Effects of Adachi Rehabilitation Programme on older adults under long-term care: A multi-centre controlled trial.

OBJECTIVES: We developed the Adachi Rehabilitation Programme (ARP), a community rehabilitation program. Under the supervision of professional caregivers, older adults cleaned and planted flowers in the park and they walked and shopped in the community. We examined the effects of ARP on individuals receiving small-group multifunctional at-home care at community facilities. METHODS: This was a multi-centre controlled trial at thirteen small multifunctional at-home care facilities in Adachi, Tokyo. The primary outcomes of the study were daily step counts and timed up & go (TUG). Secondary outcomes included gait speed, step length, Barthel Index for Activities of Daily Living, Functional Independence Measure, Mini-Mental State Examination (MMSE) and EuroQOL 5 Dimension. RESULTS: Ninety-six individuals at thirteen small multifunctional at-home care facilities were recruited for participation in December 2017. They were allocated to intervention (38) and control (40) groups. The average daily step count of the control group decreased from 852 to 727, but it increased by approximately 650 steps, from 990 to 1635, for the intervention group. Average TUG decreased from 16.1 s to 14.0 s and MMSE score increased from 15.9 to 16.3 for the intervention group, but a significant interaction was not found. On non-intervention home days, the daily step counts of the intervention group increased significantly from 908 steps to 1485 steps, while those of the control group decreased from 865 steps to 722 steps. CONCLUSIONS: ARP may have effectively increased the physical activity of older adults under long-term care by increasing motivation and changing behaviour.

Is a portable accelerometer-based navigation system useful in total hip arthroplasty?: A systematic review and meta-analysis.

BACKGROUND: Precise implant alignment is a crucial prognostic factor for successful outcomes following total hip arthroplasty (THA). A portable accelerometer-based navigation (PN) device may achieve the same accuracy as that achieved by the computer-assisted navigation surgery technique, with the convenience of a conventional technique. Although the usefulness of PN in THA (PN-THA) has been reported, whether it is more accurate than performing THA with a conventional technique (CON-THA) remains controversial. The difference in surgical time between PN-THA and CON-THA is also unclear. Therefore, we conducted a systematic review and meta-analysis of studies comparing results of PN-THA with those of CON-THA. We focused on the following question: is PN-THA superior to CON-THA in terms of radiological parameters and surgical time? PATIENTS AND METHODS: A literature search was conducted in PubMed, Web of Science, and Cochrane Library, to identify studies that met the following inclusion criteria: randomised controlled trials (RCT) or non-RCT, studies involving patients who underwent PN-THA and patients who underwent CON-THA, studies including data on radiological parameters and surgical outcomes. Author names, publication year, country, study design, surgical approach, demographic characteristics of the participants (diagnosis, gender, age, and body mass index), and surgical outcomes (the radiological parameters and the surgical time) were extracted. We calculated the mean differences (MDs) for continuous data with 95% confidence intervals (CIs) for each outcome. p<0.05 was considered significant. RESULTS: Three studies were included in this meta-analysis. The meta-analysis showed that absolute deviation of the postoperative measured angles from the target position for the cup anteversion was significantly smaller in PN-THA than in CON-THA (MD=-1.70, 95% CI=-2.91 to -0.50, [p=0.005]). There was no significant difference in the absolute deviation of the postoperative measured angles from the target position for cup abduction between the groups (MD=-1.82, 95% CI=-4.32-0.67, [p=0.15]). The surgical time was significantly longer in PN-THA than in CON-THA (MD=8.58, 95% CI=4.05-13.10, [p=0.0002]). DISCUSSION: This systematic review and meta-analysis of studies comparing the results of PN-THA with those of CON-THA showed that the PN-THA is advantageous for precise cup implantation compared to CON-THA, although PN-THA has a longer surgical time compared to CON-THA. LEVEL OF EVIDENCE: III.

Central mechanisms underlying fish swimming.

Although the basic swimming rhythm is created by central pattern generators (CPGs) located in each spinal segment, command signals from the brain should be indispensable for the activation of CPGs to initiate swimming. We hypothesized that the nucleus of medial longitudinal fascicles (Nflm) is the midbrain locomotor region driving swimming rhythms in teleosts. To test this hypothesis, we recorded neuronal activities from Nflm neurons in swimming carp and analyzed the cytoarchitecture of the nucleus. We identified two types of Nflm neurons exhibiting electric activities closely related to swimming rhythms. Remarkably, tonic neurons that continued firing during swimming were found. The Nflm and neighboring oculomotor nucleus contain about 600 neurons in total, and among them as many as 500 were labeled retrogradely by an intraspinal tracer implantation and 400 neurons showed glutamatergic immunoreactivity. They are the most likely candidates for the descending neurons as the origin of driving signals that initiate swimming. Double-labeling experiments demonstrated direct connections of Nflm neurons to spinal neurons consisting of the CPG. These data imply that most Nflm neurons possibly exert an excitatory drive to the spinal CPGs through the descending axons with excitatory transmitter(s), probably glutamate. Furthermore, we confirmed that the caudal part of Nflm and the rostral part of the oculomotor nucleus overlap rostrocaudally by approximately 200 mum. In connection with the control of swimming by the brain, we carried out experiments to clarify the efferent system of the cerebellum of the goldfish. Cerebellar efferent fibers terminated in most brain regions except for the telencephalon. Importantly, the cerebellum projected also to the Nflm, suggesting the involvement of this brain region in the control of swimming. We have also determined that in the carp so-called eurydendroid cells are cerebellar efferent neurons.