Progress in rehabilitation medicine最新文献

Background: Many patients with coronavirus disease 2019 (COVID-19) develop malnutrition after a prolonged stay in the intensive care unit (ICU) with mechanical ventilation. Early enteral nutrition is recommended, but optimal nutrition management during post-extubation recovery remains challenging.

Cases: The subjects were 12 acute respiratory distress syndrome patients with COVID-19 (9 men, 3 women; median age, 55.6 years). We reviewed patient characteristics, physical function, and nutrient intake during hospitalization from just after extubation to discharge. During this period, the median Functional Oral Intake Scale score improved from 4.5 (interquartile range [IQR] 3.3-5.3) to 7.0 (IQR 5.8-7.0), the median Medical Research Council (MRC) scale score improved from 45.0 (IQR 39.3-48.5) to 53.5 (IQR 47.5-59.3), and the median Barthel index improved from 7.5 (IQR 0-16.3) to 72.5 (IQR 42.5-95.0). In 3 patients, the MRC scale score remained below 48 before discharge, indicating that ICU-acquired weakness had been prolonged. The median daily caloric intake during this phase increased from 6.9 kcal/kg per day (3.5-10.2 kcal/kg per day) to 24.8 kcal/kg per day (21.0-27.9 kcal/kg per day). About half of these patients showed caloric intake below 25 kcal/kg per day before discharge. Based on the Global Leadership Initiative on Malnutrition (GLIM) diagnostic scheme, 10 patients were diagnosed with malnutrition during hospitalization.

Discussion: Physical function improved in more than half of the patients, but nutritional status was not recovered. More studies for nutritional management are required to prevent malnutrition and to enhance functional recovery during the post-extubation rehabilitation phase.

Background: Constraint-induced aphasia therapy (CIAT) has been reported as a short-term, intensive language training program for improving language function in patients with chronic aphasia. We report the recovery of language function in a patient with chronic aphasia who was evaluated in the baseline assessment as having reached a plateau.

Case: The patient with subcortical aphasia was a 62-year-old, right-handed man. At 192 days after left putamen hemorrhage, he visited our hospital to begin CIAT. The patient's language and speech abilities were evaluated 1 month before and immediately before the start of CIAT. To evaluate the training effect, language function was assessed immediately after, 1 month after, 3 months after, and 6 months after the end of CIAT. The Western Aphasia Battery (WAB), the single-word-naming task in the Test of Lexical Processing in Aphasia (TLPA), and the Verbal Activity Log (VAL) were used to assess his language function and the amount of spoken language. From 1 month before CIAT to 6 months after CIAT, the WAB Aphasia Quotient increased by 6.1 points. Compared with before therapy, the errors of apraxia of speech in the TLPA disappeared from immediately after to 6 months after CIAT. Although the VAL score at 3 months after CIAT was higher than that before the start of CIAT, the score decreased after 6 months because of reduced opportunities for communication with friends.

Discussion: CIAT improved the word-naming ability and amount of spontaneous, real-world spoken language in a patient with chronic aphasia.

Objectives: To provide a safe and appropriate out-of-bed program for stroke patients, screening for stroke-related functional impairments and disabilities should be performed in advance. However, few tools are available for clinical assessment of out-of-bed mobility while patients are still on bed. We sought to establish the validity and reliability of a newly developed Functional Bridge Test (FBT) for hemiplegic patients with acute stroke.

Methods: This repeated-measures, observational study was conducted at a stroke care unit at an acute hospital. We assessed the validity of the FBT score, intra-rater and inter-rater reliabilities of the FBT, and concurrent validity of the FBT in stroke patients with hemiplegia. In addition to the original qualitative assessment, the FBT was also assessed quantitatively to evaluate the validity of the FBT score. Outcome measures included stroke severity, lower limb muscle strength, and basic mobility.

Results: We enrolled 32 patients with acute stroke. The newly developed FBT score had high validity. Intra-rater and inter-rater reliabilities (weighted kappa coefficient, 95% confidence interval) showed almost perfect agreement (0.95, 0.88-1.00; 0.98, 0.94-1.00, respectively). The FBT score was significantly associated with stroke severity, physical function, and basic mobility.

Conclusions: The FBT has sufficient validity and reliability for acute stroke patients with hemiplegia. The advantages of the FBT in a clinical setting are based on its ability to be quickly administered on a bed without the need for specialized equipment. The FBT may help in screening functional impairment and disability in hemiplegic patients with acute stroke before they resume out-of-bed activities.

Background: We previously reported that swallowing in the bridge position (bridge swallowing) strengthened esophageal contractions and increased the lower esophageal sphincter pressure against gravity. Furthermore, bridge swallowing exercise improved the symptoms of gastroesophageal reflux disease (GERD) in subjects with GERD. Bridge swallowing may have the potential to strengthen esophageal peristalsis and improve GERD. In this case series, we evaluated the effect of bridge swallowing on GERD symptoms and esophageal residue observed by videofluoroscopic examination of swallowing (VF) in patients with dysphagia after stroke.

Cases: We reviewed the cases of five patients hospitalized with stroke and concurrent GERD symptoms. Dry swallowing exercises in the bridge (hip lift) position were performed ten times per day for 4 weeks. Frequency Scale for Symptoms of GERD (FSSG) questionnaire scores and esophageal residue on VF were compared before and after exercise. All patients completed the bridge swallowing exercise without adverse events and all showed improved FSSG scores after the exercise. Three patients showed improvements in esophageal residue on VF after exercise.

Discussion: Our findings indicated that the bridge swallowing exercise can improve FSSG scores. Some patients showed improved esophageal residue on VF. This exercise was performed easily and safely without adverse events. Further studies are needed to validate the effectiveness of the bridge swallowing exercise in improving GERD.

Objectives: Physical activity is an important prognostic factor in managing hemodialysis patients. During winter, physical activity decreases, which necessitates interventions to maintain physical function. This study investigated whether snow removal is an effective physical activity to maintain physical function in hemodialysis patients.

Methods: This retrospective cohort study examined 32 patients (aged 68.9 ± 14.2 years, 21 men) who underwent hemodialysis at Uonuma Kikan Hospital from March 2021 to March 2022. The patients were divided into snow-remover and non-snow-remover groups. The primary outcome was the Short Physical Performance Battery (SPPB). Secondary outcomes were grip strength, skeletal muscle index, and physical activity level. Differences in outcomes between the groups were investigated at 1 year of follow-up.

Results: The snow-remover group had significantly high SPPB score, grip strength (men), skeletal muscle index (men), and physical activity at baseline. The decline in SPPB after 1 year was significantly smaller in the snow-remover group than in the non-snow-remover group. The level of physical activity in the non-snow-remover group decreased over time.

Conclusions: Snow removal contributed to the maintenance of physical function in hemodialysis patients after 1 year. However, snow removal is not recommended for all hemodialysis patients, and further studies should identify other safe winter activities to maintain physical function.

Objectives: The WISH-type S-form hip brace (WISH brace) has significantly improved hip function and functional mobility in patients with hip osteoarthritis (OA). However, most patients later undergo surgery. The main purpose of this study was to evaluate how long the orthosis can be effectively used by patients with hip OA, and to reveal the associated prognostic factors.

Methods: This prospective study examined the survival curve of the equipment by using surgery as an endpoint and investigated how the duration of use affects patients. Harris Hip Score, muscle strength, and the Timed Up and Go test (TUG) were evaluated as prognostic factors.

Results: By drawing the survival curves of 26 patients, approximately one third were expected to be still using the brace after 7 years. A rapid decrease in use was observed at around 1 year. A significant difference between patients with and without bracing at 1 year was found for the TUG result with the unaffected leg inside (ULI) at the start of bracing. A cut-off value of 9.5 s for the TUG with ULI significantly differentiated patients with and without bracing at 1 year, suggesting a possible predictor of brace survivorship in the early phase.

Conclusions: The TUG with ULI with a cut-off value of 9.5 s, or at most 10 s, may be a possible predictor of persistence of brace use in the early phase.

Objectives: We previously reported that swallowing in the bridge position (bridge swallowing) increased distal esophageal contractions and lower esophageal sphincter pressure against gravity. Moreover, bridge swallowing had the potential to strengthen esophageal peristalsis. In this study, we sought to evaluate whether the bridge swallowing exercise could improve gastroesophageal reflux disease (GERD) symptoms and gastroscopy findings.

Methods: Seventeen subjects with scores of 8 points or higher on the Frequency Scale for Symptoms of GERD (FSSG) questionnaire participated in the study. The exercise of dry swallowing in the bridge posture lasted 4 weeks and was performed ten times per day. FSSG scores were compared before and after exercise. Three of the 17 participants underwent upper gastrointestinal endoscopy. The modified Los Angeles classification of reflux esophagitis was used for objective assessment before and after exercise.

Results: No participants dropped out of this study. FSSG scores improved significantly after exercise (from median [range] 16 [13-21] points before exercise to 5 [4-10] points after exercise, P <0.001). Upper gastrointestinal endoscopy showed improvement in the modified Los Angeles classification grade in one participant.

Conclusions: The bridge swallowing exercise significantly improves FSSG scores. This exercise can be performed easily and safely without adverse events. Further multicenter prospective studies are needed to validate that the bridge swallowing exercise is effective in improving GERD.

Objectives: The gait characteristics of people with bilateral transtibial amputation are not well understood. This study aimed to clarify changes in trunk lateral bending and the trunk flexion angle during walking in people with bilateral transtibial amputation.

Methods: In this cross-sectional study, four participants with bilateral transtibial amputation who could walk without assistance (BTTA group) and ten able-bodied participants (control group) were recruited. The range of motion of trunk lateral bending, the trunk flexion angle, and other gait parameters during comfortable-speed and maximum-speed walking were measured using a three-dimensional motion analysis system and force plates. These parameters were compared between the amputees and the controls.

Results: During maximum-speed walking, the BTTA group walked slower with a smaller trunk flexion angle (median, 1.75° vs. 4.79°, P=0.036) and greater double leg support time (0.18 vs. 0.12, P=0.008) when compared with the control group. The other parameters during maximum-speed walking were not significantly different between the two groups. During comfortable-speed walking, none of the parameters were significantly different between the two groups.

Conclusions: Compensatory trunk flexion angle decreases markedly during maximum-speed walking in people with bilateral transtibial amputation. People with bilateral transtibial amputation may be changing the trunk flexion angle to walk faster. When evaluating gait compensation for people with bilateral transtibial amputation, trunk flexion angle may be an important index and maximum-speed walking is needed to detect the change in trunk flexion angle.