Takahashi K, Hori S, Wada A, Takahashi S. Relationship Between the Revised Version of the Ability for Basic Movement Scale and Motor Functional Independence Measure Scores and Gain. Jpn J Compr Rehabil Sci 2026; 17: 53-58. Objective:This study analyzed the relationship between the Revised Version of the Ability for Basic Movement Scale (ABMS II) and the motor Functional Independence Measure (FIM) total score, as well as between ABMS II and motor FIM gain. Methods:In total, 373 patients were admitted to a convalescent rehabilitation ward in Japan. The relationships between admission ABMS II and admission motor FIM, discharge motor FIM, and motor FIM gain (discharge - admission) were examined. Spearman's rank correlation coefficient was used. Results:Admission ABMS II positively correlated with admission motor FIM (rs = 0.75) and discharge motor FIM (rs = 0.69). Admission ABMS II showed a weak negative correlation with motor FIM gain (rs = -0.20), whereas patients with moderate ABMS II scores tended to have higher motor FIM gain. Conclusion:The relationship of admission ABMS II with motor FIM total score was linear, whereas that with motor FIM gain was nonlinear. This pattern may be explained by the limited improvement in FIM scores among patients with low ABMS II scores and the ceiling effect among those with mild ABMS II scores. Patients with moderate ABMS II scores at admission showed higher motor FIM gain. ABMS II may provide a useful clinical indicator for interpreting both the motor FIM total score and motor FIM gain.
Takaoka T, Kasai F, Ikai T. Association between activities of daily living and the introduction of home-visit medical care in patients with stroke discharged from a convalescent rehabilitation ward. Jpn J Compr Rehabil Sci 2026; 17: 33-39. Objectives:The Japanese government has implemented a community-based integrated care system, under which some patients with stroke receive home-visit medical care. This study aimed to determine the proportion of patients with stroke discharged from a convalescent rehabilitation ward who received home-visit medical care, and to identify the factors influencing its introduction. Methods:We analyzed 129 patients with stroke (cerebral infarction, n = 83; cerebral hemorrhage, n = 40; subarachnoid hemorrhage, n = 6) discharged from our convalescent rehabilitation ward in 2023. Patients were classified into a home-visit medical care group or an outpatient care group. Data collected included age, sex, hospitalization duration, functional independence measure (FIM) scores at admission and discharge, and the number of family members. Multivariate logistic regression analysis identified independent factors associated with the introduction of home-visit medical care. Results:The home-visit medical care introduction rate was 10.9%. Patients in this group were older and had longer hospital stays. Multivariate logistic regression analysis identified FIM motor scores (FIM-M) at discharge (odds ratio [OR] = 0.933, p = 0.027) and age (OR = 1.095, p = 0.011) as independent factors. Among patients with high FIM-M scores, those of older age and with lower FIM cognitive scores (FIM-C) were more likely to receive home-visit medical care. Conclusions:Older patients with lower FIM-M scores at discharge were more likely to receive home-visit medical care. Additionally, even among those with a high FIM-M score, older age and lower FIM-C scores increased this likelihood. Early discharge planning that includes information on home-visit medical care may facilitate transitions to home care.
Murakami M, Sato R, Ogasawara K, Kimura Y. Prediction Models for Gait Independence in Patients with Post-Stroke Hemiplegia in a Convalescent Rehabilitation Ward: Comparison of Predictive Performance Between Different Trunk Function Assessments. Jpn J Compr Rehabil Sci 2026; 17: 24-32. Objective:This study aimed to compare the predictive performance for walking independence at discharge using two trunk function assessments: the Functional Assessment for Control of Trunk (FACT) and the Trunk Control Test (TCT), alongside activities of daily living (ADL) ability and physical function at admission, in patients with post-stroke hemiplegia admitted to a convalescent rehabilitation ward. Methods:A cohort of 196 patients with post-stroke hemiplegia admitted to a convalescent rehabilitation ward between October 2020 and March 2024 was retrospectively analyzed. Patients achieving a walking score of 6 or higher on the Functional Independence Measure (FIM) at discharge were classified as the walking-independent group. Independent variables included motor FIM (m-FIM), cognitive FIM (c-FIM), paretic lower-extremity function on the Stroke Impairment Assessment Set (SIAS), Ueda's 12-Grade Hemiplegic Function Test, non-paretic-side SIAS function, age, sex, and either FACT or TCT. Decision-tree analysis served as the primary analytical method, with logistic regression and receiver operating characteristic (ROC) curve analyses conducted as supplementary approaches to examine discriminative performance. Results:The cohort included 102 men and 94 women, with a mean age of 77.7 ± 11.2 years. The walking-independent group comprised 47 patients (24.0%). Decision-tree analyses indicated that both the FACT and TCT models identified m-FIM and non-paretic-side SIAS function as predictive factors. Additionally, FACT and TCT were each selected as predictive factors in their respective models. ROC analysis demonstrated high discriminative ability for both models (FACT model: area under the curve [AUC] = 0.968; TCT model: AUC = 0.971). Conclusion:Both models utilizing FACT or TCT as trunk function assessments demonstrated high predictive accuracy, suggesting their potential utility for prognostic prediction in clinical practice.
Morita K, Abe S, Ono K, Takahashi R, Ara Y, Abe M, Shirasaka T. Predicting Motor FIM at Discharge for Recovery Stroke Patients in a Rehabilitation Ward Using an AI Predictive Analysis Tool. Jpn J Compr Rehabil Sci 2026; 17: 40-45. Objective:This study aimed to create a prediction model for motor Functional Independence Measure (FIM) at discharge using an artificial intelligence (AI) predictive analysis tool (Prediction One, Sony Network Communications Inc.) and to clarify its accuracy. Methods:This study included 457 stroke patients discharged between April 2020 and March 2022 as the training dataset, and 43 stroke patients discharged between April and October 2022 as the validation dataset. First, an AI prediction model was developed using the training dataset. Next, the prediction accuracy was evaluated using the validation dataset. As part of the accuracy validation, the residuals between the actual motor FIM at discharge and the predicted values of the AI and therapists, as well as the correlation coefficients and coefficients of determination for each prediction result were calculated and statistically compared. Results:The coefficient of determination for the prediction model was 0.799. The residuals from the actual values were 5.43 ± 5.93 points for AI predictions and 6.42 ± 5.52 points for therapist predictions. The correlation coefficients and R2 values for the prediction results were 0.939 and 0.881 for AI predictions, and 0.943 and 0.889 for therapist predictions, respectively. No significant difference was observed between the two correlation coefficients (z = -0.295, p = 0.768). The residual distributions indicated that the therapist predictions tended to overestimate the actual values. Conclusion:The model developed in this study demonstrated an accuracy no less than that reported in previous studies. Furthermore, it achieved a predictive performance comparable to that of the therapists. This model could potentially predict motor FIM at discharge with consistent accuracy, regardless of the years of experience. In the future, we plan to expand the range of target conditions and assess their external validity.
Kaizu R, Maruyama H, Tanaka N, Takahashi H, Kigawa H. A Case of Platypnea-Orthodeoxia Syndrome Following COVID-19 Pneumonia Treated in a Convalescent Rehabilitation Ward. Jpn J Compr Rehabil Sci 2026; 17: 46-52. Platypnea-orthodeoxia syndrome (POS), characterized by worsening hypoxemia associated with postural changes, has been reported as a complication following pneumonia due to coronavirus disease 2019 (COVID-19). In most cases, POS improves during the acute phase. We report a case in which POS was diagnosed in a convalescent rehabilitation ward, with symptoms persisting for more than 100 days, ultimately enabling discharge to home. The patient was a 76-year-old man who, despite receiving acute-phase treatment for COVID-19 pneumonia, continued to exhibit marked oxygen desaturation and dyspnea in the sitting and standing positions, resulting in difficulty with mobilization. Following admission to the convalescent rehabilitation ward, decreases in SpO2 and arterial partial pressure of oxygen associated with postural changes were confirmed, leading to a diagnosis of POS. Rehabilitation therapy was administered in short, high-frequency sessions, focusing on low-load sitting training and instruction on breathing techniques, while adjusting oxygen supplementation to facilitate mobilization. In addition, activities of daily living (ADL) training were initiated with early consideration of home oxygen therapy. As a result, sitting tolerance and ADL improved, and the patient was successfully discharged home with home oxygen therapy. POS may persist even in patients admitted to a convalescent rehabilitation ward. Even in cases where oxygen desaturation occurs with postural changes, appropriate adjustment of oxygen supplementation combined with short-duration, high-frequency mobilization may contribute to improvements in ADL and facilitate discharge to home.
Mizumoto T, Matsubara K, Kambayashi Y, Nomura T, Fukushima A, Ueki Y, Aida N. A case of long-term comprehensive rehabilitation culminated in weaning from a ventilator and regaining oral intake for a patient who underwent tracheostomy, mechanical ventilation, and alternative nutritional management because of type II respiratory failure after ascending aortic artificial vascular replacement. Jpn J Compr Rehabil Sci 2026; 17: 8-15. Long-term mechanical ventilation and alternative nutritional management make it difficult to wean patients from the ventilator and to regain oral intake. Furthermore, persistent functional dysfunction also makes it difficult to maintain motivation for rehabilitation training and markedly reduces quality of life (QOL). In this report, we describe a case in which comprehensive rehabilitation achieved favorable results in a patient who underwent long-term mechanical ventilation and alternative nutritional management. The patient was a woman in her eighties. In February of year X, she developed type II respiratory failure due to phrenic nerve injury after artificial vascular replacement of the ascending aorta. She subsequently underwent tracheostomy, mechanical ventilation, and alternative nutritional management for six months. She was transferred to our hospital in August of year X. At the time of intervention, respiratory and swallowing dysfunction and general muscle weakness were observed. She wished to attend her grandchild's wedding scheduled for the following year and began training with the long-term goal of attending the wedding. Multidisciplinary rehabilitation programs incorporating swallowing, respiratory and phonation training, and whole-body exercise were carried out in stages in collaboration with multiple professionals. After approximately one year of training, she achieved weaning from both mechanical ventilation and alternative nutritional management, regained independent ambulation and oral intake of three meals per day, and successfully attended the wedding. This case demonstrates that even in patients with long-term respiratory and swallowing dysfunction, clear goal setting and stepwise comprehensive rehabilitation can lead to meaningful functional recovery and improvements in QOL.
Tokunaga M, Sannomiya K. Predictive accuracy of multiple regression analysis stratified into four groups of admission motor FIM based on decision tree analysis. Jpn J Compr Rehabil Sci 2025; 16: 68-73. Objective:Factors affecting improvement in the Functional Independence Measure (FIM) differ among patient subgroups, and therefore several studies have performed multiple regression analyses after stratifying patients by relevant factors. However, the optimal variables and criteria for stratification remain unclear. Decision tree analysis can identify contributing variables and branching criteria for stratification. This study aimed to compare the predictive accuracy of multiple regression analysis stratified based on decision tree analysis with that of conventional multiple regression analysis. Methods:We included 1,100 stroke patients admitted to a convalescent rehabilitation ward. Based on the decision tree results reported by Okamoto et al., patients were stratified into four groups according to admission motor FIM scores: 13-18, 19-30, 31-53, and 54-90. Stepwise multiple regression analysis was then performed with discharge motor FIM as the dependent variable. We compared the predictive performance of a single regression equation derived from conventional multiple regression with that of four equations derived from stratified analyses by calculating the residual sum of squares and comparing the absolute residuals using the Wilcoxon signed-rank test. Results:The conventional single equation yielded a median absolute residual of 7.5 points and a residual sum of squares of 14.7 × 104. In contrast, the four stratified equations yielded a median absolute residual of 4.2 points and a residual sum of squares of 9.9 × 104, and the absolute residuals were significantly smaller in the stratified regression models. Conclusion:Stratifying patients into four groups based on decision tree analysis improved the predictive accuracy of multiple regression analysis.
Kisa T, Kato M, Sakai Y, Maguchi T, Uchida M, Kawasumi K, Ishihara H, Ohta M. Two cases of hemiplegia at 5 years post-stroke onset showing changes in corticospinal and cortico-reticular pathways after 1 month of intensive rehabilitation including repetitive facilitative exercise. Jpn J Compr Rehabil Sci 2025; 16: 60-67. Case reports have described the findings of diffusion tensor tractography (DTT) during the recovery phase of stroke hemiplegia but not during the chronic phase. We report here the cases of two patients with hemiplegia due to stroke, at 5 years post-onset, who underwent 1 month of intensive rehabilitation therapy including repetitive facilitative exercises and a phenol block, whose spasticity and paralysis improved. In both cases, significant changes were observed post-versus pre-DTT; the corticospinal tract (CST) was not visualized on the lesion side before treatment, but was visualized originating in M1 and extending downward after treatment. In the first case, over 5 years, transcallosal fibers (TCF) and transpontine fibers (TPF) extended from the contralateral side to the affected hemisphere, and the cortico-reticular pathway (CRP) of the DP descending motor pathways (DP) increased on both the affected and contralateral sides (particularly the former). However, after treatment, the CRP decreased on both sides. In the second case, the affected and contralateral sides. In the second case, the TCF became denser and the CRP on the contralateral side increased significantly. Previous case reports tracking changes in DTT were all within 1 year of hemiplegia onset. The two cases discussed here were 5 years post-stroke, and intensive rehabilitation not only improved upper limb and hand motor function in a short period but also produced imaging changes consistent with functional improvements on DTT. This is the first study to track changes in DTT before versus after intensive rehabilitation in old cases of stroke-induced hemiplegia. Most of the changes, such as the emergence of new CST patterns, increased CRP, and appearance of the TCF, were consistent with the working hypothesis derived from the accumulation of previous cases within 1 year of onset. However, in one case, the CRP decreased after treatment. This finding represents new insights not included in the working hypothesis and is discussed herein.
Fujihara H, Kishimoto M, Kose E, Shinonaga H, Tanaka E, Nakamichi M, Mizokami F. The impact of pharmacist intervention on FIM gain in patients with musculoskeletal disorders in Kaifukuki rehabilitation wards. Jpn J Compr Rehabil Sci 2025; 16: 53-59. Objective:Currently, in Kaifukuki (convalescent) rehabilitation wards, pharmacists' services are not reimbursed under the medical fee system, which has hindered the placement of pharmacists in wards and made it difficult to fully clarify their usefulness. In this study, we classified patients with musculoskeletal disorders into groups that received active pharmacist intervention and those that did not, and evaluated the effect of pharmacist intervention on changes in ADL. Method:This was a multicenter retrospective cohort study targeting Kaifukuki rehabilitation wards. Participating hospitals were recruited through the website of the Japanese Society of Hospital Pharmacists. The study included patients with musculoskeletal disorders who were discharged from each participating hospital between October 1 and October 31, 2022. The primary outcome measure was FIM gain, which was compared between the active and non-intensive intervention groups. Results:Responses were received from 140 hospitals, and information was collected from 1,265 patients. After adjusting for propensity scores, 742 patients (371 in the active intervention group and 371 in the non-intensive intervention group) were included in the analysis. When comparing the FIM gains between the two groups, the active intervention group showed significantly higher values than the non-intensive intervention group. Discussion:Pharmacist intervention in patients with musculoskeletal disorders admitted to rehabilitation wards was significantly associated with improvements in ADL. Pharmacists working in Kaifukuki rehabilitation wards should actively participate in ward activities and contribute to the appropriate use of medications for hospitalized patients, including deprescribing.
Okamoto Y, Nishioka S, Okamoto T, Miyai I. Effect of the Presence of Registered Dietitians and Dental Hygienists on the Body Weight and Activities of Daily Living of Elderly Patients with Low BMI in a Kaifukuki (Convalescent) Rehabilitation Ward. Jpn J Compr Rehabil Sci 2025; 16: 46-52. Objective:This study aimed to examine the association between the presence of registered dietitians (RD) and dental hygienists (DH) and the changes in the activities of daily living and body weight in elderly patients with a low body mass index (BMI) who were admitted to a Kaifukuki (convalescent) rehabilitation ward (KRW) class 1. Methods:Patients aged 70 years or older with a BMI of less than 20.0 kg/m2, who were admitted to hospitals with a KRW class 1 as per the 2022 survey data from the Japanese Association of Rehabilitation in Post-acute Care, were included in the study. The patients were divided into two groups based on the presence of DH: the RD+DH+ group and the RD+DH- group. The Functional Independence Measure (FIM) gain, change in BMI, and percentage of patients with improved BMI (an increase of ≥0.7 kg/m2) were compared using univariate and multivariate analyses. Results:A total of 3,329 patients (61.8% female, mean age of 83.3 years) were analyzed. The RD+DH+ group consisted of 431 patients, and the RD+DH- group consisted of 2,834 patients. No significant difference in FIM gain was found between the two groups. However, the RD+DH+ group showed significantly greater change in BMI and a higher percentage of patients with improved BMI than the RD+DH- group. Furthermore, the change in BMI and the percentage of BMI improvement were associated with the presence of RD and DH. Conclusion:The findings of this study suggest that the presence of RD and DH in a KRW may improve the BMI of elderly patients.
Komaki S, Baba S, Yotsumoto Y, Yamashita T, Takayoshi S, Niidome H, Imamura M, Mihara M, Hirahara D. Development and Evaluation of a Virtual Reality-Based Teaching Material for Interprofessional Education: A Case Study on Swallowing Videofluorography. Jpn J Compr Rehabil Sci 2025; 16: 37-45. Objective:With the advancement of team-based medical care, effective interprofessional collaboration (IPC) has become increasingly important. However, implementing IPC without appropriate interprofessional education (IPE) remains challenging. This study aimed to clarify the educational effects of a virtual reality-based IPE teaching material on students' awareness and understanding of IPC. Specifically, it evaluated changes in awareness before and after lectures and the impact of different viewing environments on educational effectiveness. Methods:A total of 224 students from six medical and welfare-related departments participated in lectures focused on IPC using a swallowing videofluorography scenario. The students were divided into three groups based on viewing environment: personal computer (PC), classroom screen, and virtual reality (VR). All groups viewed the same teaching material. Awareness and understanding of IPC were assessed before and after the lectures using a 12-item self-administered questionnaire. Results:Post-lecture comparisons revealed significant increases in scores across all questionnaire items. In comparing the viewing environments, the VR group scored significantly higher than the PC group in the areas of "problem-solving skills" and "respectful attitude." Conclusion:This study suggests that VR-based teaching materials are effective in enhancing students' awareness and understanding of interprofessional collaboration.
Kanega S, Muraoka Y. Real-Time Estimation of Lower Limb Posture and Joint Angles Using Wearable IMUs: Reproduced Hemiparetic and Normal Gait. Jpn J Compr Rehabil Sci 2025; 16: 19-29. A low-computational-load posture estimation method was employed, assuming integration into a functional electrical stimulation (FES) device, to estimate thigh and shank inclination angles as well as the knee joint angle during gait. The accuracy and processing time of the method were evaluated to assess its practical feasibility. Two inertial measurement units (IMUs) were mounted on the lateral thigh and shank. Two healthy adults performed level-ground gait, including normal gait and gait reproducing the characteristics of circumduction gait, which is typically observed in individuals with post-stroke hemiparesis. A custom gait pacemaker was developed to replicate the spatiotemporal asymmetry of hemiparetic gait. Posture estimation in the sagittal and frontal planes was performed on a microcontroller using a low-computational-load Madgwick filter, and the processing time was recorded. The estimation accuracy was assessed by comparing the results with optical motion capture data using root mean square error (RMSE) and cross-correlation analysis. The average total processing time, including sampling, posture estimation, and stimulation control, was 6.8 ms. The RMSE of sagittal plane posture angles was less than 4° in all cases, suggesting estimation accuracy comparable to previous studies. For the frontal plane posture angles, the estimation accuracy was relatively high during the reproduced circumduction gait, indicating that the system effectively captured the circumduction motion. Conversely, the accuracy tended to be lower during normal gait. Compared with previous studies, the posture estimation method used in this study, which employed the Madgwick filter, was able to estimate posture without compromising accuracy. The entire process, including sampling, posture estimation, and stimulation control, was completed within 10 ms, reflecting the feasibility of real-time processing at 100 Hz.
Ishizaka M, Imai Y, Murata S, Okazaki T. Prosthesis Rehabilitation in a Left Transfemoral Amputee with Rheumatoid Arthritis. Jpn J Compr Rehabil Sci 2025; 16: 30-36. Background:This report describes the rehabilitation experience of a left-sided transfemoral amputee. The patient developed rheumatoid arthritis and multiple pyogenic arthritis immediately after left transfemoral amputation; additionally, he had multiple joint dysfunction and complications of immobilization, which altered his activities of daily living (ADL). He experienced difficulties in maintaining his economic status and living in his environment. Case presentation:The patient was in his 50s, and at the beginning of the intervention, upper limb joint pain due to rheumatoid arthritis, muscle weakness of the limbs and trunk, reduced exercise tolerance caused by immobilization, and ADL disturbances, including one-leg standing, made prosthetic gait training impossible. Nevertheless, the patient was young, and his physical activity had been preserved until the left transfemoral amputation. Therefore, we speculated that he could achieve a prosthetic gait by improving the complications of immobilization under appropriate rheumatoid arthritis control. Rehabilitation training was conducted to improve ADL ability in stages taking rheumatoid arthritis into consideration, and social resources were utilized. Finally, he achieved prosthetic gait ability, which was necessary for survival in his living environment, and was discharged. Discussion:Even in cases where successful prosthetic ambulation is considered difficult during lower limb amputation, it is important not to exclude a patient from prosthesis fabrication by carefully predicting residual abilities that could be acquired afterward.
Itoh S, Tanikawa H, Kondo H, Ozeki S, Ito T, Fujimura K, Teranishi T. Minimal Detectable Change in Muscle Strength Measurements Obtained Using a Hand-Held Dynamometer in Patients with Stroke. Jpn J Compr Rehabil Sci 2025; 16: 9-18. Objective:The current study aimed to evaluate the reliability of muscle strength measurements using a hand-held dynamometer (HHD) in patients with chronic stroke. Further, it examined the minimal detectable change (MDC95). Methods:Patients who presented with chronic stroke hemiplegia for > 180 days post-stroke onset were analyzed. Muscle strength in the paretic lower limb was assessed using an HHD, and gait speed was evaluated. Results:For hip flexion, hip adduction, hip abduction, knee extension, ankle dorsiflexion, and ankle plantarflexion, the intra-rater reliability of the muscle strength measurements, as assessed using the intraclass correlation coefficient (ICC), ranged from 0.989 to 0.998. The inter-rater reliability, as assessed using ICC, ranged from 0.886 to 0.939. Bland-Altman analysis did not indicate systematic errors, and the MDC95 of each joint movement was calculated. Muscle strength in hip flexion, hip adduction, knee extension, ankle dorsiflexion, and ankle plantarflexion were significantly associated with gait speed, but not with hip abduction strength. The MDC95 of each muscle strength measurement was established, thereby providing a criterion for detecting actual changes that exceed the measurement error. Conclusions:The HHD had a high reliability in measuring lower limb muscle strength in patients with chronic stroke hemiplegia. Moreover, an association was found between individual muscle strength and gait ability. Based on this study, specific target muscles for interventions that aim to improve gait speed can be identified. Further, the use of MDC95 allows for a more accurate assessment of the intervention effects.
Takarada H, Honke T. Short-term effects of goal setting by rehabilitation professionals on aspects of psychology: a non-randomized controlled trial involving recovering stroke survivors. Jpn J Compr Rehabil Sci 2025; 16: 1-8. Objective:In rehabilitation, goals expected to have an effect on aspects of psychology, such as promoting participation in the program and reducing anxiety, are set between the patient and the therapist. This study aimed to compare and test the short-term effects of goal setting on such psychological aspects in an experimental group, in which the therapist selected the highest priority goals proposed by the patient, and a control group, in which the goals were proposed by the therapist. Methods:Between October 2023 and March 2024, 88 stroke survivors were admitted to the Kaifukuki Rehabilitation Ward, of whom 32 met the inclusion criteria. The patients were divided into two groups: a goal-setting group in which the patient chose the highest priority goal (experimental group: n = 17) and a goal-setting group in which the patient agreed with the goal proposed by the therapist (control group: n = 15). The primary outcome was treatment engagement in rehabilitation, and the secondary outcomes were anxiety/depression and mental health scores. Results:Outcomes improved in both groups after goal setting. Between-group comparisons showed a significant improvement in treatment engagement in the experimental group (p < 0.001). The sample size required for the randomized controlled trial was 46 participants in each group. Conclusion:In the short term, treatment engagement was influenced by the patient's consideration and choice of priority goals.
Kanega S, Muraoka Y. Real-Time Estimation of Lower Limb Posture and Joint Angles Using Wearable IMUs: Reproduced Hemiparetic and Normal Gait. Jpn J Compr Rehabil Sci 2025; 16: 19-29. Objective:A low-computational-load posture estimation method was employed, assuming integration into a functional electrical stimulation (FES) device, to estimate thigh and shank inclination angles as well as the knee joint angle during gait. The accuracy and processing time of the method were evaluated to assess its practical feasibility. Methods:Two inertial measurement units (IMUs) were mounted on the lateral thigh and shank. Two healthy adults performed level-ground gait, including normal gait and gait reproducing the characteristics of circumduction gait, which is typically observed in individuals with post-stroke hemiparesis. A custom gait pacemaker was developed to replicate the spatiotemporal asymmetry of hemiparetic gait. Posture estimation in the sagittal and frontal planes was performed on a microcontroller using a low-computational-load Madgwick filter, and the processing time was recorded. The estimation accuracy was assessed by comparing the results with optical motion capture data using root mean square error (RMSE) and cross-correlation analysis. Results:The average total processing time, including sampling, posture estimation, and stimulation control, was 6.8 ms. The RMSE of sagittal plane posture angles was less than 4° in all cases, suggesting estimation accuracy comparable to previous studies. For the frontal plane posture angles, the estimation accuracy was relatively high during the reproduced circumduction gait, indicating that the system effectively captured the circumduction motion. Conversely, the accuracy tended to be lower during normal gait. Conclusion:Compared with previous studies, the posture estimation method used in this study, which employed the Madgwick filter, was able to estimate posture without compromising accuracy. The entire process, including sampling, posture estimation, and stimulation control, was completed within 10 ms, reflecting the feasibility of real-time processing at 100 Hz.
Yamaguchi A, Kanazawa Y, Hirano S, Aoyagi Y. A Case with Left Hemiplegia after Cerebral Infarction with Improved Walking Ability Through Robot-assisted Gait Training Combined with Neuromuscular Electrical Stimulation for Foot Drop. Jpn J Compr Rehabil Sci 2024; 15: 88-93. Background:Gait training-assist robots and neuromuscular electrical stimulation devices have been shown to be useful in gait training for patients with hemiplegia. However, no case reports have documented the combined use of a gait training-assist robot and a neuromuscular electrical stimulator for gait rehabilitation. In this study, we present the case of a patient with left hemiplegia who demonstrated remarkable improvement in walking ability after using a combination of a gait training-assist robot and a neuromuscular electrical stimulator for foot drop. Case Presentation:A 60-year-old man developed severe left hemiplegia following a stroke in the right middle cerebral artery region. His lower limb motor function, as assessed by the Stroke Impairment Assessment Set (SIAS), was completely impaired (score of 0), and he was unable to walk by the 57th day post-onset. By the 66th day, his lower limb motor function remained unchanged (SIAS score of 0), and he frequently stumbled on his left foot at the start of the swing phase during gait training. As a result, robot-assisted gait training combined with neuromuscular electrical stimulation for foot drop was initiated. By the 88th day, his lower limb motor function improved to a score of 1 on the SIAS, and his Functional Independence Measure (FIM) walk item improved to a score of 4 with the use of an ankle-foot orthosis and a cane. On the 89th day, he transitioned to conventional therapy without the devices. By the 114th day, he was able to walk with a T-cane without the need for an orthosis. Conclusion:The combination of a gait training-assist robot and a neuromuscular electrical stimulator for foot drop facilitated dorsiflexion of the ankle during the swing phase, allowed the patient to practice walking with minimal assistance. This promoted active patient-led walking and more efficient motor learning, ultimately leading to independent walking.
Taketa T, Uchiyama Y, Sakamoto Y, Tanaka Y, Suehiro T, Nakagawa S, Sakata K, Domen K. Impact of a Nosocomial COVID-19 Outbreak on Convalescent Rehabilitation Outcomes of Post-Stroke Patients. Jpn J Compr Rehabil Sci 2024; 15: 79-87. Objective:This study aimed to elucidate the impact of a nosocomial COVID-19 outbreak on convalescent rehabilitation outcomes of post-stroke patients. Methods:This retrospective observational study included post-stroke patients who were hospitalized in convalescent rehabilitation wards of our hospital during a COVID-19 outbreak between July 22, 2022 and August 13, 2022 (outbreak group). The control group consisted of patients hospitalized in convalescent rehabilitation wards from October 1 to December 31, 2022 (non-outbreak group). The two groups were compared in terms of motor Functional Independence Measure (FIM) effectiveness at discharge, Brunnstrom Recovery Stage, length of stay, and duration of rehabilitation therapy. Furthermore, within the outbreak group, outcomes were compared according to whether patients were infected with SARS-CoV-2. The impact of the outbreak on motor FIM effectiveness at discharge was also evaluated. Results:There were 30 patients in the outbreak group (COVID-19, n = 18; close contacts, n = 12) and 33 patients in the non-outbreak group. Motor FIM effectiveness at discharge was significantly lower in the outbreak group, but there was no significant difference in outcomes according to SARS-CoV-2 infection status. After adjusting for SARS-CoV-2 infection, the nosocomial outbreak was significantly associated with lower motor FIM effectiveness at discharge. Conclusion:A nosocomial COVID-19 outbreak affected motor FIM effectiveness in convalescent rehabilitation for post-stroke patients, regardless of SARS-CoV-2 infection status.
