Association of comorbidities with postoperative walking independence in patients with hip fractures: a single-center, retrospective, observational study.

Hip fractures (HFs) are common in the elderly and lead to decreased walking independence. Although comorbidities may be associated with gaining walking independence, few studies have comprehensively examined baseline and preoperative clinical factors. We aimed to evaluate the effects of comorbidities on the postoperative walking independence of patients with HFs. This single-center, retrospective, observational study included patients with HFs admitted to an acute care hospital between 1 May 2022 and 1 March 2023, who before the incident were able to walk independently [functional independence measure (FIM) walk score ≥6 points]. Postoperative walking independence was evaluated using the walk item of the FIM. The Charlson comorbidity index (CCI) was used to evaluate comorbidities at admission, and the patients were divided into two categories with CCI scores of 0 points and ≥1 point. The effect of comorbidities, assessed using the CCI, on postoperative walking independence was evaluated using Cox proportional hazards analysis. Ninety-four participants were included in the analysis. The Cox proportional hazards model adjusted for potential confounders (age, operative delay and nutritional status) revealed that the CCI was significantly associated with postoperative walking independence ( P < 0.05). The hazard ratio and 95% confidence interval (CI) for the CCI for postoperative walking independence were 0.40 (95% CI, 0.189-0.865). Preoperative assessment of comorbidities using the CCI may aid in predicting the postoperative walking independence of patients with HFs.

Effect of rehabilitation motivation on improving activities of daily living in subacute stroke patients.

OBJECTIVES: To determine the effect of rehabilitation motivation on activities of daily living improvement in subacute stroke patients starting intensive rehabilitation. MATERIALS AND METHODS: This was a single-center cohort study involving patients with a subacute stroke who were admitted to or discharged from a Recovery Rehabilitation Unit between February 2021 and August 2022. Improvement in Activity of Daily Living was evaluated using the Functional Independence Measure. We calculated the corrected motor Functional Independence Measure effectiveness using its motor-related items at admission and discharge. The Behavioral Regulation in Exercise Questionnaire 2 was used to evaluate admission rehabilitation motivation, and the Relative Autonomy index was calculated. Hierarchical multiple regression analysis was used to examine the relationship between the corrected motor Functional Independence Measure effectiveness and the Relative Autonomy Index. RESULTS: Eighty-six of the 231 patients (37.2 %) were included in the analysis. Hierarchical multiple regression analysis adjusted for demographic and clinical variables demonstrated that age, comorbidities, and Relative Autonomy Index were significantly associated with corrected motor Functional Independence Measure effectiveness (R2 = 0.423, p ≺ .001). CONCLUSION: Motivation at intensive rehabilitation initiation in patients with a subacute stroke influences Activities of Daily Living improvement. These results may help develop rehabilitation programs aimed at improving Activities of Daily Living in patients with subacute strokes.

Relationship between first mobilization following the onset of stroke and clinical outcomes in patients with ischemic stroke in the general ward of a hospital: A cohort study.

OBJECTIVE: The purpose of this study was to compare the effects of first mobilization following a stroke with independently performing the activities of daily living at discharge in acute phase ischemic stroke patients in a general ward of a hospital. METHODS: A total of 158 patients with ischemic strokes were admitted to a general ward from June 1, 2014 to March 31, 2015. Of the 158 patients, 53 met the study's eligibility criteria. First mobilization was defined as the transfer of a patient from the bed to a wheelchair by a rehabilitation therapist. A favorable primary outcome at discharge was defined as a modified Rankin Scale score of < 3. The outcome was analyzed using the proportional hazards analysis and receiver operating characteristic curves. RESULTS: The age of the participants was 78.2 ± 11.7 years, stroke severity evaluated by the National Institutes of Health Stroke Scale scores on admission was 14.3 ± 10.6 points, and first mobilization of this population was 6.4 ± 5.2 days. Thirteen [25%] patients had a favorable outcome. Hazards analysis showed a favorable outcome due to first mobilization (adjusted hazards ratio 0.80, 95% confidence interval 0.65-0.98; p < 0.05). The cutoff point for first mobilization to produce a favorable outcome was 6.5 days after the stroke onset (area under the curve 0.729; p < 0.05). CONCLUSION: As seen in stroke units, early first mobilization is associated with improved clinical outcomes in ischemic stroke patients admitted to a general ward.

Comparison of Functional Outcome between Lacunar Infarction and Branch Atheromatous Disease in Lenticulostriate Artery Territory.

BACKGROUND: Branch atheromatous disease (BAD) is differentiated from lacunar infarction (LI). BAD is often associated with neurological deterioration in the acute stage, but outcome of BAD patients in the chronic stage is unclear. We aimed to explore the outcome of BAD in the lenticulostriate artery (LSA) territory in comparison with those of LI from the viewpoint of activities of daily living (ADLs). METHODS: We retrospectively investigated patients who were admitted within 3 days after stroke onset. The patients underwent daily rehabilitation during hospitalization. BAD in LSA territory was defined by the presence of lesion representing 3 or more consecutive horizontal slices in magnetic resonance imaging. Patients having atrial fibrillation or more than 50% stenosis of the large artery in magnetic resonance angiography were excluded. We retrieved data on clinical characteristics and evaluation from medical records. RESULTS: Subjects were 41 BAD and 35 LI patients. There was little difference in baseline characteristics. The National Institutes of Health Stroke Scale score was significantly higher in BAD patients (P < .05). The Barthel Index (BI) score and the Brunnstrom recovery stage were lower in BAD patients at admission (P < .05 and P < .05). Hospital stay was longer in BAD patients (P < .01), but the BI score at discharge was not different. To ambulate, 8 BAD and 1 LI patients depended on orthoses (P < .05), and 21 BAD and 7 LI patients used canes (P < .01). Multivariable analysis demonstrated that BAD lesion was correlated with AFO use independent of age and sex. CONCLUSIONS: BAD patients can obtain ADLs similar to LI patients. However, many BAD patients require canes and/or orthoses.

Role of Brain-Derived Neurotrophic Factor in Beneficial Effects of Repetitive Transcranial Magnetic Stimulation for Upper Limb Hemiparesis after Stroke.

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) can improve upper limb hemiparesis after stroke but the mechanism underlying its efficacy remains elusive. rTMS seems to alter brain-derived neurotrophic factor (BDNF) and such effect is influenced by BDNF gene polymorphism. OBJECTIVES: To investigate the molecular effects of rTMS on serum levels of BDNF, its precursor proBDNF and matrix metalloproteinase-9 (MMP-9) in poststroke patients with upper limb hemiparesis. METHODS: Poststroke patients with upper limb hemiparesis were studied. Sixty-two patients underwent rehabilitation plus rTMS combination therapy and 33 patients underwent rehabilitation monotherapy without rTMS for 14 days at our hospital. One Hz rTMS was applied over the motor representation of the first dorsal interosseous muscle on the non-lesional hemisphere. Fugl-Meyer Assessment and Wolf Motor Function (WMFT) were used to evaluate motor function on the affected upper limb before and after intervention. Blood samples were collected for analysis of BDNF polymorphism and measurement of BDNF, proBDNF and MMP-9 levels. RESULTS: Two-week combination therapy increased BDNF and MMP-9 serum levels, but not serum proBDNF. Serum BDNF and MMP-9 levels did not correlate with motor function improvement, though baseline serum proBDNF levels correlated negatively and significantly with improvement in WMFT (ρ = -0.422, p = 0.002). The outcome of rTMS therapy was not altered by BDNF gene polymorphism. CONCLUSIONS: The combination therapy of rehabilitation plus low-frequency rTMS seems to improve motor function in the affected limb, by activating BDNF processing. BDNF and its precursor proBDNF could be potentially suitable biomarkers for poststroke motor recovery.

Successful rehabilitation after hip fracture to a patient with previous above-elbow amputation.

We experienced successful rehabilitation of an elderly man after hip fracture (HF) who had had ipsilateral above-elbow amputation. He was a wounded soldier whose right arm had been amputated more than 60 yrs ago, and he had never used a prosthesis. He had been admitted to our hospital because of exacerbation of chronic obstructive pulmonary disease. During his admission, he had a fall-related hip fracture. We devised a special upper-limb prosthesis so that he could hold an ipsilateral crutch to enable appropriate acute-phase rehabilitation for HF. As a result, effects of disuse were prevented and he gained improvement of lower-limb function. The specialized upper-limb prosthesis also reduced his anxiety regarding walking. It can be considered that the prosthesis contributed to his quality of life with regard to activities of daily living after discharge.

Histochemical characterization of skeletal muscles in rats with photochemically-induced stroke.

PRIMARY OBJECTIVE: The aim of this study was to assess skeletal muscle showing a complete functional recovery after induction of pan-necrotic lesions in the right sensorimotor cortex in rats. RESEARCH DESIGN AND METHODS: A focal lesion of the right sensorimotor cortex was induced photochemically. Rats were divided into three groups; the sham-operated group (CON), Stroke (RB) and Stroke plus severed right sciatic nerve (RBD). MAIN OUTCOMES AND RESULTS: All RB rats showed complete functional recovery in the beam-walking test within 10 days. The score of CON rats was 7 for 21 days. The wet weight of the soleus muscle (SOL) only in the RB and RBD was significantly greater than in the CON. The cross-sectional area of type I fibres was increased in SOL. CONCLUSIONS: It was concluded that the functional recovery was mainly due to increased wet weight and cross-sectional area of type I SOL fibres, which probably reflected the functional reorganization and neuromodulation in the non-damaged contralateral sensorimotor cortex and ipsilateral sensorimotor cortex lateral to the lesion identified in a previous study.

Language-related brain function during word repetition in post-stroke aphasics.

We compared fMRI findings (using SPM99) obtained with repetition task in normal subjects with those of two patients with Broca's and Wernicke's aphasia who received speech therapy and showed complete recovery. Both aphasic patients with left hemisphere damage who showed complete recovery exhibited activation of only the compensatory area in the right hemisphere during the repetition task. Recovery from Broca's aphasia involves reorganization and neuromodulation between the external temporopolar area and the anterior superior temporal area of the superior temporal gyrus, putamen and the inferior frontal gyrus, while that from Wernicke's aphasia involves reorganization and neuromodulation between the superior temporal gyrus of the temporal region, the posterior supramarginal gyrus and inferior parietal lobule of the parietal region.

[Examination of NIRS for evaluation of frontal lobe function in diffuse axonal injury (DAI) patients].

The purpose of this study is to compare diffuse axonal injury (DAI) patients with healthy controls by using near infrared spectroscopy (NIRS). The Wisconsin Card Sorting Test Keio Version (KWCST), a standard task paradigm to detect human frontal lobe dysfunction was set as a method. The result of the examination showed that compared with DAI patients, wider increase of total hemoglobin was admitted in the frontal part of the brain of healthy people during the KWCST. This suggests that NIRS would serve as an objective indicator to evaluate the frontal lobe function in DAI patients.

Influence of isoflurane concentration and hypoxia on functional magnetic resonance imaging for the detection of bicuculline-induced neuronal activation.

Our present study shows that transient changes in relative cerebral blood volume (rCBV) induced by stimulation with bicuculline under six different conditions of anesthesia can be detected with high spatial resolution functional magnetic resonance imaging (fMRI). Bicuculline was administered at a low dose to induce neural activation, and no seizure activity was noted. Of the six conditions, the maximal reaction to bicuculline was observed under 1.5% isoflurane in 60% nitrogen and 40% oxygen. Our results imply that the rCBV changes under this level of isoflurane anesthesia with body temperature maintained at 37.5 degrees C are probably suitable for further fMRI studies.

[Lowered VIQ level following traumatic brain injury].

A patient with traumatic brain injury (TBI) is often associated with incidence of cognitive dysfunction as a sequela. We have conducted WAIS-R to 237 patients who were diagnosed as TBI at the Kanagawa Rehabilitation Hospital in order to assess their intellectual function. Twelve patients, whose VIQ being marked significantly lower than PIQ, were retrospectively analyzed in terms of their Functional Independence Measure (FIM), neuropsychological test results and lesions found in diagnostic images. In consequence, presence of a patient group whose VIQ level is significantly lowered due to the TBI sequela is recognized, in addition to a finding that trauma sites of cerebral contusion or other incidents are not necessarily corresponding to the results of neuropsychological test. Furthermore, based on an observation that those patients with lowered VIQ level are also associated with aggravation of PIQ 'digit symbol', Trail Making Test, or word fluency levels. This result was before similar with the result of "32 cases of DAI (diffuse axonal injury)" which authors reported, and it was guessed anew that the main factor of a cognitive dysfunction was damage on axon.

Functional evaluation of vascular hemiparetics and traditional Japanese houses.

PURPOSE: To study the functional status of vascular hemiparetics in outpatient clinics in Japan. METHOD: Following five functional tasks were evaluated to (1) pick up a pencil from the floor, (2) stand up from the floor, (3) sit up straight, (4) squat, (5) ambulate as far as possible. Patients were asked whether they added handrails and used a bed or a Japanese Futon. RESULTS: Sixty-three of 85 patients were able to pick up a pencil from the floor and to stand up from the floor. Patients with poor motor recovery of the lower extremities were able get into and out of a bathtub as well as patients with good motor recovery. All patients who could not ambulate for more than 100 m and could not stand up from the floor began to use beds after their strokes. CONCLUSIONS: Ninety-five per cent of patients who could stand up from the floor were able to get into and out of bathtubs. All of the patients who could not stand up from the floor started to use beds.

[Cognitive dysfunction in 32 diffuse axonal injury cases].

In acute stage of traumatic brain injury, it is not easy to diagnose diffuse axonal injury (DAI) by computer imaging. Even in chronic stage, DAIs occasionally show no remarkable abnormality by ordinal CT or MRI images. We retrospectively studied 32 DAI cases by the Functional Independence Measure (FIM), a battery of neuropsychological tests and CT or MRI films of acute and chronic phase. The result showed decrease of cognitive function in 32 DAI cases. The degree of enlargement of the ventricles in chronic stage did not correlate with cognitive dysfunction.

Behavioural recovery correlated with MRI in a rat experimental stroke model.

PRIMARY OBJECTIVE: To characterize a necrotic lesion using MRI and motor recovery using behavioural methods. RESEARCH DESIGN: Stroke model based on two steps: (1) development of a lesion using MR-imaging parameters and (2) behavioural recovery. METHODS AND PROCEDURES: Seventy male Sprague-Dawley rats were used. A focal lesion of the right sensorimotor cortex was induced photochemically. MAIN OUTCOMES AND RESULTS: The maximum volume of oedema and the lesion damage was reached by approximately 6 hours. In the lesion area, the apparent diffusion coefficient (ADC) increased from 6 hours, then decreased from 24 hours. All animals spontaneously recovered motor function by day 10, despite the continued presence of the cortical lesion. CONCLUSIONS: The results show that this model mimics a core lesion, as well as the late phase in a human stroke episode. This model might be used for longitudinal study of the basic mechanisms of motor recovery.

Dynamic postural control in patients with hemiparesis.

OBJECTIVE: Decreased postural stability is a common problem associated with hemiparesis secondary to stroke. The purpose of this study was to evaluate dynamic postural control in patients with hemiparesis and in normal subjects matched for age. DESIGN: Quantitative posturography (EquiTest System) was performed to assess the response of subjects to sudden perturbations. A total of 59 patients with hemiparesis and 98 healthy volunteers were evaluated. All the patients were able to walk inside their house without lower limb orthoses. Both the patients and the healthy volunteers were subjected to forward and backward perturbations while standing on a movable force platform. Balance responses were analyzed in terms of weight symmetry, latency, amplitude (relative response strength), and strength symmetry. They were also subjected to toes-up and toes-down perturbations to evaluate their response to a disruptive balance force. RESULTS: The response latency to perturbations was longer and the response strength was weaker on the paretic side of patients with hemiparesis. The dynamic postural control was impaired in patients with hemiparesis as compared with healthy subjects. CONCLUSION: The results suggest that patients with hemiparesis tend to fall easily and that the risk of falls toward the paretic side is high.