Optimizing shoulder elevation assist rate in exoskeletal rehabilitation based on muscular activity indices: a clinical feasibility study.

BACKGROUND: Restoring shoulder function is critical for upper-extremity rehabilitation following a stroke. The complex musculoskeletal anatomy of the shoulder presents a challenge for safely assisting elevation movements through robotic interventions. The level of shoulder elevation assistance in rehabilitation is often based on clinical judgment. There is no standardized method for deriving an optimal level of assistance, underscoring the importance of addressing abnormal movements during shoulder elevation, such as abnormal synergies and compensatory actions. This study aimed to investigate the effectiveness and safety of a newly developed shoulder elevation exoskeleton robot by applying a novel optimization technique derived from the muscle synergy index. METHODS: Twelve chronic stroke participants underwent an intervention consisting of 100 robot-assisted shoulder elevation exercises (10 × 10 times, approximately 40 min) for 10 days (4-5 times/week). The optimal robot assist rate was derived by detecting the change points using the co-contraction index, calculated from electromyogram (EMG) data obtained from the anterior deltoid and biceps brachii muscles during shoulder elevation at the initial evaluation. The primary outcomes were the Fugl-Meyer assessment-upper extremity (FMA-UE) shoulder/elbow/forearm score, kinematic outcomes (maximum angle of voluntary shoulder flexion and elbow flexion ratio during shoulder elevation), and shoulder pain outcomes (pain-free passive shoulder flexion range of motion [ROM] and visual analogue scale for pain severity during shoulder flexion). The effectiveness and safety of robotic therapy were examined using the Wilcoxon signed-rank sum test. RESULTS: All 12 patients completed the procedure without any adverse events. Two participants were excluded from the analysis because the EMG of the biceps brachii was not obtained. Ten participants (five men and five women; mean age: 57.0 [5.5] years; mean FMA-UE total score: 18.7 [10.5] points) showed significant improvement in the FMA-UE shoulder/elbow/forearm score, kinematic outcomes, and pain-free passive shoulder flexion ROM (P < 0.05). The shoulder pain outcomes remained unchanged or improved in all patients. CONCLUSIONS: The study presents a method for deriving the optimal robotic assist rate. Rehabilitation using a shoulder robot based on this derived optimal assist rate showed the possibility of safely improving the upper-extremity function in patients with severe stroke in the chronic phase.

Validity of the Functional Classification of the Upper Extremities for Duchenne Muscular Dystrophy.

Objectives: Some upper-limb function assessments can evaluate treatments in the non-ambulatory stage of Duchenne muscular dystrophy (DMD). The Functional Classification of the Upper Extremities (FCUE) was developed for DMD in Japan. The FCUE is easier to use than the Performance of Upper Limb (PUL) and is more detailed than the Brooke Upper Extremity Scale. This study aimed to determine the concurrent validity of FCUE with other methods of assessment for DMD. Methods: This retrospective study reviewed the medical records of 39 boys with DMD from the National Center of Neurology and Psychiatry to evaluate the concurrent validity of the FCUE and PUL using non-parametric Spearman rank correlation (ρ). We also determined the concurrent validity of the Brooke Upper Extremity Scale and PUL for comparison. Results: The ρ value between the FCUE and PUL was -0.914 (P<0.001). The FCUE showed robust concurrent validity with the PUL. That correlation between the FCUE and Brooke Upper Extremity Scale gave a ρ value of -0.854 (P<0.001). Conclusions: The FCUE had a higher concurrent validity with the PUL than with the Brooke Upper Extremity Scale. The FCUE is considered a valid assessment tool of upper-limb function in boys with DMD. Selecting the best assessment method depends on the severity of the patient's condition and a balance between assessment accuracy and evaluation time.

Do Pharmacological Treatments Act in Collaboration with Rehabilitation in Spinal Cord Injury Treatment? A Review of Preclinical Studies.

There is no choice other than rehabilitation as a practical medical treatment to restore impairments or improve activities after acute treatment in people with spinal cord injury (SCI); however, the effect is unremarkable. Therefore, researchers have been seeking effective pharmacological treatments. These will, hopefully, exert a greater effect when combined with rehabilitation. However, no review has specifically summarized the combinatorial effects of rehabilitation with various medical agents. In the current review, which included 43 articles, we summarized the combinatorial effects according to the properties of the medical agents, namely neuromodulation, neurotrophic factors, counteraction to inhibitory factors, and others. The recovery processes promoted by rehabilitation include the regeneration of tracts, neuroprotection, scar tissue reorganization, plasticity of spinal circuits, microenvironmental change in the spinal cord, and enforcement of the musculoskeletal system, which are additive, complementary, or even synergistic with medication in many cases. However, there are some cases that lack interaction or even demonstrate competition between medication and rehabilitation. A large fraction of the combinatorial mechanisms remains to be elucidated, and very few studies have investigated complex combinations of these agents or targeted chronically injured spinal cords.

Trajectories of Activities of Daily Living in the Last Eight Weeks of Life Among Patients With Terminal Cancer in a Palliative Care Unit: A Retrospective Study.

Background: Although cancer patients' activities of daily living (ADL) are reported to decline before death, ADL trajectories have not been sufficiently clarified due to limitations in the assessment and analysis methods. Objectives: To clarify the multiple trajectories of ADL in patients with terminal cancer using a comprehensive assessment measure. Design: This was a retrospective observational study. Setting/Study Subjects: Cancer patients aged ≥18 years discharged at death from a single-center palliative care unit. Measurements: Functional Independence Measure (FIM) total scores for eight weeks retrospectively. Results: In total, 306 patients were analyzed. Group-based trajectory modeling analysis estimated four groups as the best model for the FIM trajectory over eight weeks using the following trajectories: (1) a No Decline group, in which ADL did not decline until just before death; (2) a Rapid Decline group, in which ADL declined rapidly two weeks before death from a trajectory similar to the No Decline group; (3) a Moderate Disability and Slow Decline group, in which the patient slowly declined from requiring mild-to-severe assistance; and (4) a Severe Disability group, in which the patient continuously required severe assistance. Conclusions: Multiple ADL trajectories were identified in the last eight weeks of life of patients with terminal cancer. These findings suggest that palliative care needs to be tailored to the characteristics of each patient.

Chronic Spinal Cord Injury Regeneration with Combined Therapy Comprising Neural Stem/Progenitor Cell Transplantation, Rehabilitation, and Semaphorin 3A Inhibitor.

Spinal cord injury (SCI) often results in various long-term sequelae, and chronically injured spinal cords exhibit a refractory feature, showing a limited response to cell transplantation therapies. To our knowledge, no preclinical studies have reported a treatment approach with results surpassing those of treatment comprising rehabilitation alone. In this study of rats with SCI, we propose a novel combined therapy involving a semaphorin 3A inhibitor (Sema3Ai), which enhances axonal regeneration, as the third treatment element in combination with neural stem/progenitor cell transplantation and rehabilitation. This comprehensive therapeutic strategy achieved significant improvements in host-derived neuronal and oligodendrocyte differentiation at the SCI epicenter and promoted axonal regeneration even in the chronically injured spinal cord. The elongated axons established functional electrical connections, contributing to significant enhancements in locomotor mobility when compared with animals treated with transplantation and rehabilitation. As a result, our combined transplantation, Sema3Ai, and rehabilitation treatment have the potential to serve as a critical step forward for chronic SCI patients, improving their ability to regain motor function.

Psychometric Properties of the Japanese Version of the Edmonton Functional Assessment Tool 2.

CONTEXT: Physical symptoms such as pain and cancer-related fatigue limit physical function and activities of daily living among patients with terminal cancer, which can lead to a decline in quality of life. Therefore, comprehensive functional impairments should be evaluated to determine the progression of the disease and the effectiveness of palliative treatment. OBJECTIVE: To validate the psychometric properties of the Japanese version of the Edmonton Functional Assessment Tool 2 (EFAT2-J). METHODS: We developed a Japanese version of the EFAT-2 in accordance with international guidelines. To verify the reliability and validity of the EFAT2-J, patients were evaluated by a physiotherapist and a nurse separately, and correlations with existing evaluation scales for physical function, physical symptoms, and quality of life were analyzed, respectively. The significance level was set at 5%. RESULTS: Twenty patients participated in the reliability measurement. The average EFAT2-J scores were 7.95 ± 4.12 for physical therapists and 7.20 ± 4.23 for nurses, and the intraclass correlation coefficient was 0.95. The weighted kappa coefficient (κ) for each item was 0.57-1.00. Fifty-five patients participated in the validity measurement. The EFAT2-J showed significant correlations with Eastern Cooperative Oncology Group Performance Status and the Karnofsky Performance Scale, Barthel Index, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative Care sub-item "physical function." CONCLUSION: These results indicate that the EFAT2-J has robust psychometric properties and is useful for evaluating physical function in patients with terminal cancer, and thus may be an acceptable clinical instrument in research and practice.

Summary of Japanese clinical practice guidelines for head and neck cancer - 2022 update edited by the Japan society for head and neck cancer.

The aim of the "Japanese Clinical Practice Guidelines for Head and Neck Cancer - 2022 Update" is to review the latest evidence regarding head and neck cancer and to present the current standard approaches for diagnosis and treatment. These evidence-based recommendations were created with the consensus of the Guideline Committee, which is composed of otorhinolaryngologists and head and neck surgeons, together with radiologists, radiation oncologists, medical oncologists, plastic surgeons, dentists, palliative care physicians, and rehabilitation physicians. These guidelines were created by the Clinical Practice Guideline Committee of the Japan Society for Head and Neck Cancer based on the "Head and Neck Cancer Treatment Guidelines 2018 Edition," and the revised draft was compiled after evaluation by the Assessment Committee and public comments. The 'Clinical questions and recommendations' section consists of 13 categories, and 59 clinical questions are described in total. Here we describe 6 clinical questions specific to other sets of guidelines with recommendations and comments.

Decision Tree Analysis Accurately Predicts Discharge Destination After Spinal Cord Injury Rehabilitation.

OBJECTIVES: To predict discharge destination after spinal cord injury (SCI) rehabilitation. STUDY DESIGN: A retrospective, single-center study. We collected the following data from medical charts: age, sex, living arrangement before injury, acute length of stay (LOS), level of injury on admission, American Spinal Injury Association Impairment Scale (AIS) on admission, Upper Extremity Motor Score (UEMS) on admission, Lower Extremity Motor Score on admission (LEMS), Spinal Cord Independence Measure (SCIM) scores on admission and discharge, and discharge destination. A decision tree algorithm was used to establish prediction models in a train-test split manner using features on admission or discharge. SETTING: A spinal center in Tokyo, Japan. PARTICIPANTS: Participants were individuals with SCI admitted to our hospital from March 2016 to October 2021 for the first rehabilitation after the injury. The study included 210 participants divided into 2 groups: training (n=140) and testing (n=70). Random sampling without replacement was used. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Prediction accuracy was evaluated with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating curve (AUC). RESULTS: AIS was significantly different between the groups. The prediction model using total SCIM scores on discharge (D-Classification and Regression Tree [CART]) revealed that a cut-off value of 40 accurately predicted the discharge destination. In contrast, the prediction model using features on admission (A-CART) revealed that subtotal SCIM mobility scores of 5, age of 74 years, and UEMS of 23 were significant predictors. Sensitivity, specificity, PPV, NPV, and AUC of D-CART and A-CART were 0.837, 0.810, 0.911, 0.680, and 0.832 and 0.857, 0.810, 0.913, 0.708, and 0.869, respectively. CONCLUSIONS: D-CART and A-CART showed comparable prediction accuracies. This suggests that, even during the early stages of rehabilitation, it is possible to predict the discharge destination.

Functional Outcome Prediction After Spinal Cord Injury Using Ensemble Machine Learning.

OBJECTIVES: To establish a machine learning model to predict functional outcomes after SCI with Spinal Cord Independence Measure (SCIM) using features present at the time of rehabilitation admission. STUDY DESIGN: A retrospective, single-center study. The following data were collected from the medical charts: age, sex, acute length of stay (LOS), level of injury, American Spinal Injury Association Impairment Scale (AIS), motor scores of each key muscle, Upper Extremity Motor Score (UEMS), Lower Extremity Motor Score (LEMS), SCIM total scores, and subtotal scores on admission and discharge. Based on the multivariate linear regression analysis, age, acute LOS, UEMS, LEMS, and SCIM subtotal scores were selected as features for machine learning algorithms. Random forest, support vector machine, neural network, and gradient boosting were used as the base models and combined using ridge regression as a metamodel. SETTING: A spinal center in Tokyo, Japan. PARTICIPANTS: Participants were individuals with SCI admitted to our hospital from March 2016 to October 2021 for the first rehabilitation after the injury. They were divided into 2 groups: training (n=140) and testing (n=70). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The root-mean-square error (RMSE), R2, and Mean Absolute Error (MAE) were used as accuracy measures. RESULTS: RMSE, R2, and MAE of the meta-model using the testing group were 9.7453, 0.8835, and 7.4743, respectively, outperforming any other single base model. CONCLUSIONS: Our study revealed that functional prognostication could be achieved using machine-learning methods with features present at the time of rehabilitation admission. Goals can be set at the beginning of rehabilitation. Moreover, our model can be used to evaluate advanced medical treatments, such as regenerative medicine.

Risk Factors for Post-Stroke Pneumonia in a Patient Population with Subacute Stroke: A Retrospective Cohort Study.

The risk of pneumonia and death is higher in acute stroke patients with signs of pulmonary infection on chest computed tomography (CT) at admission. However, few reports have examined the incidence of pneumonia and its predictors in subacute stroke patients. The aim of this study was to examine factors related to post-stroke pneumonia in subacute stroke patients. A total of 340 subacute stroke patients were included. Univariable logistic regression analysis was performed using variables that may contribute to pneumonia, with the development of pneumonia as the dependent variable. Multivariable logistic regression analysis using the three independent variables with the lowest p-values on the univariable logistic regression analysis was also performed to calculate adjusted odds ratios. Twenty-two patients developed pneumonia during hospitalization. The univariable logistic regression analysis showed that the top three items were serum albumin (Alb), functional Oral Intake Scale (FOIS) score, and signs of pulmonary infection on chest CT at admission. Multivariable logistic regression analysis adjusted for these three items showed that the presence of signs of pulmonary infection on chest CT at admission was the independent variable (OR: 4.45; 95% CI: 1.54-12.9). When signs of pulmonary infection are seen on admission chest CT, careful follow-up is necessary because pneumonia is significantly more likely to occur during hospitalization.

Combined Ankle Robot Training and Robot-assisted Gait Training Improved the Gait Pattern of a Patient with Chronic Traumatic Brain Injury.

Background: : Walking disability caused by central nervous system injury often lingers. In the chronic phase, there is great need to improve walking speed and gait, even for patients who walk independently. Robot-assisted gait training (RAGT) has been widely used, but few studies have focused on improving gait patterns, and its effectiveness for motor function has been limited. This report describes the combination of "RAGT to learn the gait pattern" and "ankle robot training to improve motor function" in a patient with chronic stage brain injury. Case: : A 34-year-old woman suffered a traumatic brain injury 5 years ago. She had residual right hemiplegia [Fugl-Meyer Assessment-Lower Extremity (FMA-LE): 18 points] and mild sensory impairment, but she walked independently with a short leg brace and a cane. Her comfortable gait speed was 0.57 m/s without an orthosis, and her 6-m walk test distance was 240 m. The Gait Assessment and Intervention Tool (G.A.I.T.) score was 35 points. After hospitalization, ankle robot training was performed daily, with RAGT performed 10 times in total. Post-intervention evaluation performed on Day 28 showed: FMA-LE, 23 points; comfortable walking speed, 0.69 m/s; G.A.I.T., 27 points; and three-dimensional motion analysis showed ankle dorsiflexion improved from 3.22° to 12.59° and knee flexion improved from 1.75° to 16.54° in the swing phase. Discussion: : This is one of few studies to have examined the combination of two robots. Combining the features of each robot improved the gait pattern and motor function, even in the chronic phase.

Priority of the basic and instrumental activities of daily living in older patients with cancer prescribed rehabilitation: a cross-sectional survey.

BACKGROUND: There is no information on whether vulnerable older patients with cancer consider basic activities of daily living (BADL) and instrumental activities of daily living (IADL) important outcomes. Our survey aimed to investigate the priority of BADL and IADL in outcomes among vulnerable older patients with cancer. METHODS: This was a single-center survey in a Japanese cancer center. Eligible patients were ≥ 65 years of age and were prescribed in-hospital rehabilitation while under cancer treatment. Using original self-administered ranking questionnaires, patients were asked to rank outcomes and subdomain of BADL and IADL. High-priority domains were defined as the highest, second-highest, and third-highest priority domains in individuals. RESULTS: A total of 169 patients were analyzed. The mean age was 74.0 years (standard deviation, 5.1 years) and the number of males was 107 (63%). The order of ranking of high-priority outcomes was BADL and IADL (n = 155), cognitive function (n = 91), mental function (n = 82), nutrition (n = 61), social function (n = 51), comorbidity (n = 39), and life span (n = 28). The top three high-priority independence subdomains of BADL and IADL were toilet use (n = 140), feeding (n = 134), and mobility (n = 69) among the BADL and shopping (n = 93), food preparation (n = 88), and ability to handle finances (n = 85) among the IADL. CONCLUSIONS: BADL and IADL can be considered the most important health outcomes in clinical trials and in practice among older patients with cancer and physical vulnerabilities.

Parameter mapping of hemiplegic shoulder electrical stimulation for motor function: A scoping review.

BACKGROUND: Electrical stimulation (ES) of the shoulder is effective in treating subluxation and shoulder pain. However, few studies have reported on ES of the hemiplegic shoulder with motor function as an outcome; thus, the method remains unclear. OBJECTIVE: We aimed to map the existing evidence and identify the parameters for ES of the hemiplegic shoulder for motor function in stroke patients. METHODS: A literature search was performed through PubMed and Scopus to retrieve original articles from 1975 to March 2023 using the terms "stroke", "shoulder", and "electricity". We selected studies in which ES was performed on hemiplegic shoulders after stroke, parameters were described, and upper extremity motor functional assessment was included as an outcome. The extracted data included study design, phase, sample size, electrode position, parameters, intervention period, evaluation frequency, outcomes, and results. RESULTS: Of the 449 titles identified, 25 fulfilled the inclusion and exclusion criteria. Nineteen were randomized controlled trials. The most common electrode positions and parameters (frequency and pulse width) were over the posterior deltoid and the supraspinatus (upper trapezius) muscles, 30 Hz, and 250µs, respectively. The intervention period was 30-60 minutes per day, 5-7 days per week, for 4-5 weeks in over half of the studies. CONCLUSION: Stimulation positions and parameters for electrical stimulation of the hemiplegic shoulder are inconsistent. Whether ES represents a significant treatment option remains unclear. Establishing universal ES methods is necessary to improve the motor function of hemiplegic shoulders.

Comparing the contribution of each clinical indicator in predictive models trained on 980 subacute stroke patients: a retrospective study.

Post-stroke disability affects patients' lifestyles after discharge, and it is essential to predict functional recovery early in hospitalization to allow time for appropriate decisions. Previous studies reported important clinical indicators, but only a few clinical indicators were analyzed due to insufficient numbers of cases. Although review articles can exhaustively identify many prognostic factors, it remains impossible to compare the contribution of each predictor. This study aimed to determine which clinical indicators contribute more to predicting the functional independence measure (FIM) at discharge by comparing standardized coefficients. In this study, 980 participants were enrolled to build predictive models with 32 clinical indicators, including the stroke impairment assessment set (SIAS). Trunk function had the most significant standardized coefficient of 0.221. The predictive models also identified easy FIM sub-items, SIAS, and grip strength on the unaffected side as having positive standardized coefficients. As for the predictive accuracy of this model, R2 was 0.741. This is the first report that included FIM sub-items separately in post-stroke predictive models with other clinical indicators. Trunk function and easy FIM sub-items were included in the predictive model with larger positive standardized coefficients. This predictive model may predict prognosis with high accuracy, fewer clinical indicators, and less effort to predict.

Association of sarcopenia with relative dose intensity of neoadjuvant chemotherapy in older patients with locally advanced esophageal cancer: A retrospective cohort study.

INTRODUCTION: Sarcopenia impacts the toxicity of chemotherapy in patients with cancer, but there is little information on the association of sarcopenia with the relative dose intensity (RDI) of chemotherapy. We investigated the association of sarcopenia with RDI of neoadjuvant chemotherapy (NAC) in older patients with locally advanced esophageal cancer (LAEC). MATERIALS AND METHODS: This was a single-center retrospective cohort study of patients aged ≥65 years who underwent curative esophagectomy after NAC for LAEC between 2016 and 2020. Skeletal muscle mass index (SMI) was calculated from computed tomography images at the L3 level. Sarcopenia was defined using the Youden index of SMI. Average RDI was calculated from delivered-dose intensity and standard-dose intensity of all drugs. The cutoff point of low average RDI was defined as <85%. The multivariate logistic regression model was used for the endpoint. RESULTS: We analyzed 188 patients with a mean age of 71.3 years. The cutoff points of sarcopenia for low average RDI were defined as 42.81 cm2/m2 in males and 37.48 cm2/m2 in females. Sarcopenia significantly affected low average RDI, adjusted for age, sex, body mass index, drug regimen, clinical stage, and creatinine clearance (adjusted odds ratio: 2.195, 95% confidence interval: 1.107-4.411, p = 0.024). Compared with the non-sarcopenia patients, the sarcopenia patients with low average RDI had a higher rate of dose reduction, delayed, or discontinuation after the first cycle because of neutropenia (45% vs. 38%), and decreased performance status (11% vs. 0%). DISCUSSION: Sarcopenia predicted low average RDI (<85%) of NAC in older patients with LAEC. In the future, the information about the mechanism of association of sarcopenia with RDI will progress the development of intervention strategy and novel supportive care.

Retrospective study on the trajectories of lower limb volume after outpatient-based complex decongestive therapy in post-operative gynecological cancer patients with lymphedema.

PURPOSE: To determine the effect of outpatient-based complex decongestive therapy in patients with secondary lower limb lymphedema (LLL) after gynecologic cancer surgery using group-based trajectory modeling (GBTM), and to examine factors predictive of the treatment course. METHODS: This retrospective study included participants who underwent surgery for gynecological cancer with pelvic lymph node dissection and subsequently visited the outpatient clinic for the treatment of stage II LLL according to the International Society of Lymphology. The improvement rate of edema at the initial visit and 3, 6, and 12 months later was assessed by calculating the volume of the lower extremity using the circumferential method. For evaluation of the patterns of treatment course, logistic regression analysis was performed after group estimation by the trend of the treatment course using GBTM. RESULTS: A total of 148 women (mean age 60.6 years (standard deviation: 13.4 years)) were analyzed. Three improvement trajectories were identified: (1) no response group, with worsening rather than improvement (n = 26); (2) moderate response group, with a slow improvement rate (n = 89); and (3) high response group, with a high improvement rate (n = 33). In addition, adherence to compression therapy at 3 months post-intervention was found to be a predictor in the no response group. CONCLUSIONS: GBTM estimated that there are three patterns of the treatment course in patients with LLL after gynecologic cancer surgery. Adherence to compression therapy at 3 months post-intervention is a predictor of the treatment effectiveness.

Skeletal muscle mass recovery after oesophagectomy and neoadjuvant chemotherapy in oesophageal cancer: retrospective cohort study.

OBJECTIVE: Skeletal muscle mass (SMM) is an important biomarker for prognosis and health in older patients with cancer. Limited information is available on the recovery course of SMM after oesophagectomy following neoadjuvant chemotherapy (NAC) in older patients. This study was performed to investigate the recovery course of SMM after oesophagectomy following NAC and the preoperative predictors of delayed recovery in older patients with locally advanced oesophageal cancer (LAEC). METHODS: This single-centre retrospective cohort study involved older (≥65 years) and non-older (<65 years) patients with LAEC who underwent oesophagectomy following NAC. The SMM index (SMI) was calculated using CT images. One-way analysis of variance and multivariate logistic regression analysis were performed. RESULTS: In total, 110 older patients and 57 non-older patients were analysed. Loss of the SMI after NAC to 12 months postoperatively was significantly greater in older patients than in non-older patients (p<0.01). The significant preoperative predictor of delayed recovery of the SMI 12 months after surgery was loss of the SMI during NAC in older patients (per 1%: adjusted OR 1.249; 95% CI 1.131 to 1.403; p<0.001), but not in non-older patients (per 1%: OR 1.074; 95% CI 0.988 to 1.179; p=0.108). CONCLUSIONS: There is an especially large unmet need for preventing the long-term sequelae of SMM loss in older patients with LAEC after oesophagectomy following NAC. In older patients, loss of SMM during NAC is an especially useful biomarker for prescribing postoperative rehabilitation to prevent postoperative loss of SMM.

Improvement of predictive accuracies of functional outcomes after subacute stroke inpatient rehabilitation by machine learning models.

OBJECTIVES: Stepwise linear regression (SLR) is the most common approach to predicting activities of daily living at discharge with the Functional Independence Measure (FIM) in stroke patients, but noisy nonlinear clinical data decrease the predictive accuracies of SLR. Machine learning is gaining attention in the medical field for such nonlinear data. Previous studies reported that machine learning models, regression tree (RT), ensemble learning (EL), artificial neural networks (ANNs), support vector regression (SVR), and Gaussian process regression (GPR), are robust to such data and increase predictive accuracies. This study aimed to compare the predictive accuracies of SLR and these machine learning models for FIM scores in stroke patients. METHODS: Subacute stroke patients (N = 1,046) who underwent inpatient rehabilitation participated in this study. Only patients' background characteristics and FIM scores at admission were used to build each predictive model of SLR, RT, EL, ANN, SVR, and GPR with 10-fold cross-validation. The coefficient of determination (R2) and root mean square error (RMSE) values were compared between the actual and predicted discharge FIM scores and FIM gain. RESULTS: Machine learning models (R2 of RT = 0.75, EL = 0.78, ANN = 0.81, SVR = 0.80, GPR = 0.81) outperformed SLR (0.70) to predict discharge FIM motor scores. The predictive accuracies of machine learning methods for FIM total gain (R2 of RT = 0.48, EL = 0.51, ANN = 0.50, SVR = 0.51, GPR = 0.54) were also better than of SLR (0.22). CONCLUSIONS: This study suggested that the machine learning models outperformed SLR for predicting FIM prognosis. The machine learning models used only patients' background characteristics and FIM scores at admission and more accurately predicted FIM gain than previous studies. ANN, SVR, and GPR outperformed RT and EL. GPR could have the best predictive accuracy for FIM prognosis.

Impacts of increases and decreases of drugs on rehabilitation outcomes of subacute stroke patients.

OBJECTIVE: To examine changes in drugs for subacute stroke patients and elucidate the impact of medications on rehabilitation outcomes. MATERIALS AND METHODS: A total of 295 subacute stroke patients who were admitted to the convalescent rehabilitation ward between June 2018 and May 2019 were included. Polypharmacy was defined as five or more drugs at admission. The primary outcome was the Functional Independence Measure Total score (FIM-T) at discharge. Multiple regression analysis was performed to examine the relationships between the FIM-T at discharge and drug changes or other factors. This study was conducted in two stages. The first analysis included all stroke patients, and the second analysis included only stroke patients with polypharmacy. RESULTS: On multiple regression analysis, the number of drugs at admission (ß=-0.628) was associated with FIM-T at discharge of all stroke patients. Furthermore, the number of additional drugs during hospitalization (ß=-1.964) was associated with FIM-T at discharge in the 176 stroke patients with polypharmacy. CONCLUSION: This study suggested that the number of drugs at admission and the addition of drugs during hospitalization might have a negative impact on the rehabilitation outcomes of subacute stroke patients.

Electrically Induced Sensory Trick in a Patient with Musician's Dystonia: A Case Report.

A sensory trick is a specific maneuver that temporarily improves focal dystonia. We describe a case of musician's dystonia in the right-hand fingers of a patient, who showed good and immediate improvement after using an electrical stimulation-mimicking sensory trick. A 49-year-old professional guitarist presented with chronic involuntary flexion of the right-hand third and fourth fingers that occurred during guitar performances. Electrical stimulation with a frequency of 40 Hz and an intensity of 1.5 times the sensory threshold was administered on the third and fourth fingernails of the right hand, which facilitated fluent guitar playing. While he played guitar with and without electrical stimulation, we measured the surface electromyograms (sEMG) of the right extensor digitorum and flexor digitorum superficialis muscles to evaluate the sensory-trick-like effects of electrical stimulation. This phenomenon can offer clues for developing electrical stimulation-based treatment devices for focal dystonia. Electrical stimulation has the advantage that it can be turned off to avoid habituation. Moreover, the device is easy to use and portable. These findings warrant further investigation into the use of sensory stimulation for treating focal dystonia.