研究者詳細 - 辻　哲也

論文 - 辻　哲也

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Experience of rehabilitation for swallowing disorders after esophagectomy for esophageal cancer

Tsubosa Yasuhiro, Sato Hiroshi, Nemoto Masayuki, Ando Makiko, Tsuji Tetsuya

Japanese Journal of Gastroenterological Surgery 38 （ 5 ） 571 - 576 2005年

ISSN 0386-9768

We assessed the clinical experience and problem of rehabilitation in swallowing disorders following esophagectomy for thoracic esophageal cancer. Postoperative swallowing disorders were studied in 9 thoracic esophageal cancer patients who had undergone esophagectomy with lymph node dissection. Nine with actual or potential swallowing disorders underwent rehabilitation involving (1) anatomical and physiological assessment of organ-related swallowing, bolus movement, aspiration level, safe reclining angle and food safety using videofluorography: (2) repetition of direct and indirect training based on videofluorography assessment; (3) reassessment using videofluorography; and (4) repetition of (1) to (3) until dietetic self-help was possible. Five of the 9 undergoing rehabilitation had paralysis of the recurrent laryngeal nerve, including 1 with paralysis of the bilateral recurrent laryngeal nerves. Eight of the 9 undergoing rehabilitation achieved dietetic self-help without severe aspiration pneumonia. Of these 8, mean rehabilitation took 9.6 days and postoperative hospitalization 25.3 days. Mean rehabilitation for the patient with bilateral recurrent laryngeal nerve paralysis took 23 days, and postoperative hospitalization 96 days. Excluding the patient with paralysis of the bilateral recurrent laryngeal nerves, none suffered post-discharge aspiration pneumonia. It is possible that rehabilitation including complementary measures, such as appropriate reclining posture and selection of food consistencies, is effective in postoperative swallowing disorders for thoracic esophageal cancer. The patient who had paralysis of the bilateral recurrent laryngeal nerves required concomitantly greater care. ©2005 The Japanese Society of Gastroenterological Surgery.

Twenty-seven years of complication-free life with clean intermittent self-catheterization in a patient with spinal cord injury

Mizuno Katsuhiro, Tsuji Tetsuya, Kimura Akio, Liu Meigen, Masakado Yoshihisa, Chino Naoichi

Archives of Physical Medicine and Rehabilitation 85 （ 10 ） 1705 - 1707 2004年10月

ISSN 0003-9993

Mizuno K, Tsuji T, Kimura A, Liu M, Masakado Y, Chino N. Twenty-seven years of complication-free life with clean intermittent self-catheterization in a patient with spinal cord injury: a case report. Arch Phys Med Rehabil 2004;85:17057. Currently, clean intermittent self-catheterization (CISC) is the most prevalent method of bladder management in patients with spinal cord injury (SCI) at discharge from rehabilitation centers. However, half of the patients discontinue using CISC and change to other methods of bladder management several months postdischarge despite the fact that it the best way to prevent urinary tract complications. Few studies, however, report the long-term consequences of CISC. In this case, we present a woman in her early fifties who had sustained thoracic SCI and had continued using CISC for 27 years without developing any complications. The possible reasons for her success were absence of incontinence because of underactive and normal capacity bladder; normal upper-extremity functions and absence of marked spasticity of lower extremities that facilitated CISC technique; and absence of sociovocational problems, enabling her to keep proper intervals between catheterizations each day. This case indicates that CISC is useful for long-term bladder management in patients with SCI, even for 25 years or more. Long-term outcomes of CISC and factors leading to success need to be delineated in future studies with larger samples. © 2004 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.

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Development of a New Measure to Assess Trunk Impairment After Stroke (Trunk Impairment Scale): Its Psychometric Properties

Fujiwara Toshiyuki, Liu Meigen, Tsuji Tetsuya, Sonoda Shigeru, Mizuno Katsuhiro, Akaboshi Kazuto, Hase Kimitaka, Masakado Yoshihisa, Chino Naoichi

American Journal of Physical Medicine and Rehabilitation 83 （ 9 ） 681 - 688 2004年09月

ISSN 0894-9115

Objective: The purpose of this study was to investigate reliability, validity, internal structure, and responsiveness of our newly developed Trunk Impairment Scale (TIS) for patients with stroke. Design: A total of 73 patients with stroke participated in this prospective study. Interrater reliability (weighted kappa statistics), content validity (principal component analysis), concurrent validity (Spearman's rank correlation with the Trunk Control Test), predictive validity (prediction of discharge FIM™ scores), and responsiveness (standardized response mean values) were examined. Internal consistency and item difficulties were analyzed with Rasch analysis. Results: The weighted kappa of each TIS item ranged from 0.66 to 1.0. Principal component analysis revealed that the TIS measured a domain similar to the Stroke Impairment Assessment Set trunk items but different from the Stroke Impairment Assessment Set motor and visuospatial items. The TIS correlated with the Trunk Control Test (r = 0.91). To predict discharge FIM motor scores, addition of the TIS as one of the predictors to age, time from onset, and admission FIM score increased the adjusted R² from 0.66 to 0.75. With Rasch analysis, the misfit was acceptable, except for the abdominal muscle strength item. The difficulty patterns were similar at admission and discharge, except for the abdominal muscle strength item. The responsiveness of the TIS was satisfactory and comparable with that of the Trunk Control Test (standardized response mean values, 0.94 and 1.06). Conclusions: Our newly developed TIS is reliable, valid, and responsive for use in stroke outcome research.

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Physical fitness in persons with hemiparetic stroke: its structure and longitudinal changes during an inpatient rehabilitation programme

Tsuji Tetsuya, Liu Meigen, Hase Kimitaka, Masakado Yoshihisa, Takahashi Hidetoshi, Hara Yukihiro, Chino Naoichi

Clinical Rehabilitation 18 （ 4 ） 450 - 460 2004年06月

ISSN 0269-2155

Objective: To test the hypothesis that the structure of fitness in patients with hemiparetic stroke can be categorized into impairment/disability, cardiopulmonary, muscular and metabolic domains, and to study longitudinal changes in their fitness during an inpatient rehabilitation programme. Design: Structure analysis of multiple fitness parameters with principlal component analysis (PCA), and a before and after trial. Setting: Tertiary rehabilitation centre in Japan. Patients: One hundred and seven consecutive inpatients with hemiparetic stroke. Intervention: A conventional stroke rehabilitation programme consisting of 80 minutes of physical therapy and occupational therapy sessions five days a week, and daily rehabilitation nursing for a median duration of 105.5 days. Main outcome measures: Principal component scores extracted from measurement of paresis/daily living (the Stroke Impairment Assessment Set (SIAS) and the Functional Independence Measure (FIM)); muscular (grip strength (GS), knee extensor torque, and cross-sectional areas of thigh muscles); metabolic (body mass index (BMI) and fat accumulation on CT); cardiopulmonary (heart rate oxygen coefficient (HR-O₂-Coeff) obtained with a graded bridging activity and a 12-minute propulsion distance). Results: PCA categorized the original 15 variables into four factors corresponding to paresis/activities of daily living, muscular, metabolic and cardiopulmonary domains, and explained 78.1 % of the total variance at admission and 69.6% at discharge. Except the metabolic domain, PCA scores for the other three domains improved significantly at discharge (paired t-test, p < 0.05). Conclusion: The hypothetical structure of fitness was confirmed, and the PCA scores were useful in following longitudinal changes of fitness during inpatient rehabilitation. © Arnold 2004.

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Functional status and muscle strength in people with Duchenne muscular dystrophy living in the community

Uchikawa Ken, Liu Meigen, Hanayama Kozo, Tsuji Tetsuya, Fujiwara Toshiyuki, Chino Naoichi

Journal of Rehabilitation Medicine 36 （ 3 ） 124 - 129 2004年05月

ISSN 1650-1977

Objective: To describe activity limitation of people with Duchenne muscular dystrophy who are living in the community and to correlate it with age and muscle strength. Design: Descriptive, correlational. Subjects: Twenty-seven children with Duchenne muscular dystrophy aged 7-14 years who are living in the community. Methods: The subjects' activity limitation was evaluated using the Functional Independence Measure and the muscle strength of their major upper and lower limb muscles was evaluated with manual muscle testing. The Functional Independence Measure was correlated with age and manual muscle testing, and the pattern of activities of daily living limitations and factors related to it were analysed. Results: There were significant correlations between age and averaged MMT score (Spearman's rho = -0.63, p < 0.01), age and Functional Independence Measure motor score (rho = -0.52, p < 0.01), and Functional Independence Measure motor score and averaged manual muscle testing (rho = 0.77, p < 0.01). At similar manual muscle testing level, children with good cognitive function (Functional Independence Measure cognitive score ≥26) showed significantly higher Functional Independence Measure motor scores than those with poor cognitive function (Mann-Whitney U test, p < 0.01). For individual Functional Independence Measure items, eating and bowel management were the easier, whereas transfer and stair climbing were the more difficult. Patients with mean muscle strength ≥grade 3 were rated as relatively independent, while those with a mean muscle strength <grade 3 were rated as maximal or total assistance (Mann-Whitney U test, p < 0.05). Conclusion: Activities of daily living in patients with Duchenne muscular dystrophy are related to age and muscle strength, and manual muscle testing grade 3 is an important cut-off point to predict their disability. © 2004 Taylor & Francis.

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Rehabilitation research from a non-English speaking country published in peer-reviewed English journals - The Japanese experience

Liu Meigen, Hase Kimitaka, Masakado Yoshihisa, Tsuji Tetsuya, Otaka Yohei, Chino Naoichi

Disability and Rehabilitation 25 （ 23 ） 1304 - 1311 2003年12月

ISSN 0963-8288

Purpose: To study the status of contribution by non-English speaking countries to international rehabilitation literature taking Japan as an example, and to suggest recommendations to overcome the language barrier. Method: Descriptive study using a systematic MEDLINE search with outcome measures of annual numbers and proportions of articles by Japanese physiatrists published in peer-reviewed English rehabilitation journals, and of categories and types of studies. A database containing 292 relevant articles were used for analysis. Results: The publications have steadily increased annually both in absolute number and in proportion. The number was the largest for Arch Phys Med Rehabil (16.8%), followed by Am J Phys Med Rehabil (12.3%), Prosthet Orthot Int (8.6%), Disabil Rehabil (5.1 %) and so on. The percentage by category was the highest for stroke (26.0%), followed by spinal cord injury (11.6%), neurophysiology (11.6%) and amputation (6.2%), 67.8% of the articles were related to evaluation, 6.5% to outcome studies and 25.7% to therapy. The majority were descriptive studies (45.5%), followed by case control studies (13.0%), before-and-after trials (12.3%), case reports (7.2%) and others. Conclusion: The contribution from Japan to international rehabilitation literature is increasing. Measures were suggested to facilitate more scientific contribution by non-English speaking researchers.

Physical fitness in persons with hemiparetic stroke

Liu Meigen, Tsuji Tetsuya, Hase Kimitaka, Hara Yukihiro, Fujiwara Toshiyuki

Keio Journal of Medicine 52 （ 4 ） 211 - 219 2003年12月

ISSN 0022-9717

In persons with hemiparetic stroke, assessment and promotion of fitness have so far received limited attention, partly because of the lack of appropriate measures applicable to them. Because these mobility-impaired persons are prone to inactivity, disuse and insulin resistance are likely to occur, and can aggravate the already significant health and economic consequences that stroke entails. It is therefore important to assess objectively their fitness to devize effective and efficient fitness promotion programs. Because of physical limitations, however, many persons with stroke cannot perform traditional stress testing using a treadmill or a cycle ergometer, and maximal oxygen consumption, which is regarded as a gold standard, is not a practical measure. In this article, we reviewed the current status of research on fitness in persons with hemiparetic stroke from the perspectives of evaluation, structure analysis of fitness, and longitudinal changes during a rehabilitation program. As a measure of fitness, indices obtainable with a submaximal exercise are proposed, such as anaerobic threshold and heart rate oxygen coefficient. Protocols applicable to persons with hemiparetic stroke with a variety of functional limitations have been developed (basic bedside activities, bridging activity, or single arm ergometry). The structure of their fitness is demonstrated to be described by a fitness model of healthy persons (cardiopulmonary, muscular and metabolic dimensions) if the paresis/activities of daily living dimension is added. Several studies suggest that fitness improves during a conventional stroke rehabilitation program. Studying the changes of the above four dimensions can help develop more effective fitness training programs.

Trunk muscles in persons with hemiparetic stroke evaluated with computed tomography

Tsuji Tetsuya, Liu Meigen, Hase Kimitaka, Masakado Yoshihisa, Chino Naoichi

Journal of Rehabilitation Medicine 35 （ 4 ） 184 - 188 2003年07月

ISSN 1650-1977

Objectives: To analyse side difference in bilateral trunk muscles in patients with hemiparetic stroke, to relate it with impairment and disability variables and to evaluate longitudinal changes. Methods: In a sample of 83 inpatients with hemiparetic stroke undergoing rehabilitation, we measured the cross-sectional area of the paravertebral muscle and thigh muscles using computed tomography at admission and discharge. Classifying them by paravertebral muscle side difference (group I: contralateral > ipsilateral; II: contralateral = ipsilateral; III: contralateral < ipsilateral) we analysed group difference in the Stroke Impairment Assessment Set, the Functional Independence Measure and walk velocity. Results: In contrast to thigh muscles, the paravertebral muscle cross-sectional area was significantly greater on the side contralateral to the brain lesion. Discharge paravertebral muscle cross-sectional area increased significantly from admission values. The Stroke Impairment Assessment Set, Functional Independence Measure and walk velocity were significantly lower in group I. Conclusion: The contralateral paravertebral muscle cross-sectional area was larger than the ipsilateral ones, and this was related to the degree of impairment and functional limitations.

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Psychometric properties of the Stroke Impairment Assessment Set (SIAS)

Liu Meigen, Chino Naoichi, Tsuji Testuya, Masakado Yoshihisa, Hase Kimitaka, Kimura Akio

Neurorehabilitation and Neural Repair 16 （ 4 ） 339 - 351 2002年12月

ISSN 0888-4390

Objective: To review the psychometric properties of the Stroke Impairment Assessment Set (SIAS), which was developed in 1990 as a comprehensive instrument to assess stroke impairment. Method: Articles related to the SIAS were retrieved from the MEDLINE and the Folia Centro Japonica. Results: Thirty-five articles were retrieved and analyzed. 1) Scale quality: Rasch analysis demonstrated the unidimensionality of the SIAS. Factor analysis produced 6 factors corresponding to the 6 SIAS subscales. 2) Interrater reliability: The weighted kappas were high except for the unaffected side quadriceps item for which the score distribution was skewed. 3) Concurrent validity: Significant correlations were found between a) SIAS motor items and the Motricity Index or the Brunnstrom stage, b) SIAS lower extremity scores and the Functional Independence Measure (FIMSM) locomotion scores, c) trunk scores and abdominal manual muscle testing, d) visuospatial scores and line bisection and copying task scores, and e) speech scores and the FIMSM communication scores. 4) Predictive validity: Three studies attempting to predict discharge functional status demonstrated that adding the SIAS as one of the predictors enhanced the predictive power. 5) Responsiveness: The SIAS was more responsive to changes than the Motricity Index, the Brunnstrom stage, or the National Institutes of Health Stroke Scale. Conclusion: The SIAS is a useful measure of stroke impairment with well-established psychometric properties.

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Long lasting effects of rTMS and associated peripheral sensory input on MEPs, SEPs and transcortical reflex excitability in humans

Tsuji Tetsuya, Rothwell John C.

Journal of Physiology 540 （ 1 ） 367 - 376 2002年04月

ISSN 0022-3751

We tested the effect of repetitive transcranial magnetic stimulation (rTMS) over the motor cortex on the size of transcortical stretch and mixed nerve reflexes. Fourteen healthy subjects were investigated using either 25 min of 1 Hz rTMS or 30 min of 0.1 Hz rTMS paired with electrical stimulation of the motor point of the first dorsal interosseous muscle (FDI). Following treatment, we measured the effect on the size of. (1) EMG responses evoked in FDI by transcranial magnetic stimulation (MEPs), (2) somatosensory evoked potentials (SEPs) evoked by ulnar nerve stimulation, and (3) transcortical stretch or electrically elicited reflexes. rTMS at 1 Hz reduced the amplitude of both MEPs and long latency reflexes by 20-30 % for about 10 min after the end of stimulation. Short latency reflexes were unaffected. SEPs were not studied, as it has been shown previously that they are also suppressed. rTMS at 0.1 Hz paired with motor point stimulation (interstimulus interval of 25 ms) increased the amplitude of the MEP and the cortical components of the SEP (N20/P25 and later peaks) for up to 10 min. Longlatency reflexes were facilitated with the same time course. We conclude that rTMS over the motor cortex either alone or in conjunction with peripheral inputs can decrease or increase the excitability of the sensory and motor cortex for short periods after the end of stimulation. These changes affect not only MEPs and SEPs but also EMG responses to more'natural'inputs involved in transcortical stretch reflexes.

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The stroke impairment assessment set: its internal consistency and predictive validity

Tsuji Tetsuya, Liu Meigen, Sonoda Shigeru, Domen Kazuhisa, Chino Naoichi

Archives of Physical Medicine and Rehabilitation 81 （ 7 ） 863 - 868 2000年07月

ISSN 0003-9993

Objective: To study the scale quality and predictive validity of the Stroke Impairment Assessment Set (SIAS) developed for stroke outcome research. Design: Rasch analysis of the SIAS; stepwise multiple regression analysis to predict discharge functional independence measure (FIM) raw scores from demographic data, the SIAS scores, and the admission FIM scores; cross-validation of the prediction rule. Setting: Tertiary rehabilitation center in Japan. Patients: One hundred ninety stroke inpatients for the study of the scale quality and the predictive validity; a second sample of 116 stroke inpatients for the cross-validation study. Main Outcome Measures: Mean square fit statistics to study the degree of fit to the unidimensional model; logits to express item difficulties; discharge FIM scores for the study of predictive validity. Results: The degree of misfit was acceptable except for the shoulder range of motion (ROM), pain, visuospatial function, and speech items; and the SIAS items could be arranged on a common unidimensional scale. The difficulty patterns were identical at admission and at discharge except for the deep tendon reflexes, ROM, and pain items. They were also similar for the right- and left-sided brain lesion groups except for the speech and visuospatial items. For the prediction of the discharge FIM scores, the independent variables selected were age, the SIAS total scores, and the admission FIM scores; and the adjusted R² was .64 (p < .0001). Stability of the predictive equation was confirmed in the cross-validation sample (R² = .68, p < .001). Conclusions: The unidimensionality of the SIAS was confirmed, and the SIAS total scores proved useful for stroke outcome prediction. (C) 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.

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The internal consistency and predictive validity of the Stroke Impairment Assessment Set (SIAS)

Tsuji Tetsuya, Liu Meigen, Sonoda Shigeru, Domen Kazuhisa, Chino Naoichi

Journal of Stroke and Cerebrovascular Diseases 9 （ 2 SUPPL. ） 229 - 230 2000年

ISSN 1052-3057

Comorbidities in stroke patients as assessed with a newly developed comorbidity scale

Liu Meigen, Tsuji Tetsuya, Tsujiuchi Kazuhito, Chino Naoichi

American Journal of Physical Medicine and Rehabilitation 78 （ 5 ） 416 - 424 1999年09月

ISSN 0894-9115

We previously reported reliability and validity of our newly developed comorbidity scale (CS) for stroke outcome research based on a retrospective sample. The objectives of this study were to cross-validate the comorbidity scale in a new prospective sample and to investigate longitudinal changes of the comorbidity scale during hospitalization. In a prospective sample of 175 stroke patients admitted to five nonacute rehabilitation hospitals in Japan, we analyzed the frequency and grading of comorbidities and compared the comorbidity scale with demographic data, impairment as assessed with the Stroke Impairment Assessment Set (SIAS), and disability as measured with the Functional Independence Measure (FIM(SM)). The results were compared with our previous retrospective study. We also studied longitudinal changes by measuring the comorbidity scale on admission, 2 wk later, and at discharge of 67 patients. As a result, the comorbidity scaling was significantly lower in the prospective sample, and it increased at the second measurement and then plateaued. Among the comorbidities, hypertension ranked first, followed by shoulder pain, and diabetes mellitus. Similar to our previous retrospective study, the comorbidity scale correlated positively with age and length of stay and correlated negatively with the SIAS motor item scores and the FIM scores. In conclusion, the present study suggested concurrent and predictive validity of the comorbidity scale in a prospective sample as well and clarified the comorbidity characteristics of stroke inpatients.

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Bridging activity as a mode of stress testing for persons with hemiplegia

Tsuji Tetsuya, Liu Meigen, Tsujiuchi Kazuhito, Chino Naoichi

Archives of Physical Medicine and Rehabilitation 80 （ 9 ） 1060 - 1064 1999年09月

ISSN 0003-9993

Objective: To establish a stress testing protocol for hemiplegic persons using graded bridging activity at the rates of 3 to 24 repetitions per minute. Design: Paired comparisons of exercise parameters and admission and discharge data between hemiplegic and control groups. Setting: Inpatient rehabilitation program of a tertiary rehabilitation center in Japan. Patients: (1) Preliminary study: five hemiplegic patients. (2) Comparison with normal subjects. 39 hemiplegic patients and 10 age-matched controls. (3) Study of reproducibility five hemiplegic patients and five controls. (4) Longitudinal changes 30 hemiplegic patients. Main Outcome Measures: Oxygen consumption (Vo₂), heart rate (HR), and HR oxygen coefficient (regression coefficient between HR and Vo₂). Results: The testing protocol was applicable to 88.6% of hemiplegic patients. The relationship between HR and Vo₂ was linear, and HR oxygen coefficient was significantly lower in hemiplegic patients than the controls. The intraclass correlation coefficients were greater than 0.7 for Vo₂, HR, and HR oxygen coefficient, indicating satisfactory reproducibility HR decreased longitudinally for the same stress levels and the HR oxygen coefficient increased, indicating improved fitness level. Conclusions: The bridging activity protocol is a useful mode for stress-testing hemiplegic persons. The linearity between HR and VO₂ with this protocol allows us to use the indices of fitness obtainable from this relationship.

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ADL structure for nondisabled Japanese children based on the functional independence measure for children (WeeFIM(TM))

Tsuji Tetsuya, Liu Meigen, Toikawa Hiroyuki, Hanayama Kozo, Sonoda Shigeru, Chino Naoichi

American Journal of Physical Medicine and Rehabilitation 78 （ 3 ） 208 - 212 1999年05月

ISSN 0894-9115

The Functional Independence Measure for Children (WeeFIM(TM)) instrument was developed, based on the FIM(TM) instrument, to assess disability in children aged 6 mo to 7 yr. Normative data are reported for American and Japanese children, and it is increasingly used for the disabled. Our purpose was to confirm scale quality and to determine the difficulty pattern of the WeeFIM in Japan. The WeeFIM was measured in 225 children (113 girls and 112 boys) aged 6 mo to 7 yr without developmental delays. The scores were converted to an interval scale by Rasch analysis, which assumes unidimensionality of the measurement items, determines the degree of the fit to the assumption, and decides item difficulty. When the WeeFIM items were divided into two groups of motor and cognitive items to minimize misfit, the degree of misfit was acceptable, except for eating, bladder management, tub/shower transfer, and comprehension. For the motor items, grooming, bathing, and bladder control were more difficult, and stairs, bed/chair transfer, and walk or wheelchair were easier. Concerning the cognitive items, expression and comprehension were easier, and problem-solving was most difficult. When we compared item difficulty patterns in the four age groups (6-21 mo, 22-45 mo, 46-62 mo, and 63-100 mo), we found no differences, except in toilet transfer. It was more difficult for younger children, possibly because of its different pattern of chronological change, which shows rapid changes from dependent to independent levels over a short period of time. Our study confirmed the scale quality of the WeeFIM instrument with Rasch analysis and demonstrated the difficulty pattern of the WeeFIM in nondisabled Japanese children.

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Osteoporosis in hemiplegic stroke patients as studied with dual-energy x-ray absorptiometry

Liu Meigen, Tsuji Tetsuya, Higuchi Yoshiko, Domen Kazuhisa, Tsujiuchi Kazuhito, Chino Naoichi

Archives of Physical Medicine and Rehabilitation 80 （ 10 ） 1219 - 1226 1999年

ISSN 0003-9993

Objectives: To compare bone mineral densities (BMDs) of the affected and unaffected limbs in stroke patients at multiple sites; to study longitudinal changes during a 3-month rehabilitation program; and to relate BMDs to demographic, impairment, and disability variables. Design: Descriptive study. Setting: Tertiary rehabilitation center. Patients: One hundred four consecutive hemiplegic inpatients, 69 men, age 56.5 ± 13.2yrs, 47 with left- sided brain lesion. Median days from onset to admission and median length of stay days were 83 and 105.5, respectively. Main Outcome Measures: BMDs of proximal humerus, distal radius, femoral neck, and calcaneus bilaterally, and third lumbar vertebra, measured with dual-energy x-ray absorptiometry (DXA), were compared between affected and unaffected sides at admission and discharge. Results: Stroke Impairment Assessment Set (SIAS) motor scores, Functional Independence Measure (FIM) scores, grip strength, and awake/sleep heart rate counts (activity index) improved significantly at discharge. Affected/unaffected BMD ratios were 88.3% to 98.4% at admission and 79.6% to 98.8% at discharge, lowest for the humerus. Discharge/admission ratios were 89.1% to 97.8% for the affected and 97.4% to 100% for the unaffected side. All BMDs were intercorrelated (R = .438 to .873). They correlated significantly with age, body weight, grip strength, FIM scores, and activity index. Factors selected to explain BMD with multiple regression analysis differed according to the site and timing of the measurement. Conclusions: BMDs of the affected side were lower and most marked in the humerus. Longitudinally, not only the affected but the unaffected BMDs decreased. Age, sex, duration of stroke, anthropometric measurements, motor paralysis, muscle strength, and activity level contributed differently to bone loss according to the site and timing of the measurement.

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Newly developed short behavior scale for use in stroke outcome research

Tsuji Tetsuya, Liu Meigen, Sonoda Shigeru, Domen Kazuhisa, Tsujiuchi Kazuto, Chino Naoichi

American Journal of Physical Medicine and Rehabilitation 77 （ 5 ） 376 - 381 1998年09月

ISSN 0894-9115

This study was designed to examine the scale quality of our newly developed short behavior scale and to identify its role in predicting the functional outcome of stroke patients. The short behavior scale consists of six items that assess cognitive function related to the daily behavioral status of a patient in activities of daily living and exercise. It can be scored quickly through observation of a patient's behavior. We assessed 190 stroke inpatients, who had a mean age of 61 years. The mean days and length of stay from onset were 47.3 and 138.2, respectively. We examined internal consistency with the Cronbach's alpha coefficient. Interrater reliability was tested by having two examiners evaluate 30 patients independently. We studied how the short behavior scale correlated with the admission Functional Independence Measure, Mini-Mental State Examination scores, and speech and visuospatial functions. We also studied how the short behavior scale contributed to the prediction of discharge Functional Independence Measure raw scores with stepwise multiple regression analysis. In another group of 116 patients, we cross-validated our predictive equation. The Cronbach's alpha coefficient was 0.88. The intraclass correlation coefficient was 0.84 for total score. The short behavior scale correlated significantly with cognitive Functional Independence Measure scores and Mini-Mental State Examination scores. We could explain 70.8% of the variance of discharge Functional Independence Measure scores from the Short Behavior Scale, days from onset to admission, age, speech scores, and admission Functional Independence Measure scores. Stability of the predictive equation was shown in cross-validation to a second sample of 116 patients. In conclusion, our newly developed short behavior scale proved reasonable and would be useful to enhance the precision of outcome prediction in stroke rehabilitation.

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ADL structure for stroke patients in Japan based on the functional independence measure

Tsuji T., Sonoda S., Domen K., Saitoh E., Liu M., Chino N.

American Journal of Physical Medicine and Rehabilitation 74 （ 6 ） 432 - 438 1995年

ISSN 0894-9115

The difficulty patterns of FIM (Functional Independence Measure) in Japan were determined and compared with patterns found in the United States to assess whether FIM can be used for worldwide comparisons of ADL (the activities of daily living). The FIM was measured for 190 stroke patients in several hospitals throughout Japan. The scores at admission and discharge were converted to an interval scale by Rasch analysis. Right and left brain lesion patients were analyzed separately. The FIM items were divided into two groups: motor items and cognitive items to minimize misfit. A degree of misfit was acceptable, except for bowel and bladder management, stairs, bathing, and expression. Motor items, eating, and bowel and bladder management were the easiest; stairs, bathing, and tub/shower transfers were the most difficult. The difficulty patterns of patients with left and right hemisphere lesions were almost identical. Bathing and tub/shower transfer were more difficult for Japanese patients than for those studied in the United States. Concerning the cognitive items, expression was easiest for patients with right hemisphere lesions but most difficult for those with left hemisphere lesions. Social interaction was easier for Japanese patients with left hemisphere lesions than the other patients. The item difficulty patterns in Japan differs slightly from those in the United States because of cultural differences. As countries show different patterns of difficulty, we must be careful when making international comparisons of FIM data converted by Rasch analysis.

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