Physiotherapy management focusing on proprioceptive impairment in a patient with gait and balance impairments following stroke: A case report.

BACKGROUND: Proprioceptive impairment contributes to gait and balance impairments in patients with stroke. Diagnosis functional impairments and evaluation treatment efficacy require quantitative proprioception assessment. However, proprioception assessment has remained limited to ordinal scale measurement, with a lack of ratio scale measurements. PURPOSE: This case report describes a physiotherapy management program focusing on proprioceptive impairment in patients with stroke using quantitative tests such as Threshold to Detect Passive Motion (TDPM) and Joint Position Sense (JPS). CASE DESCRIPTION: A63-year-old male patient with an acute pontine lacunar infarction was admitted to our hospital. His muscle strength, selective movement, and trunk activity were preserved. However, the Berg Balance Scale (BBS) and Gait Assessment andIntervention Tool (GAIT) score were 42 and 9 points, observing balance impairment and the buckling knee pattern with hip ataxia during gait. Based on these, TDPM and JPS using image capture were performed. In physiotherapeuticdiagnosis, proprioceptive impairments in the hip and knee joints were the primary functional impairments related to balance and gait. To address these proprioceptive impairments, a 13-day treatment protocol incorporating transcutaneous electrical nerve stimulation (intensity: sensory threshold, frequency: 100 Hz) targeting the quadriceps femoris was performed. OUTCOMES: The patient was discharged after achieving independent ambulation and improvement in BBS (56 points) and GAIT (2 points) scores, exceeding the minimum clinically important difference. Recovery of proprioceptive impairment corresponded withimproved balance and gait ability. CONCLUSION: Quantitatively evaluating proprioceptive impairments may provide novel rehabilitation for patients with stroke who have proprioceptive impairments and contribute to clinical decision-making.

Human resource challenges for physical therapists in Japan: a hybrid time-series and system dynamics analyses for the near, mid and long-term horizons.

INTRODUCTION: There have been growing concerns that the present annual supply of more than 14,000 physical therapists in Japan may signal a potential human resource challenge. The assumption that any increase in supply would be sustained by an increase in demand from an aging population has never been adequately investigated. PURPOSE: The aim of this study was to investigate the human resource challenges faced by physical therapists in Japan, and to develop forecasting models (low, mid and high-growth) for the near (5-year), mid (20-year) and long-term (40-year) event horizons. METHODS: All human resource data were extracted from publicly available sources from January to May 2020 and categorized according to actual and forecasted supply and strength of demand variables using s system dynamics approach. The actual supply variables were used to validate the forecasted supply using time-series analysis. RESULTS: The increase in forecasted supply is expected to be most severe for the high growth scenario, particularly after the mid-term horizon. The forecasted strength of demand may be expected to decrease in both the total and aged populations. CONCLUSION: The increase in supply of PTs in Japan over the past 55-year period, and the forecasted increase over the next 45 years is still a cause for concern. The assumption that any increase in supply would be sustained by an aging population was not supported by the results of this study. These results also suggest that the possibility of a human resource challenge may arise after the mid-term event horizon.

Clinical reliability and usability of smartphone goniometers for hip range of motion measurement.

[Purpose] This study aimed to utilize the objective measurements and a survey questionnaire for assessing the intra- and inter-rater reliability, measurement time, and usability of a smartphone application type of goniometer to measure the hip joint angles. [Participants and Methods] Three examiners (physiotherapists) measured the hip joint range of motion using universal and smartphone goniometers on 30 daycare center rehabilitation patients. Reliability was calculated using the intra-class correlation coefficient. The examiners completed a questionnaire survey for assessing the usability of the goniometers. [Results] The intra-rater reliability was high, but the inter-rater reliability was low. Measurement times using the two instruments showed no difference. The usability questionnaire findings suggested that the smartphone goniometer was easier to use than the universal goniometer. [Conclusion] Reliability within the raters was high, but reliability among the raters was low. However, both goniometric devices provided a satisfactory range of motion measurement data when a single evaluator used the same device for all measurements.

The effect of vocalization on spinal excitation as measured by H wave.

The aim of this study was to measure the H wave by using voice-activated electromyography to reveal how different speech outputs affect the spinal cord segments innervating the lower limb skeletal muscles. In 21 healthy adults (16 men and 5 women) seated in a semi-reclined position, the H wave was recorded using surface electrodes over the soleus muscle of the pivot leg after stimulating the tibial nerve. The amplitude of the H wave was 1.02 SD 0.69 mV under the pre-vocalization condition; 1.51 SD 0.76 mV under the submaximal vocalization condition (≥60-<80 dB); and 1.13 SD 0.59 mV under the maximal vocalization condition (≥80 dB), demonstrating that the amplitude generated with submaximal vocalization was significantly higher than the control and maximal vocalization conditions. Mean voice intensity was around 69 dB for submaximal vocalization and around 91 dB for maximal vocalization. Submaximal vocalization results in a higher H wave amplitude than the control condition, thus suggesting increased spinal cord excitation, which may be important for initiating activities of daily living (e.g., lifting objects) or mobility (e.g., moving from a sitting to a standing position).