Reliability and validation of the Japanese version of the coma recovery scale-revised (CRS-R).

PRIMARY OBJECTIVE: This study aimed to verify the reliability and validity of the Japanese version of the Coma Recovery Scale-Revised (CRS-R). METHODS: Subjects included 59 patients with disorders of consciousness (DOC) due to acquired brain injury. To validate test-retest reliability, Evaluator A assessed the CRS-R twice on the same day (A1, A2). To examine inter-rater reliability, Evaluators A (A2) and B (B) assessed the CRS-R without a time interval. To test concurrent validity, Evaluator A (A1) assessed the CRS-R, Japan Coma Scale (JCS), and the Glasgow Coma Scale (GCS) consecutively. To validate diagnostic accuracy, we evaluated the degree of agreement between A1 and A2 and between A2 and B in their diagnosis of DOC by CRS-R. RESULTS: The test-retest (ρ = 0.92) and inter- (ρ = 0.98) reliability of CRS-R were excellent" and Concurrent validity of CRS-R with JCS (ρ = -0.82) and GCS (ρ = 0.92) were high. Results of DOC diagnosis were consistent for 48/59 cases (κ = 0.82) for A1 and A2 and for 54/59 cases (κ = 0.92) for A2 and B. CONLCUSION: The Japanese version of the CRS-R may be as reliable and valid as the original English and other language versions.

Designing artificial circadian environments with multisensory cares for supporting preterm infants' growth in NICUs.

Previous studies suggest the importance of stable circadian environments for fetuses to achieve sound physiology and intrauterine development. This idea is also supported by epidemiological and animal studies, in which pregnant females exposed to repeated shifting of light-dark cycles had increased rates of reproductive abnormalities and adverse pregnancy outcomes. In response to such findings, artificial circadian environments with light-dark (LD) cycles have been introduced to NICUs to promote better physical development of preterm infants. Such LD cycles, however, may not be fully effective for preterm infants who are less than 30 weeks gestational age (WGA) since they are too premature to be adequately responsive to light. Instead, circadian rhythmicity of incubated preterm infants less than 30 WGA may be able to be developed through stimulation of the non-visual senses such as touch and sound.

Brain Activation of Unpleasant Emotions Increases Catastrophizing in Patients with Chronic Pain.

BACKGROUND: Catastrophic thinking among patients with chronic pain impairs their quality of life and increases anxiety levels. Further, severe pain causes high emotional brain sensitivity and unpleasant feelings. However, the effects of emotional changes on catastrophic thinking in patients with chronic pain remain unclear. AIMS: We hypothesised that emotional brain activity during mild pain stimuli would affect catastrophic thinking in these patients. We aimed to examine the relationship between unpleasant emotional brain activation and catastrophic thinking due to pain stimuli in patients with chronic pain. DESIGN: This was a prospective observational study. PARTICIPANTS: We included patients with chronic pain and healthy individuals. METHODS: The impact of emotional brain activity on catastrophic thinking was evaluated, specifically, the skin conductance response and oxygenated haemoglobin levels using near-infrared spectroscopy. After receiving three different pain stimuli, the participants were evaluated using the Numeric Rating Scale, Pain Catastrophising Scale, and McGill Pain Questionnaire. RESULTS: There were 28 patients in the chronic pain group and 33 patients in the healthy group. There was no between-group difference in oxygenated haemoglobin levels during pain stimulation. The chronic pain group showed a higher Pain Catastrophising Scale score and skin conductance response than the healthy group (p < .05). In the chronic pain group, oxygenated haemoglobin levels after pain stimuli were significantly associated with the Pain Catastrophising Scale score and skin conductance response (p < .05). CONCLUSIONS: Brain activity of unpleasant emotions may influence catastrophic thinking in patients with chronic pain.

Effects of exertional dyspnea on early mobilization of patients with acute decompensated heart failure.

[Purpose] In this study, we investigated the association between exertional dyspnea and length of the mobilization program in patients with acute decompensated heart failure. [Participants and Methods] We recruited all consecutive patients with heart failure who were hemodynamically stabilized after administration of intravenous medication and were able to walk >10 m before admission. Exertional dyspnea was evaluated using the visual analog scale in all patients after the 10-m walk during each session of the mobilization program. Multiple regression analysis was used to determine the factors associated with length of the mobilization program. [Results] Our study included 52 patients. Multiple regression analysis showed that the length of the mobilization program was significantly associated with the visual analog scale on day 3 and the length before the start of the mobilization program; however, the length of the mobilization program showed no significant association with age and blood urea nitrogen levels. The standardized coefficients for the visual analog scale scores on day 3 and the length before the start of the mobilization program were 0.49 and 0.33, respectively. [Conclusion] Exertional dyspnea is a good predictor of the length of the mobilization program. Our findings highlight the importance of evaluation of exertional dyspnea.

Validity and Reliability of a 2-Min Walk Test to Assess the Exercise Capacity in Vertebral Compression Fracture Patients: A Pilot Study.

BACKGROUND: The 2-min walk test (2MWT) may be a simple and easy measurement of exercise tolerance for vertebral compression fracture (VCF) patients. But, the validity and reliability of the 2MWT in patients with VCFs have not been verified. The aim of this pilot study was to investigate the validity and reliability of the 2MWT in VCF patients. METHODS: Ten patients with VCFs were selected from the inpatient convalescence rehabilitation ward. These patients were required to walk for a minimum of 6 minutes. The study was conducted over three test days. On the first and second test days, the participants completed one trial of the 2MWT each day. These data were used in the analyses for an intra-class correlation coefficient (ICC [1,1]). On the third test day, participants completed the 6-min walk test (6MWT). These data assessed the construct validity of the 2MWT. Participants completed testing on 3 days within a 5-day period. RESULTS: A significant correlation was found between the 2MWT and the 6MWT (r=0.945; p<0.05), which suggested a high construct validity of the 2MWT. The intraclass correlation coefficient of the repeated 2MWTs was high (ICC=0.98; p<0.05), intimating that it had a high test-retest reliability. CONCLUSION: The 2MWT is a valid test for the assessment of exercise capacity in patients with VCFs. It is practical, simple, and well tolerated by patients with VCFs.

Children's Perceived Competence Scale: Reference values in Japan.

To support children with chronic diseases, reference values to measure developmental changes in self-perception and self-esteem are considered a useful yardstick. To develop reference values to measure self-perceived competence and self-esteem in Japanese children, the Children's Perceived Competence Scale (CPCS) was administered to 768 children of elementary school grade 1 (6 years) to grade 6 (11 years) at four public schools in Japan, from November to December 2012. After excluding 74 with chronic diseases and/or incomplete responses, 694 children were included. CPCS measures children's self-perceived competence in cognitive, social, physical domains, and general self-worth, namely self-esteem. There was a tendency for scores of cognitive and general self-worth to decrease with increasing grade. Scores among grade 5 respondents were significantly lower than those among grade 4 respondents for both social and physical domains. Scores among boys and girls differed significantly, with boys scoring higher for physical domain in grades 3 and 6 and for general self-worth domain in grade 6. The CPCS reference values to measure self-perceived competence and self-esteem in Japanese children were developed in this study. These reference values are useful to inform practitioners supporting children with psychological or psychiatric problems or those with chronic diseases.

Differences in dual-task performance and prefrontal cortex activation between younger and older adults.

BACKGROUND: The purpose of this study was to examine task-related changes in prefrontal cortex (PFC) activity during a dual-task in both healthy young and older adults and compare patterns of activation between the age groups. We also sought to determine whether brain activation during a dual-task relates to executive/attentional function and how measured factors associated with both of these functions vary between older and younger adults. RESULTS: Thirty-five healthy volunteers (20 young and 15 elderly) participated in this study. Near-infrared spectroscopy (NIRS) was employed to measure PFC activation during a single-task (performing calculations or stepping) and dual-task (performing both single-tasks at once). Cognitive function was assessed in the older patients with the Trail-making test part B (TMT-B). Major outcomes were task performance, brain activation during task (oxygenated haemoglobin: Oxy-Hb) measured by NIRS, and TMT-B score. Mixed ANOVAs were used to compare task factors and age groups in task performance. Mixed ANOVAs also compared task factors, age group and time factors in task-induced changes in measured Oxy-Hb. Among the older participants, correlations between the TMT-B score and Oxy-Hb values measured in each single-task and in the dual-task were examined using a Pearson correlation coefficient.Oxy-Hb values were significantly increased in both the calculation task and the dual-task within patients in both age groups. However, the Oxy-Hb values associated with there were higher in the older group during the post-task period for the dual-task. Also, there were significant negative correlations between both task-performance accuracy and Oxy-Hb values during the dual-task and participant TMT-B scores. CONCLUSIONS: Older adults demonstrated age-specific PFC activation in response to dual-task challenge. There was also a significant negative correlation between PFC activation during dual-task and executive/attentional function. These findings suggest that the high cognitive load induced by dual-task activity generates increased PFC activity in older adults. However, this relationship appeared to be strongest in participants with better baseline attention and executive functions.

Effect of therapeutic touch on brain activation of preterm infants in response to sensory punctate stimulus: a near-infrared spectroscopy-based study.

OBJECTIVE: The purpose of this study was to determine whether therapeutic touch in preterm infants can ameliorate their sensory punctate stimulus response in terms of brain activation measured by near-infrared spectroscopy. METHODS: The study included 10 preterm infants at 34-40 weeks' corrected age. Oxyhaemoglobin (Oxy-Hb) concentration, heart rate (HR), arterial oxygen saturation (SaO2) and body movements were recorded during low-intensity sensory punctate stimulation for 1 s with and without therapeutic touch by a neonatal development specialist nurse. Each stimulation was followed by a resting phase of 30 s. All measurements were performed with the infants asleep in the prone position. RESULTS: sensory punctate stimulus exposure significantly increased the oxy-Hb concentration but did not affect HR, SaO2 and body movements. The infants receiving therapeutic touch had significantly decreased oxy-Hb concentrations over time. CONCLUSIONS: Therapeutic touch in preterm infants can ameliorate their sensory punctate stimulus response in terms of brain activation, indicated by increased cerebral oxygenation. Therefore, therapeutic touch may have a protective effect on the autoregulation of cerebral blood flow during sensory punctate stimulus in neonates.

Pediatric burn rehabilitation: Philosophy and strategies.

Burn injuries are a huge public health issue for children throughout the world, with the majority occurring in developing countries. Burn injuries can leave a pediatric patient with severely debilitating and deforming contractures, which can lead to significant disability when left untreated. Rehabilitation is an essential and integral part of pediatric burn treatment. The aim of this article was to review the literature on pediatric burn rehabilitation from the Medline, CINAHL, and Web of Science databases. An attempt has been made to present the basic aspects of burn rehabilitation, provide practical information, and discuss the goals and conceptualization of rehabilitation as well as the development of rehabilitation philosophy and strategies.

Changes in serum BDNF levels associated with moderate-intensity exercise in healthy young Japanese men.

PURPOSE: The purpose of this study was to examine the influence of acute moderate-intensity exercise on serum brain-derived neurotrophic factor (BDNF) levels in healthy young Japanese men. BDNF is one of a family of neurotrophic factors involved in neuronal transmission, modulation and plasticity. Previous human-based studies have demonstrated that acute exercise leads to increases in BDNF; however, to date there has been no study conducted among Japanese male subjects. METHODS: Forty young adult Japanese men (aged 24.1 ± 2.9 years) - reduced to a total of thirty three following subjection to exclusion criteria - performed 30 minutes of exercise at 60% of VO2max on a stationary bicycle. Serum BDNF was analyzed both before and after exercise. RESULTS: Eighteen of the total thirty three subjects demonstrated an increase in serum BDNF after exercise. However, on aggregate, the change in serum BDNF associated with exercise was not significant (p = .17). CONCLUSIONS: This is the first study to demonstrate that serum BDNF levels are not consistently increased by acute moderate-intensity exercise in Japanese men. It is likely that something in the lifestyle and/or environment of male Japanese subjects underlies the difference between our findings and studies conducted in other countries.

A dynamical system analysis of the development of spontaneous lower extremity movements in newborn and young infants.

This study's aim was to evaluate the characteristics of newborn and young infants' spontaneous lower extremity movements by using dynamical systems analysis. Participants were 8 healthy full-term newborn infants (3 boys, 5 girls, mean birth weight and gestational age were 3070.6 g and 39 weeks). A tri-axial accelerometer measured limb movement acceleration in 3-dimensional space. Movement acceleration signals were recorded during 200 s from just below the ankle when the infant was in an active alert state and lying supine (sampling rate 200 Hz). Data were analyzed linearly and nonlinearly. As a result, the optimal embedding dimension showed more than 5 at all times. Time dependent changes started at 6 or 7, and over the next four months decreased to 5 and from 6 months old, increased. The maximal Lyapnov exponent was positive for all segments. The mutual information is at its greatest range at 0 months. Between 3 and 4 months the range in results is narrowest and lowest in value. The mean coefficient of correlation for the x-axis component was negative and y-axis component changed to a positive value between 1 month old and 4 months old. Nonlinear time series analysis suggested that newborn and young infants' spontaneous lower extremity movements are characterized by a nonlinear chaotic dynamics with 5 to 7 embedding dimensions. Developmental changes of an optimal embedding dimension showed a U-shaped phenomenon. In addition, the maximal Lyapnov exponents were positive for all segments (0.79-2.99). Infants' spontaneous movement involves chaotic dynamic systems that are capable of generating voluntary skill movements.

[The developmental characteristics of spontaneous movement in healthy infants].

The aim of this study was to evaluate the characteristics of development of spontaneous movements in infants using dynamical systems analysis. The participants were 7 healthy, full-term, newborn infants. A tri-axial accelerometer was used to measure limb acceleration in three-dimensional space. Acceleration signals were recorded on the right wrist, when the infant was in an active alert state, lying in supine. Measurement was carried out every fourth week after birth between the ages of 1 and 5 months old. The recording time was 200 seconds, based on recommendations for this accelerometer. The time-series data was analyzed by non-linear methods using a package (TISEAN) provided with the machine, provided some evidence of non-linear deterministic structure (dimension, maximal Lyapunov exponent). The developmental change in infants' spontaneous movements was shown as "U-shaped", with the base between 2-3 months, and recovering at 4-5 months (4 of 8 infants in dimension, 6 of 8 infants in maximal Lyapunov exponent). Approximately 4-5 months after birth, infants develop voluntary movement, such as reaching for objects.

The factorial structure of the Mini-Mental State Examination (MMSE) in Japanese dementia patients.

BACKGROUND: The Mini-Mental State Examination (MMSE) is one of the most commonly used instruments in the evaluation of global cognitive status. Few studies have investigated the relationship among its components in terms of factorial structure in Japanese individuals suffering from dementia. The aims of this study were: 1) to analyze the factorial structure of MMSE in Japanese dementia patients, 2) to clarify the MMSE static structure in identifying different cognitive profiles and understanding how these profiles are related to levels of dysfunction in subsets of dementia patients. METHODS: 30,895 consecutive outpatients with dementia were evaluated. The 11 subtests composing the MMSE and the global MMSE score were analyzed. Factor analysis based on principal component analysis with Promax rotation was applied to the data representing the frequency of failures in each subtest as identified by the MMSE. RESULTS: Factor analysis identified three factors that explained approximately 44.57% of the total variance. The first factor, immediate memory, essentially constituted a simple index of the reading and writing subtests. The second factor, orientation and delayed recall, expressed the ability to handle new information. The third factor, working memory, was most closely related to the severity of dementia at the time of test administration. CONCLUSIONS: Japanese dementia patients appear to develop difficulty handling new information in the early stages of their disease. This finding, and our finding that there is a factor associated with disease severity, suggest that understanding the specific factors related to subtest items, which underlie the total MMSE score may be useful to clinicians in planning interventions for Japanese patients in the early stages of dementia.

Reorganization of sensorimotor function after functional hemispherectomy studied using near-infrared spectroscopy.

Hemimegalencephaly is a rare congenital disease that occurs with intractable epilepsy and is a childhood developmental disorder. A functional hemispherectomy is indicated for the treatment of hemimegalencephaly with intractable epilepsy. We present a case of hemimegalencephaly in a 6-month-old male. After hemispherectomy, his seizures disappeared completely and postoperative neurological examination showed right hemiplegia. His right arm and limb function were recovered gradually by rehabilitation with passive movement. We investigated cortical activation using near-infrared spectroscopy (NIRS). Serial NIRS showed right cortical activation by passive movement of his right arm. We suggest that NIRS showed the ipsilateral reorganization process as an effect of neurorehabilitation for disconnection of the brain.

Analysis of stroke patient walking dynamics using a tri-axial accelerometer.

The purpose of this study was to describe the characteristics of stroke patient gait using the acceleration signals which were obtained during walking. Sixty-three stroke hemiplegic patients and 21 age-matched healthy elderly individuals took part in this study. A wireless tri-axial accelerometer, fixed to a belt at the level of the L3 spinous process, was used to measure trunk acceleration. Subjects were instructed to walk at a self-selected, comfortable walking speed. The acceleration signal was sampled at the rate of 200 Hz. Gait parameters and functional recovery tests were also evaluated. We analyzed the correlation between the gait parameters, functional recovery and acceleration. Acceleration was utilized as the root mean square (RMS), normalized RMS by velocity and average step length, as a measure of gait smoothness, and autocorrelation (AC) as a measure of stride similarity and regularity. The raw RMS and AC values of the stroke were significantly lower than the matched healthy elderly (p<0.01) in all axes. In contrast, the stroke patients' normalized RMS values were higher than the controls (p<0.05) in all axes. These results suggest that accelerometry gait parameters can discriminate between the stroke patients and the control group. The values of normalized RMS correlated with the smoothness or dynamics of the walking pattern, which reflects motor recovery and gait abilities. This study suggests that normalized RMS of accelerometer recordings from the trunk is valid in objectively measuring walking movements as an index of treatment outcome for patients in rehabilitation.

Time series analysis of spontaneous upper-extremity movements of premature infants with brain injuries.

BACKGROUND AND PURPOSE: Comparisons of spontaneous movements of premature infants with brain injuries and those without brain injuries can provide insights into normal and abnormal processes in the ontogeny of motor development. In this study, the characteristics of spontaneous upper-extremity movements of premature infants with brain injuries and those without brain injuries were examined with time series analysis. SUBJECTS: Participants were 7 premature infants with brain injuries and 7 matched, low-risk, premature infants at the age of 1 month after term. METHODS: A triaxial accelerometer was used to measure upper-extremity limb acceleration in 3-dimensional space. Acceleration signals were recorded from the right wrist when the infant was in an active, alert state and lying in the supine position. The recording time was 200 seconds. The acceleration signal was sampled at a rate of 200 Hz. The acceleration time series data were analyzed by nonlinear analysis as well as linear analysis. RESULTS: The nonlinear time series analysis indicated that spontaneous movements of premature infants have nonlinear, chaotic, dynamic characteristics. The movements of the infants with brain injuries were characterized by larger dimensionality, and they were more unstable and unpredictable than those of infants without brain injuries. DISCUSSION AND CONCLUSION: As determined by nonlinear analysis, the spontaneous movements of the premature infants with brain injuries had the characteristics of increased disorganization compared with those of the infants without brain injuries. Infants with brain injuries may manifest problems with self-organization as a function of the coordination of subsystems. Physical therapists should be able to support interactions among the subsystems and promote self-organization of motor learning through the individualized provision of various sensorimotor experiences for infants.

Crying and behavioral characteristics in premature infants.

The aims of this study were to analyze 1) whether there was the relationship between the neonatal behavioral characteristics and amount of crying in premature infants at term age, and 2) what kind of difference between infants with high levels of crying and cry less on neonatal behavioral characteristics using the Neonatal Behavioral Assessment Scale (NBAS). The study participants consisted of 69 healthy low birth-weight infants who were admitted to the NICU at the Nagasaki University Hospital, Nagasaki, Japan. This study analyzed the relationship between NBAS scores measured neonatal behavioral performance and crying at term age. This study results indicate that there was significant statistical negative correlation between the amount of total daily crying and Habituation, Range of state, Regulation of state, and Autonomic stability cluster scores and some individual items scores (Response decrement to light, Response decrement to tactile of foot, Alert responsiveness, Examiner persistence, Motor maturity, Irritability, General irritability, Cuddliness, Consolability, Self-quieting activity, and State regulation). The high levels crying group also showed higher responsivity than less crying group in the items of Peak of excitement, Rapidity of build-up, Irritability and General irritability. In conclusion, neonatal behavioral characteristics such as poor inhibit discrete stimuli while asleep, hyper-responsivity and poor state regulation abilities were risk factors of high levels of crying.

A dynamical systems analysis of spontaneous movements in newborn infants.

The authors evaluated the characteristics of infants' spontaneous movements by using dynamical systems analysis. Participants were 6 healthy 1-month-old full-term newborn infants (3 males, 3 females). They used a triaxial accelerometer to measure limb acceleration in 3-dimensional space. Acceleration signals were recorded during 200 s from the right wrist when the infant was in an active alert state and lying supine (sampling rate 200 Hz). and was stored in the system's memory. Digitized data were transferred to a PC for subsequent processing with analysis software. The acceleration time series data were analyzed linearly and nonlinearly. Nonlinear time series analysis suggested that the infants' spontaneous movements are characterized by a nonlinear chaotic dynamics with 5 or 6 embedding dimensions. The production of infants'spontaneous movements involves chaotic dynamic systems that are capable of generating voluntary skill movements.

Neonatal behavioural profile and crying in premature infants at term age.

AIM: To analyse behavioural characteristics of infants who cried more versus those who cried less, in a sample of low-risk premature infants. METHODS: Participants were 63 low-risk healthy premature infants. At term age, the Neonatal Behavioral Assessment Scale (NBAS) was administered, and a 1-d diary for crying was recorded starting on the following day. Infants were categorized into two groups: those with "high level of crying" (> or = 75th percentile) and those with "less crying" (< 75th percentile), based on the total amount of crying time. RESULTS: Some individual NBAS scores and "habituation" and "regulation of state" cluster scores were lower in the high-level-of-crying group. Infants in the group with a high level of crying had lower thresholds for response in the "peak of excitement", "rapidity of build-up", "irritability" and "general irritability" items. Logistic regression analysis revealed that lower "habituation" and "regulation of state" cluster scores were significantly associated with lower thresholds for crying. CONCLUSION: These results suggest that neonatal behavioural characteristics, such as hyperresponsivity and poor state regulation, are associated with high levels of crying. Clinical assessments based on the NBAS may help parents elucidate their infant's level of tolerance for stimuli, and identify strategies to minimize their crying.

Neurobehaviors of Japanese newborns in relation to the characteristics of early mother-infant interaction.

The authors examined the relationship between newborn neurobehavioral profiles and the characteristics of early mother-infant interaction in Nagasaki, Japan. The authors administered the Brazelton Neonatal Behavioral Assessment Scale (NBAS; T. B. Brazelton & J. K. Nugent, 1995) in the newborn period and the Nursing Child Assessment Teaching Scale at 1 month (NCATS; G. Sumner & A. Spietz, 1994). They administered the Perceived Stress Scale (S. Cohen, T. Kamarck, & R. Mermelstein, 1983) as an index of maternal stress experienced over the past month. Lower irritability, higher stability in skin coloration, and lower tremulousness in the neonatal period were correlated with higher levels of maternal nurturing behaviors at 1 month. Birth weight and 2 NBAS range-of-state items (peak of excitement, irritability) predicted 31% of the variance in NCATS caregiver subscale score. The NBAS autonomic stability items (tremulousness, startles, lability of skin color) predicted 31% of the variance in the NCATS child subscale score. Perceived stress and maternal sociodemographic variables (education, income, age, parity) were not associated with child, caregiver, and total scores on the NCATS. The results suggested that lack of autonomic stability in Japanese neonates might serve as an early indicator of infant frailty, negative behavioral cues, and decreased maternal responsiveness.