Transitions of Activities of Daily Living Status among Inpatients with Subacute Stroke: A Latent Class Approach.

Objectives: This study investigated the transition patterns of activities of daily living (ADL) status based on the Functional Independence Measure (FIM) motor and cognitive items in patients who experienced subacute stroke. Methods: In this single-site, retrospective investigation, 1592 FIM samples were collected during the hospitalization of 373 stroke patients who were admitted between April 2018 and March 2020. FIM item levels were transformed from seven to three (FIM1-2, Complete Dependence; FIM3-5, Modified Dependence; FIM6-7, Independence). FIM samples were classified by latent class modeling into six latent ADL states based on the independence levels of FIM motor and cognitive items. We created an ADL status transition diagram based on the FIM sample's probability of belonging to each status at different hospitalization timepoints. Results: Transition diagrams for each ADL status at admission revealed distinct patterns. In two ADL statuses for which patients required full assistance in FIM motor items, the patients remained motor-dependent without achieving independence on discharge. In contrast, patients in transition from the other four ADL statuses largely achieved independence in motor items by the time of discharge. The time required to reach higher ADL status varied according to the initial ADL status at admission; the slowest improvement was observed in statuses initially classified as needing the most assistance, whereas many patients achieved transition within 3 months from admission. Conclusions: Based on the characteristics of patient ADL status and timing of its changes, the classification of ADL status and visualization of ADL transition can contribute to improved treatment.

Functional Independence Measure Subtypes among Inpatients with Subacute Stroke: Classification via Latent Class Analysis.

Objectives: Using Functional Independence Measure (FIM) records, this study used latent class analysis (LCA) to clarify the structure of activities of daily living (ADL) status in patients following stroke. Methods: In this retrospective, single-center study, we extracted the medical records of patients with stroke who were admitted to a rehabilitation hospital in Japan between April 2018 and March 2020. LCA was used to determine classes of ADL status based on response patterns in FIM items converted from the original seven levels to three levels: Complete Dependence, FIM1-2; Modified Dependence, FIM3-5; Independence, FIM6-7. We compared the length of stay and discharge destinations among subgroups of patients with different ADL status at admission. Results: From 373 patients, 1592 FIM records were analyzed. These were classified into six ADL status classes based on "Complete Dependence," "Modified Dependence," and "Independence" in the motor and cognitive domains. Significant differences were observed among the six admission ADL subgroups for the length of stay (median values in patient subgroups based on admission ADL status: 126, 146, 90, 65, 44, and 29 days in the Motor Complete/Cognitive Complete, Motor Complete/Cognitive Modified, Motor Modified/Cognitive Modified, Motor Modified/Cognitive Independent, Motor Independent/Cognitive Modified, and Motor Independent/Cognitive Independent groups, respectively) and discharge destinations (patients discharged home: 27%, 62%, 81%, 92%, 95%, and 98%, respectively, and to acute care hospitals: 18%, 14%, 8%, 8%, 2%, and 2%, respectively). Conclusions: LCA successfully stratified ADL status in patients with stroke undergoing rehabilitation and may aid in determining an appropriate treatment regimen.

Behavioral Assessment of Unilateral Spatial Neglect with the Catherine Bergego Scale (CBS) Using the Kessler Foundation Neglect Assessment Process (KF-NAP) in Patients with Subacute Stroke during Rehabilitation in Japan.

The Kessler Foundation Neglect Assessment Process (KF-NAP) is an assessment tool for unilateral spatial neglect (USN), which is the scoring method for the Catherine Bergego Scale (CBS) based on detailed instructions. This study is aimed at determining the reliability and validity of the Japanese version of the KF-NAP (KF-NAP-J), evaluating the improvement of neglect assessment with KF-NAP-J, and comparing it with the original CBS for subacute stroke patients. We assessed subacute stroke patients admitted to our intensive rehabilitation hospital. Two KF-NAP-trained occupational therapists (OTs) assessed 22 patients. Before implementing the KF-NAP at the hospital, two other OTs assessed the other 23 patients using the CBS. We evaluated the interrater reliability of the KF-NAP and CBS using intraclass correlation coefficients (ICC) for the total scores, weighted kappa statistics for each subscale, and internal consistency using Cronbach's alpha. We assessed the validity of the KF-NAP against the Behavioral Inattention Test (BIT) and Functional Independence Measure (FIM) using Spearman's correlation coefficient. The reliability of both the KF-NAP and CBS was excellent. The weighted kappa results demonstrated that each subscale was in better agreement with the KF-NAP than with the CBS. In the KF-NAP, all eight subscales in which weighted kappa could be calculated were in significant agreement, and two were almost in perfect agreement. The KF-NAP moderately correlated with the subscales of BIT and FIM representing USN and activities of daily living. The USN detection rates of KF-NAP and BIT in the KF-NAP group were 63.6% and 22.7%, respectively. These results suggest that the KF-NAP, as well as the CBS, is useful to assess USN, which strongly impacts the rehabilitation outcomes in subacute stroke patients.

Functional outcomes of rehabilitation in patients with subacute stroke on haemodialysis.

OBJECTIVE: To examine functional outcomes in patients with subacute stroke who are on haemodialysis. DESIGN: Observational cohort study. SUBJECTS: Patients with stroke who were admitted to rehabilitation wards between April 2011 and August 2016 were retrospectively enrolled. METHODS: Data on the Functional Independence Measure (FIM) and discharge destination were collected from medical records as outcomes. Outcomes were compared for patients who received haemodialysis and those who did not. Multiple regression analyses were carried out to explore the impact of haemodialysis on functional outcomes. RESULTS: Among 859 patients, 34 (mean age 63.6 years (standard deviation (SD) 11.7)) required haemodialysis while staying in rehabilitation wards. One hundred patients not receiving haemodialysis (mean age 70.7 years (SD 13.8) ) were randomly selected as controls. The total FIM score at discharge, FIM gain, FIM efficiency, FIM effectiveness, and discharge destination were not significantly different between the 2 groups (p > 0.05). Multiple regression analysis, adjusted for other confounding factors, found no significant difference in total FIM score between groups at discharge (p = 0.427). CONCLUSION: Dialysis was not an inhibitory factor affecting outcomes during subacute rehabilitation in patients with stroke. Rehabilitation should be considered for patients with subacute stroke requiring haemodialysis, in order to provide every opportunity to achieve adequate functional outcomes.

Structural Gray Matter Changes in the Hippocampus and the Primary Motor Cortex on An-Hour-to-One- Day Scale Can Predict Arm-Reaching Performance Improvement.

Recent studies have revealed rapid (e.g., hours to days) training-induced cortical structural changes using magnetic resonance imaging (MRI). Currently, there is great interest in studying how such a rapid brain structural change affects behavioral improvement. Structural reorganization contributes to memory or enhanced information processing in the brain and may increase its capability of skill learning. If the gray matter (GM) is capable of such rapid structural reorganization upon training, the extent of volume increase may characterize the learning process. To shed light on this issue, we conducted a case series study of 5-day visuomotor learning using neuroanatomical imaging, and analyzed the effect of rapid brain structural change on motor performance improvement via regression analysis. Participants performed an upper-arm reaching task under left-right mirror-reversal for five consecutive days; T1-weighted MR imaging was performed before training, after the first and fifth days, and 1 week and 1 month after training. We detected increase in GM volume on the first day (i.e., a few hours after the first training session) in the primary motor cortex (M1), primary sensory cortex (S1), and in the hippocampal areas. Notably, regression analysis revealed that individual differences in such short-term increases were associated with the learning levels after 5 days of training. These results suggest that GM structural changes are not simply a footprint of previous motor learning but have some relationship with future motor learning. In conclusion, the present study provides new insight into the role of structural changes in causing functional changes during motor learning.

Resting-State Fluctuations of EEG Sensorimotor Rhythm Reflect BOLD Activities in the Pericentral Areas: A Simultaneous EEG-fMRI Study.

Blockade of the scalp electroencephalographic (EEG) sensorimotor rhythm (SMR) is a well-known phenomenon following attempted or executed motor functions. Such a frequency-specific power attenuation of the SMR occurs in the alpha and beta frequency bands and is spatially registered at primary somatosensory and motor cortices. Here, we hypothesized that resting-state fluctuations of the SMR in the alpha and beta frequency bands also covary with resting-state sensorimotor cortical activity, without involving task-related neural dynamics. The present study employed functional magnetic resonance imaging (fMRI) to investigate the neural regions whose activities were correlated with the simultaneously recorded SMR power fluctuations. The SMR power fluctuations were convolved with a canonical hemodynamic response function and correlated with blood-oxygen-level dependent (BOLD) signals obtained from the entire brain. Our findings show that the alpha and beta power components of the SMR correlate with activities of the pericentral area. Furthermore, brain regions with correlations between BOLD signals and the alpha-band SMR fluctuations were located posterior to those with correlations between BOLD signals and the beta-band SMR. These results are consistent with those of event-related studies of SMR modulation induced by sensory input or motor output. Our findings may help to understand the role of the sensorimotor cortex activity in contributing to the amplitude modulation of SMR during the resting state. This knowledge may be applied to the diagnosis of pathological conditions in the pericentral areas or the refinement of brain-computer interfaces using SMR in the future.

Simultaneous illumination method: application in a two-channel emission fluorometer with multi-wavelength excitation.

We developed a new illumination method called the simultaneous illumination method. This method does not require synchronization between light sources and sensor signals, which drastically simplifies the instrumentation. As a proof-of-concept, we applied this method to an oceanographic fluorometer. In principle, using this method, one can easily increase the number of characterized emission wavelengths by mounting optical sensors for as many emission wavelengths as needed. Our fluorometer has two emission-wavelength channels and twelve excitation wavelengths. The aim of this prototype is to demonstrate a viable in situ N-channel emission fluorometer with multiple wavelengths of excitation, which has not been previously realized.

Poly (ricinoleic acid) based novel thermosetting elastomer.

A novel bio-based thermosetting elastomer was prepared by the lipase-catalyzed polymerization of methyl ricinoleate with subsequent vulcanization. Some mechanical properties of the cured carbon black-filled polyricinoleate compounds were evaluated as a thermosetting elastomer. It was found that the carbon black-filled polyricinoleate compounds were readily cured by sulfur curatives to produce a thermosetting elastomer that formed a rubber-like sheet with a smooth and non-sticky surface. The curing behaviors and mechanical properties were dependent on both the molecular weight of the polyricinoleate and the amount of the sulfur curatives. Cured compounds consisting of polyricinoleate with a molecular weight of 100,800 showed good mechanical properties, such as a hardness of 48 A based on the durometer A measurements, a tensile strength at break of 6.91 MPa and an elongation at break of 350%.

Lipase-catalyzed synthesis and properties of poly[(12-hydroxydodecanoate)-co-(12-hydroxystearate)] directed towards novel green and sustainable elastomers.

Novel green and sustainable elastomers having both good biodegradability and chemical recyclability properties were designed and synthesized using potentially biobased materials and lipase as an environmentally benign catalyst. High molecular weight poly[(12-hydroxydodecanoate)-co-(12-hydroxystearate)] [poly(12HD-co-12HS)] samples with varying monomer ratios were prepared by the polycondensation of 12-hydroxydodecanoic acid and methyl 12-hydroxystearate using immobilized lipase from Candida antarctica (IM-CA) in toluene in the presence of molecular sieves 4A at 90 degrees C. Although poly(12HD) is a highly crystalline polyester having a melting temperature (T(m)) of 87.6 degrees C and crystalline temperature (T(c)) of 64 degrees C, by the copolymerization of 12HD with 12HS, both the T(m) and T(c) of the copolymer decreased with increasing 12HS contents, and poly(12HD-co-12HS) containing more than 60 mol-% 12HS was a viscous liquid at room temperature. At the same time, the Young's modulus and hardness also decreased with increasing 12HS content, and poly(12HD-co-36 mol-% 12HS) exhibited an elastic behavior, having a hardness of 70 A using a durometer A. In addition, it showed an excellent biodegradability by activated sludge and chemical recyclability by lipase.

Lipase-catalyzed synthesis and curing of high-molecular-weight polyricinoleate.

High-molecular-weight polyricinoleate, with an M(w) of 100,600, was enzymatically prepared by the polycondensation of methylricinoleate using immobilized lipase from Pseudomonas cepacia (IM-PC) in bulk in the presence of 4 A molecular sieves at 80 degrees C for 7 d. Polyricinoleate was a viscous liquid at room temperature with a glass transition temperature (T(g)) of -74.8 degrees C, showed no crystallinity and was biodegraded by activated sludge. Polyricinoleate was readily cured using a dicumyl peroxide at 170 degrees C for 30 min to produce a chloroform insoluble crosslinked polyricinoleate with a hardness of 50A using durometer A.