Quadriceps muscle activity during walking with a knee ankle foot orthosis is associated with improved gait ability in acute hemiplegic stroke patients with severe gait disturbance.

Introduction: A knee-ankle-foot orthosis (KAFO) prevents knee buckling during walking and enables gait training for acute hemiplegic stroke patients with severe gait disturbances. Although the goal of gait training with a KAFO is to improve gait ability, that is, to acquire walking with an ankle-foot orthosis (AFO), it is not clear how gait training with a KAFO contributes to improving gait ability. Therefore, this study aimed to investigate the relationship between muscle activities during walking with a KAFO and the improvement of gait ability in hemiplegic stroke patients with severe gait disturbance. Methods: A prospective cohort study was conducted. Fifty acute hemiplegic stroke patients who could not walk with an AFO participated. Muscle activities of the paretic rectus femoris, biceps femoris, tibialis anterior, and soleus were assessed with surface electromyogram during walking with a KAFO. Electromyograms were assessed at the beginning of gait training and at the time the Ambulation Independence Measure score improved by 3 or higher, or discharge. Results: Even in patients with complete hemiplegia, paretic rectus femoris, biceps femoris, and soleus showed periodic muscle activity during walking with a KAFO. Twenty-three patients improved to an Ambulation Independence Measure score of 3 or higher and were able to walk with an AFO (good recovery group). At the beginning of gait training, paretic rectus femoris muscle activity during the first double-limb support phase was significantly higher in the good recovery group than in the poor recovery group. The rectus femoris muscle activity significantly increased from before to after acute rehabilitation, which consisted mainly of gait training with a KAFO. Discussion: For acute hemiplegic stroke patients with severe disturbance, the induction and enhancement of paretic quadriceps muscle activity during walking with a KAFO play an important role in acquiring walking with an AFO.

New Artificial Intelligence-Integrated Electromyography-Driven Robot Hand for Upper Extremity Rehabilitation of Patients With Stroke: A Randomized, Controlled Trial.

BACKGROUND: An artificial intelligence (AI)-integrated electromyography (EMG)-driven robot hand was devised for upper extremity (UE) rehabilitation. This robot detects patients' intentions to perform finger extension and flexion based on the EMG activities of 3 forearm muscles. OBJECTIVE: This study aimed to assess the effect of this robot in patients with chronic stroke. METHODS: This was a single-blinded, randomized, controlled trial with a 4-week follow-up period. Twenty patients were assigned to the active (n = 11) and control (n = 9) groups. Patients in the active group received 40 minutes of active finger training with this robot twice a week for 4 weeks. Patients in the control group received passive finger training with the same robot. The Fugl-Meyer assessment of UE motor function (FMA), motor activity log-14 amount of use score (MAL-14 AOU), modified Ashworth scale (MAS), H reflex, and reciprocal inhibition were assessed before, post, and post-4 weeks (post-4w) of intervention. RESULTS: FMA was significantly improved at both post (P = .011) and post-4w (P = .021) in the active group. The control group did not show significant improvement in FMA at the post. MAL-14 AOU was improved at the post in the active group (P = .03). In the active group, there were significant improvements in wrist MAS at post (P = .024) and post-4w (P = .026). CONCLUSIONS: The AI-integrated EMG-driven robot improved UE motor function and spasticity, which persisted for 4 weeks. This robot hand might be useful for UE rehabilitation of patients with stroke.Clinical Trial Registry Name: The effect of robotic rehabilitation using XMM-HR2 for the paretic upper extremity among hemiparetic patients with stroke.Clinical Trial Registration-URL: https://jrct.niph.go.jp/Unique Identifier: jRCTs032200045.

Prediction of gait independence using the Trunk Impairment Scale in patients with acute stroke.

Background: Gait recovery is one of the primary goals of stroke rehabilitation. Gait independence is a key functional component of independent activities in daily living and social participation. Therefore, early prediction of gait independence is essential for stroke rehabilitation. Trunk function is important for recovery of gait, balance, and lower extremity function. The Trunk Impairment Scale (TIS) was developed to assess trunk impairment in patients with stroke. Objective: To evaluate the predictive validity of the TIS for gait independence in patients with acute stroke. Methods: A total of 102 patients with acute stroke participated in this study. Every participant was assessed using the TIS, Stroke Impairment Assessment Set (SIAS), and Functional Independence Measure (FIM) within 48 h of stroke onset and at discharge. Gait independence was defined as FIM gait scores of 6 and 7. Multiple regression analysis was used to predict the FIM gait score, and multiple logistic regression analysis was used to predict gait independence. Cut-off values were determined using receiver operating characteristic (ROC) curves for variables considered significant in the multiple logistic regression analysis. In addition, the area under the curve (AUC), sensitivity, and specificity were calculated. Results: For the prediction of the FIM gait score at discharge, the TIS at admission showed a good-fitting adjusted coefficient of determination (R 2 = 0.672, p < 0.001). The TIS and age were selected as predictors of gait independence. The ROC curve had a TIS cut-off value of 12 points (sensitivity: 81.4%, specificity: 79.7%) and an AUC of 0.911. The cut-off value for age was 75 years (sensitivity: 74.6%, specificity: 65.1%), and the AUC was 0.709. Conclusion: The TIS is a useful early predictor of gait ability in patients with acute stroke.

The MMT of Elbow Flexion and the AFE Predict Impairment and Disability at 3 Weeks in Patients With Acute Stroke.

Objective: This study aimed to investigate whether upper extremity motor function assessment within 72 h from stroke onset can predict the functional outcomes of the upper extremity. Design: This was a prospective, cohort study of patients with a first unilateral hemispheric stroke between May 2018 and March 2020. The motor arm item of the National Institutes of Health Stroke Scale, manual muscle testing of the elbow and forearm, and active finger extension scale were assessed within 72 h after stroke onset. The Fugl-Meyer assessment upper extremity motor score and action research arm test were assessed at discharge from the acute hospital. Multiple regression analysis was used to study predictors of upper extremity motor function at discharge from the acute hospital. The adjustment variables included age, sex, thumb localizing test, and visuospatial function. Results: Sixty acute stroke patients were recruited. The model with the highest coefficient of determination for the Fugl-Meyer assessment upper extremity motor score at discharge was the elbow flexion model (R 2 = 0.76), followed by the active finger extension model (R 2 = 0.69). For the action research arm test, the highest model was the active finger extension model (R 2 = 0.64), followed by the elbow flexion model (R 2 = 0.63). Conclusion: The manual muscle testing of elbow flexion and the active finger extension may be useful for predicting impairment and disability at 3 weeks in patients with acute stroke.

Cancer Rehabilitation Provided by Designated Cancer Hospitals in Japan: The Current State of Outpatient Setting and Coordination after Discharge.

Objectives: The aim of the present study was to clarify the current state of outpatient cancer rehabilitation and coordination systems provided by designated cancer hospitals in Japan. Methods: A questionnaire was sent to 427 designated cancer hospitals in Japan to investigate the status of outpatient cancer rehabilitation and whether it was sufficiently conducted. The status of regional coordination with post-discharge rehabilitation facilities was surveyed. Results: Responses were received from 235/427 facilities (55.0%). Outpatient cancer rehabilitation was implemented in 92 (39.1% of responding facilities), and of these facilities, 83.7% answered that the provision of rehabilitation was insufficient. The reasons were ineligibility for reimbursement of medical fees, a lack of human resources, a lack of awareness of the need, and a lack of education. Regional coordination was conducted by 39.1% of responding facilities, yet a regional alliance path had been established in only 9.8% of centers. The absence of coordination was associated with large facility size, the absence of physiatrists, and few rehabilitation professionals who had completed the training program; an insufficient framework for regional coordination was also given as a reason. Conclusions: To provide adequate outpatient cancer rehabilitation, sufficient human resources, the reimbursement of medical fees in the outpatient setting, and education and a framework to promote regional coordination are necessary.

Trunk Impairment as a Predictor of Activities of Daily Living in Acute Stroke.

Background and purpose: Trunk function plays a key role in performing activities of daily living (ADL) including locomotion and sitting. Sitting and ADL should be performed as early as possible especially during the acute phase of stroke rehabilitation. Therefore, this study aimed to assess trunk function among patients with acute stroke using the Trunk Impairment Scale (TIS) and to predict its functional outcomes. Methods: Overall, 67 patients with acute stroke (i.e., within 2 days of occurrence of the stroke) were included. The following clinical assessment items were obtained within 48 h after stroke onset and on the day before discharge from the hospital. Trunk function was examined using TIS and Trunk Control Test (TCT). The motor function of the upper and lower extremities was assessed using the stroke impairment assessment set motor (SIAS-M) score, and ADL was assessed using functional independence measure motor (FIM-M) items. Results: Multiple regression analysis was performed using the stepwise regression method, using the total FIM-M score following discharge as the dependent variable and age, TIS, TCT, SIAS-M, and FIM-M within 48 h after stroke onset as the independent variables. Age, TIS, and FIM-M within 48 h after stroke onset were selected as the input variables and showed a high-adjusted determination coefficient (R2 = 0.79; P < 0.001). Conclusion: TIS is a reliable method for evaluating trunk control function and is an early predictor of ADL among patients with acute stroke.

Impact of Physical Inactivity on the Risk of Disability and Hospitalization in Older Patients with Advanced Lung Cancer.

PURPOSE: This prospective observational study aimed to explore the influence of physical inactivity during initial chemotherapy on the risk of disability and hospitalization in later life among older patients with advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Patients aged 70 or above who were scheduled to receive first-line chemotherapy for newly diagnosed advanced NSCLC were recruited for the study. An electronic pedometer was used to measure daily steps; based on the change rate (cutoff: -12.5%) from pretreatment to 12 ± 4 weeks after enrolment, patients were classified as active or inactive. The Barthel Index estimated activities of daily living. We compared disability-free survival time, mean cumulative functions of hospital stays, and medical costs, between the active and inactive groups. RESULTS: Among the 29 patients enrolled, 21 were evaluable. Compared with active patients (n = 11), inactive patients (n = 10) showed shorter disability-free survival (6.4 vs 19.9 months, p < 0.05) and tended to have longer hospital stays (23.7 vs 6.3 days/person) and higher inpatient care cost (¥1.6 vs ¥0.3 million/person [US$16,000 vs US$3000/person]) during the first year. CONCLUSION: Physical inactivity during initial chemotherapy may be a risk factor for developing disability and requiring hospitalization in later life for older patients with advanced NSCLC. Our findings may indicate the need for lifestyle interventions with multidisciplinary teams, which include physicians, nurses, and physiotherapists, for older patients with advanced lung cancer during an active cancer treatment. A large-sample-sized study is needed to validate our findings.

The current status of inpatient cancer rehabilitation provided by designated cancer hospitals in Japan.

OBJECTIVE: This survey was conducted to clarify the current status of inpatient cancer rehabilitation provided by designated cancer hospitals in Japan. METHODS: A survey questionnaire was sent to 427 designated cancer hospitals in Japan. Information was sought regarding whether inpatient cancer rehabilitation was provided by the center, and if so, whether respondents regarded such provision as satisfactory. RESULTS: Responses were obtained from 235/427 surveyed institutions (55.0%). Cancer rehabilitation was provided in inpatient settings by 97.4%. Two-thirds of respondents (67.7%) regarded inpatient cancer rehabilitation provision as still inadequate. The primary reasons claimed for this inadequacy were a lack of human resources, a lack of rehabilitation professionals with the requisite knowledge/skills and patients who would benefit from cancer rehabilitation present but not prescribed. The total number of rehabilitation staff was identified as associated factor of inadequate inpatient cancer rehabilitation in multivariate analysis (odds ratio = 0.979, 95% confidence interval = 0.96-1.00, P = 0.009). CONCLUSIONS: In order to provide adequate cancer rehabilitation, a sufficient supply of rehabilitation staff, education and recognition of the need for cancer rehabilitation within oncology units are necessary.

Clinical impact of walking capacity on the risk of disability and hospitalizations among elderly patients with advanced lung cancer.

PURPOSE: Little is known about the impact of decreased walking capacity on clinical outcomes in elderly patients with cancer. This prospective observational study aimed to investigate the impact of walking capacity on the risk of disability and hospitalization in elderly patients with advanced lung cancer. METHOD: This study prospectively enrolled 60 patients aged ≥ 70 years with advanced non-small-cell lung cancer (NSCLC) scheduled to receive first-line chemotherapy or radical radiotherapy between January 2013 and December 2014 (trial registration number: UMIN000009768). Patients were classified into the mobile or less mobile group based on the median incremental shuttle walking distance (ISWD) before initial treatment. Assessments included the Barthel index, disability-free survival time, mean cumulative lengths of hospital stay, and inpatient medical costs. RESULTS: The median ISWD was 290 m (interquartile range, 245-357.5 m). The mobile group (ISWD ≥ 290 m) had a longer disability-free survival time than the less mobile group (ISWD < 290 m, 24.6 months vs. 8.4 months, p < 0.05). During the first year from study entry, the mobile group had shorter cumulative lengths of hospital stay (41.3 vs. 72.9 days/person, p < 0.05) and lower inpatient medical costs (¥1.9 vs. ¥2.9 million/person, p < 0.05) than the less mobile group. CONCLUSION: Elderly NSCLC patients with adequate walking capacity showed lower risks of disability, shorter hospitalizations, and lower inpatient medical costs than patients with reduced walking capacity. Further prospective research is needed to validate these findings. The trial was registered with the University Hospital Medical Information Network as trial number UMIN000009768 on January 13, 2013. TRIAL REGISTRATION: UMIN000009768.

Right as well as left unilateral spatial neglect influences rehabilitation outcomes and its recovery is important for determining discharge destination in subacute stroke patients.

BACKGROUND: Unilateral spatial neglect (USN) can interfere with rehabilitation processes and lead to poor functional outcome. AIM: To investigate the influence of left and right USN on rehabilitation outcomes using Catherine Bergego Scale (CBS) in stroke patients and the relationships among improvement of USN, improvement of motor autonomy (measured by functional independence measure [FIM] gain), length of stay and discharge destination. DESIGN: Observational study. SETTING: Rehabilitation hospital in Japan. POPULATION: We investigated 60 first-ever stroke patients who were admitted to a rehabilitation hospital within 3 months after stroke onset (27 patients with neglect and 33 without neglect). METHODS: Multiple regression analyses were used to explain FIM gain, FIM effectiveness and length of stay. Independent variables were motor and cognitive FIM, CBS, Stroke Impairment Assessment Set Motor Score (SIAS-M) and time after stroke onset at admission. RESULTS: The incidences of USN in patients with right and left hemisphere damage were 55.6% and 37.1%, respectively. CBS predicted motor FIM, motor FIM gain, motor FIM effectiveness and length of stay. On the other hand, SIAS-M did not predict either FIM nor length of stay. CBS Score decreased significantly in patients with USN who retuned their home, while it did not change in patients who did not. Cognitive FIM Score at admission was significantly lower in patients who did not return home than in patients who returned home. CONCLUSIONS: CBS is more useful than SIAS-M for prediction of functional outcomes in patients with both left and right hemisphere damages. Improvement of USN is important for returning home. Cognitive impairment may interfere with recovery of USN. CLINICAL REHABILITATION IMPACT: Improvements of USN are important for planning the rehabilitation goal and determination of discharge destination.

Impact of Cancer Cachexia on Hospitalization-associated Physical Inactivity in Elderly Patients with Advanced Non-small-cell Lung Cancer.

OBJECTIVE: New or worsening disability can develop in elderly patients in just 1 week of hospitalization for acute illness. Elderly patients with cancer, particularly those with cancer cachexia, are vulnerable to disability. This study aimed to explore the impact of hospitalization and cachexia on physical activity (PA) in elderly patients during chemotherapy. METHODS: We prospectively enrolled 18 patients aged ≥70 years with newly-diagnosed, advanced non-small-cell lung cancer scheduled to initiate first-line chemotherapy. PA was measured using an accelerometer (Lifecorder®, Suzuken Co., Ltd., Japan). Mean daily steps at baseline, during hospitalization, and subsequent weeks (1st, 2nd, and 3rd week after discharge) were compared. RESULTS: A total of 30 hospitalizations for chemotherapy were evaluated in 18 patients with a median age of 74.5 years. The median number of baseline daily steps was 3756. Fifteen cases (50%) showed fewer daily steps during hospitalization and no recovery to baseline level during the 1st week after discharge. Long hospitalizations (≥8 days) and the presence of cachexia were associated with persistent physical inactivity. One patient developed disability within 30 days after hospitalization. CONCLUSIONS: Physical inactivity was frequently seen after hospitalization for chemotherapy in elderly patients with advanced lung cancer. Longer in-hospital days and the presence of cancer cachexia caused slow recovery from physical inactivity. Individualized hospitalization planning based on careful consideration of patient age and the presence of cancer cachexia may be needed to prevent physical inactivity and disability.

Prospective phase II study evaluating the efficacy of swallow ability screening tests and pneumonia prevention using a team approach for elderly patients with gastric cancer.

BACKGROUND: Aging partly impairs swallowing function, which is considered a risk factor for postoperative pneumonia (PP). We evaluated the efficacy of a new team-based strategy to reduce the incidence of PP in elderly patients with gastric cancer. METHODS: This single-center, prospective phase II study included elderly patients (≥75 years old) with gastric cancer undergoing gastric surgery. The primary endpoint was the incidence of Clavien-Dindo grade II or higher PP. Patients were initially screened using three swallowing function screening tests: a symptom questionnaire, the modified water swallow test (MSWT), and the repetitive saliva swallowing test (RSST). All patients were provided standard preoperative oral checks and care and simple neck muscle training. For patients who screened positive, a videofluorographic swallowing study was performed; if an abnormality was found, the patient was given intensive swallowing rehabilitation both pre- and postoperatively. RESULTS: Of 86 eligible patients enrolled, PP developed in 3 (3.5%). The 60% confidence interval of 1.8-6.3% had an upper limit below the prespecified threshold of 7.8%. Positive screening results were found for 19 patients (22.1%) on the symptom questionnaire, 3 (3.5%) on the MSWT, and 1 (1.2%) on the RSST. PP was not observed in any patients who screened positive. CONCLUSION: In conclusion, although the screening tests we adopted here were not sufficient to identify patients at high risk of aspiration pneumonia, perioperative interventions using a team approach might be effective in reducing the incidence of PP in elderly patients with gastric cancer.

Unfavorable impact of cancer cachexia on activity of daily living and need for inpatient care in elderly patients with advanced non-small-cell lung cancer in Japan: a prospective longitudinal observational study.

BACKGROUND: Cancer cachexia in elderly patients may substantially impact physical function and medical dependency. The aim of this study was to estimate the impact of cachexia on activity of daily living (ADL), length of hospital stay, and inpatient medical costs among elderly patients with advanced non-small-cell lung cancer (NSCLC) receiving chemotherapy. METHODS: Thirty patients aged ≥70 years with advanced NSCLC (stage III-IV) scheduled to receive first-line chemotherapy were prospectively enrolled between January 2013 and November 2014. ADL was assessed using the Barthel index. The disability-free survival time (DFS) was calculated as the time between the date of study entry and the date of onset of a disabling event, which was defined as a 10-point decrease in the Barthel index from that at baseline. The mean cumulative function of the length of hospital stay and inpatient medical costs (¥, Japanese yen) was calculated. RESULTS: The study patients comprised 11 women and 19 men, with a median age of 74 (range, 70-82) years. Cachexia was diagnosed in 19 (63%) patients. Cachectic patients had a shorter DFS (7.5 vs. 17.1 months, p < 0.05). During the first year from study entry, cachectic patients had longer cumulative lengths of hospital stay (80.7 vs. 38.5 days/person, p < 0.05), more frequent unplanned hospital visits or hospitalizations (4.2 vs. 1.7 times/person, p < 0.05), and higher inpatient medical costs (¥3.5 vs. ¥2.1 million/person, p < 0.05) than non-cachectic patients. CONCLUSIONS: Elderly NSCLC patients with cachexia showed higher risks for disability, prolonged hospitalizations, and higher inpatient medical costs while receiving chemotherapy than patients without cachexia. Our results might indicate that there is a potential need for an early intervention to minimize progression to or development of cachexia, improve functional prognosis, and reduce healthcare resource burden in this population. TRIAL REGISTRATION: Trial registration number: UMIN000009768 . Name of registry: UMIN (University hospital Medical Information Network). Date of registration: 14 January 2013. Date of enrolment of the first participant to the trial: 23 January 2013.

Skeletal muscle depletion during chemotherapy has a large impact on physical function in elderly Japanese patients with advanced non-small-cell lung cancer.

BACKGROUND: Elderly patient with advanced cancer is one of the most vulnerable populations. Skeletal muscle depletion during chemotherapy may have substantial impact on their physical function. However, there is little information about a direct relationship between quantity of muscle and physical function. We sought to explore the quantitative association between skeletal muscle depletion, and muscle strength and walking capacity in elderly patients with advanced non-small cell lung cancer (NSCLC). METHODS: Thirty patients aged ≥70 years with advanced NSCLC (stage III-IV) scheduled to initiate first-line chemotherapy were prospectively enrolled between January 2013 and November 2014. Lumbar skeletal muscle index (LSMI, cm2/m2), incremental shuttle walking distance (ISWD, m), and hand-grip strength (HGS, kg) were assessed at baseline, and 6 ± 2 weeks (T2) and 12 ± 4 weeks (T3) after study enrollment. Associations were analyzed using linear regression. RESULTS: Altogether, 11 women and 19 men with a median age of 74 (range, 70-82) years were included in the study; 24 received cytotoxic chemotherapy and 6, gefitinib. Mean ± standard deviation of LSMI, ISWD and HGS were 41.2 ± 7.8 cm2/m2, 326.0 ± 127.9 m, and 29.3 ± 8.5 kg, respectively. LSMI and ISWD significantly declined from baseline to T2 and T3. HGS significantly declined from baseline to T2 and T3 only in men. Change in LSMI was significantly associated with change in HGS (ß = 0.3 ± 0.1, p = 0.0127) and ISWD (ß = 8.8 ± 2.4, p = 0.0005). CONCLUSIONS: Skeletal muscle depletion accompanied with physical functional decline started in the early phase of the chemotherapy in elderly patients with advanced NSCLC. Our results suggest that there may be a need for early supportive care in these patients to prevent functional decline during chemotherapy. TRIAL REGISTRATION: Trial registration number: UMIN000009768 Name of registry: UMIN (University hospital Medical Information Network). URL of registry: Date of registration: 14 January 2013. Date of enrolment of the first participant to the trial: 23 January 2013.

After-effects of pedaling exercise on spinal excitability and spinal reciprocal inhibition in patients with chronic stroke.

PURPOSE OF THE STUDY: To evaluate the after-effects of pedaling on spinal excitability and spinal reciprocal inhibition in patients with post-stroke spastic hemiparesis. MATERIALS AND METHODS: Twenty stroke patients with severe hemiparesis participated in this study and were instructed to perform 7 min of active pedaling and 7 min of passive pedaling with a recumbent ergometer at a comfortable speed. H reflexes and M waves of paretic soleus muscles were recorded at rest before, immediately after and 30 min after active and passive pedaling. The Hmax/Mmax ratio and H recruitment curve were measured. Reciprocal inhibition was assessed using the soleus H reflex conditioning test paradigm. RESULTS: The Hmax/Mmax ratio was significantly decreased after active and passive pedaling exercise. The decreased Hmax/Mmax ratio after active pedaling lasted at least for 30 min. The H recruitment curve and reciprocal inhibition did not change significantly after active or passive pedaling exercise. CONCLUSIONS: Pedaling exercise decreased spinal excitability in patients with severe hemiparesis. Pedaling may be effective in rehabilitation following stroke.

Prognostic Factors and Multidisciplinary Postoperative Chemoradiotherapy for Clinical T4a Tongue Cancer.

OBJECTIVE: The prognosis of patients with locally advanced squamous cell carcinoma (SCC) of the tongue is poor. Postoperative chemoradiotherapy (CRT) improves locoregional control and survival in high-risk patients. We investigated the prognostic factors for clinical T4a tongue SCC, and elucidated whether postoperative CRT has a benefit for patients with poor prognosis in terms of survival. METHODS: We performed a retrospective analysis of 61 patients with stage T4a SCC of the tongue who underwent primary resection and neck dissection. RESULTS: The median follow-up was 53.8 months. Multivariate analysis revealed a 4.26× relative risk of death for patients with the involvement of ≥5 regional lymph nodes (pN ≥5) compared with those with pN 0-4 (p = 0.002). In Kaplan-Meier analysis, patients with pN ≥5 who received CRT had longer overall survival rates than those who did not (hazard ratio = 0.31; p = 0.041). CONCLUSIONS: pN ≥5 is the most powerful prognostic factor for clinical T4a SCC of the tongue. Postoperative CRT is recommended in patients with pN ≥5.

[Swallowing and Voice Disorders in Cancer Patients].

Dysphagia sometimes occurs in patients with head and neck cancer, particularly in those undergoing surgery and radiotherapy for lingual, pharyngeal, and laryngeal cancer. It also occurs in patients with esophageal cancer and brain tumor. Patients who undergo glossectomy usually show impairment of the oral phase of swallowing, whereas those with pharyngeal, laryngeal, and esophageal cancer show impairment of the pharyngeal phase of swallowing. Videofluoroscopic examination of swallowing provides important information necessary for rehabilitation of swallowing in these patients. Appropriate swallowing exercises and compensatory strategies can be decided based on the findings of the evaluation. Palatal augmentation prostheses are sometimes used for rehabilitation in patients undergoing glossectomy. Patients who undergo total laryngectomy or total pharyngolaryngoesophagectomy should receive speech therapy to enable them to use alaryngeal speech methods, including electrolarynx, esophageal speech, or speech via tracheoesophageal puncture. Regaining swallowing function and speech can improve a patient's emotional health and quality of life. Therefore, it is important to manage swallowing and voice disorders appropriately.

Cancer Functional Assessment Set: a new tool for functional evaluation in cancer.

OBJECTIVE: The aim of this study was to develop and evaluate the psychometric properties of a new measurement tool, the Cancer Functional Assessment Set (cFAS). DESIGN: A total of 119 inpatients with cancer participated in this prospective cohort study. This study took place in three phases: (1) item generation, literature search, and a round-table discussion by 32 rehabilitation specialists; (2) item reduction and selection of appropriate items from the first item pool; and (3) evaluation of psychometric properties. Concurrent validity (Spearman correlation coefficients with existing scales), internal reliability (Cronbach coefficient alpha), interrater reliability (weighted kappa statistics and intraclass correlation coefficient), cross-validation, and responsiveness (standardized response mean values) were examined. RESULTS: The cFAS consisted of 24 items. Significant correlations were found between the cFAS and existing scales. Cronbach α for the total score was 0.92. Weighted κ values for each item ranged from 0.74 to 1.00. The intraclass correlation for the total score was 0.97. Concurrent validity and internal consistency were similar at two different hospitals. The cFAS was more responsive to changes than the other tools. CONCLUSIONS: The cFAS has acceptable psychometric properties, supporting its broad generalizability. It can be a useful tool in clinical trials and can contribute to the development of cancer rehabilitation.

[Rehabilitation for cancer patients].

In Japan, the number of patients with cancer is increasing drastically with the increase in number of elderly people. Therefore, recently, the necessity of rehabilitation for cancer patients has been realized. Cancer rehabilitation can be classified as preventive, restorative, supportive, or palliative and is administered according to the degree of cancer progression. Rehabilitation is of great significance even for patients with progressive cancer as it helps maintain their quality of life. Various forms of impairment, disability, and handicap are associated with cancer rehabilitation. Examples of impairments that cancer patients experience are hemiplegia and higher brain dysfunction in brain tumor cases, paraplegia and quadriplegia in spinal or spinal cord tumor cases, neuropathy and radiculopathy in cases of tumor invasion, complications after surgery, peripheral neuropathy after chemotherapy, and dysphagia after radiotherapy. It is important to evaluate these impairments and the risks associated with rehabilitation.