A cross-sectional survey of consistent rehabilitation through long-term care insurance in Japan: a questionnaire survey.

There seems to be a lack of consistency of maintenance/community-based rehabilitation through long-term care insurance. We aimed to clarify whether consistent rehabilitation can be performed through long-term care insurance by questionnaires. Materials and Methods: This study was a cross-sectional study in a nationwide survey among rehabilitation staff and care recipients who completed disease-specific rehabilitation and required maintenance/community-based rehabilitation through long-term care insurance. Consistency of rehabilitation was compared using Fisher's exact tests. The concordance of the rehabilitation evaluation and treatment conducted under medical and long-term care insurance was assessed using the κ coefficient. Results: Six hundred questionnaires from care recipients and staff were analyzed. Of the rehabilitation staff, 264 (44%) obtained rehabilitation plans from medical institutions. There was a significant difference between the responses of "referral from the same medical corporation" and "obtaining the rehabilitation plan" by Fisher's exact test (odds ratio: 3.242; P<0.001). Most rehabilitation treatments under medical insurance comprised walking or training with parallel rods/canes [498 patients (83%)], and 454 patients (76%) received stretching and range-of-motion training for the limbs and spine for long-term care insurance. Muscle strength evaluation was the most frequently conducted under medical and long-term care insurance [383 (73%) and 487 (83%), respectively]. The concordance of the evaluation and treatment content, except for disease-specific evaluation, was low (κ coefficient≤0.6). Conclusions: The rate of provision of rehabilitation plans was low, and evaluation and treatment content under medical and long-term care insurance was inconsistent. Our results draw attention to the need for consistent rehabilitation plans between disease-specific and maintenance/community-based rehabilitation.

Rehabilitation in the long-term care insurance domain: a scoping review.

PURPOSE: Since the enactment of the long-term care insurance (LTCI) act in 2000, the number of LTCI users has increased annually. However, evidence regarding what is being carried out as rehabilitation treatment under LTCI is lacking. In this study, a scoping review was performed to bridge this knowledge gap. METHODS: Articles related to rehabilitation in connection with LTCI published between April 2000 and November 2020 were searched for in PubMed, CINAHL, CENTRAL (Cochrane Central Register of Controlled Trials), Ichushi Web Ver.5, and CiNii and randomized controlled trials (RCTs) of rehabilitation provided under LTCI were examined. RESULTS: Of the 15,572 publications identified, 15 RCTs, including rehabilitation treatment by physiatrists and therapists, met the eligibility criteria of our review and were included. The rehabilitation trials in the 15 RCTs varied and included balance training, exercise therapy, cognitive tasks, and activities such as singing and dancing. The results allowed us to focus on three categories: fall prevention, dementia, and theory and tools interventions related to occupational therapy practice. CONCLUSION: The focal points of attention in the rehabilitation treatment of LTCI were identified. However, the physical function, quality of life, and activities of daily living (ADL) of those who "need support" vary from person to person. Therefore, the consolidation of evidence on rehabilitation treatment of LTCI must be continued.

An Urgent Webinar for Therapists Working in Local Facilities by Physiatrists and Therapists in a Regional Core Hospital during the COVID-19 Pandemic.

BACKGROUND: After the emergence of novel coronavirus disease (COVID-19), cluster infections occurred at several rehabilitation facilities in Japan. Because rehabilitation is necessary for deconditioned COVID-19 patients, preventing cluster infections and providing rehabilitation while protecting therapists were also essential in the Wakayama region. WEBINAR: The rehabilitation medicine department and division of Wakayama Medical University Hospital, which consists of physiatrists and registered therapists, proposed that the Wakayama Physical Therapy Association hold an urgent webinar for therapists in the Wakayama region. The webinar (120 min in duration) comprised an overview of severe acute respiratory syndrome coronavirus 2, the significance of rehabilitation therapy for COVID-19 patients, instruction in personal protective equipment, and case reports on COVID-19 patients from an affiliated university hospital. The webinar was held on May 16, 2020, after only 9 days of preparation. Ninety-six members of 29 facilities in the Wakayama region participated, including therapists who lived far from the university. Moreover, the webinar was implemented at a lower cost than a conventional meeting. An opportunity was provided to share information among participants, speakers, instructors, and a supervisor after the presentations. The overall level of satisfaction of participants after the webinar was high. DETAILS: The rehabilitation medicine department and division of Wakayama Medical University Hospital, which consists of physiatrists and registered therapists, proposed that the Wakayama Physical Therapy Association hold an urgent webinar for therapists in the Wakayama region. The webinar (120 min in duration) comprised an overview of severe acute respiratory syndrome coronavirus 2, the significance of rehabilitation therapy for COVID-19 patients, instruction in personal protective equipment, and case reports on COVID-19 patients from an affiliated university hospital. The webinar was held on May 16, 2020, after only 9 days of preparation. Ninety-six members of 29 facilities in the Wakayama region participated, including therapists who lived far from the university. Moreover, the webinar was implemented at a lower cost than a conventional meeting. An opportunity was provided to share information among participants, speakers, instructors, and a supervisor after the presentations. The overall level of satisfaction of participants after the webinar was high. CONCLUSION: This webinar for therapists in local facilities was held by physiatrists and therapists at Wakayama Medical University, a regional core hospital, in collaboration with the regional therapy association. The preparation time was only 9 days and the cost was lower than that for a conventional meeting, thereby allowing participants to share information about infection control for COVID-19 in an efficient and cost-effective manner.

Relationship between ultrasonographically low-echoic lesions under the skin, wheelchair sitting time, and interface pressure on ischial region in individuals with chronic spinal cord injury.

Objective: To determine the relationship between physical findings, wheelchair sitting time, and interface pressure on ischial region in subjects with spinal cord injury (SCI).Design: Cross-sectional study.Setting: Rehabilitation center in Japan.Participants: Manual wheelchair users with chronic SCI (n = 45).Interventions: Pressure ulcers (PU) were diagnosed by inspection, palpation, and ultrasonography. Self-reports were obtained on wheelchair sitting time and pressure mapping was recorded while the subject was seated on the wheelchair.Outcome measures: Subjects were divided into those with ultrasonographically low-echoic lesions (PU-positive group, n = 11) and no such lesions (PU-negative group, n = 34). Outcome measures included wheelchair sitting time and interface pressure at bilateral ischial regions.Results: Using ultrasonography, 13 low-echoic lesions were identified in 11 subjects of the PU-positive group. The pressure duration was longer and interface pressure was significantly higher in subjects of the PU-positive group compared with those of the PU-negative group (P < 0.05 and P < 0.001, respectively).Conclusions: This is the first study to evaluate the interrelationship between physical findings, sitting time, and ultrasonographically measured interface pressure on ischial region area in subjects with spinal cord injury. To prevent pressure ulcers, we recommend avoidance of prolonged wheelchair sitting and measures that can reduce the interface pressure. These variables should be carefully tailored to the needs of the individual subjects with SCI.

Factors associated with dynamic knee valgus angle during single-leg forward landing in patients after anterior cruciate ligament reconstruction.

BACKGROUND: A few studies have reported on how to predict increased dynamic knee valgus angle (KVA), a risk factor for second anterior cruciate ligament (ACL) injury after ACL reconstruction. This study aimed to identify the factors with the potential to predict the KVA during single-leg hop landing. METHODS: Using three-dimensional motion analysis systems, knee motion during a single-leg hop landing task was measured in 22 patients who had undergone ACL reconstruction at 8-10 months postoperatively. The KVA at initial contact (IC) and maximum KVA during the 40-ms period after IC were calculated using the point cluster technique; correlations between the KVA and other factors were assessed. We performed multiple regression analysis to determine whether KVA could be predicted by these parameters. RESULTS: The KVA was significantly negatively correlated with the static femorotibial angle (FTA; P < 0.01) and patient height (P < 0.01). It was positively correlated with the body mass index (P < 0.05). Multiple regression analysis showed that a small FTA could predict the KVA at IC (ß: 0.52, 95% confidence interval (CI): 2.24-(-0.42); P < 0.01). The maximum KVA during the 40-ms period after IC was associated with the FTA (ß: 0.46, 95% CI: 2.22-(-0.26); P = 0.02) and height (ß: 0.40, 95% CI: 0.59-(-0.02); P = 0.04). CONCLUSION: At 8-10 months after ACL reconstruction, the KVA was significantly correlated with the FTA, with reduced FTA being associated with an increased dynamic KVA during single-leg hop landing. The measurement of anatomical parameters may aid in predicting the second ACL injury risk after reconstruction.

Effect of coronary artery bypass grafting on blood pressure response to head-up tilting.

Blood pressure response to head-up tilt (HUT) in 7 healthy subjects and 9 patients before and after coronary artery bypass grafting (CABG) was measured during supine and 15-min 60° HUT. Stroke volume (SV) and ejection fraction (EF) were assessed by echocardiography. Baseline mean arterial pressure (MAP) and heart rate (HR) in patients before CABG were similar to healthy subjects. MAP in patients decreased by 6 (4-9) mmHg [median (1st-3rd quartiles)] during 7-12 mmHg of HUT with decreased cardiac output (CO = SV × HR) while HR remained unchanged. MAP in healthy subjects remained unchanged during HUT with increased HR. Body weight decreased by 3.5 (2.5-3.7) kg and MAP decreased by 6 (2-13) mmHg during the last 3-min HUT while HR increased after CABG. Decreases in SV and CO during HUT disappeared after CABG. Blood pressure decreased during HUT in patients before and after CABG regardless of HR response.

Effects of physiatrist and registered therapist operating acute rehabilitation (PROr) in patients with stroke.

OBJECTIVE: Clinical evidence suggests that early mobilization of patients with acute stroke improves activity of daily living (ADL). The purpose of this study was to compare the utility of the physiatrist and registered therapist operating acute rehabilitation (PROr) applied early or late after acute stroke. SUBJECTS AND METHODS: This study was prospective cohort study, assessment design. Patients with acute stroke (n = 227) admitted between June 2014 and April 2015 were divided into three groups based on the time of start of PROr: within 24 hours (VEM, n = 47), 24-48 hours (EM, n = 77), and more than 48 hours (OM, n = 103) from stroke onset. All groups were assessed for the number of deaths during hospitalization, and changes in the Glasgow Coma Scale (GCS), National Institute of Health Stroke Scale (NIHSS), and Functional Independence Measure (FIM) at hospital discharge. INTERVENTIONS: All patients were assessed by physiatrists, who evaluated the specific needs for rehabilitation, and then referred them to registered physical therapists and occupational therapists to provide early mobilization (longer than one hour per day per patient). RESULTS: The number of deaths encountered during the PROr period was 13 (out of 227, 5.7%), including 2 (4.3%) in the VEM group. GCS improved significantly during the hospital stay in all three groups, but the improvement on discharge was significantly better in the VEM group compared with the EM and OM groups. FIM improved significantly in the three groups, and the gains in total FIM and motor subscale were significantly greater in the VEM than the other groups. CONCLUSIONS: PROr seems safe and beneficial rehabilitation to improve ADL in patients with acute stroke.

Noninvasive positive pressure ventilation enhances the effects of aerobic training on cardiopulmonary function.

PURPOSE: The purpose of this study was to determine the effect of aerobic training under noninvasive positive pressure ventilation (NPPV) on maximal oxygen uptake ([Formula: see text]). METHODS: Ten healthy young male volunteers participated in the study. Before the training, stroke volume (SV) and cardiac output (CO) were measured in all subjects under 0, 4, 8, and 12 cmH2O NPPV at rest. Then, the subjects exercised on a cycle ergometer at 60% of pre-training [Formula: see text] for 30 min daily for 5 consecutive days with/without NPPV. The 5-day exercise protocol was repeated after a three-week washout period without/with NPPV. The primary endpoint was changes in [Formula: see text]. The secondary endpoints were changes in SV, CO, maximum heart rate (HRmax), maximum respiratory rate (RRmax), maximum expiratory minute volume (VEmax) and the percent change in plasma volume (PV). RESULTS: NPPV at 12 cmH2O significantly reduced SV and CO at rest. [Formula: see text] significantly increased after 5 days training with and without NPPV, but the magnitude of increase in [Formula: see text] after training under 12 cmH2O NPPV was significantly higher than after training without NPPV. VEmax significantly increased after training under NPPV, but not after training without NPPV. HRmax and RRmax did not change during training irrespective of NPPV. The percent change in PV was similar between training with and without NPPV. The 5-day training program with NPPV resulted in greater improvement in [Formula: see text] than without NPPV. CONCLUSIONS: Aerobic training under NPPV has add-on effects on [Formula: see text] and exercise-related health benefits in healthy young men.

Carotid blood flow, cardiovascular and endocrine responses during head-up tilt in patients with acute cerebrovascular diseases.

The purpose of this study was to define common carotid blood flow (CBF), cardiovascular and endocrine responses during head-up tilt (HUT) in patients with acute cerebrovascular diseases (CVD). In 31 male patients with acute CVD (damage of the supratentorial area) and 21 age-matched control male subjects, we measured CBF, mean blood pressure (MBP), heart rate, stroke volume and cardiac output responses before (baseline), during and after HUT. We also measured plasma levels of antidiuretic hormone, adrenaline, noradrenaline, aldosterone and plasma renin activity. After obtaining baseline measurements during 3-minutes horizontal position, HUT was performed for 5 minutes, followed by continuation of recording for 3 more minutes in the horizontal position. During HUT, CBF decreased significantly and equally in both groups. MBP did not change during HUT in both groups. The endocrine responses were also not different between the two groups. The results suggest that damage to the supratentorial area in patients with acute CVD do not alter the CBF, cardiovascular and endocrine responses. In other words, HUT does not predispose patients with acute CVD to serious falls in MBP and CBF at upright posture.

Immediate effects of unaffected arm exercise in poststroke patients with spastic upper limb hemiparesis.

BACKGROUND: Spasticity is a major disabling symptom in stroke patients. Clinically, one of the goals of management of stroke patients should be to reduce spasticity. Recent evidence suggests that motor recovery after stroke comprises a hierarchical, dynamic framework of interacting mechanisms in brain cortex. We hypothesized that unaffected arm exercise can stimulate the ipsilateral motor cortex and change the affected upper limb function and spasticity in stroke patients. To test the hypothesis, we evaluated the effects of unaffected arm exercise on spasticity of the affected upper limb and motor function in stroke patients. METHODS: The study was performed in 41 chronic stroke patients with upper limb hemiparesis. Affected upper limb spasticity and function were assessed at baseline and after each intervention by the modified Ashworth Scale and Fugl-Meyer Assessment, respectively. Patients were also evaluated clinically by the modified Rankin Scale, Functional Independence Measurement and National Institutes of Health Stroke Scale. Subjects stood for 10 min during the control period, and then cycled an arm crank ergometer at 50% of maximum work load for 10 min by the unaffected arm in standing position. RESULTS: The mean age at study entry was 64.6 ± 1.7 years. The latency between onset of stroke and the study was 109.0 ± 17.0 months (range, 6-495). The cause of hemiparesis was cerebral infarction (n = 21), intracerebral hemorrhage (n = 17) or subarachnoid hemorrhage (n = 3). Exercise significantly improved the modified Ashworth Scale compared with baseline (p < 0.0001). No such change was noted after the control intervention. The Fugl-Meyer Assessment score did not change after exercise compared with baseline (p = 0.95). CONCLUSIONS: We conclude that 10 min of unaffected arm exercise improves the affected upper limb spasticity in stroke patients. Further studies are needed to determine the exact mechanism of such improvement and the long-term effects of unaffected arm exercise on motor performance.

Development of a new instrument for evaluating leg motions using acceleration sensors (II).

OBJECTIVE: The purpose of this study was to investigate the characteristics of the average acceleration of elderly people during walking. METHOD: The subject cohort comprised nine men and 21 women aged ≥63 years. Subjects walked a 10-m straight course (walk test) which required stepping over six obstacles (hurdle walk test). The average acceleration was calculated from the accelerograms. Functional reach test scores and the Tokyo Metropolitan Institute of Gerontology (TMIG) index of competence, fall risk assessment, fall experience within the last year, and carelessness were used as standard indices to estimate the dynamic postural movement and fall risk. RESULTS: The average acceleration during the walk test was not significantly correlated with the standard indices. The average accelerations at the lumbar and knee positions clustered with fall experience and carelessness, while those at the ankle and toe positions clustered with the hurdle walk test, TMIG index of competence, and fall risk assessment. Between the high- and low-risk groups classified by the conventional indices, there was a significant difference in the average acceleration at some measurement positions. The receiver operating characteristic analysis showed the possibility to discriminate the high-risk group according to the standard indices with average acceleration. CONCLUSIONS: The average acceleration during walking may be a composite index that encompasses standard indices and discriminate the high-risk group. As such, it may be a useful tool to estimate the dynamic postural movement and fall risk at all measurement positions.

Longitudinal changes in physical capacity over 20 years in athletes with spinal cord injury.

OBJECTIVE: To investigate the longitudinal changes in physical capacity over 20 years in athletes with spinal cord injury (SCI). DESIGN: Longitudinal study (20-y follow-up). SETTING: Laboratory setting. PARTICIPANTS: Persons with SCI (N=7). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Maximum oxygen consumption Vo(2)max) measured in 1986-1988 and in 2006. RESULTS: Subjects with SCI maintained stable Vo(2)max in 2006. Six of the 7 continued various wheelchair sports activities, while 1 person quit sports activities 1 year after the baseline study. The latter person showed reduced Vo(2)max by 53%, while 2 persons who continued strenuous wheelchair sports activities showed increased Vo(2)max by 43% and 45% after 20 years. CONCLUSION: The results indicated that physical capacity reflected the level of sports activity in subjects with SCI who maintained sports activities.

Development of new instrument for evaluating leg motions using acceleration sensors.

The purpose of this study is to develop a new system for measuring leg motions using a portable three-dimensional accelerometer. The measuring system is composed of acceleration sensors (Micro Stone, MA3-10Ac), a data logger, a data reader, and a personal computer. The personal computer draws a graph of the acceleration of movements (i.e., accelerogram) from the output signals of the acceleration sensors. We then calculated the average acceleration to evaluate leg motions. We drew the accelerograms from 19 young subjects and 36 elderly subjects during the performance of physical fitness activities and walking. Different accelerograms were obtained from two subjects for different walking styles. The average accelerations at the lumbar, ankle and toe points were higher at all axes during movements from the physical fitness activities in the elderly subjects. The accelerations of leg motion at the knee point were, however, lower in the up and down axis in the elderly subjects than in the young subjects, although they were higher in the back and forth and the right and left axes. The new instrument has enabled us to evaluate leg motions by measuring three-dimensional acceleration during the performance of physical fitness activities and walking. The average accelerations of leg motions showed age-related changes. Thus, the average acceleration of leg motions may be used as a new index for evaluating leg motions at the dynamic state.