed pathways projecting to the shoulder muscles. As such, ipsilateral ERD could be used for neurofeedback training of shoulder movement, aiming at reanimation of the i-CST.

After-effects of pedaling exercise on spinal excitability and spinal reciprocal inhibition in patients with chronic stroke.

PURPOSE OF THE STUDY: To evaluate the after-effects of pedaling on spinal excitability and spinal reciprocal inhibition in patients with post-stroke spastic hemiparesis. MATERIALS AND METHODS: Twenty stroke patients with severe hemiparesis participated in this study and were instructed to perform 7 min of active pedaling and 7 min of passive pedaling with a recumbent ergometer at a comfortable speed. H reflexes and M waves of paretic soleus muscles were recorded at rest before, immediately after and 30 min after active and passive pedaling. The Hmax/Mmax ratio and H recruitment curve were measured. Reciprocal inhibition was assessed using the soleus H reflex conditioning test paradigm. RESULTS: The Hmax/Mmax ratio was significantly decreased after active and passive pedaling exercise. The decreased Hmax/Mmax ratio after active pedaling lasted at least for 30 min. The H recruitment curve and reciprocal inhibition did not change significantly after active or passive pedaling exercise. CONCLUSIONS: Pedaling exercise decreased spinal excitability in patients with severe hemiparesis. Pedaling may be effective in rehabilitation following stroke.

The effects of anodal transcranial direct current stimulation and patterned electrical stimulation on spinal inhibitory interneurons and motor function in patients with spinal cord injury.

Supraspinal excitability and sensory input may play an important role for the modulation of spinal inhibitory interneurons and functional recovery among patients with incomplete spinal cord injury (SCI). Here, we investigated the effects of anodal transcranial direct current stimulation (tDCS) combined with patterned electrical stimulation (PES) on spinal inhibitory interneurons in patients with chronic incomplete SCI and in healthy individuals. Eleven patients with incomplete SCI and ten healthy adults participated in a single-masked, sham-controlled crossover study. PES involved stimulating the common peroneal nerve with a train of ten 100 Hz pulses every 2 s for 20 min. Anodal tDCS (1 mA) was simultaneously applied to the primary motor cortex that controls the tibialis anterior muscle. We measured reciprocal inhibition and presynaptic inhibition of a soleus H-reflex by stimulating the common peroneal nerve prior to tibial nerve stimulation, which elicits the H-reflex. The inhibition was assessed before, immediately after, 10 min after and 20 min after the stimulation. Compared with baseline, simultaneous application of anodal tDCS with PES significantly increased changes in disynaptic reciprocal inhibition and long-latency presynaptic inhibition in both healthy and SCI groups for at least 20 min after the stimulation (all, p < 0.001). In patients with incomplete SCI, anodal tDCS with PES significantly increased the number of ankle movements in 10 s at 20 min after the stimulation (p = 0.004). In conclusion, anodal tDCS combined with PES could induce spinal plasticity and improve ankle movement in patients with incomplete SCI.

Physical frailty in older people with severe aortic stenosis.

BACKGROUND: Assessment of physical frailty is important among elderly with severe aortic stenosis (AS) when considering treatment. AIMS: We aimed to: (1) investigate the prevalence of physical frailty in older people with severe AS and (2) examine factors related to physical frailty. METHODS: A total of 125 consecutive elderly AS patients (mean age 84.6 ± 4.4 year) were enrolled. Physical frailty was defined as scoring ≤8 points on the short physical performance battery (SPPB). Factors likely related to physical frailty, including cardiac function, nutritional and metabolic status, kidney function, medical history, and comorbidities, were evaluated. Logistic regression analyses were used to examine which factors were related to physical frailty. RESULTS: Physical frailty was prevalent in 38.4 %. After sex and age adjusted, the following were significantly related to physical frailty: LVEF (adjusted OR per 10 % decrease: 1.39, p < 0.05), the Mini Nutritional Assessment-Short Form (adjusted OR per 1 point decrease: 1.21, p < 0.05), serum albumin (adjusted OR per 1 g/dL decrease: 2.64, p < 0.05), HDL-C (adjusted OR per 10 mg/dL decrease: 1.52, p < 0.01), eGFR (adjusted OR per 10 mL/min decrease: 1.59, p < 0.05), grip strength (adjusted OR per 10 kg decrease: 3.60, p < 0.01), coronary heart disease (adjusted OR: 2.78, p < 0.01), cerebrovascular disease (adjusted OR: 6.06, p < 0.01), and musculoskeletal disorders (adjusted OR: 3.28, p < 0.01). CONCLUSIONS: The prevalence of physical frailty is high and related to nutritional status, comorbidities, and cardiac status.

Spatial and temporal dynamics of visual search tasks distinguish subtypes of unilateral spatial neglect: Comparison of two cases with viewer-centered and stimulus-centered neglect.

We developed a computerised test to evaluate unilateral spatial neglect (USN) using a touchscreen display, and estimated the spatial and temporal patterns of visual search in USN patients. The results between a viewer-centered USN patient and a stimulus-centered USN patient were compared. Two right-brain-damaged patients with USN, a patient without USN, and 16 healthy subjects performed a simple cancellation test, the circle test, a visuomotor search test, and a visual search test. According to the results of the circle test, one USN patient had stimulus-centered neglect and a one had viewer-centered neglect. The spatial and temporal patterns of these two USN patients were compared. The spatial and temporal patterns of cancellation were different in the stimulus-centered USN patient and the viewer-centered USN patient. The viewer-centered USN patient completed the simple cancellation task, but paused when transferring from the right side to the left side of the display. Unexpectedly, this patient did not exhibit rightward attention bias on the visuomotor and visual search tests, but the stimulus-centered USN patient did. The computer-based assessment system provided information on the dynamic visual search strategy of patients with USN. The spatial and temporal pattern of cancellation and visual search were different across the two patients with different subtypes of neglect.