Analysis of the characteristics of anticipatory postural adjustments in older adults using smartphones: Association between cognitive and balance functions.

OBJECTIVES: Using smartphones, we aimed to clarify the characteristics of anticipatory postural adjustments (APA) in older adults and examine the relationship between cognitive and balance functions. METHODS: The study participants were 10 young and 13 older adults. An accelerometer built into a smartphone was attached to the lower back (L5) of the participant, and acceleration in the mediolateral direction was measured using a one-leg stance (OLS). As APA features, we analyzed the time to the peak value in the stance direction (peak latency [PL]) and the amount of displacement to the peak value in the stance direction (peak magnitude [PM]). Additionally, the measured PL was divided by PM for each group to obtain the APA ratio (APAr). We investigated the relationship between the APAr and Mini-BESTest subitems. RESULTS: Older adults showed delayed PL and decreased PM levels (p < 0.01). While in the Mini-BESTest sub-items, deductions were most common in the order of dual-task and single-leg standing, and most participants with low APAr scores were degraded in APA of sub-items. The correlation was observed between APAr and both TUG and dual-task cost (DTC) (r= -0.56, r= -0.67). According to the receiver operating characteristic curve, the APAr value was 1.71 in the older age group. CONCLUSIONS: Older adults showed delayed PL and decreased PM, and APAr was associated with cognitive and locomotor functions. By evaluating the APAr at the initiation of movement, it may be possible to distinguish the APA of the older adluts from the possible to the impossible of OLS movement.

Analysis of in vivo humeral rotation of reverse total shoulder arthroplasty patients during shoulder abduction on the scapular plane with a load.

BACKGROUND: Few studies have investigated the kinematics after reverse total shoulder arthroplasty (RTSA). This study aimed to compare the shoulder kinematics in RTSA patients during shoulder abduction on the scapular plane with and without a load and yield information regarding the function of stabilizing the joints against gravity for the functional assessment of the shoulder after RTSA, which could lead to changes in postoperative rehabilitation treatment. METHODS: Twenty RTSA patients (7 men, 13 women; mean age: 78.1 [64-90] years) were examined. First, active shoulder abduction in the scapular plane was captured using single-plane fluoroscopic X-ray images. Imaging was performed by stipulating that one shoulder abduction cycle should be completed in 6 s. Two trials were conducted: one under a load equivalent to 2% of body weight and one without a load. Next, a three-dimensional (3D) model of each humeral and scapular component was matched to the silhouette of the fluoroscopic image to estimate the 3D dynamics. By using the 3D dynamic model obtained, the kinematics of the glenosphere and humeral implant were calculated relative to the shoulder abduction angle on the scapular plane and were compared between groups with and without a load. A one-way analysis of variance and a post hoc paired t-test with a statistical significance level of 0.05 were performed. RESULTS: The humeral internal rotation decreased with a load at shoulder abduction between 40° and 90° on the scapular plane (P < 0.01, effect size: 0.15). No significant differences in scapular upward rotation (P = 0.57, effect size: 0.022), external rotation (P = 0.83, effect size: 0.0083) and posterior tilting (P = 0.74, effect size: 0.013) were observed between groups with and without a load. The main effect was not observed with and without a load (P = 0.86, effect size: 0.0072). However, the scapulohumeral rhythm was significantly greater without a load during shoulder joint abduction between 40° and 60° on the scapular plane. CONCLUSION: In RTSA patients, the glenohumeral joint was less internally rotated, and the scapulohumeral rhythm decreased under loaded conditions. It was stabilized against the load through the mechanical advantage of the deltoid muscle and other muscles.

Reliability and validity of quantitative evaluation of anticipatory postural adjustments using smartphones.

[Purpose] This study aimed to investigate the reliability and validity of the quantitative evaluation of anticipatory postural adjustments using smartphones. [Participants and Methods] The study included 10 young control participants who underwent a one-legged stance with an accelerometer and a smartphone that were simultaneously attached to their lower back (L5). Acceleration was measured as the mediolateral component of the lumbar movement toward the stance side. The peak value of the time (peak latency) and the amount of displacement (peak magnitude) in the stance side direction of the lumbar acceleration were analyzed as anticipatory postural adjustment features. Intra-rater reliability was calculated for both accelerometer and smartphone measurements, while inter-rater reliability was calculated for smartphone measurements by two examiners. Validity was determined for both accelerometer and smartphone measurements. [Results] In this study, the intra-rater reliability of the peak latency and peak magnitude in accelerometer and smartphone measurements was confirmed, as was the inter-rater reliability in smartphone measurements. The intra-rater reliability was confirmed through re-testing, while the validity of the accelerometer and smartphone measurements was also confirmed. [Conclusion] The findings of this study suggest that the use of smartphones to measure anticipatory postural adjustments is highly reliable and valid, making it a useful clinical balance index. The method is simple and can be used for continuous patient monitoring.

Rehabilitation of Patients with Post-COVID-19 Syndrome: A Narrative Review.

Objectives: : We aimed to review the most recent articles on the rehabilitation of patients after coronavirus disease 2019 (COVID-19) and to identify the methods and effects of rehabilitation on such patients. Methods: : A literature search was conducted using PubMed and Web of Science from study inception to October 2022 using the following search terms to identify meta-analyses and randomized controlled studies with abstracts written in English: ["COVID-19" or "COVID 19" or "2019-nCoV" or "SARS-CoV" or "novel coronavirus" or "SARS-CoV-2"] and ["rehabilitation"]. Publications investigating the effects of pulmonary and physical rehabilitation on patients with COVID-19 were extracted. Results: The extraction process selected four meta-analyses, two systematic reviews, two literature reviews, and two randomized controlled trials. Pulmonary rehabilitation recovered forced vital capacity (FVC), 6-min walk distance (6MWD), health-related quality of life (HRQOL), and dyspnea. Pulmonary rehabilitation increased predicted FVC, distance in the 6MWD test, and HRQOL score compared with baseline values. Physical rehabilitation, comprising aerobic exercises and resistance training, effectively improved fatigue, functional capacity, and quality of life with no adverse events. Telerehabilitation was an effective tool to provide rehabilitation for patients with COVID-19. Conclusions: Our study suggests that rehabilitation after COVID-19 should be considered an effective therapeutic strategy to improve the functional capacity and quality of life of patients with COVID-19.

The Japan Monkey Centre Primates Brain Imaging Repository of high-resolution postmortem magnetic resonance imaging: The second phase of the archive of digital records.

A comparison of neuroanatomical features of the brain between humans and our evolutionary relatives, nonhuman primates, is key to understanding the human brain system and the neural basis of mental and neurological disorders. Although most comparative MRI studies of human and nonhuman primate brains have been based on brains of primates that had been used as subjects in experiments, it is essential to investigate various species of nonhuman primates in order to elucidate and interpret the diversity of neuroanatomy features among humans and nonhuman primates. To develop a research platform for this purpose, it is necessary to harmonize the scientific contributions of studies with the standards of animal ethics, animal welfare, and the conservation of brain information for long-term continuation of the field. In previous research, we first developed a gated data-repository of anatomical images obtained using 9.4-T ex vivo MRI of postmortem brain samples from 12 nonhuman primate species, and which are stored at the Japan Monkey Centre. In the present study, as a second phase, we released a collection of T2-weighted images and diffusion tensor images obtained in nine species: white-throated capuchin, Bolivian squirrel monkey, stump-tailed macaque, Tibet monkey, Sykes' monkey, Assamese macaque, pig-tailed macaque, crested macaque, and chimpanzee. Our image repository should facilitate scientific discoveries in the field of comparative neuroscience. This repository can also promote animal ethics and animal welfare in experiments with nonhuman primate models by optimizing methods for in vivo and ex vivo MRI scanning of brains and supporting veterinary neuroradiological education. In addition, the repository is expected to contribute to conservation, preserving information about the brains of various primates, including endangered species, in a permanent digital form.

Preoperative Predictors of Instrumental Activities of Daily Living Disability in Older Adults 6 Months After Knee Arthroplasty.

OBJECTIVE: To investigate preoperative predictors of instrumental activities of daily living (IADL) disability in older adults 6 months after knee arthroplasty (KA). DESIGN: Prospective cohort study. SETTING: General hospital with an orthopedic surgery department. PARTICIPANTS: Two hundred twenty (N=220) patients 65 years or older with total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: IADL status was evaluated for 6 activities. Participants chose "able," "need help," or "unable" according to their capacity of executing these IADL. If they chose "need help" or "unable" for 1 or more items, they were defined as "disabled." Their usual gait speed (UGS), range of motion for the knee, isometric knee extension strength (IKES), pain status, depressive symptoms, pain catastrophizing, and self-efficacy were evaluated as predictors. Baseline and follow-up assessments were conducted 1 month before and 6 months after KA, respectively. Logistic regression analyses with IADL status as the dependent variable were performed at follow-up. All models were adjusted using age, sex, severity of the knee deformity, operation type (TKA or UKA), and preoperative IADL status as covariates. RESULTS: In total, 166 patients completed the follow-up assessment, and 83 (50.0%) reported IADL disability 6 months after KA. Preoperative UGS, IKES on the non-operated side, and self-efficacy were statistically significantly different between those with a disability at follow-up and those who did not and were therefore included in logistic regression models as independent variables. UGS (odds ratio, 3.22; 95% CI, 1.38-7.56; P=.007) was determined as a significant independent variable. CONCLUSIONS: The present study demonstrated the importance of evaluating preoperative gait speed to predict the presence of IADL disability in older adults 6 months after KA. Patients with poorer preoperative mobility should be provided careful postoperative care and treatment.

Psychological factors associated with instrumental activities of daily living disability in older adults with moderate to severe knee osteoarthritis.

BACKGROUND: The population of older adults with knee osteoarthritis (OA)-related disabilities is increasing globally. However, studies regarding instrumental activities of daily living (IADL) in older adults with knee OA are limited. OBJECTIVE: This study investigated the psychological factors associated with IADL disability in older adults with moderate to severe knee OA. METHODS: A cross-sectional study was conducted on 179 patients with knee OA aged ⩾ 65 years. The six-item short form of the Pain Catastrophizing Scale (PCS-6), the four-item short form of the Pain Self-Efficacy Questionnaire (PSEQ-4), and the fifteen-item Geriatric Depression Scale (GDS-15) were used to assess psychological factors. The participants were divided into IADL disabled and non-disabled groups. Binary logistic regression analyses were performed with the IADL disability status as the dependent variable. The PCS-6, PSEQ-4, and GDS-15 tools were included as independent variables in the logistic regression model. RESULTS: Of the 179 participants, 88 (49.1%) showed disability in conducting IADL. PSEQ-4 (odds ratio = 0.90, 95%; confidence interval = 0.82-0.99, p= 0.02) was a significant independent variable among all psychological factors. CONCLUSION: Even after controlling for cofounders, our study found that self-efficacy, assessed using the PSEQ-4, was related to IADL disability in older adults with moderate to severe knee OA.

New quantitative evaluation of anticipatory postural adjustments using a smartphone in patients with Parkinson's disease.

OBJECTIVE: To investigate a smartphone-enabled quantitative evaluation of anticipatory postural adjustments (APA) during one-leg stance (OLS) movements among individuals with Parkinson's disease (PD). METHODS: This cross-sectional study included 10 young controls, 10 older individuals, and 13 individuals with PD. A smartphone and accelerometer were attached to the participants' lower back (L5), and the movements of the lower back toward the stance side during OLS were measured. For acceleration, the time to the peak value in the stance direction (peak latency [PL]) and the amount of displacement to the peak value in the stance direction (peak magnitude [PM]) were analyzed as APA characteristics. Additionally, the measured PL was divided by the PM for each group to obtain the APA ratio (APAr) as a new index. RESULTS: Individuals with PD showed a delayed PL and decreased PM (vs. young controls: p = .002 for PL, p < .001 for PM) (vs. older individuals: p = .022 for PL, p = .001 for PM). The APAr clustered the young controls, older individuals, and individuals with PD. According to the receiver operating characteristic curve the APAr value was 0.95, and individuals in the PD group were identified (i.e. area under the curve: 0.98; sensitivity: 85.0%; specificity: 100%). Moreover the APAr was correlated with severity and balance ability in individuals with PD (p = .015 for NFOG-Q, p = .028 for UPDRS, p = .036 for TUG, p = .015 for Mini-BESTest, p = .018 for OLS time). CONCLUSIONS: This smartphone-based evaluation using the APAr index was reflective of disease severity and decreased balance ability among individuals with PD. The facilitation of this measurement can help clinicians and physiotherapists quantitatively evaluate the APA of individuals with PD at laboratories and hospitals as well as in home environments.

Correlation between the Photographic Cranial Angles and Radiographic Cervical Spine Alignment.

The cranial vertical angle (CVA) and cranial rotation angle (CRA) are used in clinical settings because they can be measured on lateral photographs of the head and neck. We aimed to clarify the relationship between CVA and CRA photographic measurements and radiographic cervical spine alignment. Twenty-six healthy volunteers were recruited for this study. Lateral photographs and cervical spine radiographs were obtained in the sitting position. The CVA and CRA were measured using lateral photographs of the head and neck. The C2-7 sagittal vertical axis (SVA), cervical lordosis (C2-7), and occipito-C2 lordosis (O-C2) were measured using radiographic imaging as a standard method of evaluating cervical spine alignment. Correlations between the CVA and CRA on photographs and cervical spine alignment on radiographs were analyzed. The CVA and SVA were significantly negatively correlated (ρ = −0.51; p < 0.05). Significant positive correlations were found between CVA and C2-7 (ρ = 0.59; p < 0.01) and between CRA and O-C2 (ρ = 0.65; p < 0.01). Evaluating the CVA and CRA on photographs may be useful for ascertaining head and neck alignment in the mid-lower and upper parts of the sagittal plane.

Rehabilitation Characteristics of Acute-stage COVID-19 Survivors Managed with Extracorporeal Membrane Oxygenation in the Intensive Care Unit.

Objectives: This study aimed to describe the rehabilitation characteristics of patients with acute stage coronavirus disease managed with extracorporeal membrane oxygenation (ECMO) in the intensive care unit. Methods: This retrospective study enrolled coronavirus disease patients who underwent rehabilitation following ECMO between April 21, 2020, and August 20, 2021. The following patient data were evaluated: age, sex, weaning, peak C-reactive protein, lowest albumin level, white blood cell count, use of steroids and muscle relaxants, duration of respiratory management, ECMO management and rehabilitation, Medical Research Council (MRC) score, and Barthel index after sedation and at discharge. Results: ECMO was performed in 20 patients, and 16 were weaned successfully. The median durations of ECMO and respiratory management in survivors were 14.5 and 38 days, respectively. The median MRC scores after sedation and after rehabilitation therapy were 18 and 45, respectively. The median rehabilitation duration after sedation was 14 days. The MRC score after sedation showed significant correlations with the durations of ECMO and intubation. The median Barthel index values after sedation and at discharge were 0 and 30, respectively. Conclusions: Rehabilitation was important for patients with severe coronavirus disease because muscle weakness advanced in proportion with the durations of ECMO and ventilation management in the intensive care unit.

Separated center-of-pressure measurements reveal new characteristics of reduced anticipatory postural adjustments during gait initiation in patients with Parkinson's disease.

BACKGROUND AND OBJECTIVE: Accelerations, ground reaction force data, and other quantitative data obtained from kinematic analyses of gait initiation serve as measures of dyskinesia in patients with Parkinson's disease. The objective of this study was to determine whether a separate center of pressure information could reveal new characteristics of reduced anticipatory postural adjustments in patients with Parkinson's disease. METHODS: Ten healthy elderly subjects and 10 patients with Parkinson's disease participated in this study. Motions at gait initiation in response to a light signal to begin the task were analyzed. Anticipatory postural adjustments were characterized using trunk acceleration data and center of pressure displacement data. RESULTS: The separated center of pressure in patients with Parkinson's disease showed longer peak latency (p < .01) and larger peak magnitude (p < .01) in the stance leg than in the stepping leg. In patients with Parkinson's disease, the displacement peak latency of the stance leg center of pressure correlated negatively with the Timed Up and Go time (r = -0.46, p < .05), while displacement peak latency of the stepping leg center of pressure correlated negatively with Unified Parkinson's Disease Rating Scale (r=  -0.47, p < .05), and positively with Berg Balance Scale score (r = 0.50, p < .05). CONCLUSIONS: Patients with Parkinson's disease experience asymmetry between the stance leg and stepping leg at gait initiation. These findings may help clinicians understand the changes to motor function in patients with Parkinson's disease and suggest strategies for improved rehabilitation training.

Gait speed and pain status as discriminatory factors for instrumental activities of daily living disability in older adults with knee osteoarthritis.

AIM: Factors related to instrumental activities of daily living disability in older adults with knee osteoarthritis are unclear. This study aimed to examine the discriminatory accuracy for the presence of instrumental activities of daily living disability in older adults with knee osteoarthritis by combining two factors of gait ability and pain status. METHODS: A cross-sectional study was conducted on 114 patients with knee osteoarthritis aged ≥ 65 years. Participants were divided into instrumental activities of daily living disabled or non-disabled groups. A logistic regression model was created with usual gait speed and knee injury and osteoarthritis outcome score-pain subscale as independent variables for discriminating the presence of instrumental activities of daily living disability. The area under the receiver operating characteristic curve was inspected to determine discriminatory accuracy of the logistic regression model, usual gait speed, knee injury and osteoarthritis outcome score-pain subscale. RESULTS: Of the 114 patients, 26 (22.8%) had instrumental activities of daily living disability. The area under the curves was 0.91 (95% confidence interval: 0.85-0.96) for the logistic regression model, 0.78 (95% confidence interval: 0.68-0.89) for usual gait speed, and 0.73 (95% confidence interval: 0.61-0.84) for knee injury and osteoarthritis outcome score-pain subscale. CONCLUSIONS: This study showed that gait speed and pain status were independent discriminatory factors and combining these factors to discriminate more accurately the presence or absence of instrumental activities of daily living disability in older adults with knee osteoarthritis was important. Geriatr Gerontol Int 2021; 21: 683-688.

Measurements of the centre of pressure of individual legs reveal new characteristics of reduced anticipatory postural adjustments during gait initiation in patients with post-stroke hemiplegia.

OBJECTIVES: To determine whether individual measurements of the centre of pressure for the stance and stepping legs can reveal new characteristics of reduced anticipatory postural adjustments during gait initiation in post-stroke hemiplegic patients. METHODS: Subjects included 30 stroke patients and 10 healthy age-matched controls. The acceleration of the trunk, and the centre of pressure of each leg, were measured during gait initiation, 3 times each with the paretic and non-paretic legs leading. Anticipatory postural adjustments were characterized using trunk acceleration and centre of pressure displacement data. RESULTS: Latency of the posterior displacement peak of the paretic leg centre of pressure with either the paretic or non-paretic leg leading was significantly longer in stroke patients compared with controls, and was also longer than that of the non-paretic leg. The magnitude of the posterior displacement peak of the paretic leg centre of pressure was smaller than that of the non-paretic leg. Peak latency of the paretic stepping leg centre of pressure correlated with the clinical measures of motor dysfunction, postural balance, and gait ability. CONCLUSION: Measurements of the latency and magnitude of centre of pressure displacement peak individually for the paretic and non-paretic legs can help elucidate the mechanism behind reduced anticipatory postural adjustments. This information will be useful in designing new treatment strategies for stroke patients.

Rehabilitation for Patients with COVID-19: A Japanese Single-center Experience.

OBJECTIVES: The aim of the study was to describe the characteristics and efficiency of rehabilitation for patients diagnosed with moderate-to-severe coronavirus disease (COVID-19). METHODS: We retrospectively assessed the medical records of patients with COVID-19 who underwent rehabilitation for early mobilization and to maintain activities of daily living at our hospital between April 21 and August 20, 2020. The following patient data were evaluated: age, sex, diseases, and the total number of sessions completed by patients with severe COVID-19 in the intensive care unit (ICU) and by patients with moderate disease in the general COVID-19 wards. The number of daily sessions performed by physiotherapists was also evaluated. RESULTS: Of 161 patients with COVID-19 admitted during the study period, 95 underwent rehabilitation (78 in the general COVID-19 wards and 17 in the ICU). These 95 COVID-19 patients completed 1035 rehabilitation sessions in total (882 in the general ward and 153 in the ICU). Polymerase chain reaction test results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were positive for 79 patients on the initiation of rehabilitation. Moreover, 86 sessions were supervised remotely, thereby reducing the duration of the medical staff's stay in the SARS-CoV-2 isolation area. Patients with COVID-19 in the ICU received significantly more daily physiotherapy sessions than general ward patients (P<0.001). Each physiotherapist performed, on average, 4.6 sessions daily, with 4.3 daily sessions being performed wearing personal protective equipment (PPE). CONCLUSIONS: COVID-19 rehabilitation required more efforts as wearing PPE was necessary for most cases although tried with remote rehabilitation in some cases. Overall, a longer rehabilitation period was needed for ICU patients.

Bone quality in adults with severe motor and intellectual disabilities.

OBJECTIVE: To determine bone quality in adults with severe motor and intellectual disabilities. DESIGN: A retrospective cohort study. PATIENTS: Bone quality of 60 patients with severe motor and intellectual disabilities (28 men, 32 women; mean age 57 years) at a long-term care facility for adults was examined retrospectively. METHODS: Quantitative ultrasonography was used to measure the stiffness index, T-score and Z-score of the calcaneus. A multiple linear regression model, including sex, age, anti-epileptic drug use, tube-feeding status, and current and peak physical abil-ities, was used to identify significant predictors of T-scores. RESULTS: Quantitative ultrasonography revealed that all patients had lower bone quality (based on T-scores, Z-scores, and stiffness index), and all patients had T-scores with standard deviations (SD) below 1.8. Current physical ability, age, and anti-epileptic drug use were significant factors in T-score determination, while tube-feeding and peak physical ability were not. The ability to walk without assistance was the most significant predictor in quantitative ultrasonography. CONCLUSION: Severely low bone quality is observed in patients with severe motor and intellectual disabilities; and it is strongly associated with current physical activity. It is important that patients with severe motor and intellectual disabilities preserve their physical abilities to prevent osteoporosis-related fractures.

Asymmetry of the Cross-sectional Area of the Gluteus Medius Muscle Persists Eight Years after Total Hip Arthroplasty for Osteoarthritis of the Hip.

OBJECTIVES: The objective of the present study was to compare the cross-sectional areas (CSAs) of the gluteus medius on the affected and unaffected sides to assess long-term changes after total hip arthroplasty (THA). METHODS: : The data for 23 women who were diagnosed with unilateral hip osteoarthritis and who underwent primary THA via the posterolateral approach were retrospectively reviewed. The demographic data of the patients and the Japanese Orthopaedic Association hip scores were obtained from medical records. The CSA of the gluteus medius was measured on computed tomography images obtained at three different time points: preoperatively, 3 years postoperatively, and 8 years postoperatively. RESULTS: The CSA of the gluteus medius on the affected side was significantly greater than the preoperative value at 3 (P<0.005) and 8 years postoperatively (P<0.001). The mean increase in the CSA relative to the preoperative value was 24.0% at 3 years and 37.5% at 8 years postoperatively. There was no significant change in the CSA of the unaffected side at any time point. The CSA of the gluteus medius was significantly smaller on the affected side than on the unaffected side preoperatively (P<0.001), 3 years postoperatively (P<0.001), and 8 years postoperatively (P<0.003). CONCLUSIONS: Because the gluteus medius is important for achieving stability when walking, it is important to maintain or increase the CSA of the gluteus medius by regular or long-term rehabilitation interventions (such as maintaining abductor muscle strength) from the early stages of osteoarthritis and to provide guidance on effective training both before and after THA.

Vitamins K and D deficiency in severe motor and intellectually disabled patients.

OBJECTIVES: We aimed to determine serum 25-hydroxyvitamin D (25(OH)D) and undercarboxylated osteocalcin (ucOC) levels in severe motor and intellectual disabilities (SMID) patients and their association with bone turnover biomarkers. METHODS: We assessed vitamin D and K levels as indicators of osteoporosis in institutionalized adults with SMID. From December 2019 to February 2020, 93 institutionalized patients (48 men, 45 women; median age, 49 years) underwent annual routine examinations. Serum ucOC, 25(OH)D, bone-specific alkaline phosphatase (BAP), and tartrate-resistant acid phosphatase A 5b (TRACP-5b) levels as bone formation and resorption markers and calcium and phosphorous levels were measured. Vitamin K deficiency was indirectly assessed based on ucOC levels. RESULTS: Mean ucOC levels were higher than normal (i.e., vitamin K deficiency). Serum 25(OH)D levels were markedly diminished. Overall, 86% of patients had deficient 25(OH)D levels. These 25(OH)D-deficient patients had higher ucOC levels. Multiple linear regression analysis revealed an inverse correlation between 25(OH)D and ucOC levels. ucOC levels were significantly higher and 25(OH)D levels were significantly lower in tube feeding. TRACP-5b levels were significantly higher in elderly than in young women. BAP and TRACP-5b levels were normal in adults. No relationship existed between vitamin D and antiepileptic drug use. CONCLUSIONS: Vitamin K and D co-deficiency was common in SMID patients. Vitamin K and D deficiencies were worse in tube-fed patients than in oral intake patients. SMID patients should undergo regular monitoring of vitamin D and K levels and supplementation of these vitamins.

Remote rehabilitation for patients with COVID-19.

OBJECTIVE: To describe the effectiveness and risk management of remote rehabilitation for coronavirus disease (COVID-19) patients. DESIGN: Single-centre, retrospective, observational study. PATIENTS: COVID-19 patients undergoing rehabilitation (24 April to 24 May 2020). METHODS: All COVID-19 inpatients undergoing rehabilitation in the general ward were assessed. Data were collected on age, sex, physical ability, rehabilitation modality (remote/direct), need for intubation or extracorporeal membrane oxygenation, degree of pneumonia, oxygen therapy from the start of rehabilitation, D-dimer and C-reactive protein levels, and rehabilitation-related complications. Activities of daily living were measured using the Barthel Index. RESULTS: Out of a total of 43 patients, 14 were initially provided with remote rehabilitation and 29 with direct rehabilitation. Four patients were switched from direct to remote rehabilitation during the study, thus at the end of the study there were 18 in the remote rehabilitation group and 25 in the direct rehabilitation group. Patients in remote rehabilitation were significantly younger than those in direct rehabilitation. Of 12 patients who required intubation, 3 were given remote rehabilitation. One extracorporeal membrane oxygenation survivor underwent direct rehabilitation. All patients on remote rehabilitation were discharged home or to a hotel. Twelve out of 29 patients were transferred to a rehabilitation hospital due to delayed recovery of activities of daily living. No serious adverse events occurred. CONCLUSION: Effective and safe remote rehabilitation was performed in 41.9% of COVID-19 patients in this study, which resulted in improved rehabilitation in COVID-19 zones.

The Safety and Effect of Early Mobilization in the Intensive Care Unit According to Cancellation Criteria.

OBJECTIVE: The aim of this study was to investigate the effect and risk management of early mobilization in the intensive care unit (ICU) with multidisciplinary collaboration and daily goal planning. METHODS: Rehabilitation of ICU patients in our hospital between April 1, 2019, and September 30, 2019, was investigated retrospectively. The following factors were evaluated: age and sex of the subjects; diseases; the total number of early mobilization therapy sessions done at a lowered goal level; the clinical course of the step-down sessions; reasons for lowering goal levels that corresponded to the cancellation criteria from the officially issued guidelines of the Japanese Association of Rehabilitation Medicine, the expert consensus on ICU, or other reasons for step down; and the rate of planned goals that were achieved. RESULTS: Of the 1908 overall rehabilitation sessions carried out during the period of investigation, 9.6% had the planned level lowered; changes in vital signs accounted for 54.6% of the reasons for lowering the level. Of the step-down sessions, 92.3% corresponded with the cancellation criteria of rehabilitation. Early mobilization in the ICU in accordance with daily goal planning via collaboration within the multidisciplinary team during rounds was accomplished in 90.4% of sessions. No serious mobilization-related adverse events were noted during the study period. CONCLUSION: Early mobilization should be performed with daily goal planning by a multidisciplinary team during rounds and should be governed by the cancellation criteria of rehabilitation.

Assessment of the Need for Early Initiation of Rehabilitation Treatments in Patients with Coronavirus Disease 2019.

OBJECTIVE: The aim of this study was to describe the clinical characteristics of coronavirus disease (COVID-19) patients, including risk factors for deep vein thrombosis and pulmonary embolism, and to evaluate the need for rehabilitation to prevent pulmonary embolism. METHODS: A retrospective medical record review was conducted of patients admitted to the study hospital with COVID-19 between April 2 and April 23, 2020. The clinical characteristics and blood test results of patients with no history on admission of oral anticoagulant use were evaluated to assess the importance of inflammation and clotting function as risk factors for pulmonary embolism. RESULTS: A total of 51 patients with COVID-19 were admitted during the study period. Their median age was 54.0 years (range: 41-63 years) and 38 of 51 (74.5%) were men. The most common comorbidities in men were diabetes (9/38, 23.7%) and hypertension (13/38, 34.2%). On admission, white blood cell counts were normal in both sexes, whereas C-reactive protein and hemostatic marker levels, except for the activated partial thromboplastin time, were significantly higher in men. Moreover, C-reactive protein and hemostatic marker levels were significantly higher in patients that required invasive ventilation. Two patients were diagnosed with acute pulmonary embolism, neither of whom required invasive ventilation. CONCLUSIONS: Hypercoagulability and hyperinflammation were observed in COVID-19 patients, especially in men with high oxygen demand. We recommend anticoagulant therapy and early rehabilitation intervention to prevent pulmonary embolism in COVID-19 patients.