Long-term body-weight-supported treadmill training for incomplete cervical spinal cord injury: a case report.

[Purpose] To investigate the effects of long-term body-weight-supported treadmill training on walking ability and physical function in an elderly individual with incomplete cervical spinal cord injury. [Participant and Methods] The patient was a 68 year-old male with an incomplete spinal cord injury at the C3/C4 level, incurred when he was 56 years old. He initiated home-based body-weight-supported treadmill training using a body-weight-supported treadmill installed at his home. His walking ability was measured as the percentage of body weight load reduction, and his physical function was evaluated using manual muscle testing and measuement of the range of motion of his lower limbs. [Results] The physical function of the lower limbs was improved, maintained, or showed delayed decline until 9.5 years post-injury. [Conclusion] Long-term body-weight-supported treadmill training may improve, maintain, or at least delay the decline of the physical function of participants for several years, without causing any remarkable complications.

A 3-month multicomponent home-based rehabilitation program for older people with restricted life-space mobility: a pilot study.

[Purpose] The purpose of this study was to verify the effects of a 3-month multicomponent home-based rehabilitation program developed on the basis of the reevaluation of older people with restricted life-space mobility. [Participants and Methods] The participants were residents in Japan aged ≥65 years who had Life-Space Assessment scores ≤52.3. Multicomponent home-based rehabilitation was conducted by physical and occupational therapists. Each visit included 40-60 min of combined exercise, practicing activities of daily living, improving the home environment, and caregiver support. The programs were developed in accordance with a flow diagram. The primary outcome was life-space mobility evaluated using the Life-Space Assessment score. [Results] Overall, 30 participants completed the intervention. The mean age of the participants was 82.4 ± 7.5 years. Three months after the intervention initiation, the Life-Space Assessment scores significantly improved from 12.0 to 30.5. The proportion of participants at maximal life-space level 5 (unlimited mobility) doubled from 16.7% at baseline to 33.3%. The functional independent measure score, fall efficacy scale score, and lower limb strength associated with standing up also significantly improved. We found no significant changes in the geriatric depression scale 5 and self-rated good health scores. [Conclusion] Multicomponent home-based rehabilitation can improve life-space mobility in older people with restricted life-space mobility.

Tailored feedback reduced prolonged sitting time and improved the health of housewives: a single-blind randomized controlled pilot study.

Reducing sitting time, independent of physical activity, is important for health. However, few reports have been published regarding physical activity of housewives compared to that of employed women. We examined strategies to shorten housewives' sitting time using a single-blind randomized controlled trial. Forty-eight housewives (38.0 ± 4.5 years old) were randomly assigned to one of three groups: pamphlet, self-feedback, and tailored feedback groups. All participants received a pamphlet describing the risks of prolonged sitting. The self-feedback and tailored feedback groups were also given feedback on sitting time by a smartphone application. The tailored feedback group received individual suggestions regarding lifestyle to shorten sitting time. We measured physical activity using an accelerometer and health-related quality of life using the Short-Form 8. The longest prolonged sitting time significantly decreased over time, a significant reduction was observed after the intervention only in the tailored feedback group. Vitality, mental health, and role emotional components of health-related quality of life showed a significant improvement with time but no significant differences were observed among the study groups. We suggested an easy approach to shortening prolonged sitting time in housewives using a pamphlet and feedback by smartphone. However, tailored consulting was necessary to yield a more effective result.

Custom-Made Daily Routine Increases the Number of Steps Taken by Frail Older Adults.

This study examined whether the number of steps taken by frail older adults increased after two types of interventions (custom-made daily routine [CDR] vs. exercise) were conducted over 12 weeks. The participants were 36 frail older adults aged 84.5 ± 6.0 years who attended a day-care center. They were assigned to one of three groups: CDR (n = 13), home-based exercise (HE, n = 10), or control (CON, n = 13). A wrist-worn accelerometer was used to measure their step count in 24 hr for 6 days. The CDR group demonstrated a daily step count change of approximately 25%, which was significantly higher than that of the CON group (effect size [r] = .51, p = .040). There were no significant changes in the HE group. Thus, a CDR might be useful for increasing the number of steps in frail older adults.

Scanning RNA-Seq and RAD-Seq approach to develop SNP markers closely linked to MALE STERILITY 1 (MS1) in Cryptomeria japonica D. Don.

Cryptomeria japonica is a major forestry tree species in Japan. Male sterility of the species is caused by a recessive gene, which shows dysfunction of pollen development and results in no dispersed pollen. Because the pollen of C. japonica induces pollinosis, breeding of pollen-free C. japonica is desired. In this study, single nucleotide polymorphism (SNP) markers located at 1.78 and 0.58 cM to a male sterility locus (MS1) were identified from an analysis of RNA-Seq and RAD-Seq, respectively. SNPs closely linked to MS1 were first scanned by a method similar to MutMap, where a type of index was calculated to measure the strength of the linkage between a marker sequence and MS1. Linkage analysis of selected SNP markers confirmed a higher efficiency of the current method to construct a partial map around MS1. Allele-specific PCR primer pair for the most closely linked SNP with MS1 was developed as a codominant marker, and visualization of the PCR products on an agarose gel enabled rapid screening of male sterile C. japonica. The allele-specific primers developed in this study would be useful for establishing the selection of male sterile C. japonica.

Instrumental activities of daily living and number of daily steps in frail older females.

[Purpose] Reportedly, males take fewer steps than females among frail older adults. The step count of frail older adults may be influenced by domestic roles in the instrumental activities of daily living. In this study, we aimed to investigate the association between instrumental activities of daily living and the number of steps in frail older females. [Participants and Methods] In this cross-sectional study, we included 27 frail older females aged 84.4 ± 6.5 years who attended a day-care center. We used the Fillenbaum's instrumental activities of daily living screener and measured the number of steps using an accelerometer, functional independence measure, grip strength, and short physical performance battery. We investigated the association between instrumental activities of daily living and daily steps. Furthermore, we compared the outcomes of the differences in the independence using a subscale of instrumental activities of daily living. [Results] Instrumental activities of daily living and step counts showed a significant correlation. Participants dependent on meal preparation and housework took significantly fewer steps per day. The dependence of their activities also caused low functional independence measure and weak grip strength. [Conclusion] In frail older females, decreased ability for instrumental activities of daily living were associated with fewer steps. Domestic roles may increase the daily steps in frail older adults.

A modified seated side tapping test in which the arms are crossed also reflects gait function in community-dwelling elderly.

[Purpose] Seated side tapping test (SST) performance is associated with mobility impairment in the elderly. Although this test was developed to assess trunk function, interpretation of its results may be confounded by the upper-limb movements in its protocol. Here, this study aimed to validate the association between trunk function and gait function by means of the Arms Crossed SST (AC-SST), a modified version of the SST in which the arms are crossed over the chest, to exclude the effects of the upper limbs. [Subjects and Methods] A total of 116 community-dwelling elderly people were enrolled in the study (mean age: 75.1 ± 5.5 yrs). Measurement categories were gait function (gait speed and TUG), lower extremity strength (knee extension and flexion strength), trunk muscle endurance (trunk extension and flexion endurance), and trunk function (SST and AC-SST). [Results] AC-SST performance significantly correlated with gait function items, as did SST performance. Moreover, AC-SST was one of the significant predictor variables of gait function selected in stepwise multiple regressions. [Conclusion] Gait function associated with performance on the AC-SST, a test of trunk function in which the effects of upper limb function were excluded, reinforcing the importance of trunk function to elderly mobility.

Toe-Out Gait Decreases the Second Peak of the Medial Knee Contact Force.

Toe-out angle alternation is a potential tactic for decreasing the knee adduction moment during walking. Published reports have not examined the medial knee contact force during the toe-out gait, although it is a factor affecting knee articular cartilage damage. This study investigated the effects of increased toe-out angle on the medial knee contact force, using musculoskeletal simulation analysis. For normal and toe-out gaits in 18 healthy subjects, the muscle tension forces were simulated based on the joint moments and ground reaction forces with optimization process. The medial knee contact force during stance phase was determined using the sum of the muscle force and joint reaction force components. The first and second peaks of the medial knee contact force were compared between the gaits. The toe-out gait showed a significant decrease in the medial knee contact force at the second peak, compared with the normal gait. In contrast, the medial knee contact forces at the first peak were not significantly different between the gaits. These results suggest that the toe-out gait is beneficial for decreasing the second peak of the medial knee contact force.

Plantarflexor training affects propulsive force generation during gait in children with spastic hemiplegic cerebral palsy: a pilot study.

[Purpose] The purpose of this preliminary study was to assess the trade-off relationship between the hip and ankle joints after plantarflexor training in children with spastic hemiplegic cerebral palsy (CP). [Subjects and Methods] Three boys aged 9, 10, and 13 years with spastic hemiplegic CP participated in the study. Gait analysis was performed using a three-dimensional motion analysis device and a floor reaction force detection device before and after plantarflexor training. Data on gait speed and stride length for both sides were collected. Peak hip and ankle powers in the sagittal plane and ankle-to-hip power ratio (A2/H3 ratio) were calculated. Plantarflexor training comprised heel raises and exercise band resistance at the participant's home (3 times/week for 12 weeks). [Results] The A2/H3 ratio increased significantly on both sides in two of three subjects after training. Peak A2 power increased significantly on both sides in subject 3 and on the affected side of subject 2. Peak H3 power decreased significantly on the non-affected side of subjects 1 and 2. [Conclusion] This study confirmed that two of three subjects demonstrated a trade-off relationship between the hip and ankle joints during gait after plantarflexor training.

Kinetic Relationships between the Hip and Ankle Joints during Gait in Children with Cerebral Palsy: A Pilot Study.

[Purpose] The purpose of this study was to evaluate kinetic relationships between the ankle and hip joints during gait, in the late stance, in children with spastic cerebral palsy (CP). [Subjects] The subjects were 3 ambulant children with spastic hemiplegic CP (aged 10, 13, and 14: CP group) and 3 typically developing children with the same ages (control). [Methods] A three-dimensional gait analysis including force data was performed to compare the peak moment, power, and ankle/hip power ratio between the hemiplegic (uninvolved and hemiplegic) and the control groups. In the statistical analysis, mean values from 5 gait cycles for each of 3 conditions (uninvolved, hemiplegic and control) were used. The three conditions were compared by performing a Kruskal-Wallis test and Steel-Dwass multiple comparisons. [Results] The peak moments of ankle plantar flexors in the 10-year-old case, were significantly lower on the uninvolved and hemiplegic sides compared with the control group, respectively. The peak flexion moments of the hip on the hemiplegic side were significantly higher compared with the control in the 14- and 13-year-old cases. The peak of ankle power generation (A2) in the 13- and 10-year-old cases were significantly lower on the uninvolved and hemiplegic sides, respectively, compared with the control. The peaks of hip flexor power generation (H3) in the 14- and 13-year-old cases were significantly higher on the uninvolved and hemiplegic sides, respectively. The A2/H3 ratios were significantly lower on the uninvolved and hemiplegic sides compared with the control, and the ratio for the hemiplegic side was lower than that for the uninvolved side. [Conclusion] This study shows that propulsion of walking is generated by hip, rather than the ankle, on both the hemiplegic and involved sides.

Improving Motor Skills in Five Children With Developmental Coordination Disorder Traits and Its Impact on Parenting Stress: A Case Series.

Poor motor skills in children with developmental coordination disorder (DCD) are associated with childcare stress. This study aimed to assess whether improving the motor skills of children with DCD could reduce parenting stress. The participants were five boys aged 7-10 years with probable DCD and their parents. The intervention comprised 1 hour per week of motor skills training for nine weeks. We measured improvements in the children's motor skills and reductions in parenting stress before and after the intervention. All five children showed improvements in motor skills. Parenting stress was reduced in two parents, whereas it worsened in three parents. Improving motor skills in children with probable DCD may not necessarily reduce parenting stress.

Effect of aging on seated stepping variability.

[Purpose] Accuracy in coordinating limb movements decreases with aging. The effect of aging on the variability of cyclic movements is not well known. The aim of this study was to examine the effect of aging on seated stepping variability. [Subjects and Methods] Twenty-six healthy young adults and 15 healthy elderly adults were instructed to walk at their preferred speed. Foot contact was monitored using reflective markers. Seated stepping was performed on force plates. The participants synchronized their stepping with 6 different metronome beats: 90-140 beats per minute (bpm). The time-series coefficient of variation (CV) was calculated. [Results] The cadence of young adults was 121 steps/min and that of the elderly adults was 125 steps/min in the elderly adults. The seated stepping CV decreased gradually from 90 to 120 bpm, but sharply increased at 130 and 140 bpm. Compared to young adults, the elderly adults had significantly higher CVs of seated stepping; however, the intergroup difference in the CV of seated stepping at 120 bpm was negligible. [Conclusions] Our results suggest that the stepping accuracy of the elderly is decreased; however, the rhythmic seated stepping accuracy does not decrease at the same rate as gait.

[Lateral trunk control in a sitting test is associated with mobility and Instrumental Activities of Daily Living among community-dwelling elderly people].

AIM: We hypothesized that during walking, mediolateral instability with gait disorders could be reflected in the characteristics of lateral trunk control while sitting. We investigated the association between lateral trunk control while sitting, mobility and Instrumental Activities of Daily Living (IADL) among community-dwelling elderly people. METHODS: A cross-sectional analysis was carried out of the data of 33 men and 102 women in a community-dwelling elderly population (average age, 73.2±6.0 years). A Seated Side-Tapping test was developed to assess lateral trunk control while sitting. We used the Lawton IADL scale, the 5-m normal walking test and the Timed "Up & Go" test (TUG) to measure mobility. RESULTS: The mean duration of the Seated Side-Tapping test was 5.0±0.9 seconds, ranging from 3.1 to 8.2 seconds. The test was normally distributed (p=0.200). The Seated Side-Tapping test was significantly associated with TUG, after controlling for age (r=0.46). The group with disability in at least 1 IADL item was significantly slower in the Seated Side-Tapping test, especially in men (5.7 sec for men, 5.5 sec for women vs. the independent group, 4.8 sec for both). Only the Seated Side-Tapping test remained significantly associated with IADL disability after logistic regression analysis. CONCLUSIONS: These results indicate that lateral trunk control in sitting is associated with mobility and disability in at least 1 item of the IADL. These results support the potential use of the Seated Side-Tapping test to safely carry out risk assessments for frail elderly patients.

Internet-Based Information Sharing With Families of Patients With Stroke in a Rehabilitation Hospital During the COVID-19 Pandemic: Case-Control Study.

BACKGROUND: The spread of COVID-19 has affected stroke rehabilitation. Given that inpatient visits are restricted in most institutions, alternative ways of providing information to family members are imperative. Informing families about patients' rehabilitation progress via the web may help involve families in the rehabilitation process, enhance patients' motivation to continue rehabilitation, and contribute overall to patients' improvement in activities of daily living (ADL). OBJECTIVE: We aimed to investigate the feasibility of the Internet-Based Rehabilitation Information Sharing (IRIS) intervention for families of patients with stroke at a rehabilitation hospital and examine the effect of IRIS on patients' ADL improvement. METHODS: In this case-control study, participants were inpatients at a rehabilitation hospital between March 2020 and April 2021. The intervention group (information and communication technology [ICT] group) included patients and families who requested IRIS, which consisted of a progress report on patients' rehabilitation using text, photos, and videos. Those who did not receive internet-based information were included in the non-ICT group. The control group, matched with the ICT group based on a 1:1 propensity score, was selected from the non-ICT group. The covariates for calculating the propensity score were patients' age, sex, and motor and cognitive scores on the Functional Independence Measure at admission. The main outcome was the degree of ADL improvement during hospitalization. Multiple regression analysis (forced entry method) was performed to confirm the impact of ICT use on ADL improvement. The independent variables were the presence of intervention, length of hospital stay, and number of days from onset to hospitalization. RESULTS: In total, 16 groups of patients and families participated in the IRIS. The mean age of patients was 78.6 (SD 7.2) and 78.6 (SD 8.2) years in the ICT and control groups, respectively. The median total Functional Independence Measure difference was 28.5 (IQR 20.3-53.0) and 11.0 (IQR 2.8-30.0) in the ICT and control groups, respectively, and the ICT group showed significant improvement in ADL function (P=.02). In the multiple regression analysis of the ICT and control groups, the unstandardized regression coefficient was 11.97 (95% CI 0.09-23.84) for ICT use. These results indicate that ICT use was independently and significantly associated with improvement in ADL. CONCLUSIONS: This study examined the effect of IRIS on family members to improve ADL in patients with stroke who are hospitalized. The results showed that IRIS promotes the improvement of patients' ADL regardless of age, sex, motor and cognitive functions at admission, and the length of hospital stay.

Fall Prevention Program Using Home Floor Plans in an Acute-Care Hospital: A Preliminary Randomized Controlled Trial.

We provided fall prevention programs using home floor plans for older adult patients discharged from an acute-care hospital and verified the fall prevention measures' effectiveness six months after discharge. The research design was a preliminary randomized controlled trial. Orthopedic patients with a falls' history were randomized to the control (n = 30) or the intervention groups (n = 30). Before discharge, the control group was treated with general physiotherapy for their disease characteristics. The intervention group received the same programs before discharge; additionally, a simple house evaluation was conducted using the subject's home floor plan. A six-month follow-up survey was conducted on falls and near-falls after discharge, completed by 51 of the 60 subjects (85%). Within two months, falls occurred in 7.7% of the control group but not in the intervention group, after which, falls occurred in the intervention group, and no significant difference was noted between the two groups (three-month (p = 0.322) and six-month (p = 0.931) follow-ups). The intervention group had significantly fewer near-falls than the control group within three months (p = 0.034), but no significant difference was observed after three months. The results suggested that our program effectively expanded the role of an acute care hospital for discharged patients who need to transition from hospital care to home health care.

Effectiveness of a Tailored Fall-Prevention Program for Discharged Older Patients: A Multicenter, Preliminary, Randomized Controlled Trial.

This multicenter, preliminary, randomized controlled trial investigated the effect of a tailored fall-prevention program using home floor plans for discharged orthopedic patients aged ≥65 years who experienced ≥1 fall(s) in the past year (n = 72) at five acute-care hospitals. The control group received standard care (exercise to prevent recurrent falls), whereas the intervention group received a tailored fall-prevention program in addition to usual care. A physical therapist conducted the tailored education program using each patient's home floor plans before discharge. A follow-up survey of falls and near-falls at home was performed using a monthly fall calendar for the 1-month period after discharge. Data on 81.5% of participants remained for the final analyses. No falls occurred in the intervention group; however, 4.3% of those in the control group experienced a fall. Near-falls were reported by 3.7% and 26.9% of the participants in the intervention and control groups, respectively. The proportion of participants who did not experience near-falls in the 1st month after discharge was lower in the intervention than in the control group (p = 0.018). In conclusion, the tailored fall-prevention program using home floor plans in multiple acute-care hospitals was effective in reducing falls and near-falls in discharged orthopedic patients.

[A cross-sectional study on the relationship between the Trail Making Test and mobility-related functions in community-dwelling elderly].

AIM: The Trail Making Test (TMT) has been studied in western countries as an indicator of executive function, but there are few data on the TMT in Japan. This study was conducted to assess the characteristics of TMT and to explore the effect of TMT on physical function among community-dwelling elderly Japanese to promote health in the aged. METHODS: Subjects were 175 individuals aged>or=65 years (57 men and 118 women). The TMT test which consists of two parts (part A and part B)was performed. 8 physical function items such as indicators of functional decline (usual walking speed, timed up-and-go (TUG), one-leg standing balance, and handgrip strength), and indicators of mobility (maximum walking speed, TUG with cup, stair-climbing, obstacle-negotiating gait) were measured. For this analysis, we used a difference score defined as TMT calculated as the difference between times (part B-part A=TMT). Data were analyzed by sex respectively. RESULTS: The median TMT value was 58.61 seconds in men and 65.67 seconds in women. TMT value increased with age and there was no difference between men and women in absolute values. multinomial logistic regression analysis showed that poor TMT was related to low tertiles of TUG, handgrip strength, MWS, TUG with cup, stair-climbing and obstacle-negotiating gait, and to intermediate tertile of MWS with adjustment for age and sex. CONCLUSION: TMT was significantly associated with mobility-related functions, suggesting that TMT, as the indicator of executive function, should be considered to be included in the test batteries for evaluating older people.

[Evaluation of the best indicator of muscle mass in community-dwelling elderly persons].

AIM: The purpose of this study was to determine the best way to indicate muscle mass of community-dwelling elderly men and women. METHODS: We recruited 398 elderly men and women (age range, 61-96, years) who use a community center and live in a metropolitan suburb. We measured appendicular and whole body muscle mass by using bioelectrical impedance analysis and analyzed our results in relation to indicators of physical function. We assessed muscle mass with no adjustment, adjustment by body mass, and adjustment by body height. RESULTS: In men, appendicular muscle mass adjusted by body mass correlated significantly with 10-m obstacle walking time, and whole body muscle mass adjusted by body mass correlated significantly with all indicators physical function except five chair stands and maximum walking speed. In women, appendicular and whole body muscle mass adjusted by body mass correlated significantly with all indicators of physical function. However, appendicular and whole body muscle mass adjusted by body height were unrelated to indicators of physical function. CONCLUSIONS: Only whole body muscle mass adjusted by body mass was related to physical function in both men and women. This finding suggests that whole body muscle mass adjusted by body mass is the best indicator of muscle mass in community-dwelling elderly persons.

A validation study of devices designed to reduce loads in provision of care: whether these assistive devices are used, or not, and whether work posture is appropriate or not.

Our country already faces an aging society, but many care workers suffer from work-related musculoskeletal disorders and assistive devices have not been adopted in care-work sites. In order to evaluate the effectiveness of assistive devices, we conducted a study on care work-load; whether the assistive devices are used or not, and whether work posture is appropriate or not, on five female healthcare workers by measuring surface electromyography (SEMG) of biceps brachii, the trapezius (upper extremity) and lumbar paraspinals between L3 and L4 (low back), and the trunk inclination angle (TIA). Moreover, subjective evaluations both by the caregivers and also the care receivers were verified. The caregivers were asked to rate perceived exertion using the Borg scale and the care receiver was asked to rate dissatisfaction. Work condition 1: Repositioning of a supine patient towards the head of bed. Work condition 2: Transferring a patient from sitting on the bed to sitting in a wheelchair. Under the two work conditions there were five set tasks in which subjects used or did not use the assistive devices and worked with or without the appropriate procedure and posture. The representative value adopted was the 95 percentile value. SEMG: Under both work conditions and at all measurement sites, we observed the statistically significant effectiveness of the appropriate procedure and posture as compared to manual handling. When the assistive devices were used improperly, or in work with low bed height, there was no reduction in workloads on the upper extremities. TIA: In both work conditions we observed statistically significant effectiveness of the appropriate procedure and posture as compared to not only manual handling but also working with improper assistive devices and with low bed heights. Findings of the subjective evaluations: The caregiver's perceived exertion and care receiver's dissatisfaction, showed statistical significance in satisfaction with the appropriate procedure and posture as compared to manual handling. Therefore, to reduce workload, and prevent work-related musculoskeletal disorders of caregivers, it is necessary not only to provide assistive devices but also to supervise the proper procedures and work postures and to improve the work environment.