Accelerometer-based gait characteristics and their discrimination of gait independence in inpatients with subacute stroke.

BACKGROUND: Gait analysis using inertial measurement devices can identify multifaceted gait disorders after a stroke. Although the usefulness of gait assessment using inertial measurement devices has been reported, its accuracy in discriminating gait independence in patients hospitalized for subacute stroke has not yet been validated. RESEARCH QUESTION: Can trunk acceleration indices discriminate between dependent and independent walking in patients with subacute stroke? METHODS: Thirty-five patients with subacute stroke (mean ± standard deviation, 75.5 ± 9.8 years, 19 males), who were able to understand instructions, had a premorbid modified Rankin scale <3, and were able to walk 16 m straight ahead under supervision were included. The stride regularity, harmonic ratio, and normalized root mean square of trunk accelerations were measured in three directions (mediolateral, vertical, and anterioposterior) during comfortable walking. The Functional Ambulation Categories were used as the dependent variable to classify the patients into two groups (dependent and independent walking groups), and each trunk acceleration index was used as the independent variable to calculate the area under the curve using receiver operating characteristic curves. RESULTS: Twelve patients were in the dependent group and 23 were in the independent group. The normalized root mean square in both the mediolateral and vertical directions were excellent discriminators of walking independence, with an area under the curve greater than 0.8. The cutoff values (sensitivity/specificity) were 2.20 m2/s2 (0.783/0.833) and 2.82 m2/s2 (0.739/0.833), respectively. SIGNIFICANCE: The magnitude of vertical and lateral acceleration during gait in patients with subacute stroke, has excellent accuracy in discriminating between dependent and independent gaits. The results of this study will be useful for inexperienced clinicians working with stroke patients presenting with gait disturbances to accurately determine gait independence based on objective data.

Minimal detectable change in inertial measurement unit-based trunk acceleration indices during gait in inpatients with subacute stroke.

Gait analysis using inertial measurement units (IMU) provides a multifaceted assessment of gait characteristics, but minimal detectable changes (MDC), the true change beyond measurement error, during gait in patients hospitalized with subacute stroke has not been clarified. This study aimed to determine the MDC in IMU-based trunk acceleration indices during gait in patients hospitalized with subacute stroke. Nineteen patients with subacute stroke (mean ± SD, 75.4 ± 10.9 years; 13 males) who could understand instructions, had a pre-morbid modified Rankin Scale < 3 and could walk straight for 16 m under supervision were included. As trunk acceleration indices, Stride regularity, harmonic ratio (HR), and normalized root mean square (RMS) during gait were calculated on three axes: mediolateral (ML), vertical (VT), and anterior-posterior (AP). MDC was calculated from two measurements taken on the same day according to the following formula: MDC = standard error of measurement × 1.96 × 2. The MDCs for each trunk acceleration index were, in order of ML, VT, and AP: 0.175, 0.179, and 0.149 for stride regularity; 0.666, 0.741, and 0.864 for HR; 4.511, 2.288, and 2.680 for normalized RMS. This finding helps determine the effectiveness of rehabilitation interventions in the gait assessment of patients with stroke.

Relationship between gait regularity and harmony, and gait speed at discharge in inpatients with subacute stroke.

[Purpose] Accelerometry indices are a promising and simple method to quantify gait stability. However, the long-term relationship between gait stability and walking ability in patients with stroke has not been fully investigated. The purpose of this study was to longitudinally examine the relationship between gait regularity and harmony at admission and gait speed at discharge in inpatients with subacute mild stroke. [Participants and Methods] Sixteen patients with subacute stroke (median age, 69.5 years [1st-3rd interquartile range, 58.0-73.8 years]; 13 males) were enrolled in the study. A Spearman's rank correlation coefficient was calculated for step regularity, stride regularity, the harmonic ratio at admission, and the walking speed at discharge. We also calculated the partial rank order correlation, controlling for balance ability. [Results] The vertical step regularity, harmonic ratio, and anterior-posterior harmonic ratio were all positively correlated with the walking speed at discharge. Positive correlations with vertical step regularity and harmonic ratio were found in partial rank order correlations when controlled for balance ability. [Conclusion] Vertical step regularity and gait harmony had predictive validity for discharge gait speed in patients with subacute stroke.

Short-term effects of pedaling exercise combined with integrated volitional control electrical stimulation in an older patient hospitalized for subacute stroke: ABA single-case design.

[Purpose] The purpose of this study was to examine effects on gait indices produced by a short-term intervention of pedaling combined with integrated volitional control electric stimulation in an older patient with stroke. [Participant and Methods] This study was a single-case ABA (A-control, B-treatment) design. Each phase lasted four consecutive days (12 days total). Ten minutes of pedaling were performed daily. In Phase B, pedaling was combined with integrated volitional control electric stimulator on the rectus femoris of the affected side. The primary outcomes were the coefficient of variation, a measure of stride time homogeneity during gait; and the root mean square, a measure of trunk sway in the triaxial direction (mediolateral, vertical, anteroposterior) during gait. Assessments were measured before the intervention (day 0) and after the end of each phase (days 4, 8, and 12). [Results] Changes from the previous coefficient of variation were +1.13%, -3.95%, and +0.82% in Phases A, B, and A', respectively, with the greatest improvement occurring after Phase B. The root mean square improved the most with -5.13 for mediolateral after Phase B, -3.33 for vertical, and -6.99 for anteroposterior after Phase A. [Conclusion] A short-term intervention consisting of pedaling combined with integrated volitional control electric stimulation may contribute to the improvement of gait abnormalities.

Association between self-perceived activity performance and upper limb functioning in subacute stroke.

BACKGROUND AND PURPOSE: This study aimed to investigate to what extent upper limb (UL) motor impairment, trunk compensation, and activity performance are related to self-perception of UL activity performance in subacute stroke. METHODS: This was a prospective observational study. Twenty-four adults with subacute stroke (age: 65.4 ± 10.8 years) underwent clinical and kinematic assessments at baseline (33.9 ± 5.2 days after stroke onset) and 4 weeks after the baseline. The clinical assessment included the UL Fugl-Meyer motor assessment (FMA), Simple Test for Evaluating hand Function (STEF), and the performance and satisfaction scores of the Canadian Occupational Performance Measure (COPM). The kinematic measurement was performed using a motion capture system during a standardized reach-to-grasp task. Endpoint performance variables and trunk displacement were calculated as kinematic outcomes. An inpatient rehabilitation program of 3 h/day was provided every day for 4 weeks between the two measurement points. The relationships between COPM scores and clinical/kinematic outcomes were examined by multiple regression analysis. Significance levels of p < 0.05 were used. RESULTS: The results of the multiple regression analysis showed that the changes in STEF (ß = 0.520, p = 0.005) and trunk compensation (ß = -0.398, p = 0.024) were moderately related to the change in the COPM satisfaction (R2 adj  = 0.426, p = 0.001), while the change in UL FMA was not. DISCUSSION: The changes in activity performance and trunk compensation were related to improved self-perception of UL activity performance. Therapeutic management for activity performance and trunk compensation may be important for improving self-perception of UL activity performance after stroke.

Fall prediction using decision tree analysis in acute care units.

[Purpose] To present an accurate and straight-forward system of fall prediction by performing decision tree analysis using both the fall assessment sheet and Berg balance scale (BBS). [Participants and Methods] The participants in this retrospective study were inpatients from acute care units. We extracted the risk factors for falls from the fall assessment and performed a decision tree analysis using the extracted fall risk factors and BBS score. [Results] "History of more than one fall in the last 1 year", "Muscle weakness", "Use of a walking aid or wheelchair", "Requires assistance for transfer", "Use of Narcotics", "Dangerous behavior", and "High degree of self-reliance" were fall risk factors. The decision tree analysis extracted five fall risk factors, with an area under the curve of 0.7919. Patients with no history of falls and who did not require assistance for transfer or those with a BBS score ≥51 did not fall. [Conclusion] Decision tree-based fall prediction was useful and straightforward and revealed that patients with no history of falling and those who did not require assistance for transfer or had a BBS score ≥51 had a low risk of falling.

The validity of an accelerometer-based method for estimating fluidity in the sit-to-walk task in a community setting.

[Purpose] Fluidity in the sit-to-walk task has been quantitatively measured with three-dimensional motion analysis system. The purpose of this study was to determine the validity of an accelerometer-based method for estimating fluidity in community-dwelling elderly individuals. [Subjects and Methods] Seventeen community-dwelling elderly females performed a sit-to-walk task. The motion was recorded by an accelerometer, a three-dimensional motion analysis system and a foot pressure sensor simultaneously. The timings of events determined from the acceleration waveform were compared to the timings determined from the three-dimensional motion analysis data (task onset, maximum trunk inclination) or foot pressure sensor data (first heel strike). Regression analysis was used to estimate the fluidity index from the duration between events. [Results] The characteristics of the acceleration waveform were similar to those previously reported in younger adults. Comparisons of event timings from accelerometer and motion analysis system data indicated no systematic bias. Regression analysis showed that the duration from maximum trunk inclination to the first heel strike was the best predictor of fluidity index. [Conclusion] An accelerometer-based method using the duration between characteristic events may be used to precisely and conveniently assess fluidity in a sit-to-walk task in a community setting.

An accelerometer-based method for estimating fluidity in the sit-to-walk task.

[Purpose] The purpose of this study was to clarify the validity of accelerometer data for quantifying fluidity during the sit-to-walk task. [Subjects] The participants were 16 healthy young males. [Methods] The timing of events (task onset, maximum trunk inclination, and first heel strike) was determined from the acceleration waveform and compared to the timing determined from a three-dimensional motion analysis (task onset, maximum trunk inclination) or foot pressure sensor data (first heel strike). Regression analysis was used to estimate the fluidity index (FI) from the duration between events and the magnitude of the acceleration peak. The task was performed at two speeds (comfortable and maximum). [Results] A comparison of the timings from two different systems indicated no systematic bias. Specific events could be identified from acceleration data using regression analysis under both speed conditions. In addition, significant regression equations predictive of FI were constructed using the duration between events under both speed conditions. The duration from the maximum trunk inclination to the first heel strike was the best predictor of FI. [Conclusion] Accelerometer data may be used to precisely and conveniently evaluate fluidity. The clinical utility of these data should be tested in elderly individuals or patient populations.

Effects of Directional Change on Postural Adjustments during the Sit-to-walk Task.

[Purpose] The purpose of this study was to clarify the effects of directional change on postural adjustments during the sit-to-walk (STW) task. [Subjects] Fifteen healthy young men participated in this study. [Methods] Subjects were required to stand up from a chair and walk toward a target. The first step was limited to the right limb only. Three conditions of target direction (straight, ipsilateral and contralateral) were set. For the ipsilateral and contralateral conditions, the target was placed at an angle 45° clockwise and 45° counterclockwise from straight ahead, respectively. Trials were recorded by a motion capture system and force plates. The forward momentum of the body, time of events, center of pressure (COP) and center of gravity (COG) displacement were measured and compared between conditions. [Results] In the contralateral condition, the fluidity index was significantly lower than that in the straight condition. In the contralateral condition, COP displacement toward the swing limb was larger than in the other conditions. [Conclusion] The present results indicate that a directional change during the STW task affects fluidity and postural adjustments. When the STW direction was changed to diagonal, the lateral component of postural control became more important.

[Clinical studies of inverted papilloma of the bladder].

Inverted papilloma of the bladder is an uncommon urothelial neoplasm. Although it is traditionally regarded as a benign tumor, there are conflicting data on multiplicity, reoccurrence rate, and association with urothelial carcinoma. From 2005 to 2011, 14 cases of inverted papilloma of the bladder were diagnosed at our hospital. Clinical features of 14 cases were summarized. These patients ranged in age from 25 to 81 years (mean, 61 years). The most frequently occurring symptom was gross hematuria. Eleven bladder tumors arose from the trigone or near the bladder neck. One case was associated with urothelial carcinoma. One was suspected to be a case of tumor recurrence. All other patients were free of tumor recurrence during the mean follow-up of 16.4 months (range, 0-75 months). This study does not suggest the malignant potential of inverted papilloma. However, since inverted papilloma may correlate with urothelial carcinoma. Post-treatment follow up for inverted papilloma should include cystoscopic follow up.

[Comparison of naftopidil and silodosin in the treatment of male lower urinary tract symptoms associated with benign prostatic hyperplasia: a randomized, crossover study].

We compared the efficacy, safety, and patient preferences for two α1-adrenoceptor (AR) antagonists with different affinity for AR subtypes, naftopidil (Naf) and silodosin (Silo), for the treatment of male lower urinary tract symptoms associated with benign prostatic hyperplasia (male LUTS/BPH). New patients diagnosed with male LUTS/BPH were randomly divided into either the Naf-Silo group or the Silo-Naf group (Naf : 50-75 mg once daily for 2 weeks followed by 75 mg once daily for 4 weeks ; Silo : 2-4 mg twice daily for 2 weeks followed by 4 mg twice daily for 4 weeks). A survey was conducted to evaluate patient drug preferences after completion of the study and the reasons for the preferences. Naf and Silo improved the total International Prostate Symptom Score (IPSS) compared with baseline. There was no significant difference between Naf and Silo in improvement in the IPSS total score. Adverse effects were more frequent with Silo than with Naf (P=0. 002). No significant difference in patient preference for the drugs was observed. These findings indicate that Naf and Silo provide similar clinical efficacy, with no difference in patient preference for the drugs, although adverse effects were significantly more frequent with Silo than with Naf.

[A case of recurrent intracaval renal cell carcinoma effectively treated with sunitinib].

A 67-year-old man received left radical nephrectomy for left renal cell carcinoma (RCC) (clear cell carcinoma, G2, pT3bN0M0). After 9 months, he presented with an acute onset of left extremity edema. A computed tomographic (CT) scan and magnetic resonance imaging reveal recurrent renal cell carcinoma in the inferior vena cava (IVC) and the left renal fossa, thrombus in the left external vein and acute pulmonary embolism. We performed treatment with sunitinib for 5 months after anticoagulant therapy for 3 weeks. A new CT scan showed disappearance of RCC in the IVC and reduction in the size of RCC in the renal fossa. Only 11 cases are reported as recurrent RCC in the IVC. We report the first case of recurrent intracaval RCC in which sunitinib treatment was effective.

[Rupture of renal angiomyolipoma during pregnancy: a case report].

A 39-year-old woman, who was followed because of a 4 cm asymptomatic angiomyolipoma (AML) in the left kidney, presented with an acute onset of lower left back pain in the 38th week of her first pregnancy. An ultrasound revealed an 8 cm mass suggestive of AML rupture and retroperitoneal hemorrhage. An emergency caesarean delivery was performed. A post-delivery computed tomographic scan confirmed the AML rupture and selective embolization was performed. This was a case in which the AML grew rapidly during the pregnancy ; therefore, we discuss the relationship between AML and pregnancy.

[Segmental infarction of the testis presenting as acute scrotum: a case report].

We report a case of segmental testicular infarction that is a rare and usually idiopathic. The patient is a 36-year-old man who presented with acute right scrotal pain and swelling. Scrotal ultrasound demonstrated a round hypoechoic lesion and magnetic resonance imaging (MRI) findings could not rule out intratesticular hemorrhage or necrotic tissue associated with malignant neoplasm. Therefore right high orchiectomy was performed. The histopathological examination revealed segmental infarction of the testis at the upper and middle pole with coagulation necrosis.

[A case of hormone/docetaxel-refractory prostate cancer in which PSA level decreased after docetaxel+zoledronic acid treatment].

The patient was a 63-year-old man who had a recurrence and bone metastasis of prostate cancer after total prostatectomy. He was diagnosed with prostate cancer refractory to hormones. Subsequently, the PSA level decreased after docetaxel therapy, but then gradually increased. Thus, he was diagnosed with bone metastasis of prostate cancer refractory to therapy with hormones or docetaxel. The PSA level decreased after the start of therapy with docetaxel+ zoledronic acid. Zoledronic acid seems to be effective not only for the prevention but also for the treatment of skeletal related events(SRE)in patients with prostate cancer with bone metastases.

[Retroperitoneal Castleman's disease presenting characteristic image finding].

A 30-year-old woman was hospitalized in our institute with fever up and abdominal pain. Computerized tomography showed a retroperitoneal mass (8 cm in diameter) with arborizing calcification, which was enhanced homogeneously in the arterial phase. The operation was performed and parthological diagnosis revealed hyaline vascular type Castleman's disease. This characteristic calcification pattern is considered unique to Castleman's disease, and could be useful for future diagnosis.

[Multi-center trial on the early effects of silodosin on lower urinary tract symptoms associated with benign prostatic hyperplasia].

Silodosin (URIEF), a new so-called 3rd generation alpha-1 blocker, is widely expected to be effective and useful for lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), due to its high specificity to alpha-1A receptor. We evaluated the efficacy of Silodosin, on 187 males 50 years old or over with the diagnosis of BPH. Silodosin significantly improved the International Prostate Symptom Score (IPSS) and quality of life (QOL) score from the day after administration was started. Among 166 patients whose data were available for the analysis of efficacy of Silodosin, 77.5% showed apparent subjective improvement. Eighty three patients, who had been taking another alpha-1 blocker but without satisfactory effects, showed almost the same improvements in IPSS and QOL score after switching to Silodosin as the remaining 83 patients who had no preceding treatment with an alpha-1 blocker. The improvements were not only in voiding symptoms but also in storage symptoms. The patients, who had serious storage symptoms, responded rather well to Silodosin and showed significant improvement. Taken together, Silodosin showed a quick effect for improving subjective symptoms and QOL, and was found to be useful for the management of LUTS with BPH.