Quantitative measurement of resistance force and subsequent attenuation during passive isokinetic extension of the wrist in patients with mild to moderate spasticity after stroke.

BACKGROUND: Spasticity is evaluated by measuring the increased resistance to passive movement, primarily by manual methods. Few options are available to measure spasticity in the wrist more objectively. Furthermore, no studies have investigated the force attenuation following increased resistance. The aim of this study was to conduct a safe quantitative evaluation of wrist passive extension stiffness in stroke survivors with mild to moderate spastic paresis using a custom motor-controlled device. Furthermore, we wanted to clarify whether the changes in the measured values could quantitatively reflect the spastic state of the flexor muscles involved in the wrist stiffness of the patients. MATERIALS AND METHODS: Resistance forces were measured in 17 patients during repetitive passive extension of the wrist at velocities of 30, 60, and 90 deg/s. The Modified Ashworth Scale (MAS) in the wrist and finger flexors was also assessed by two skilled therapists and their scores were averaged (i.e., average MAS) for analysis. Of the fluctuation of resistance, we focused on the damping just after the peak forces and used these for our analysis. A repeated measures analysis of variance was conducted to assess velocity-dependence. Correlations between MAS and damping parameters were analyzed using Spearman's rank correlation. RESULTS: The damping force and normalized value calculated from damping part showed significant velocity-dependent increases. There were significant correlations (ρ = 0.53-0.56) between average MAS for wrist and the normalized value of the damping part at 90 deg/s. The correlations became stronger at 60 deg/s and 90 deg/s when the MAS for finger flexors was added to that for wrist flexors (ρ = 0.65-0.68). CONCLUSIONS: This custom-made isokinetic device could quantitatively evaluate spastic changes in the wrist and finger flexors simultaneously by focusing on the damping part, which may reflect the decrease in resistance we perceive when manually assessing wrist spasticity using MAS. Trial registration UMIN Clinical Trial Registry, as UMIN000030672, on July 4, 2018.

Factors Influencing the Improvement of Activities of Daily Living during Inpatient Rehabilitation in Newly Diagnosed Patients with Glioblastoma Multiforme.

Glioblastoma multiforme (GBM) is the most common and aggressive brain tumor. To identify the factors influencing the improvement of the activities of daily living (ADL) in newly diagnosed patients with GBM, we investigated the characteristics and variable factors and overall survival. A total of 105 patients with GBM were retrospectively analyzed and categorized into the following three groups according to the quartile of change of their Barthel index score from admission to discharge: deterioration (n = 25), no remarkable change (n = 55), and good recovery (n = 25). A statistical difference was observed in the pre-operative, intra-operative, post-operative, and rehabilitation-related factors between the deterioration and good recovery groups. Multiple regression analysis identified the following significant factors that may influence the improvement of ADL after surgery: the improvement of motor paralysis after surgery, mild fatigue during radio and chemotherapy, and length up to early walking training onset. The median overall survival was significantly different between the deterioration (10.6 months) and good recovery groups (18.9 months, p = 0.025). Our findings identified several factors that may be associated with post-operative functional improvement in patients with GBM. The inpatient rehabilitation during radio and chemotherapy may be encouraged without severe adverse events and can promote functional outcomes, which may contribute to the overall survival of newly diagnosed patients with GBM.

Feasibility and effectiveness of home-based exercise programs on physical performance and health-related quality of life of the older people dwelling on an isolated, doctor-less island.

AIM: To promote preventive care among older individuals dwelling on an isolated, doctor-less island, we investigated the feasibility and the efficacy of a home-based exercise program, depending on their functional status and health-related quality of life. METHODS: A total of 23 older (mean age 72.6 years) participants were assigned to a home-based exercise program (intervention group), and 34 older (mean age 74.2 years) participants were assigned to a group without any intervention (control group). The participants of the intervention group attended the exercise program three times a week for 3 months. The exercise program consisted of various exercises involving stretching, muscle strengthening, balance retraining and walking. The physical performance, Functional Independence Measure and Short-Form 36-item health survey were used to assess the physical and the mental wellbeing of the participants. RESULTS: There was no significant difference between the changes in physical performance at baseline and post 3 months in both groups. However, the motor and the cognitive Functional Independence Measure scores significantly improved in the intervention group post 3 months. The domains of the Short-Form 36-item health survey improved post 3 months; particularly, significant improvement was observed in the physical functions, general health, vitality, mental health and mental component summary. CONCLUSIONS: Although an isolated island has several problems to support preventive care services, such as a lack of medical resources and availability of only a few healthcare workers, the present study provides evidence on the feasibility and efficacy of nurse-led home-based exercise programs for improving the physical and mental health of the older people dwelling on an isolated, doctor-less island. Geriatr Gerontol Int 2018; 18: 1313-1317.