Progress in rehabilitation medicine最新文献

Objectives: This study aimed to assess the effectiveness of neuromuscular electrical stimulation (NMES) in reducing muscle atrophy in patients with acute stroke.

Methods: In acute stroke patients with hemiparesis, NMES or control treatment was applied to the quadriceps muscles for 2 weeks. The change of the quadriceps muscle thickness was assessed using ultrasound after 2 weeks.

Results: Sixty-three patients were randomized to control treatment or NMES treatment. On the paretic side, muscle thickness changed by -2.65 ± 4.24 mm in the NMES group and -4.64 ± 4.58 mm in the control group (P=0.119). On the non-paretic side, the respective changes were -0.42 ± 5.19 mm and -1.93 ± 3.36 mm (P=0.223). In an exploratory subgroup analysis, no significant effect was observed in severely affected patients, whereas patients with mild-to-moderate stroke (National Institute of Health Stroke Scale score <12, n=23) showed a smaller reduction in quadriceps thickness on the paretic side in the NMES group compared with controls (0.00 ± 3.21 mm vs. -3.88 ± 5.11 mm, P=0.043). These exploratory subgroup findings should be regarded as hypothesis-generating.

Conclusions: This underpowered trial did not demonstrate a significant preventive effect of 2 weeks of NMES on quadriceps atrophy in patients with acute stroke. Exploratory subgroup findings suggest a potential benefit in patients with less severe stroke, but these results should be considered hypothesis-generating and require confirmation in future adequately powered trials.

Objectives: Physical complications in psychiatric patients and the role of physical therapy (PT) are gaining attention. However, research remains limited. This study examined the necessity, effectiveness, and inhibiting factors of PT in a psychiatric ward.

Methods: This retrospective observational study evaluated inpatients undergoing rehabilitation in the psychiatric ward of a general hospital between April 2017 and March 2022. The data collected included characteristics, psychiatric diagnosis, physical complications, time to rehabilitation initiation, training implementation rate, training time, Barthel Index (BI) at admission and discharge, length of hospital stay, and residence before and after hospitalization. Univariate analysis was performed to compare patients who received PT with those who did not receive PT. Among patients who received PT, factors inhibiting independence in ADLs (BI ≥85) and the BI gain were analyzed using binomial logistic regression and multiple regression analysis.

Results: Of all patients, 772 received PT, and they were significantly older, more likely to be institutionalized, and had higher rates of organic mental disorders, musculoskeletal disorders, and internal conditions compared to the 317 patients who did not receive PT. PT resulted in a significant BI gain, with 596 individuals achieving independence. Independence and BI gain were significantly associated with pre-hospitalization factors, including age, psychiatric diagnosis, residence, and BI, whereas rehabilitation-related indicators showed no significant association.

Conclusions: Many patients with advanced age, organic mental disorders, physical complications, and low BI achieved functional independence following PT. However, reduced activity levels before hospitalization hindered recovery. Preventive efforts should target physical decline in both community and hospital settings.

Objectives: : Nocturnal pain is common in rotator cuff tears (RCTs). Among its patterns, a pain type relieved by sitting upright, referred to here as "sitting-relief pain," appears to behave differently from other nocturnal pain types. Peak systolic velocity in the anterior humeral circumflex artery (PSV-AHCA) has been suggested as a marker, but findings have varied across settings. Exploring this vascular response may help connect patients' subjective pain experiences with objective physiological data, potentially offering a bridge between symptoms and measurable signs. This study investigated the association between PSV-AHCA and nocturnal pain characteristics in patients with RCTs.

Methods: : A cross-sectional study was conducted with 78 patients with RCTs. Participants were classified into three groups based on nocturnal pain characteristics: Sitting-Relief-Pain, Other-Pain, and Pain-Free. PSV-AHCA was measured in both sitting and supine positions using Doppler ultrasound. After confirming the absence of major confounders, comparisons were made across groups and positions.

Results: : The Sitting-Relief-Pain group showed an increase in PSV-AHCA from sitting to supine (22.7 to 26.7 cm/s; d=0.712; P=0.001), whereas the Other-Pain and Pain-Free groups showed no significant changes. In the supine position, PSV-AHCA was higher in the Sitting-Relief-Pain group than in the Other-Pain (P=0.008) and Pain-Free (P=0.004) groups.

Conclusions: : Sitting-relief pain may represent a specific pattern of nocturnal pain in RCTs, with a distinct vascular response to posture. Doppler ultrasound in physiotherapist-led assessment may assist in identifying this pattern and distinguishing it from other types of nocturnal pain.

Objectives: The incidence of falls in patients with stroke is high, which may be related to their posture during hemiplegic gait. However, no study has examined the relationship between the dynamic stability of the center of mass (COM) and postural evaluation during hemiplegic gait. This study investigated the differences in dynamic stability of the COM during gait between patients with stroke and hemiplegia and healthy older adults, based on the margin of stability (MOS).

Methods: The MOS was calculated during gait in 22 patients with hemiplegia (hemiplegic group: 10 men/12 women) and 24 healthy older adults (healthy group: 12 men/12 women) to evaluate the dynamic stability of the COM. An unpaired t-test was conducted to examine the differences in the MOS, spatiotemporal gait parameters, and joint angles.

Results: Regarding spatiotemporal parameters, the hemiplegic group demonstrated a significantly slower walking velocity, shorter step length, and wider step width than the healthy group. They also had significantly larger MOS in the anteroposterior (AP) and mediolateral (ML) directions than the healthy group. The hemiplegic group had significantly reduced lateral trunk flexion, smaller hip flexion angle, larger hip abduction angle, and smaller knee flexion angle.

Conclusions: Compared with healthy adults, patients with hemiplegia exhibited larger MOS in both the AP and ML directions. These findings suggest the adoption of conservative, compensatory gait strategies to maintain safety during gait, rather than a reflection of superior balance control.

Objectives: The two-step test is a key component of the locomotive syndrome risk test, but few studies have examined its systematic errors, particularly in young adults. We investigated errors in young and older adults and identified the threshold for measurement errors.

Methods: This cross-sectional study included 95 university students and 40 older adults and was conducted between April 2023 and March 2025. Participants performed the two-step test twice within a 7-day interval. Bland-Altman analysis assessed fixed and proportional bias for the two-step test length (length) and value (length normalized to height), and minimal detectable change (MDC) and limit of agreement (LOA) were calculated.

Results: In young adults, the two-step test length was 279.2 ± 24.4 cm (difference: 8.4 ± 12.3 cm) and the two-step test value was 1.70 ± 0.11 cm/height (difference: 0.05 ± 0.07 cm/height); in older adults, these respective results were 140.7 ± 34.3 cm (0.0 ± 13.7 cm) and 0.89 ± 0.21 cm/height (0.00 ± 0.09 cm/height). In young adults, fixed bias was identified for length and value, whereas no systematic errors were detected in older adults. LOA ranged from -11.5 to 28.2 cm for length and from -0.07 to 0.17 cm/height for value in young adults. The MDC in older adults was 26.9 cm for length and 0.17 cm/height for value.

Conclusions: In young adults, the result for the two-step test tended to increase during retesting, requiring caution in interpreting intervention effects. An increase at retesting of more than 0.17 cm/height for the test value or 25-30 cm for test length may be a clinically useful indicator, exceeding the smallest detectable change for both young and older adults based on LOA and MDC.

Objectives: The prevalence of somatosensory dysfunction after stroke exceeds 50%, and its severity is negatively correlated with upper limb function and the ability to perform self-care tasks. This study objectively assessed somatosensory deficits in the acute post-stroke phase and characterized muscle-output imbalance across severity levels.

Methods: This prospective observational pilot study was conducted at Saitama Medical University International Medical Center between June 2021 and July 2023. Forty-one patients (age 66 ± 10 years) with acute stroke were assessed for somatosensory deficits and muscle-output imbalance. The severity of somatosensory disturbance was grouped according to short-latency sensory evoked potentials (SSEP), and the change in the muscle co-contraction index (CCI) from surface electromyography (sEMG) was compared at two points within 1 week. The sEMG data for each SSEP group were replicated 1000 times using the bootstrap method.

Results: An interaction was observed across all movement directions. In the comparison analysis, significant changes were observed in the normal group except for elbow flexion on the non-paretic side. In the delayed group, only wrist flexion on the non-paretic side changed more than one standard deviation. The changes observed in the severe SSEP group were inferred as fluctuations in CCI, even in the early stages of stroke onset.

Conclusions: This study showed that changes in CCI of the upper extremity vary with the severity of somatosensory disturbance in patients with acute stroke and that muscle-output imbalance can change within 1 week of onset of acute stroke.

Background: Achondroplasia, a common skeletal dysplasia, results from a gain-of-function mutation in the fibroblast growth factor receptor 3 gene. It is characterized by short-limbed dwarfism and is frequently associated with skeletal deformities, including genu varum and tibial bowing, which often impair gait and limit daily function. Although limb lengthening with an external fixator is a widely utilized intervention, quantitative evaluations of its effectiveness remain limited.

Case: A 10-year-old boy with achondroplasia presented with progressive lower limb deformity and gait disturbance. Preoperative assessments revealed pronounced genu varum, tibial bowing, and mechanical axis deviation. Bilateral tibiofibular lengthening using the Taylor Spatial Frame was performed, achieving a 6-cm increase in limb length. The external fixator was removed 1 year postoperatively. Gait rehabilitation commenced 4 months postoperatively, with full independent ambulation achieved by 6 months. Quantitative assessments using the 6-minute walk test (6MWT) and three-dimensional gait analysis (3DGA) demonstrated improvements in walking distance, cadence, and a reduction in the Physiological Cost Index (0.29 to 0.1). Preoperative 3DGA revealed significant gait deviations, which improved postoperatively, including a 9.5° reduction in the Gait Profile Score.

Discussion: Moment analysis indicated reductions in knee flexion and varus moments, suggesting improved gait efficiency. These findings suggest that limb lengthening enhances both limb alignment and functional gait performance. The integration of 3DGA and 6MWT with conventional radiographic evaluation offers a comprehensive assessment of treatment outcomes, reinforcing the effectiveness of surgical intervention and rehabilitation in patients with achondroplasia.