Relationship between muscle activity characteristics and physical therapy parameters during posterior gait assistance with knee-ankle-foot orthosis in severe acute stroke hemiplegic patients.

[Purpose] This study aimed to verify muscle activity patterns during posterior gait assistance with a knee-ankle-foot orthosis (KAFO) in patients with severe acute stroke hemiplegia and clarify its relationships with physical therapy parameters. [Participants and Methods] We measured activity in the rectus femoris, biceps femoris, tibialis anterior, and gastrocnemius muscles in 30 patients with acute stroke during KAFO posterior gait assistance and examined their muscle activity patterns using the Japan Coma Scale (JCS), Brunnstrom Recovery Stage (BRS), Berg Balance Scale (BBS), Functional Movement Screen (FMS), and Functional Independence Measure (FIM). We divided lower extremity muscle activity into first and second half of the stance phase, compared muscle activity during the first half of the stance phase and the second half of the stance phase. In addition, the relationship between muscle activity during gaiting and each parameter was analyzed. [Results] All four muscles showed significantly higher values in the first half of the stance phase than in the second half of the stance phase. Rectus femoris first half of the stance phase muscle activity showed a moderate correlation with the BRS, BBS, and FMS scores. [Conclusion] The amount of gastrocnemius muscle activity when KAFO assists walking from behind increases in the latter half of stance in healthy individuals. However, in patients with stroke, the activity was lower and deviated from the gastrocnemius muscle activity during walking in healthy individuals.

Factors associated with improvement in impaired consciousness during the acute phase of cerebral infarction: a prospective observational study.

[Purpose] In this study, we investigated factors that contribute to improvement in impaired consciousness following cerebral infarction. [Participants and Methods] This prospective observational study included 186 patients with cerebral infarction. We investigated 21 variables including the rehabilitation status to determine factors that contribute to improvement in impaired consciousness. [Results] Improvement in impaired consciousness was correlated with age, delirium, the Japan Coma Scale score at initiation of rehabilitation, worsening, cerebral edema, and standing practice. [Conclusion] We conclude that the aforementioned factors may serve as predictors of possible improvement and that standing practice may contribute to improvement in impaired consciousness.

Rehabilitation intervention safety in patients with malignant lymphoma with low blood cell counts.

[Purpose] We established criteria for patients with malignant lymphoma with low blood counts, who did not meet the criteria to discontinue rehabilitation or the blood transfusion criteria even though they were borderline for discontinuing rehabilitation. We investigated physical symptoms, activities of daily living, and adverse events in patients who were permitted to undergo rehabilitation intervention using the new criteria. [Participants and Methods] Forty-two patients met the criteria to discontinue rehabilitation based on blood data, and the new-criteria group included 153 patients who received permission for rehabilitation from a hematologist despite not meeting the criteria to discontinue rehabilitation. The survey items were Barthel index at the time of admission and discharge and the length of hospital stay. A two-group comparison was performed, and the occurrence of adverse events associated with exercise intervention were investigated. [Results] The length of hospital stay was shortened in the new-criteria group, and the rehabilitation intervention rate improved. [Conclusion] For patients with malignant lymphoma with low blood cell counts, continuing rehabilitation intervention with physician permission may prevent a decline in activities of daily living as well as maintain and improve motor function.

Changes in cerebral blood flow before, during, and after forward and backward walking in stroke patients trained using virtual reality walking videos with deliberately induced inaccuracies in walking speed estimations.

[Purpose] The aim of this study was to examine the effects of virtual reality (VR) training, with deliberately induced inaccuracies in walking speed estimations, on brain activity. [Participants and Methods] The study participants were 21 stroke patients, and the walking tasks involved forward and backward walking. While the VR walking speed was set at 3 km/h, estimation errors were induced by using an actual walking speed of 1 km/h during the walking tasks. Cerebral blood flow was measured using two functional near-infrared spectroscopy (fNIRS) channels located over the left and right prefrontal cortices, to determine changes in oxyhemoglobin levels from the resting state. Cerebral hemodynamics were compared during and after the VR training. [Results] The backward walking task induced a significant increase in cerebral blood flow in the right prefrontal cortex during and after the VR training. No significant changes were observed during the forward walking task. [Conclusion] In the backward walking condition, greater activation of the right prefrontal cortex was observed during and immediately after the VR training. Watching VR may have led to inaccurate walking-speed estimations, necessitating postural control (which may be attributed to the activation of the prefrontal cortex) during walking.

Effects of different baggage carrying methods on walking while wearing an arm sling in simulated hemiplegic stroke patients.

[Purpose] We aimed to clarify the effects of different baggage carrying methods on the movement of the trunk and pelvis while walking with an arm sling in simulated hemiplegic stroke patients. [Participants and Methods] The participants were 14 healthy young adults. Measurements were obtained using a three-dimensional motion analysis device in the following order: normal walking, walking with an arm sling on the upper left limb, walking with baggage on the right side, vertical walking, and diagonal walking. The range of motion of the trunk and pelvis during one walking cycle was analyzed. [Results] The range of motion of the lateral tilt of the pelvis significantly differed between normal and vertical walking, as well as between normal walking and diagonal walking. A significant difference was observed in the range of movement in pelvic rotation during the three walking cycles-walking with baggage, vertical walking, and diagonal walking. The range of movement in pelvic rotation was seemingly smaller under other conditions compared to that in normal walking. [Conclusion] It was shown that walking with restrictions on the upper limbs, such as wearing an arm sling or carrying baggage, may impose slight restrictions on the lateral tilt as well as on the rotation of the pelvis.

Safety of rehabilitation interventions for patients with hematologic diseases associated with low blood counts-verification focusing on blood cancer.

[Purpose] This study aimed to establish unique criteria for hematologic patients with low blood counts in the borderline region of or below the threshold for discontinuing cancer rehabilitation without meeting the criteria for blood transfusion, and to investigate the physical symptoms and activities of daily living. [Participants and Methods] Among the 251 participants, 128 had blood test results below the discontinuation criteria. They were permitted to engage in rehabilitation interventions by a hematologist based on the new criteria. The remaining 123 patients were classified under the discontinuation group. The Barthel Index scores during admission and discharge were compared between the two groups, in terms of chemotherapy, physical symptoms of nausea, petechial hemorrhage, pyrexia, and diarrhea. [Results] There was no significant difference between the two groups in terms of the Barthel Index score during admission or discharge. Pyrexia occurred more frequently in patients managed under the new criteria. [Conclusion] Patients with low blood counts that fall between the criteria for discontinuing rehabilitation and receiving blood transfusions can continue undergoing rehabilitation interventions with the permission of their doctors, provided that measures are taken to manage adverse events. This strategy prevents activities of daily living reduction.

Immediate effect of video viewing with an illusion of walking at a faster speed using virtual reality on actual walking of stroke patients.

[Purpose] The objective of this study was to provide cerebral stroke patients with virtual reality videos of gait occurring at a faster speed than their actual measured gait speed and ascertain the effect on generating errors of gait. [Participants and Methods] The participants were 12 stroke patients. They were given a 2-minute virtual reality presentation of gait occurring at a speed faster than their actual measured comfortable walking speed. Immediately following the presentation, their 10-m walking speed was measured again to observe the immediate effect of the intervention, after which the time required to walk at maximum gait speed was measured. Stride length, cadence, and walking speed before and after the intervention were compared. In addition, heard an immersive feeling. [Results] At a comfortable walking speed, the cadence improved significantly post-intervention. Walking speed and stride length also tended to increase. At the maximum walking speed, there were no significant differences in any parameter. There was no problem with the immersive feeling. [Conclusion] After watching virtual reality videos of gait at a speed faster than the patients' actual gait speed, their walking speed tended to increase in comfortable walking. It was speculated that this technique could be applied to walking training, depending on the device.

Changes in cerebral blood flow during forward and backward walking with speed misperception generated by virtual reality.

[Purpose] The purpose of this study was to investigate the effect of speed misperception on brain activity, created by a speed difference between actual walking and virtual reality walking videos. [Participants and Methods] The participants were 20 healthy young people. The walking speed in the video was set to 3 km/h to induce an error, while the actual walking speed was 1 km/h. Cerebral blood flow was measured using an optical imaging brain function measurement device. Left and right prefrontal cortices were analyzed using two channels and oxyhemoglobin level change from rest was used as a cerebral blood flow index. A t-test compared the cerebral blood flow dynamics before, during, and after the virtual reality video viewing under forward and backward walking conditions. [Results] Regarding changes in oxyhemoglobin levels during walking after watching the virtual reality video, cerebral blood flow increased especially in the backward walking state, where the difference was large in the right prefrontal cortex. [Conclusion] The backward walking that caused misperception by virtual reality is an extraordinary movement compared to forward walking. Thus, it is necessary to voluntarily adjust the movement by the cerebral cortex, and it is thought that activation of the prefrontal cortex occurs.

Verification of spatial recognition ability of stroke patients required to resume automobile driving.

[Purpose] To help patients who had a stroke resume automobile driving, we evaluated their ability to recognize three-dimensional space like that experienced in actual driving situations, with a focus on sensing car width. [Participants and Methods] Seven patients who had a stroke and 29 healthy adults participated in the study. Three 50-cm-wide chairs and 2 panels, 3 m apart, were placed 9 m from the chair in which the participant sat. One panel was fixed and the other panel could be moved toward the fixed panel in a horizontal direction. The participants were asked to signal when they believed that the width of the chair was the same as the space between the panels. [Results] In the simulation of driving a real car, the mean error in judging distance was 13.2 ± 10.4 cm for the Healthy group and that of the Stroke group was two times greater than that of the Healthy group. [Conclusion] These findings show that spatial recognition cannot be evaluated using paper-based two-dimensional higher brain function tests. To help patients who had a stroke resume driving requires evaluation of three-dimensional spatial recognition ability under circumstances that simulate actual driving situations.

Effect of arm swaying from wearing a self-applied arm sling with a loop on walking and other mobility skills.

[Purpose] This study aimed to investigate how wearing a self-applied arm sling with a loop during rising, standing up, and walking affects the magnitude of arm swaying and activities among elderly individuals compared with wearing a triangular bandage. [Participants and Methods] Fourteen elderly individuals participated in the study. The methods involved attaching a triaxial accelerometer to an arm wearing a triangular bandage or arm sling and conducting a 5-m walk test, sit-to-stand test five times, and rising up. We then calculated the time required for each action, and the acceleration, vibration intensity, and coefficient of variation of the affected arm; these were then compared between the two groups. [Results] All the participants were able to put on the arm sling with a loop. The step rate with a triangular bandage was higher than that without one. Swaying in the front/back direction in standing up was greater with the triangular bandage. [Conclusion] The self-applied arm sling with a loop was shown to have less front/back swaying during standing up. Wearing a triangular bandage may have narrowed the stride and increased the step rate due to discomfort. This result should be applied with caution, because it remains unclear whether arm slings with loops are advantageous.

Effects of arm swing on walking abilities in healthy adults restricted in the Wernicke-Mann's limb position.

. [Purpose] Arm swing is seldom considered while designing clinical rehabilitation protocols for hemiplegic patients with upper or lower extremity disabilities, likely due to the unclear role that arm swinging plays in the ability to walk. We, therefore, aimed to investigate the effect of arm swinging on walking abilities. [Participants and Methods] The study enrolled 20 healthy adults who performed a 10 m walking test with normal gait, single-arm restricted gait, both-arms restricted gait, and maximum arm-swing gait with one arm fixed in the Wernicke-Mann's position. The walking time, number of steps taken, and pelvic fluctuation were measured for the four gaits. A fixed-trunk type arm sling was used for maintaining the Wernicke-Mann's position. [Results] Velocity and stride length decreased significantly while walking with the single-arm restricted gait and both-arms restricted gait in comparison to normal gait. The maximum arm-swing gait showed no significant differences from normal gait in terms of cadence, velocity, and stride. Pelvic fluctuations also had no significant differences among all gaits. [Conclusion] Restricting movement of one or both arms limited the walking speed and stride; however, in Wernicke-Mann's limb position, if the arm is intentionally swung, the walking speed and stride resembled that of normal gait.

Effects of different oral instructions on kinematic and kinetic parameters during drop vertical jump.

[Purpose] This study aimed to examine the impact of changing the drop vertical jump stance time on kinematic and kinetic parameters by ordering to high jump or quick jump for consistent stance time and a more accurate assessment of anterior cruciate ligament injury risk. [Participants and Methods] The participants were 20 healthy female students. The drop vertical jump was started by instructing the participants to stand on a 30-cm platform with both legs stationary. The task was performed while the participants were instructed to perform high jump or quick jump. [Results] Stance time was significantly shorter with quick jump than with high jump. Quick jump showed significantly higher knee abduction angles at initial contact and peak vertical ground reaction force, and lower hip flexion, knee flexion, and ankle dorsiflexion angles at the lowest point of the center of mass. Quick jump showed a significantly higher peak vertical ground reaction force. The knee abduction moment at initial contact was not significantly different between the 2 conditions. [Conclusion] Quick jump was better than high jump for making stance time consistent, and the differences in kinematic and kinetic characteristics by oral instructions should be considered when using drop vertical jump.

Comparison of forward walking and backward walking in stroke hemiplegia patients focusing on the paretic side.

[Purpose] To investigate the features of backward walking in stroke patients with hemiplegia by focusing on the joint movements and moments of the paretic side, walking speed, stride length, and cadence. [Subjects and Methods] Nine stroke patients performed forward walking and backward walking along a 5-m walkway. Walking speed and stride length were self-selected. Movements were measured using a three-dimensional motion analysis system and a force plate. One walking cycle of the paretic side was analyzed. [Results] Walking speed, stride length, and cadence were significantly lower in backward walking than in forward walking. Peak hip extension was significantly lower in backward walking and peak hip flexion moment, knee extension moment, and ankle dorsiflexion and plantar flexion moments were lower in backward walking. [Conclusion] Unlike forward walking, backward walking requires conscious hip joint extension. Conscious extension of the hip joint is hard for stroke patients with hemiplegia. Therefore, the range of hip joint movement declined in backward walking, and walking speed and stride length also declined. The peak ankle plantar flexion moment was significantly lower in backward walking than in forward walking, and it was hard to generate propulsion power in backward walking. These difficulties also affected the walking speed.

Rate of oral intake and effects of mechanical insufflation-exsufflation on pulmonary complications in patients with duchenne muscular dystrophy.

[Purpose] In Duchenne muscular dystrophy, it increases risks of difficulties of expectoration of secretion, asphyxia, aspiration pneumonia because of decreased cough function. The aim of this study is to prove that manually assisted coughing or mechanical insufflation-exsufflation prevents pulmonary complication and contribute to continue oral intake safely and continue rate of oral intake in Duchenne muscular dystrophy. [Subjects and Methods] We investigated the status of using ventilator, manually assisted coughing or mechanical insufflation-exsufflation, and oral intake or not. In addition, we inspected the frequency of fever (over 37 °C) needed antibiotics from medical records for index of respiratory tract infection, and compared with every period of using mechanical insufflation-exsufflation from respiratory evaluation on cough peak flow. [Results] Fifty-eight patients participated in this study. There were 45 Full-time noninvasive positive pressure ventilation patients. Forty-three in 45 Full-time noninvasive positive pressure ventilation patients (95.6%) avoided tracheostomy and continued noninvasive positive pressure ventilation because they continued oral intake without tracheal intubation due to the respiratory acute exacerbation by asphyxia or aspiration pneumonia. [Conclusion] Duchenne muscular dystrophy patients can continue oral intake safely while preventing pulmonary complication by using manually assisted coughing or mechanical insufflation-exsufflation.

Effectiveness of new sedation and rehabilitation methods for critically ill patients receiving mechanical ventilation.

[Purpose] The purpose of this study was to investigate the effects of new sedation management methods and cooperation between nurses and physical therapists on the duration of mechanical ventilation and hospitalization. [Subjects and Methods] Patients who had been treated at the study hospital 2 years before and after the implementation of the new methods were analyzed retrospectively and classified into a "control group" and an "intervention group", respectively. Both groups were analyzed and subsequently compared regarding the effects of the new sedation and cooperative rehabilitation. [Results] A total of 70 patients met the inclusion criteria and were divided evenly into the two groups. No significant differences were found between the groups in age, APACHE II score, or duration of stay in hospital. On the other hand, significant decreases were seen in the duration of sedation and intubation, mechanical ventilation, and stay in the emergency ward, as well as time until standing. In addition, after intervention, three patients undergoing ventilator treatment were able to be ambulated. [Conclusion] These results suggest that the new sedation and cooperative rehabilitation methods for critically ill patients were effective in the early stage of treatment and shortened the duration of stay in the ward.