Long-Term Outcomes of FIM Motor Items Predicted From Acute Stage NIHSS of Patients With Middle Cerebral Artery Infarct

Objective To outline the association between the National Institutes of Health Stroke Scale (NIHSS) in the acute stage and the Functional Independence Measure (FIM) of motor items several months later. Methods Seventy-nine infarct cases with middle-cerebral-artery region transferred to long-term rehabilitation facilities were analyzed. Patients were allocated to either the model-development group or the confirmatory group at a 2:1 ratio. Independent variables were based on the NIHSS during the acute care and on demographic factors such as age and modified Rankin Scale (mRS) before onset. Multivariate logistic analyses were performed to predict the independence of each FIM motor item. These models were evaluated in the confirmatory group. Results Multivariate logistic analyses in the model-development group (n=53) indicated that at least one NIHSS item was statistically significantly associated with the functional independence of a single FIM motor item. Of the NIHSS items, the affected lower extremity item was the most widely associated with 11 of the FIM motor items, except for eating and shower transfer. The affected upper extremity function was the second widely involved factor associated with 7 of the FIM motor items including eating, grooming, bathing, toileting, bed transfer, toilet transfer, and shower transfer. Age and mRS were also statistically significant contributing factors. The obtained predictive models were assessed in the confirmatory group (n=26); these were successful except for the stairs climb item. Conclusion In combination with age and pre-stroke status, the NIHSS items (especially the affected extremity items) may be useful for the prediction of long-term outcome in terms of activities in daily living

Diffusion tensor imaging in elderly patients with idiopathic normal pressure hydrocephalus or Parkinson’s disease: diagnosis of gait abnormalities

BACKGROUND: Gait abnormalities in the elderly, characterized by short steps and frozen gait, can be caused by several diseases, including idiopathic normal pressure hydrocephalus (INPH), and Parkinson’s disease (PD). We analyzed the relationship between these two conditions and their association with gait abnormalities using laboratory test data and findings from diffusion tensor imaging (DTI). METHODS: The study involved 10 patients with INPH, 18 with PD, and 10 healthy individuals (control group). Fractional anisotropy (FA) of five brain areas was measured and compared among the three groups. In addition, the association of INPH and PD with gait capability, frontal lobe function, and FA of each brain area was evaluated. RESULTS: The INPH group had significantly lower FA for anterior thalamic radiation (ATR) and forceps minor (Fmin) as compared to the PD group. The gait capability correlated with ATR FA in the INPH and PD groups. We found that adding DTI to the diagnosis assisted the differential diagnosis of INPH from PD, beyond what could be inferred from ventricular size alone. CONCLUSIONS: We expect that DTI will provide a useful tool to support the differential diagnosis of INPH and PD and their respective severities

Assessment of the Efficacy of ReoGo-J Robotic Training Against Other Rehabilitation Therapies for Upper-Limb Hemiplegia After Stroke: Protocol for a Randomized Controlled Trial

Background: Stroke patients experience chronic hemiparesis in their upper extremities leaving negative effects on quality of life. Robotic therapy is one method to recover arm function, but its research is still in its infancy. Research questions of this study is to investigate how to maximize the benefit of robotic therapy using ReoGo-J for arm hemiplegia in chronic stroke patients.Methods: Design of this study is a multi-center parallel group trial following the prospective, randomized, open-label, blinded endpoint (PROBE) study model. Participants and setting will be 120 chronic stroke patients (over 6 months post-stroke) will be randomly allocated to three different rehabilitation protocols. In this study, the control group will receive 20 min of standard rehabilitation (conventional occupational therapy) and 40 min of self-training (i.e., sanding, placing and stretching). The robotic therapy group will receive 20 min of standard rehabilitation and 40 min of robotic therapy using ReoGo®-J device. The combined therapy group will receive 40 min of robotic therapy and 20 min of constraint-induced movement therapy (protocol to improve upper-limb use in ADL suggests). This study employs the Fugl-Meyer Assessment upper-limb score (primary outcome), other arm function measures and the Stroke Impact Scale score will be measured at baseline, 5 and 10 weeks of the treatment phase. In analysis of this study, we use the mixed effects model for repeated measures to compare changes in outcomes between groups at 5 and 10 Weeks. The registration number of this study is UMIN000022509.Conclusions: This study is a feasible, multi-site randomized controlled trial to examine our hypothesis that combined training protocol could maximize the benefit of robotic therapy and best effective therapeutic strategy for patients with upper-limb hemiparesis

第1回学校法人兵庫医科大学リハビリテーションセミナー 実践報告

departmental bulletin pape

Development of a program to determine optimal settings for robot-assisted rehabilitation of the post-stroke paretic upper extremity: a simulation study

Abstract Robot-assisted therapy can effectively treat upper extremity (UE) paralysis in patients who experience a stroke. Presently, UE, as a training item, is selected according to the severity of the paralysis based on a clinician’s experience. The possibility of objectively selecting robot-assisted training items based on the severity of paralysis was simulated using the two-parameter logistic model item response theory (2PLM-IRT). Sample data were generated using the Monte Carlo method with 300 random cases. This simulation analyzed sample data (categorical data with three difficulty values of 0, 1, and 2 [0: too easy, 1: adequate, and 2: too difficult]) with 71 items per case. First, the most appropriate method was selected to ensure the local independence of the sample data necessary to use 2PLM-IRT. The method was to exclude items with low response probability (maximum response probability) within a pair in the Quality of Compensatory Movement Score (QCM) 1-point item difficulty curve, items with low item information content within a pair in the QCM 1-point item difficulty curve, and items with low item discrimination. Second, 300 cases were analyzed to determine the most appropriate model (one-parameter or two-parameter item response therapy) to be used and the most favored method to establish local independence. We also examined whether robotic training items could be selected according to the severity of paralysis based on the ability of a person (θ) in the sample data as calculated by 2PLM-IRT. Excluding items with low response probability (maximum response probability) in a pair in the categorical data 1-point item difficulty curve was effective in ensuring local independence. Additionally, to ensure local independence, the number of items should be reduced to 61 from 71, indicating that the 2PLM-IRT was an appropriate model. The ability of a person (θ) calculated by 2PLM-IRT suggested that seven training items could be estimated from 300 cases according to severity. This simulation made it possible to objectively estimate the training items according to the severity of paralysis in a sample of approximately 300 cases using this model