Objective Criteria for Judging Walking Independence in a Convalescent Rehabilitation Ward for Hemiparetic Stroke：A Study Using Decision Tree Analysis / The Japanese Journal of Rehabilitation Medicine

Objective：This study aimed to clarify the objective criteria for assessing walking independence using cane in patients with stroke in the convalescent rehabilitation ward.Methods：Participants were in-patients with hemiparetic stroke who could walk with a cane, and they were categorized into the independent (ID) and supervised (SV) walking groups. Stroke impairment assessment set-motor for lower extremity (SIAS-LE), trunk control test (TCT), Berg balance scale (BBS), 10-m walking speed (m/s), and functional independence measure-cognitive (FIM-C) were assessed. ID and SV used the scores at the time of independent walking and at the discharge time, respectively. Additionally, falls after independence were investigated. Statistical analysis was performed using univariate analysis and decision tree analysis.Results：In total, 148 patients (ID：n=101, 68±13 years, SV：n=47, 79±12) were included. Significant differences were observed in walking speed, TCT score, BBS score, and FIM-C score between the groups. Moreover, walking speed, FIM-C score, and BBS score were selected in the decision tree analysis in this order and divided into five groups namely：1) walking speed ≥ 0.42 and FIM-C ≥ 22 (percentage of independent patients 97％/percentage of fallers 5％), 2.) walking speed ≥ 0.42, FIM-C＜22, and BBS ≥ 50 (100％/0％), 3.) walking speed ≥ 0.42, FIM-C＜22, and BBS＜50 (52％/8％), 4.) walking speed＜0.42, and BBS ≥ 28 (49％/28％), and 5) walking speed＜0.42 and BBS＜28 (0％/0％). The overall percentage of fallers was 8.9％, with group 4 having the highest number of fallers.Conclusion：Walking speed, FIM-C, and BBS, in decreasing order, were involved in walking independence. Patients with low walking speed were more likely to fall. Therefore, careful assessment of walking independence is particularly required.

Clinical Applications of Heart Rate Variability in Neurological Disorders

Heart rate variability (HRV) is a useful marker for predicting mortality and cardiovascular events in cardiac diseases. Various time- and frequency-domain parameters are used for assessing HRV. The time-domain measures include standard deviation of the NN intervals (SDNN), standard deviation of the average NN interval, root mean square of the successive differences SDNN index, NN50 count, and pNN50, while the power spectrum that is used the most widely in frequency-domain analyses is divided into low frequency (LF), high frequency (HF), LF norm, HF norm, and LF/HF. The HF band is modulated by the parasympathetic nervous system, while the LF band is modulated by both the sympathetic and parasympatheticnervous systems. Altered or reduced HRV parameters have been shown to be related to cardiovascular events in patients with various neurological disorders, such as parkinsonian syndromes, dementia, cerebrovascular disorder, and epilepsy. Furthermore, analyses of HRV have attempted to distinguish different diseases and evaluate the degree of disability. This article discusses the clinical use of HRV in the neurological field.

Movement Disorders Following Cerebrovascular Lesions in Cerebellar Circuits

Cerebellar circuitry is important to controlling and modifying motor activity. It conducts the coordination and correction of errors in muscle contractions during active movements. Therefore, cerebrovascular lesions of the cerebellum or its pathways can cause diverse movement disorders, such as action tremor, Holmes' tremor, palatal tremor, asterixis, and dystonia. The pathophysiology of abnormal movements after stroke remains poorly understood. However, due to the current advances in functional neuroimaging, it has recently been described as changes in functional brain networks. This review describes the clinical features and pathophysiological mechanisms in different types of movement disorders following cerebrovascular lesions in the cerebellar circuits.

An Important Consideration when Using Botulinum Toxin Injections for Treating Claw Foot Deformity / The Japanese Journal of Rehabilitation Medicine

Objectives : In this study, we assessed the muscle contraction pattern of each toe by stimulating the flexor hallucis longus (FHL) and flexor digitorum longus (FDL) muscles in patients with claw foot deformity caused by spasticity in the lower extremity in order to increase the benefit of their botulinum toxin treatments. Subjects and Methods : Fifteen post-stroke patients (11 male and 4 female ; mean age, 62.3 years) were recruited for the study. In this observational study, the muscle contraction patterns of the hallux and digits on electrical stimulation of the FHL or FDL were examined by two doctors, and the data was then analyzed. In addition, the FHL and FDL were identified in 6 feet from 3 cadaver specimens below the ankle to near the end of each muscle on each toe. Results : In muscles that could be observed, muscle contraction was observed in the hallux in every subject and in the second digit in 92.3% subjects when the FHL was stimulated electrically. Muscle contraction was not observed in the second digit in 64.3% of the subjects when the FDL was stimulated electrically. In the cadaver dissections, the tendons of the FHL sent fibers to the FDL tendons in all 6 feet examined. Conclusion : In conclusion, when botulinum toxin is to be injected into the FHL or FDL muscle for treating claw foot deformity in patients with lower extremity spasticity, especially when the treatment target is the second digit, the injection should be performed not only in the FDL muscle, but also in the FHL muscle to increase the effectiveness of the treatment.

Development-assistance Strategies for Stroke in Low- and Middle-income Countries

While communicable diseases still pose a serious health threat in developing countries, previously neglected health issues caused by non-communicable diseases such as stroke are rapidly becoming a major burden to these countries. In this review we will discuss the features and current status of stroke in low- and middle-income countries (LMICs). Overall the global burden of hemorrhagic stroke is larger than ischemic stroke, with a disproportionately greater burden, measured in incidence and disability-adjusted life-years, regionally localized in LMICs. Patients in poorer countries suffer due to insufficient primary care needed to control risk factors such as hypertension, and inadequate emergency care systems through which sudden events should be managed. In light of these situations, we emphasize two strategic points for development assistance. First, assistance should be provided for bolstering, integrating, and coordinating both the primary health and emergency care systems, in order to prevent stroke and strengthen stroke management, respectively. Second, the assistance needs to focus on programs at the community level, to reduce life-style risks of stroke in a more sustainable manner, and to improve stroke outcomes more effectively.

Intracranial Vasculopathy in a Patient with Systemic Sclerosis: Atherosclerotic or Moyamoya-Like Disease?

No abstract available.

High Prevalence of Peripheral Arterial Disease in Korean Patients with Coronary or Cerebrovascular Disease

This prospective study surveyed the prevalence of peripheral arterial disease (PAD) in Korean patients with coronary arterial disease (CAD) or cerebrovascular disorder (CVD). From March 2010, 576 hospitalized patients in cardiovascular or stroke center were enrolled as the study group. Ankle-brachial index (ABI) was measured and the cut-off point for diagnosing PAD was or = 50 yr was enrolled as the control group. The prevalence of PAD was significantly higher in the study group than the control group (7.6% vs 1.7%; P < 0.001). To analyze the relationship of other vascular diseases and PAD, the patients were regrouped; group A (no CAD or CVD), group B (CAD only), group C (CVD only), and group D (CAD and CVD). Compared with group A, those with other vascular diseases (group B, C, D) had significantly higher prevalence of PAD, diabetes, dyslipidemia, renal insufficiency and claudication. The trend that patients with CAD or CVD are at risk of PAD is observed in this cross-sectional study in Koreans. Routine ABI measurement is recommended in these high-risk groups for early detection and proper management of PAD.

Factors for Approving Cerebrovascular Disorders and Cardiovascular Diseases as Work-related Diseases in Chronically Overworked Workers / 대한산업의학회지

OBJECTIVES: This study was conducted to analyze the factors that affected the decision of claims for cerebrovascular disorders and cardiovascular diseases in chronically overworked workers, that submitted their claims after the reformation of approval standards in the Industrial Accident Compensation Insurance Act on 1 July 2008. METHODS: Of 2909 cases, who claimed between January 1. and December 31. 2009, 1046 cases were selected based on their worker's compensation record and investigated following 6 provincial committees for work-related diseases. The approval rate and odds ratio were analyzed with respect to the general characteristics, past medical history and work-related information using a logistical regression and Student t-test. RESULTS: Of the 1046 selected cases, the approval rate was 18.5%(194 cases). In the multivariate logistical regression analysis, the factors for approving cerebrovascular disorders and cardiovascular diseases as work-related diseases were found to be the average working time over the last 1 week, occupational category, gender, age, death or survival, the presence of an associated disease, claimed province, and smoking. CONCLUSION: Factors for approving claims of cerebrovascular disorders and cardiovascular diseases as work-related diseases were the average working time over last 1 week, gender, age, death or survival, claimed disease, presence of associated disease, claimed province, smoking.

The Effect of Increased Training Time for Patients with Feeding Tubes in a Kaifukuki Rehabilitation Ward / The Japanese Journal of Rehabilitation Medicine

After April 2006, the Japanese Ministry of Health and Labor raised the permitted training time from 6 to 9 units (1 unit of training time corresponds to 20 minutes of exercise with a therapist) for patients in a kaifukuki (convalescent) rehabilitation ward. We examined the effect of the increased rehabilitative training time on patients using feeding tubes in a kaifukuki rehabilitation ward after an initial cerebrovascular disorder, with a particular focus on improving swallowing disorders. Our study was comprised of post-stroke patients with feeding tubes who underwent rehabilitation from April 2001 to March 2006 (<i>N</i>=14, 6-unit group) and from April 2006 to March 2009 (<i>N</i>=16, 9-unit group). All patients went to the ward within two months after suffering a stroke. There was no significant difference in the Functional Independence Measure(FIM) efficiency or length of hospital stay between the two groups. Feeding tube removal was more common in the 9-unit group compared to the 6-unit group (81.3% vs. 35.7%, <i>p</i><0.05), and the 9-unit group also had more training time per day. Logistic regression analysis showed that the increased training time per day spent with a speech therapist contributed to improving swallowing disorders (<i>p</i><0.01).

Current State and Future Challenges facing Kaifukuki Rehabilitation Wards / The Japanese Journal of Rehabilitation Medicine

Currently, there are more than 53,000 beds in kaifukuki rehabilitation wards throughout Japan. The development of kaifukuki rehabilitation wards is proceeding smoothly in terms of quantity. It is suggested that, with this development, the activities of daily living of patients will significantly improve, leading to an increase in the likelihood of patients returning home when a large unit of daily rehabilitation training is provided via one of these kaifukuki rehabilitation wards. The tasks remaining to be completed for the optimal realization of the kaifukuki rehabilitation wards are to reduce the disparity in the number of beds among prefectures, to realize a mature team approach to the rehabilitation program, to encourage full-time ward physicians of the rehabilitation department to exercise leadership, to enhance subacute medical services, to enhance human resources such as nurses and rehabilitation specialists and to improve the education and training system for the staff. Other major tasks remaining are to strengthen the cooperation between kaifukuki rehabilitation wards and acute hospitals, by which such rehabilitation wards will become capable of actively accepting patients from an early stage, and to establish cooperation between kaifukuki rehabilitation wards and the home care system.