Improving Motor Skills in Five Children With Developmental Coordination Disorder Traits and Its Impact on Parenting Stress: A Case Series.

Poor motor skills in children with developmental coordination disorder (DCD) are associated with childcare stress. This study aimed to assess whether improving the motor skills of children with DCD could reduce parenting stress. The participants were five boys aged 7-10 years with probable DCD and their parents. The intervention comprised 1 hour per week of motor skills training for nine weeks. We measured improvements in the children's motor skills and reductions in parenting stress before and after the intervention. All five children showed improvements in motor skills. Parenting stress was reduced in two parents, whereas it worsened in three parents. Improving motor skills in children with probable DCD may not necessarily reduce parenting stress.

Long-term body-weight-supported treadmill training for incomplete cervical spinal cord injury: a case report.

[Purpose] To investigate the effects of long-term body-weight-supported treadmill training on walking ability and physical function in an elderly individual with incomplete cervical spinal cord injury. [Participant and Methods] The patient was a 68 year-old male with an incomplete spinal cord injury at the C3/C4 level, incurred when he was 56 years old. He initiated home-based body-weight-supported treadmill training using a body-weight-supported treadmill installed at his home. His walking ability was measured as the percentage of body weight load reduction, and his physical function was evaluated using manual muscle testing and measuement of the range of motion of his lower limbs. [Results] The physical function of the lower limbs was improved, maintained, or showed delayed decline until 9.5 years post-injury. [Conclusion] Long-term body-weight-supported treadmill training may improve, maintain, or at least delay the decline of the physical function of participants for several years, without causing any remarkable complications.

Fall Prevention Program Using Home Floor Plans in an Acute-Care Hospital: A Preliminary Randomized Controlled Trial.

We provided fall prevention programs using home floor plans for older adult patients discharged from an acute-care hospital and verified the fall prevention measures' effectiveness six months after discharge. The research design was a preliminary randomized controlled trial. Orthopedic patients with a falls' history were randomized to the control (n = 30) or the intervention groups (n = 30). Before discharge, the control group was treated with general physiotherapy for their disease characteristics. The intervention group received the same programs before discharge; additionally, a simple house evaluation was conducted using the subject's home floor plan. A six-month follow-up survey was conducted on falls and near-falls after discharge, completed by 51 of the 60 subjects (85%). Within two months, falls occurred in 7.7% of the control group but not in the intervention group, after which, falls occurred in the intervention group, and no significant difference was noted between the two groups (three-month (p = 0.322) and six-month (p = 0.931) follow-ups). The intervention group had significantly fewer near-falls than the control group within three months (p = 0.034), but no significant difference was observed after three months. The results suggested that our program effectively expanded the role of an acute care hospital for discharged patients who need to transition from hospital care to home health care.

Internet-Based Information Sharing With Families of Patients With Stroke in a Rehabilitation Hospital During the COVID-19 Pandemic: Case-Control Study.

BACKGROUND: The spread of COVID-19 has affected stroke rehabilitation. Given that inpatient visits are restricted in most institutions, alternative ways of providing information to family members are imperative. Informing families about patients' rehabilitation progress via the web may help involve families in the rehabilitation process, enhance patients' motivation to continue rehabilitation, and contribute overall to patients' improvement in activities of daily living (ADL). OBJECTIVE: We aimed to investigate the feasibility of the Internet-Based Rehabilitation Information Sharing (IRIS) intervention for families of patients with stroke at a rehabilitation hospital and examine the effect of IRIS on patients' ADL improvement. METHODS: In this case-control study, participants were inpatients at a rehabilitation hospital between March 2020 and April 2021. The intervention group (information and communication technology [ICT] group) included patients and families who requested IRIS, which consisted of a progress report on patients' rehabilitation using text, photos, and videos. Those who did not receive internet-based information were included in the non-ICT group. The control group, matched with the ICT group based on a 1:1 propensity score, was selected from the non-ICT group. The covariates for calculating the propensity score were patients' age, sex, and motor and cognitive scores on the Functional Independence Measure at admission. The main outcome was the degree of ADL improvement during hospitalization. Multiple regression analysis (forced entry method) was performed to confirm the impact of ICT use on ADL improvement. The independent variables were the presence of intervention, length of hospital stay, and number of days from onset to hospitalization. RESULTS: In total, 16 groups of patients and families participated in the IRIS. The mean age of patients was 78.6 (SD 7.2) and 78.6 (SD 8.2) years in the ICT and control groups, respectively. The median total Functional Independence Measure difference was 28.5 (IQR 20.3-53.0) and 11.0 (IQR 2.8-30.0) in the ICT and control groups, respectively, and the ICT group showed significant improvement in ADL function (P=.02). In the multiple regression analysis of the ICT and control groups, the unstandardized regression coefficient was 11.97 (95% CI 0.09-23.84) for ICT use. These results indicate that ICT use was independently and significantly associated with improvement in ADL. CONCLUSIONS: This study examined the effect of IRIS on family members to improve ADL in patients with stroke who are hospitalized. The results showed that IRIS promotes the improvement of patients' ADL regardless of age, sex, motor and cognitive functions at admission, and the length of hospital stay.

Effectiveness of a Tailored Fall-Prevention Program for Discharged Older Patients: A Multicenter, Preliminary, Randomized Controlled Trial.

This multicenter, preliminary, randomized controlled trial investigated the effect of a tailored fall-prevention program using home floor plans for discharged orthopedic patients aged ≥65 years who experienced ≥1 fall(s) in the past year (n = 72) at five acute-care hospitals. The control group received standard care (exercise to prevent recurrent falls), whereas the intervention group received a tailored fall-prevention program in addition to usual care. A physical therapist conducted the tailored education program using each patient's home floor plans before discharge. A follow-up survey of falls and near-falls at home was performed using a monthly fall calendar for the 1-month period after discharge. Data on 81.5% of participants remained for the final analyses. No falls occurred in the intervention group; however, 4.3% of those in the control group experienced a fall. Near-falls were reported by 3.7% and 26.9% of the participants in the intervention and control groups, respectively. The proportion of participants who did not experience near-falls in the 1st month after discharge was lower in the intervention than in the control group (p = 0.018). In conclusion, the tailored fall-prevention program using home floor plans in multiple acute-care hospitals was effective in reducing falls and near-falls in discharged orthopedic patients.

A 3-month multicomponent home-based rehabilitation program for older people with restricted life-space mobility: a pilot study.

[Purpose] The purpose of this study was to verify the effects of a 3-month multicomponent home-based rehabilitation program developed on the basis of the reevaluation of older people with restricted life-space mobility. [Participants and Methods] The participants were residents in Japan aged ≥65 years who had Life-Space Assessment scores ≤52.3. Multicomponent home-based rehabilitation was conducted by physical and occupational therapists. Each visit included 40-60 min of combined exercise, practicing activities of daily living, improving the home environment, and caregiver support. The programs were developed in accordance with a flow diagram. The primary outcome was life-space mobility evaluated using the Life-Space Assessment score. [Results] Overall, 30 participants completed the intervention. The mean age of the participants was 82.4 ± 7.5 years. Three months after the intervention initiation, the Life-Space Assessment scores significantly improved from 12.0 to 30.5. The proportion of participants at maximal life-space level 5 (unlimited mobility) doubled from 16.7% at baseline to 33.3%. The functional independent measure score, fall efficacy scale score, and lower limb strength associated with standing up also significantly improved. We found no significant changes in the geriatric depression scale 5 and self-rated good health scores. [Conclusion] Multicomponent home-based rehabilitation can improve life-space mobility in older people with restricted life-space mobility.

Tailored feedback reduced prolonged sitting time and improved the health of housewives: a single-blind randomized controlled pilot study.

Reducing sitting time, independent of physical activity, is important for health. However, few reports have been published regarding physical activity of housewives compared to that of employed women. We examined strategies to shorten housewives' sitting time using a single-blind randomized controlled trial. Forty-eight housewives (38.0 ± 4.5 years old) were randomly assigned to one of three groups: pamphlet, self-feedback, and tailored feedback groups. All participants received a pamphlet describing the risks of prolonged sitting. The self-feedback and tailored feedback groups were also given feedback on sitting time by a smartphone application. The tailored feedback group received individual suggestions regarding lifestyle to shorten sitting time. We measured physical activity using an accelerometer and health-related quality of life using the Short-Form 8. The longest prolonged sitting time significantly decreased over time, a significant reduction was observed after the intervention only in the tailored feedback group. Vitality, mental health, and role emotional components of health-related quality of life showed a significant improvement with time but no significant differences were observed among the study groups. We suggested an easy approach to shortening prolonged sitting time in housewives using a pamphlet and feedback by smartphone. However, tailored consulting was necessary to yield a more effective result.

Custom-Made Daily Routine Increases the Number of Steps Taken by Frail Older Adults.

This study examined whether the number of steps taken by frail older adults increased after two types of interventions (custom-made daily routine [CDR] vs. exercise) were conducted over 12 weeks. The participants were 36 frail older adults aged 84.5 ± 6.0 years who attended a day-care center. They were assigned to one of three groups: CDR (n = 13), home-based exercise (HE, n = 10), or control (CON, n = 13). A wrist-worn accelerometer was used to measure their step count in 24 hr for 6 days. The CDR group demonstrated a daily step count change of approximately 25%, which was significantly higher than that of the CON group (effect size [r] = .51, p = .040). There were no significant changes in the HE group. Thus, a CDR might be useful for increasing the number of steps in frail older adults.

Instrumental activities of daily living and number of daily steps in frail older females.

[Purpose] Reportedly, males take fewer steps than females among frail older adults. The step count of frail older adults may be influenced by domestic roles in the instrumental activities of daily living. In this study, we aimed to investigate the association between instrumental activities of daily living and the number of steps in frail older females. [Participants and Methods] In this cross-sectional study, we included 27 frail older females aged 84.4 ± 6.5 years who attended a day-care center. We used the Fillenbaum's instrumental activities of daily living screener and measured the number of steps using an accelerometer, functional independence measure, grip strength, and short physical performance battery. We investigated the association between instrumental activities of daily living and daily steps. Furthermore, we compared the outcomes of the differences in the independence using a subscale of instrumental activities of daily living. [Results] Instrumental activities of daily living and step counts showed a significant correlation. Participants dependent on meal preparation and housework took significantly fewer steps per day. The dependence of their activities also caused low functional independence measure and weak grip strength. [Conclusion] In frail older females, decreased ability for instrumental activities of daily living were associated with fewer steps. Domestic roles may increase the daily steps in frail older adults.

Scanning RNA-Seq and RAD-Seq approach to develop SNP markers closely linked to MALE STERILITY 1 (MS1) in Cryptomeria japonica D. Don.

Cryptomeria japonica is a major forestry tree species in Japan. Male sterility of the species is caused by a recessive gene, which shows dysfunction of pollen development and results in no dispersed pollen. Because the pollen of C. japonica induces pollinosis, breeding of pollen-free C. japonica is desired. In this study, single nucleotide polymorphism (SNP) markers located at 1.78 and 0.58 cM to a male sterility locus (MS1) were identified from an analysis of RNA-Seq and RAD-Seq, respectively. SNPs closely linked to MS1 were first scanned by a method similar to MutMap, where a type of index was calculated to measure the strength of the linkage between a marker sequence and MS1. Linkage analysis of selected SNP markers confirmed a higher efficiency of the current method to construct a partial map around MS1. Allele-specific PCR primer pair for the most closely linked SNP with MS1 was developed as a codominant marker, and visualization of the PCR products on an agarose gel enabled rapid screening of male sterile C. japonica. The allele-specific primers developed in this study would be useful for establishing the selection of male sterile C. japonica.

A modified seated side tapping test in which the arms are crossed also reflects gait function in community-dwelling elderly.

[Purpose] Seated side tapping test (SST) performance is associated with mobility impairment in the elderly. Although this test was developed to assess trunk function, interpretation of its results may be confounded by the upper-limb movements in its protocol. Here, this study aimed to validate the association between trunk function and gait function by means of the Arms Crossed SST (AC-SST), a modified version of the SST in which the arms are crossed over the chest, to exclude the effects of the upper limbs. [Subjects and Methods] A total of 116 community-dwelling elderly people were enrolled in the study (mean age: 75.1 ± 5.5 yrs). Measurement categories were gait function (gait speed and TUG), lower extremity strength (knee extension and flexion strength), trunk muscle endurance (trunk extension and flexion endurance), and trunk function (SST and AC-SST). [Results] AC-SST performance significantly correlated with gait function items, as did SST performance. Moreover, AC-SST was one of the significant predictor variables of gait function selected in stepwise multiple regressions. [Conclusion] Gait function associated with performance on the AC-SST, a test of trunk function in which the effects of upper limb function were excluded, reinforcing the importance of trunk function to elderly mobility.

Tailored education program using home floor plans for falls prevention in discharged older patients: A pilot randomized controlled trial.

OBJECTIVE: To investigate the effect of a tailored education program using home floor plans on falls prevention in discharged older patients. DESIGN: A single-center, parallel, pragmatic, pilot randomized controlled trial with equal allocation to the intervention and control groups. SETTING: Discharged hospital patients were followed-up in their home settings. PARTICIPANTS: All discharged orthopedic patients aged ≥65 years who experienced ≥1 fall(s) in the past year (n=60). INTERVENTIONS: Both groups received standard care (exercises) and the intervention group also received a tailored education program for falls prevention using home floor plans. MEASUREMENTS: Falls and near-falls at the participants' homes using a 1-month fall calendar during the 1-month period after discharge. The evaluators were blinded at the baseline assessment. RESULTS: Nine participants were withdrawn from the study, leaving 51 of 60 (85%) participants for the final analyses. No falls occurred in the intervention group (n=25) during follow-up. However, 2 participants (7.7%) fell in the control group (n=26). Near-falls were reported by 7 participants (28.0%) in the intervention group and 13 participants (50.0%) in the control group. The intervention group had 75% less near-falls compared with the control group, as assessed using a Cox proportional hazards model (hazard ratio, 0.25; 95% confidence interval, 0.09-0.75). CONCLUSIONS: The tailored education program using home floor plans at the hospital was effective for reducing falls and near-falls among discharged orthopedic patients. Registration of clinical trials: This study was registered with the Research Ethics Committee of University Hospital Medical Information Network (UMIN) Center (000018201).

The association between intersegmental coordination in the lower limb and gait speed in elderly females.

Human multi-segmental motion is a complex task requiring motor coordination. Uncoordinated motor control may contribute to the decline in mobility; however, it is unknown whether the age-related decline in intersegmental coordination relates to the decline in gait performance. The aim of this study was to clarify the association between intersegmental coordination and gait speed in elderly females. Gait measurements were performed in 91 community-dwelling elderly females over 60 years old. Foot, shank, and thigh sagittal motions were assessed. Intersegmental coordination was analyzed using the mean value of the continuous relative phase (mCRP) during four phases of the gait cycle to investigate phase differences in foot-shank and shank-thigh motions during a normal gait. The results showed that foot-shank mCRP at late stance had negative correlations with gait speed (r=-0.53) and cadence (r=-0.54) and a positive correlation with age (r=0.25). In contrast, shank-thigh mCRP at late stance had positive correlations with gait speed (r=0.37) and cadence (r=0.56). Moreover, partial correlation, controlling age, height, and weight, revealed that foot-shank mCRP at late stance had negative correlations with gait speed (r=-0.52) and cadence (r=-0.54). Shank-thigh mCRP at late stance had a positive correlation with gait speed (r=0.28) and cadence (r=0.51). These findings imply that the foot-shank and shank-thigh coordination patterns at late stance relate to gait speed, and uncoordinated lower limb motion is believed to be associated with the age-related decline in cadence.

Plantarflexor training affects propulsive force generation during gait in children with spastic hemiplegic cerebral palsy: a pilot study.

[Purpose] The purpose of this preliminary study was to assess the trade-off relationship between the hip and ankle joints after plantarflexor training in children with spastic hemiplegic cerebral palsy (CP). [Subjects and Methods] Three boys aged 9, 10, and 13 years with spastic hemiplegic CP participated in the study. Gait analysis was performed using a three-dimensional motion analysis device and a floor reaction force detection device before and after plantarflexor training. Data on gait speed and stride length for both sides were collected. Peak hip and ankle powers in the sagittal plane and ankle-to-hip power ratio (A2/H3 ratio) were calculated. Plantarflexor training comprised heel raises and exercise band resistance at the participant's home (3 times/week for 12 weeks). [Results] The A2/H3 ratio increased significantly on both sides in two of three subjects after training. Peak A2 power increased significantly on both sides in subject 3 and on the affected side of subject 2. Peak H3 power decreased significantly on the non-affected side of subjects 1 and 2. [Conclusion] This study confirmed that two of three subjects demonstrated a trade-off relationship between the hip and ankle joints during gait after plantarflexor training.

Dual-tasking over an extended walking distance is associated with falls among community-dwelling older adults.

AIM: Dual-task methods, in which walking is the primary task, are not sufficient for accurately screening for the risk of falls among healthy older adults. Therefore, the goal of this research was to investigate whether using a dual-task method over an extended walking distance can predict falls among community-dwelling older adults. METHODS: We enrolled independent community-dwelling adults aged ≥65 years. Physical performance, cognitive function, psychological function, and a dual-task test were assessed at baseline. Our dual-task test required the subjects to walk 60 m while stepping over lines. The intervals between the lines ranged from 50-100 cm and were unequal. Falls and fall-related injuries were measured over a 12-month follow-up period using monthly postal surveys. RESULTS: Ninety-two of 118 subjects (mean age, 75.4±5.5 years) completed the 12-month follow-up. Sixteen (17.4%) of fallers had injurious falls or fell more than or equal to two times. There were no significant differences between the fallers and non-fallers, except in age and in the number of missteps during the dual-task test when walking ≥40 m. The Kaplan-Meier analysis revealed that those who had more than one misstep while walking ≥40 m had a significantly higher incidence of injurious or multiple falls than those who had no missteps. CONCLUSION: Our findings suggest that the dual-task method with an extended walking distance may be able to predict falls among community-dwelling older adults.

Toe-Out Gait Decreases the Second Peak of the Medial Knee Contact Force.

Toe-out angle alternation is a potential tactic for decreasing the knee adduction moment during walking. Published reports have not examined the medial knee contact force during the toe-out gait, although it is a factor affecting knee articular cartilage damage. This study investigated the effects of increased toe-out angle on the medial knee contact force, using musculoskeletal simulation analysis. For normal and toe-out gaits in 18 healthy subjects, the muscle tension forces were simulated based on the joint moments and ground reaction forces with optimization process. The medial knee contact force during stance phase was determined using the sum of the muscle force and joint reaction force components. The first and second peaks of the medial knee contact force were compared between the gaits. The toe-out gait showed a significant decrease in the medial knee contact force at the second peak, compared with the normal gait. In contrast, the medial knee contact forces at the first peak were not significantly different between the gaits. These results suggest that the toe-out gait is beneficial for decreasing the second peak of the medial knee contact force.

Kinetic Relationships between the Hip and Ankle Joints during Gait in Children with Cerebral Palsy: A Pilot Study.

[Purpose] The purpose of this study was to evaluate kinetic relationships between the ankle and hip joints during gait, in the late stance, in children with spastic cerebral palsy (CP). [Subjects] The subjects were 3 ambulant children with spastic hemiplegic CP (aged 10, 13, and 14: CP group) and 3 typically developing children with the same ages (control). [Methods] A three-dimensional gait analysis including force data was performed to compare the peak moment, power, and ankle/hip power ratio between the hemiplegic (uninvolved and hemiplegic) and the control groups. In the statistical analysis, mean values from 5 gait cycles for each of 3 conditions (uninvolved, hemiplegic and control) were used. The three conditions were compared by performing a Kruskal-Wallis test and Steel-Dwass multiple comparisons. [Results] The peak moments of ankle plantar flexors in the 10-year-old case, were significantly lower on the uninvolved and hemiplegic sides compared with the control group, respectively. The peak flexion moments of the hip on the hemiplegic side were significantly higher compared with the control in the 14- and 13-year-old cases. The peak of ankle power generation (A2) in the 13- and 10-year-old cases were significantly lower on the uninvolved and hemiplegic sides, respectively, compared with the control. The peaks of hip flexor power generation (H3) in the 14- and 13-year-old cases were significantly higher on the uninvolved and hemiplegic sides, respectively. The A2/H3 ratios were significantly lower on the uninvolved and hemiplegic sides compared with the control, and the ratio for the hemiplegic side was lower than that for the uninvolved side. [Conclusion] This study shows that propulsion of walking is generated by hip, rather than the ankle, on both the hemiplegic and involved sides.

Knee adduction moment and medial knee contact force during gait in older people.

External knee adduction moment has been studied as a surrogate for medial knee contact force. However, it is not known whether adduction moment is a rational measure for predicting medial knee contact force. The aim of this study was to investigate the correlation between knee adduction moment and medial knee contact force in older people, using musculo-skeletal simulation analysis. One hundred and twenty-two healthy older subjects participated in this study. Knee moment and medial knee contact force were calculated based on inverse dynamics analysis of normal walking. Muscle force and joint reaction force were used to determine the medial knee contact force during stance phase. The results showed that the maximum medial knee contact force was moderately correlated to the maximum knee adduction (r = 0.59) as well as the maximum extension moment (r = 0.60). The first peak of medial knee contact force had a significant strong correlation with the first peak of adduction moment and a moderate correlation with the maximum flexion moment. The second peak of medial knee contact force had a significant moderate correlation with both the second peak of adduction and the maximum extension moment. These results implied that the maximum adduction moment value could be used, to some extent, as a measure of the maximum medial knee contact force.