研究者詳細 - 辻　哲也

論文 - 辻　哲也

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The effect of zaltoprofen on physiotherapy for limited shoulder movement in breast cancer patients: a single-blinded before-after trial

Hase Kimitaka, Kamisako Michiyo, Fujiwara Toshiyuki, Tsuji Tetsuya, Liu Meigen

Archives of Physical Medicine and Rehabilitation 87 （ 12 ） 1618 - 1622 2006年12月

ISSN 0003-9993

Hase K, Kamisako M, Fujiwara T, Tsuji T, Liu M. The effect of zaltoprofen on physiotherapy for limited should movement in breast cancer patients: a single-blinded before-after trial. Objective: To determine the efficacy of oral administration of zaltoprofen on shoulder range of motion (ROM) exercises for breast cancer patients after surgery. Design: Single-blind, before-after trial. Setting: Rehabilitation facility in a Japanese university hospital. Participants: Forty breast cancer patients (age range, 37-72y) with limited shoulder movement after surgery. Intervention: Single session of physiotherapy (PT) with or without oral administration of zaltoprofen. Main Outcome Measures: Active shoulder ROM in flexion, abduction, and external rotation, as well as subjective pain score during shoulder movements. Results: Active shoulder movements after ingesting a zaltoprofen tablet significantly improved in flexion, abduction (P<.001), and external rotation (P<.005). PT treatment improved flexion and abduction ROM in both the zaltoprofen and control groups and led to significantly larger flexion and abduction movements in the zaltoprofen group than in the control group (P<.01). There were no differences in pain scores between groups, but 2 patients who did not receive zaltoprofen complained of increased pain just after ROM exercises. Conclusion: Zaltoprofen taken orally before ROM exercises for painful shoulder after breast cancer surgery may enhance the effects of PT. © 2006 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.

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Stroke rehabilitation--functional evaluation and rehabilitation approach

Tsuji Tetsuya

Nippon rinsho. Japanese journal of clinical medicine 64 Suppl 7 753 - 763 2006年10月

ISSN 0047-1852

Development of a short version of the motor fim™ for use in long-term care settings

Yamada S., Liu M., Hase K., Tanaka N., Fujiwara T., Tsuji T., Ushiba J.

Journal of Rehabilitation Medicine 38 （ 1 ） 50 - 56 2006年01月

ISSN 0036-5505

Objective: To develop a short version of the motor Functional Independence Measure (FIM™) for use in long-term care settings. Participants: For model construction, the participants were 398 community-dwelling persons with disability (mean age 79.3 years (SD 10.3)) who were receiving visiting nurse services. For cross-validation, 169 patients with stroke (mean age 78.0 years (SD 11.2)) in the chronic phase and 187 patients with stroke (mean age 63.4 years (SD 12.7)) in the recovery phase. Design: Model construction and cross-validation study. Main outcome measures: The second power of correlation coefficient (R 2) was used for agreement analysis between the short and the full version. Cross-validation of the models was estimated with the intraclass correlation coefficient (ICC). Results: Five to 7 motor FIM™ items were selected for the models based on Rasch calibration and consideration of internal consistency. Total motor FIM™ was estimated with the 6-item and 7-item models with regression analysis, which yielded high correlations with the original 13-item motor FIM™ score (R2>0.95). Regression formulas derived from the models could estimate total motor FIM™ scores accurately in the 2 cross-validation samples (ICC>0.98). Conclusion: The short version of the motor FIM™ developed is a useful measure of functional status, not only in long-term care but in the recovery phase rehabilitation settings. © 2006 Taylor & Francis.

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Clinical electromyography and electrodiagnosis course at Keio University Hospital - A 7-year experience

Liu M., Hase K., Tsuji T., Fujiwara T., Yamada S., Masakado Y., Kimura A.

Keio Journal of Medicine 54 （ 4 ） 193 - 196 2005年12月

ISSN 0022-9717

Although electromyography and electrodiagnosis (EMG-EDX) is one of the most fundamental skills in rehabilitation medicine, the number of residency programs that can provide comprehensive postgraduate EMG-EDX training is still limited in Japan. Under these circumstances, we started a 2-day primer course in EMG-EDX at Keio University Hospital in 1998. To review our 7-year experience with the course, we analyzed the number and specialty of the participants, their appraisal of the lectures and practical sessions, and the score distribution of the final examination. The number of participants totaled 288 during the past 7 years, and the mean number for each year was 41. The distribution by specialty for the whole period was 64.0% for rehabilitation medicine, 25.4% for orthopedic surgery, 5.1% for neurology, 1.0% for pediatrics, 0.5% for gerontology and 4.1% for physical therapists and occupational therapists. The difficulty levels of the lectures were judged as appropriate by 81 to 95.5% of the participants, and the presentation was judged as good by 34 to 67% of them. For the practice sessions, the difficulty levels were judged as appropriate by 88% of the participants, and the quality of the supervisors was judged as good by 64% of them. The mean score for the final examination was 56.0 (SD 15.2, median 60). In conclusion, our course has played an important role to promote EMG-EDX in our country by providing compact introductory exposure to EMG-EDX for beginners. A follow-up system for the course graduates is planned to support their EMG-EDX practice.

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Palatoplasty and total laryngectomy for untreated cleft palate with laryngeal cancer

Nakagawa Masahiro, Inoue Keita, Ugumori Toru, Ebihara Mitsuru, Onitsuka Tetsuro, Tsuji Tetsuya, Ando Makiko

Japanese Journal of Plastic and Reconstructive Surgery 48 （ 9 ） 1039 - 1044 2005年09月

ISSN 0021-5228

Aging cleft palate and total laryngectomy patients suffer degradation of their deglutition function. We experienced an elderly patient with laryngeal cancer and untreated cleft palate. The operation, which consisted of a total laryngectomy and cleft palate plasty via the push back method, was simultaneously performed. The patient did not have dysphagia because of complete velopharyngeal closure after the operation. Also, he was able to rapidly resume eating a general diet. In the course of their treatment, we also need to consider the dietary QOL of cancer patients with head and neck lesions.

Identification of a simple screening tool for dysphagia in patients with stroke using factor analysis of multiple dysphagia variables

Nishiwaki Kaori, Tsuji Tetsuya, Liu Meigen, Hase Kimitaka, Tanaka Naofumi, Fujiwara Toshiyuki

Journal of Rehabilitation Medicine 37 （ 4 ） 247 - 251 2005年07月

ISSN 1650-1977

Objective: To identify a most useful and simple clinical screening tool to predict videofluoroscopic aspiration in patients with stroke. Design: Factor analysis of multiple dysphagia variables and sensitivity and specificity testing with chi-square test. Patients: Sixty-one consecutive stroke patients with symptoms suggestive of dysphagia admitted to a university hospital and its 4 affiliated hospitals in Japan. Methods: Factors were extracted from 6 oromotor examinations (lip closure, tongue movement, palatal elevation, gag reflex, voice quality and motor speech function), 2 swallow screen tests (saliva swallowing test and our modified water swallowing test using 30 ml of water) and 4 parameters evaluated with a videofluoroscopic swallow study. Sensitivity and specificity of each dysphagia-related variable was determined against aspiration in a videofluoroscopic swallow study. Results: Factor analysis revealed that cough/voice change in the water swallowing test and aspiration on videofluoroscopic swallow study belonged to the same factor. Chi-square analysis showed that cough/voice change in the water swallowing test was the only variable that was significantly associated with aspiration on videofluoroscopic swallow study, with a sensitivity of 72% (95% CI: 61-83%) and a specificity of 67% (CI: 55-79%) as a predictor of aspiration (p < 0.05). Conclusion: We recommend our modified 30 ml water-swallowing test as a useful single task-screening tool to detect aspiration. © 2005 Taylor & Francis.

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Long-lasting effects of paired associative stimulation in hemiparetic stroke patients

Tsuji Tsuji, Suzuki Kanjiro, Masakado Yoshihisa, Ota Tetsuo, Kimura Akio, Liu Meigen, Chino Naoichi

International Congress Series 1278 280 - 283 2005年03月

ISSN 0531-5131

Purpose: To establish whether motor point stimulation paired with repetitive transcranial magnetic stimulation (rTMS) produces a lasting modulation of the primary motor cortex in persons with hemiparetic stroke. Methods: Subjects were nine hemiparetic patients after stroke, all right-handed. The mean days from onset were 80 days. Repeated measurements of the motor evoked potential (MEP) in the affected first dorsal inter osseous (FDI) muscle in all subjects were performed. For determination of baseline, a single measurement of the MEPs was given before intervention stimulation. Subjects received 30 min of just suprathreshold motor point stimulation of the affected abductor pollicis brevis (APB) muscle paired every 10 s with TMS over the motor cortex. After intervention stimulation, measures of MEPs were taken immediately (0 min) and at 10, 20 and 30 min. Results: The MEPs significantly increased in amplitude immediately after pairing stimulation and recovered to baseline after 30 min in amplitude. Conclusions: In stroke hemiparetic patients, as well as healthy subjects, paired stimulation increases the corticomotor excitability for short periods after stimulation. This finding might have potential therapeutic implications for stroke rehabilitation. © 2005.

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Visual evoked fields in patients of unilateral spatial neglect

Mizuno Katsuhiro, Tsuji Tetsuya, Masakado Yoshihisa, Ota Tetsuo, Honaga Kaoru, Liu Meigen, Kimura Akio, Ohde Hisao

International Congress Series 1278 215 - 218 2005年03月

ISSN 0531-5131

Purpose: To establish whether the visual evoked fields (VEFs) in patients of unilateral spatial neglect (USN) caused by cerebrovascular accident (CVA) are different from ones in subjects without USN. Method: In three patients of CVA with left USN and three controls (a healthy subject, a patient of CVA without USN and a patient of hemianopsia), the VEFs following pattern reversal stimulation on the left hemifield were measured. Magnetic recordings were conducted using a 160-channel helmet-type axial superconducting quantum interference device (SQUID) gradiometer system. The behavioural inattention test (BIT) was also scored in patients of USN. Results: Magnetic source imaging revealed two components (P100m and N145m) on the VEFs in the healthy subject and patient of CVA without USN, and no component in the patient of hemianopsia. The pattern of two components in patients with USN was various. Only P100m for patient 1, N145m for patient 2 and both components for patient 3 were detected. Concerning the BIT scores, line bisection and cancellation task for patient 1, coping, drawing and cancellation task for patient 2, and only cancellation task for patient 3 were impaired. Conclusion: Our results demonstrate that pattern of two components (P100m and N145m) on the VEFs does not reflect only hemianopsia, but also USN caused by deficits of the cortical process of attention. © 2005.

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Experience of rehabilitation for swallowing disorders after esophagectomy for esophageal cancer

Tsubosa Y., Sato H., Nemoto M., Ando M., Tsuji T.

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.

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Pedaling exercise for neuromuscular re-education

Fujiwara Toshiyuki, Liu Meigen, Tanuma Akira, Hase Kimitaka, Tsuji Testuya

Critical Reviews in Physical and Rehabilitation Medicine 17 （ 3 ） 163 - 177 2005年

ISSN 0896-2960

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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 T., Liu M., Tsuji T., Sonoda S., Mizuno K., Akaboshi K., Hase K., Masakado Y., Chino N.

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 K., Liu M., Hanayama K., Tsuji T., Fujiwara T., Chino N.

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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