論文 - 辻　哲也

Factors associated with ADL-defined disability-free survival among patients with advanced cancer in a palliative care setting: a retrospective cohort study

Soeda, R; Kawakami, M; Nagashima, K; Harada, T; Yamaguchi, T; Furukawa, Y; Tsuji, T

BMC PALLIATIVE CARE 24 （ 1 ） 206 - 206 2025年07月

ISSN  1472-684X

　概要を見る

OBJECTIVES: Disability-free survival (DFS) focusing on essential activities of daily living (ADL) is a critical outcome for patients with advanced cancer receiving palliative care, yet remains underexplored. This study aimed to examine DFS for core ADL components (eating, toileting, and walking) in patients admitted to the palliative care unit (PCU) and to identify associated factors using a competing risk model. Understanding these factors may guide targeted interventions to preserve functional independence and enhance quality of life. METHODS: This retrospective cohort study included advanced cancer patients admitted to the PCU between August 2018 and September 2022, excluding those discharged home. The primary endpoint was DFS, defined as the period from admission to an event resulting in a Functional Independence Measure (FIM™) score below 6 in eating, toileting, or walking. FIM™ is a widely used tool for assessing functional independence across multiple domains. DFS was estimated using a competing risk model to account for death as a competing event, and Fine–Gray regression analysis was conducted to identify factors associated with DFS. RESULTS: A total of 143, 48, and 46 patients were analyzed for eating, toileting, and walking, respectively. The median DFS (95% confidence interval) was 4 (3–5) weeks for eating, 3.5 (3–6) weeks for toileting, and 3 (2–6) weeks for walking. Cognitive function (FIM™ cognitive items) and the cachexia (modified Glasgow Prognostic Score) at admission were commonly associated with DFS. Neutrophil-to-lymphocyte ratio was specifically associated with DFS for eating, and bone and liver metastases were associated with DFS for toileting and walking. CONCLUSIONS: Monitoring ADL-defined DFS and key factors such as cognitive function and inflammation-nutritional status may enable timely interventions, optimize care strategies, and support quality of life for patients with advanced cancer in palliative care settings. Future studies could explore prospective validation of these findings and investigate whether early interventions targeting these factors can extend disability-free survival. In addition, integrating rehabilitation strategies and routine cognitive assessments may further enhance the benefits of individualized care in this population. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12904-025-01847-7.

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Factors responsible for the decline in physical fitness during neoadjuvant chemotherapy in older patients with esophageal cancer: an exploratory prospective cohort study

Harada, T; Tsuji, T; Ueno, J; Konishi, N; Yanagisawa, T; Hijikata, N; Ishikawa, A; Hashimoto, K; Kagaya, H; Tatematsu, N; Zenda, S; Kotani, D; Kojima, T; Fujita, T

SUPPORTIVE CARE IN CANCER （Springer Science and Business Media LLC）  33 （ 5 ） 428 2025年04月

ISSN  0941-4355

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Combining therapeutic strategies with rehabilitation improves motor recovery in animal models of spinal cord injury: A systematic review and meta-analysis

Zhang, L; Yamada, S; Nagoshi, N; Shinozaki, M; Tsuji, T; Nakamura, M; Okano, H; Tashiro, S

ANNALS OF PHYSICAL AND REHABILITATION MEDICINE 68 （ 3 ） 101911 - 101911 2025年04月

ISSN  1877-0657

　概要を見る

BACKGROUND: Despite the lack of clinically validated strategies for treating spinal cord injury (SCI), combining therapeutic strategies with rehabilitation is believed to promote recovery of motor function; however, current research findings are inconsistent. OBJECTIVES: To explore whether combination therapy involving therapy and rehabilitative training (CIRT) has a synergistic effect on motor function recovery in animal models of SCI. METHODS: We conducted a systematic review and meta-analysis of studies identified in a keyword search of 6 databases and extracted open-field motor scores from the Basso Mouse Scale (BMS) and the Basso, Beattie, and Bresnahan Locomotor Rating Scale (BBB) for meta-analysis using a weighted mean difference (WMD) and 95 % CI. We also performed qualitative synthesis and analysis of secondary outcome measures related to histological improvements and adverse effects. RESULTS: Eighty-seven preclinical studies were included. Combination treatment with treadmill training resulted in a significant improvement in motor function (1.40, 95 % CI 0.82 to 1.98, P < 0.01, I2 = 49 %), especially when initiated 1-2 weeks post-injury (1.77, 95 % CI 1.10 to 2.45, P < 0.01, I2 = 33 %) in rats. In mice, CIRT lasting <6 weeks may enhance recovery (0.95, 95 % CI 0.49 to 1.40, P < 0.01, I2 = 33 %). Although there is a trend toward better outcomes in the chronic phase, insufficient sample sizes prevent definitive conclusions from being drawn. Combined therapy also enhances the reorganization of inhibitory synaptic structures and functions, without aggravating allodynia or spasticity. CONCLUSIONS: This systematic review and meta-analysis suggest that CIRT can lead to superior motor function recovery compared to single-modality therapy (SMT) in animal models of SCI, with no significant adverse effects on allodynia or spasticity. However, the efficacy of CIRT depends on various factors, and further research is needed to establish optimal treatment strategies and understand the underlying mechanisms of recovery.

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Current status of prehabilitation before esophagectomy for patients with esophageal cancer among board-certified hospitals by the Japan Esophageal Society

Harada, T; Tsuji, T; Fukushima, T; Konishi, N; Nakajima, H; Suzuki, K; Ikeda, T; Toyama, S; Matsumori, K; Yanagisawa, T; Hashimoto, K; Kagaya, H; Zenda, S; Kojima, T; Fujita, T; Ueno, J; Hijikata, N; Ishikawa, A; Hayashi, R

ESOPHAGUS （Springer Science and Business Media LLC）  22 （ 3 ） 340 - 348 2025年03月

ISSN  1612-9059

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[Current Status and Future Perspectives of Cancer Rehabilitation].

Tsuji T

Gan to kagaku ryoho. Cancer & chemotherapy 52 （ 2 ） 89 - 95 2025年02月

ISSN  0385-0684

Characteristics of dysarthria in patients with spinocerebellar degeneration and multiple system atrophy: a cross-sectional and longitudinal study using the Frenchay Dysarthria Assessment Second Edition (FDA-2).

Kawabata A, Wada A, Kawakami M, Kaji K, Nakanishi K, Otsuka T, Tsuji T

Frontiers in neurology 16   1734012 - 1734012 2025年

ISSN  1664-2295

　概要を見る

PURPOSE: The purpose of this study was to evaluate the dysarthria of patients with spinocerebellar degeneration and multiple system atrophy (SCD/MSA) cross-sectionally and longitudinally using the Frenchay Dysarthria Assessment Second Edition (FDA-2), which provides a comprehensive assessment of dysarthria, and to clarify characteristic patterns and longitudinal changes. MATERIALS AND METHODS: A total of 21 patients with SCD and MSA were included. Patients' dysarthria was assessed using the FDA-2 and the Scale for the Assessment and Rating of Ataxia (SARA) item 4(SARA speech) at intervals of ≥ 12 months. Changes over time were examined with a paired t-test and Wilcoxon's signed-rank test. Multiple regression analysis explored determinants of speech intelligibility, with FDA-2 intelligibility as the dependent variable and respiration, lips, palate, laryngeal, and tongue subscores as predictors. RESULTS: The number of patients according to disease types was SCA2 in 1, SCA3 in 8, SCA31 in 1, MSA-C in 8, and an undetermined disease type in 3. The examination interval was 31.1 ± 15.6 months. FDA-2 scores were lower for repetitive-movement or speech items than for rest items. Lips and palate subscores were relatively higher, whereas laryngeal and tongue subscores were lower. Over time, reflex, lips, laryngeal, tongue, and total scores declined significantly, whereas the palate, respiration, and intelligibility scores remained stable. Multiple regression identified the laryngeal subscores as the only significant predictor of intelligibility (Sβ = 0.77, p = 0.047). CONCLUSION: The FDA-2 revealed a distinct dysarthria profile in SCD/MSA. Longitudinal FDA-2 monitoring may facilitate early detection and targeted intervention.

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Current Status and Future Perspectives of Cancer Rehabilitation

辻 哲也

Gan To Kagaku Ryoho 52   89 - 95 2025年

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Association of Preoperative Physical Fitness With Post-Esophagectomy Pneumonia in Older With Locally Advanced Esophageal Cancer: An Exploratory Prospective Study

Harada, T; Tsuji, T; Ueno, J; Konishi, N; Yanagisawa, T; Hijikata, N; Ishikawa, A; Hashimoto, K; Kagaya, H; Tatematsu, N; Zenda, S; Kotani, D; Kojima, T; Fujita, T

JOURNAL OF SURGICAL ONCOLOGY （Wiley）  131 （ 7 ） 1284 - 1292 2024年12月

ISSN  0022-4790

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ABSTRACT

Backgrounds

Currently, there is a lack of evidence of prehabilitation during neoadjuvant chemotherapy (NAC) to prevent pneumonia of older patients. This study aimed to investigate the association of preoperative physical fitness after NAC with post‐esophagectomy pneumonia in older patients with locally advanced esophageal cancer (LAEC).

Methods

This single‐center exploratory prospective cohort study included 80 patients aged ≥ 65 years with LAEC scheduled for curative esophagectomy after NAC between 2021 and 2023. The post‐NAC short incremental shuttle walk test (ISWT) by sex was established using the Youden index. The association of the post‐NAC short ISWT with postoperative pneumonia was investigated via Firth's penalized logistic regression model with statistical significance set as two‐tailed p &lt; 0.05.

Results

A total of 69 patients were analyzed. The mean post‐NAC ISWT values were 353.5 m. Short ISWT distance was defined as ≤ 395 and ≤ 195 m for men and women, respectively. Postoperative pneumonia developed in 17 (25%) patients. Short post‐NAC ISWT distance was significantly associated with postoperative pneumonia (adjusted odds ratio: 1.840, 95%CI: 1.760–28.440, p = 0.004).

Conclusions

Decline in physical fitness was associated with post‐esophagectomy pneumonia, which may be a key targeted factor of prehabilitation during NAC for older patients with LAEC.

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Development of a quantitative assessment for abnormal flexor synergy index in patients with stroke: a validity and responsiveness study

Ito, D; Kawakami, M; Hosoi, Y; Kamimoto, T; Yamada, Y; Takemura, R; Tsuji, T

JOURNAL OF NEUROENGINEERING AND REHABILITATION 21 （ 1 ） 229 - 229 2024年12月

　概要を見る

BACKGROUND: Arm-lifting movements (shoulder flexion) are essential for upper extremity rehabilitation after a stroke. Abnormal flexor synergy (elbow flexion) is frequently observed during shoulder flexion, impeding functional improvement. However, no quantitative method exists for assessing abnormal flexor synergy. This study investigated the validity and responsiveness of a newly developed index to quantitatively evaluate abnormal flexor synergy. METHODS: Participants included 103 patients (mean age: 58.0 ± 10.1 years; 64 men, 39 women) with stroke. Using three-dimensional coordinate data during shoulder flexion obtained from a depth sensor camera, we calculated the abnormal flexor synergy based on our developed index. The abnormal flexor synergy index decreases with increasing flexion of the elbow joint during shoulder flexion (the maximum value is 100% without abnormal flexor synergy). The validity of the abnormal flexor synergy index was assessed by analyzing the correlation between the index and both the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) four-category scores and the Modified Ashworth Scale (MAS) scores for elbow, wrist, and finger flexors, using Pearson's and Spearman's correlation coefficients. Responsiveness was studied in 17 inpatients (mean age: 59.5 ± 8.1 years; 7 men, 10 women) who underwent proximal upper extremity intervention for approximately 3 weeks, evaluating change from admission to discharge using the standardized response mean (SRM). RESULTS: Significant correlations were observed between the abnormal flexor synergy index and FMA-UE scores: A (r = 0.625, p < 0.001), B (r = 0.433, p < 0.001), C (r = 0.418, p < 0.001), and D (r = 0.411, p < 0.001), as well as MAS scores for elbow flexors (r = -0.283, p = 0.004) and proximal interphalangeal flexors (r = -0.201, p = 0.042). The highest responsiveness was observed in the FMA-UE A score (SRM = 0.81), followed by the abnormal flexor synergy index (SRM = 0.79). CONCLUSIONS: The newly developed index for assessing abnormal flexor synergy demonstrated superior validity and high responsiveness. These results suggest the potential for using this index to evaluate upper extremity function in patients with stroke.

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Efficacy of Cognitive Stimulation Therapy for Cognition in Patients with Vascular Cognitive Impairment: A Pilot Randomized Controlled Trial.

Mori N, Otaka Y, Ito D, Shimizu A, Narita A, Honaga K, Matsuura D, Kondo K, Liu M, Tsuji T

The Keio journal of medicine 73 （ 4 ） 39 - 46 2024年12月

ISSN  0022-9717

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Cognitive effect of passively induced kinesthetic perception associated with virtual body augmentation modulates spinal reflex

Okada, K; Okawada, M; Yoneta, M; Kuwahara, W; Unai, K; Kawakami, M; Tsuji, T; Kaneko, F

JOURNAL OF NEUROPHYSIOLOGY （American Physiological Society）  133 （ 1 ） 69 - 77 2024年11月

ISSN  0022-3077

　概要を見る

The virtual movement of an augmented body, perceived as part of oneself, forms the basis of kinesthetic perception induced by visual stimulation (KINVIS). KINVIS is a visually induced virtual kinesthetic perception that clinically suppresses spasticity. The present study hypothesized that central neural network activity during KINVIS affects subcortical neural circuits. The present study aimed to elucidate whether reciprocal and presynaptic inhibition occurs during KINVIS. Seventeen healthy participants were recruited (mean age: 27.9 ± 3.6 years), and their soleus Hoffmann-reflexes (H-reflexs) were recorded by peripheral nerve stimulation while perceiving the dorsiflexion kinesthetic illusion in the right-side foot (seated in a comfortable chair). Two control conditions were set to observe the same foot video without the kinesthetic illusion while focusing on the static foot image. Unconditioned H-reflex and two types of conditioned H-reflexes were measured: Ia (reciprocal inhibition) and D1 (presynaptic inhibition). Reciprocal Ia and D1 inhibition of the soleus muscle was significantly enhanced during the kinesthetic illusion compared to the condition without kinesthetic illusion (a post-hoc analysis using the Bonferroni test: Ia inhibition, p = 0.002; D1 inhibition, p = 0.049). This study indicates that kinesthetic illusion elicits an inhibitory effect on the monosynaptic reflex loop of Ia afferents, potentially inhibiting the hyperexcitability of the stretch reflex. These findings demonstrate that brain activity associated with visually induced kinesthetic illusions acts on spinal inhibition circuits. These insights may be valuable in clinical rehabilitation practice, specifically for the treatment of spasticity.

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Clinical mechanism of muscle mass loss during neoadjuvant chemotherapy in older patients with esophageal cancer: a prospective cohort study

Harada, T; Tsuji, T; Ueno, J; Konishi, N; Yanagisawa, T; Hijikata, N; Ishikawa, A; Hashimoto, K; Kagaya, H; Tatematsu, N; Zenda, S; Kotani, D; Kojima, T; Fujita, T

DISEASES OF THE ESOPHAGUS （Oxford University Press (OUP)）  38 （ 1 ）  2024年11月

ISSN  1120-8694

　概要を見る

Abstract

In older patients with locally advanced esophageal cancer (LAEC), loss of skeletal muscle mass during neoadjuvant chemotherapy (NAC) is associated with poor clinical outcomes. This study aimed to investigate factors associated with loss of skeletal muscle mass during NAC in older patients with LAEC. This was a single-center exploratory prospective cohort study. Consecutive patients aged ≥65 years with LAEC scheduled for curative esophagectomy after NAC were enrolled between October 2021 and December 2023. As a primary endpoint, loss of skeletal muscle mass index (ΔSMI: pre-NAC minus post-NAC value) was calculated from computed tomography images before and after NAC. Significant pre-NAC and during-NAC factors with ΔSMI were detected with a multivariate regression model. Statistical significance was considered as two-tailed P &amp;lt;0.05. A total of 69 patients were analyzed. The mean age was 72.9 years, and 53 (77%) were male. Mean SMI before and after NAC was 43.1 and 40.9 cm2/m2, and mean ΔSMI was 2.2 cm2/m2. In multivariate analysis, ΔSMI was associated with increased sitting time during NAC (per 1 min/day, adjusted coefficient 0.007, 95% confidence interval [CI] 0.001 to 0.013, P = 0.016), decreased Geriatric Nutritional Risk Index during NAC (per 1 score, adjusted coefficient −0.146, 95% CI −0.213 to −0.013, P = 0.002), and worsening decreased appetite during NAC (vs. no worsening, adjusted coefficient 1.571, 95% CI 0.279 to 2.862, P = 0.018). It was hypothesized that the inactivity-related mechanism and malnutrition-related mechanism are important for skeletal muscle mass loss during NAC in older patients with LAEC.

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Efficacy of Cognitive Stimulation Therapy for Cognition in Patients with Vascular Cognitive Impairment: A Pilot Randomized Controlled Trial

Mori, N; Otaka, Y; Ito, D; Shimizu, A; Narita, A; Honaga, K; Matsuura, D; Kondo, K; Liu, MG; Tsuji, T

KEIO JOURNAL OF MEDICINE 2024年08月

ISSN  0022-9717

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Efficacy of Cognitive Stimulation Therapy for Cognition in Patients with Vascular Cognitive Impairment: A Pilot Randomized Controlled Trial.

Naoki Mori, Yohei Otaka, Daisuke Ito, Ayaka Shimizu, Ayako Narita, Kaoru Honaga, Daisuke Matsuura, Kunitsugu Kondo, Meigen Liu, Tetsuya Tsuji

The Keio journal of medicine 2024年08月

　概要を見る

The efficacy of cognitive stimulation therapy (CST) in patients with vascular cognitive impairment has not been explored, and no studies investigating CST in the convalescent rehabilitation phase have been reported. This study examined the effect of CST on the cognitive function of patients with vascular cognitive impairment. A randomized controlled, assessor-blinded, single-centered trial with two parallel groups was conducted in a convalescent rehabilitation hospital. Twenty participants were randomly allocated to CST (n=10) and control (n=10) groups. Participants in the CST group underwent two CST sessions a day, five times a week for 8 weeks, in addition to conventional rehabilitation. Participants in the control group underwent conventional rehabilitation only. The primary outcome was the Mini-Mental State Examination (MMSE) score, and the outcome between the groups was compared using a generalized linear mixed model (GLMM). The mean (standard deviation) scores of MMSE increased by 3.50 (3.08) points and 4.50 (1.61) points from baseline to the end of the study (week 8) in the CST and control groups, respectively. The GLMM showed a significant effect of TIME on MMSE (F=21.121, P<0.001), whereas no significant effect on MMSE was observed for GROUP (intervention vs. control, P=0.817) or the interaction term (TIME×GROUP, P=0.649). Although a significant improvement in cognitive function was observed in each group, no significant effect of CST was evident. This result indicates that the effect may have been masked by improvements caused by natural history or rehabilitation. Future studies with a sufficient sample size are required to confirm the findings.

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Feasibility of a Neurorehabilitation Pipeline and an Automated Algorithm to Select Appropriate Treatments for Upper Extremity Motor Paralysis in Individuals With Chronic Stroke

Kuwahara, W; Kawakami, M; Okawada, M; Tanamachi, K; Sasaki, S; Kamimoto, T; Yamada, Y; Tsuji, T; Kaneko, F

AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION （Ovid Technologies (Wolters Kluwer Health)）  104 （ 2 ） 117 - 126 2024年07月

ISSN  0894-9115

　概要を見る

Abstract

Objective

This study aimed to investigate the feasibility of a neurorehabilitation pipeline and develop an algorithm to automatically select the appropriate treatment for individuals with upper extremity motor paralysis after stroke in the chronic phase.

Design

In Experiment 1, eight post-stroke participants in the chronic phase who underwent treatment sustaining two to three phases were assessed before and after treatment. In Experiment 2, a decision tree analysis was performed in which the dependent variable was set as the treatment option determined by a board-certified physiatrist for 95 post-stroke participants; the independent variables were only motor function scores or both motor function scores and electromyogram variables.

Results

In Experiment 1, the clinical assessment scores were improved significantly after treatment. Experiment 2 showed that the agreements of the model with only motor function scores as the dependent variable and with motor function scores and electromyogram variables as the dependent variables were 75.8% and 82.1%, respectively.

Conclusions

This novel treatment package is feasible for improvement of motor function in post-stroke individuals with severe motor paralysis. The study also established an automated algorithm for selecting appropriate treatments for upper extremity motor paralysis after stroke, identifying standard values of key variables, including electromyography variables.

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Do Pharmacological Treatments Act in Collaboration with Rehabilitation in Spinal Cord Injury Treatment? A Review of Preclinical Studies

Tashiro, S; Shibata, S; Nagoshi, N; Zhang, L; Yamada, S; Tsuji, T; Nakamura, M; Okano, H

CELLS 13 （ 5 ）  2024年02月

査読有り

　概要を見る

There is no choice other than rehabilitation as a practical medical treatment to restore impairments or improve activities after acute treatment in people with spinal cord injury (SCI); however, the effect is unremarkable. Therefore, researchers have been seeking effective pharmacological treatments. These will, hopefully, exert a greater effect when combined with rehabilitation. However, no review has specifically summarized the combinatorial effects of rehabilitation with various medical agents. In the current review, which included 43 articles, we summarized the combinatorial effects according to the properties of the medical agents, namely neuromodulation, neurotrophic factors, counteraction to inhibitory factors, and others. The recovery processes promoted by rehabilitation include the regeneration of tracts, neuroprotection, scar tissue reorganization, plasticity of spinal circuits, microenvironmental change in the spinal cord, and enforcement of the musculoskeletal system, which are additive, complementary, or even synergistic with medication in many cases. However, there are some cases that lack interaction or even demonstrate competition between medication and rehabilitation. A large fraction of the combinatorial mechanisms remains to be elucidated, and very few studies have investigated complex combinations of these agents or targeted chronically injured spinal cords.

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Chronic Spinal Cord Injury Regeneration with Combined Therapy Comprising Neural Stem/Progenitor Cell Transplantation, Rehabilitation, and Semaphorin 3A Inhibitor

Yoshida, T; Tashiro, S; Nagoshi, N; Shinozaki, M; Shibata, T; Inoue, M; Ogawa, S; Shibata, S; Tsuji, T; Okano, H; Nakamura, M

ENEURO 11 （ 2 ）  2024年02月

　概要を見る

Spinal cord injury (SCI) often results in various long-term sequelae, and chronically injured spinal cords exhibit a refractory feature, showing a limited response to cell transplantation therapies. To our knowledge, no preclinical studies have reported a treatment approach with results surpassing those of treatment comprising rehabilitation alone. In this study of rats with SCI, we propose a novel combined therapy involving a semaphorin 3A inhibitor (Sema3Ai), which enhances axonal regeneration, as the third treatment element in combination with neural stem/progenitor cell transplantation and rehabilitation. This comprehensive therapeutic strategy achieved significant improvements in host-derived neuronal and oligodendrocyte differentiation at the SCI epicenter and promoted axonal regeneration even in the chronically injured spinal cord. The elongated axons established functional electrical connections, contributing to significant enhancements in locomotor mobility when compared with animals treated with transplantation and rehabilitation. As a result, our combined transplantation, Sema3Ai, and rehabilitation treatment have the potential to serve as a critical step forward for chronic SCI patients, improving their ability to regain motor function.

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Decision Tree Analysis Accurately Predicts Discharge Destination After Spinal Cord Injury Rehabilitation

Kato, C; Uemura, O; Sato, Y; Tsuji, T

ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION 105 （ 1 ） 88 - 94 2024年01月

ISSN  0003-9993

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Functional Outcome Prediction After Spinal Cord Injury Using Ensemble Machine Learning

Kato, C; Uemura, O; Sato, Y; Tsuji, T

ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION 105 （ 1 ） 95 - 100 2024年01月

ISSN  0003-9993

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Efficacy of Cognitive Stimulation Therapy for Cognition in Patients with Vascular Cognitive Impairment: A Pilot Randomized Controlled Trial

Mori, N; Otaka, Y; Ito, D; Shimizu, A; Narita, A; Honaga, K; Matsuura, D; Kondo, K; Liu, MG; Tsuji, T

KEIO JOURNAL OF MEDICINE 73 （ 4 ） 39 - 46 2024年

ISSN  0022-9717

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APPLICATION OF TRANSCRANIAL ALTERNATING CURRENT STIMULATION TO HAND REHABILITATION FOR CHRONIC STROKE PATIENTS WITH SEVERE UPPER LIMB PARESIS - A PHASE I CLINICAL TRIAL

Tashiro, S; Takemi, M; Yamada, S; Tsuji, T

INTERNATIONAL JOURNAL OF STROKE 18 （ 3 ） 430 - 430 2023年10月

ISSN  1747-4930

DMD患者における上肢運動機能障害度分類の併存的妥当性の検討

宮崎 裕大, 原 貴敏, 上村 亜希子, 山野 真弓, 萩原 和樹, 西田 大輔, 竹下 絵里, 小牧 宏文, 水野 勝広, 辻 哲也, 安保 雅博

国立病院総合医学会講演抄録集 （国立病院総合医学会）  77回   643 - 643 2023年10月

DMD患者における上肢運動機能障害度分類の併存的妥当性の検討

宮崎 裕大, 原 貴敏, 上村 亜希子, 山野 真弓, 萩原 和樹, 西田 大輔, 竹下 絵里, 小牧 宏文, 水野 勝広, 辻 哲也, 安保 雅博

国立病院総合医学会講演抄録集 （国立病院総合医学会）  77回   643 - 643 2023年10月

Charcot-Marie-Tooth病における短下肢装具療法の治療効果を定量的に評価した1例

宮崎 裕大, 原 貴敏, 加藤 太郎, 西田 大輔, 萩原 和樹, 安保 雅博, 辻 哲也

臨床神経生理学 （(一社)日本臨床神経生理学会）  51 （ 5 ） 577 - 577 2023年10月

ISSN  1345-7101

Charcot-Marie-Tooth病における短下肢装具療法の治療効果を定量的に評価した1例

宮崎 裕大, 原 貴敏, 加藤 太郎, 西田 大輔, 萩原 和樹, 安保 雅博, 辻 哲也

臨床神経生理学 （(一社)日本臨床神経生理学会）  51 （ 5 ） 577 - 577 2023年10月

ISSN  1345-7101

Charcot-Marie-Tooth病における短下肢装具療法の治療効果を定量的に評価した1例

宮崎 裕大, 原 貴敏, 加藤 太郎, 西田 大輔, 萩原 和樹, 安保 雅博, 辻 哲也

臨床神経生理学 （(一社)日本臨床神経生理学会）  51 （ 5 ） 577 - 577 2023年10月

ISSN  1345-7101

Association of sarcopenia with relative dose intensity of neoadjuvant chemotherapy in older patients with locally advanced esophageal cancer: A retrospective cohort study

Harada, T; Tsuji, T; Ueno, J; Hijikata, N; Ishikawa, A; Kotani, D; Kojima, T; Fujita, T

JOURNAL OF GERIATRIC ONCOLOGY （Elsevier BV）  14 （ 7 ） 101580 - 101580 2023年09月

ISSN  1879-4068

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Comparing the contribution of each clinical indicator in predictive models trained on 980 subacute stroke patients: a retrospective study

Miyazaki, Y; Kawakami, M; Kondo, K; Tsujikawa, M; Honaga, K; Suzuki, K; Tsuji, T

SCIENTIFIC REPORTS （Springer Science and Business Media LLC）  13 （ 1 ） 12324 2023年07月

ISSN  2045-2322

　概要を見る

Abstract

Post-stroke disability affects patients’ lifestyles after discharge, and it is essential to predict functional recovery early in hospitalization to allow time for appropriate decisions. Previous studies reported important clinical indicators, but only a few clinical indicators were analyzed due to insufficient numbers of cases. Although review articles can exhaustively identify many prognostic factors, it remains impossible to compare the contribution of each predictor. This study aimed to determine which clinical indicators contribute more to predicting the functional independence measure (FIM) at discharge by comparing standardized coefficients. In this study, 980 participants were enrolled to build predictive models with 32 clinical indicators, including the stroke impairment assessment set (SIAS). Trunk function had the most significant standardized coefficient of 0.221. The predictive models also identified easy FIM sub-items, SIAS, and grip strength on the unaffected side as having positive standardized coefficients. As for the predictive accuracy of this model, R² was 0.741. This is the first report that included FIM sub-items separately in post-stroke predictive models with other clinical indicators. Trunk function and easy FIM sub-items were included in the predictive model with larger positive standardized coefficients. This predictive model may predict prognosis with high accuracy, fewer clinical indicators, and less effort to predict.

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COVID-19と誤嚥性肺炎による嚥下障害悪化にリハビリテーション治療が有効であったレット症候群の一例

堀川 ゆい子, 大森 まいこ, 中井 咲貴子, 久保 悠, 益田 結子, 岡 亜沙子, 朝倉 めぐみ, 櫛田 幸, 杉山 遥, 辻 哲也

The Japanese Journal of Rehabilitation Medicine （(公社)日本リハビリテーション医学会）  60 （ 特別号 ） 3 - 8 2023年05月

ISSN  1881-3526

Electrically Induced Sensory Trick in a Patient with Musician's Dystonia: A Case Report

Nishida, D; Mizuno, K; Takahashi, O; Liu, MG; Tsuji, T

BRAIN SCIENCES 13 （ 2 ）  2023年01月

ISSN  2076-3425

　概要を見る

A sensory trick is a specific maneuver that temporarily improves focal dystonia. We describe a case of musician's dystonia in the right-hand fingers of a patient, who showed good and immediate improvement after using an electrical stimulation-mimicking sensory trick. A 49-year-old professional guitarist presented with chronic involuntary flexion of the right-hand third and fourth fingers that occurred during guitar performances. Electrical stimulation with a frequency of 40 Hz and an intensity of 1.5 times the sensory threshold was administered on the third and fourth fingernails of the right hand, which facilitated fluent guitar playing. While he played guitar with and without electrical stimulation, we measured the surface electromyograms (sEMG) of the right extensor digitorum and flexor digitorum superficialis muscles to evaluate the sensory-trick-like effects of electrical stimulation. This phenomenon can offer clues for developing electrical stimulation-based treatment devices for focal dystonia. Electrical stimulation has the advantage that it can be turned off to avoid habituation. Moreover, the device is easy to use and portable. These findings warrant further investigation into the use of sensory stimulation for treating focal dystonia.

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Early Phase Functional Recovery after Spinal Intramedullary Tumor Resection Could Predict Ambulatory Capacity at 1 Year after Surgery

Suzuki, T; Tsuji, O; Ichikawa, M; Ishii, R; Nagoshi, N; Kawakami, M; Watanabe, K; Matsumoto, M; Tsuji, T; Fujiwara, T; Nakamura, M

ASIAN SPINE JOURNAL 17 （ 2 ） 355 - 364 2023年01月

ISSN  1976-1902

　概要を見る

STUDY DESIGN: This is a single-center retrospective cohort study with a university hospital setting. PURPOSE: This study aims to evaluate the short-term course of physical function and walking ability after intramedullary spinal cord tumor (ISCT) resection and predict walking independence 1 year after surgery. OVERVIEW OF LITERATURE: Although several reports have shown the postoperative functional prognosis of spinal intramedullary tumors with long-term follow-up, no reports have identified the predictors associated with the functional outcome at an early stage. METHODS: A total of 79 individuals who underwent ISCT resection at our institute between 2014 and 2019 were enrolled in the study, whose preoperative walking state was independent ambulator regardless of cane support with the Functional Independence Measure Locomotor Scale (FIM-L) score of ≥6. The FIM-L, the American Spinal Injury Association (ASIA) motor and sensory scores in the lower extremities, and the Walking Index for Spinal Cord Injury II (WISCI II) were assessed for walking independence, lower-limb function, and walking ability, respectively. These evaluations were performed at 4 time points: preoperatively, 1 week (1W), 2 weeks (2W), and 1 year after surgery. RESULTS: In the early phase after surgery, 71% and 43% of the participants were nonindependent ambulators at 1W and 2W, respectively. Histopathology indicated that patients with solid tumors (ependymoma, astrocytoma, or lipoma) showed significantly lower indices at 1W and 2W than those with vascular tumors (hemangioblastoma or cavernous hemangioma). Regarding tumor location, thoracic cases exhibited poorer lower-limb function at 1W and 2W and poorer walking ability at 2W than cervical cases. According to the receiver operating characteristic (ROC) analysis, 2 WISCI II points at 2W had the highest sensitivity (100%) and specificity (92.2%) in predicting the level of walking independence at 1 year postoperatively (the area under the ROC curve was 0.99 (95% confidence interval, 0.93-1.00). CONCLUSIONS: The higher the lower-limb function scores in the early phase, the better the improvement in walking ability is predicted 1 year after ISCT resection.

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Combined Ankle Robot Training and Robot-assisted Gait Training Improved the Gait Pattern of a Patient with Chronic Traumatic Brain Injury

Kamimoto, T; Hosoi, Y; Tanamachi, K; Yamamoto, R; Yamada, Y; Teramae, T; Noda, T; Kaneko, F; Tsuji, T; Kawakami, M

Progress in Rehabilitation Medicine （公益社団法人 日本リハビリテーション医学会）  8 （ 0 ） n/a - n/a 2023年

　概要を見る

<p><b>Background </b>: Walking disability caused by central nervous system injury often lingers. In the chronic phase, there is great need to improve walking speed and gait, even for patients who walk independently. Robot-assisted gait training (RAGT) has been widely used, but few studies have focused on improving gait patterns, and its effectiveness for motor function has been limited. This report describes the combination of “RAGT to learn the gait pattern” and “ankle robot training to improve motor function” in a patient with chronic stage brain injury.</p><p><b>Case </b>: A 34-year-old woman suffered a traumatic brain injury 5 years ago. She had residual right hemiplegia [Fugl-Meyer Assessment-Lower Extremity (FMA-LE): 18 points] and mild sensory impairment, but she walked independently with a short leg brace and a cane. Her comfortable gait speed was 0.57 m/s without an orthosis, and her 6-m walk test distance was 240 m. The Gait Assessment and Intervention Tool (G.A.I.T.) score was 35 points. After hospitalization, ankle robot training was performed daily, with RAGT performed 10 times in total. Post-intervention evaluation performed on Day 28 showed: FMA-LE, 23 points; comfortable walking speed, 0.69 m/s; G.A.I.T., 27 points; and three-dimensional motion analysis showed ankle dorsiflexion improved from 3.22° to 12.59° and knee flexion improved from 1.75° to 16.54° in the swing phase.</p><p><b>Discussion </b>: This is one of few studies to have examined the combination of two robots. Combining the features of each robot improved the gait pattern and motor function, even in the chronic phase.</p>

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Effect of Postoperative Oral Intake Status on Sarcopenia Six Months After Esophageal Cancer Surgery (Jun, 10.1007/s00455-022-10471-z, 2022)

Hijikata, N; Ishikawa, A; Matsuda, S; Kawakami, M; Muraoka, K; Ando, M; Mayanagi, S; Irino, T; Kawakubo, H; Kitagawa, Y; Tsuji, T

DYSPHAGIA 38 （ 1 ） 351 - 352 2022年12月

ISSN  0179-051X

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ASO Author Reflections: Significance of Loss of Skeletal Muscle Mass During Neoadjuvant Chemotherapy in Older Patients with Esophageal Cancer

Harada, T; Tsuji, T; Fujita, T

ANNALS OF SURGICAL ONCOLOGY 29 （ 13 ） 8140 - 8141 2022年12月

ISSN  1068-9265

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Cognitive function is associated with home discharge in subacute stroke patients: a retrospective cohort study

Daisuke Ito, Michiyuki Kawakami, Ryota Ishii, Masahiro Tsujikawa, Kaoru Honaga, Kunitsugu Kondo, Tetsuya Tsuji

BMC Neurology （Springer Science and Business Media LLC）  22 （ 1 ）  2022年12月

　概要を見る

Abstract

Aim

To investigate the cognitive function and its relation to the home discharge of patients following subacute stroke.

Methods

This retrospective cohort study included 1,229 convalescent patients experiencing their first subacute stroke. We determined discharge destination and demographic and clinical information. We recorded the following measurement scores: Mini-Mental State Examination (MMSE) score, Stroke Impairment Assessment Set score, grip strength, and Functional Independence Measure (FIM). We performed a multivariable logistic regression analysis with the forced-entry method to identify factors related to home discharge.

Results

Of the 1,229 participants (mean age: 68.7 ± 13.5 years), 501 (40.8%), 735 (59.8%), and 1,011 (82.3%) were female, had cerebral infarction, and were home discharged, respectively. Multivariable logistic regression analysis revealed that age (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.91 – 0.96; P &lt; 0.001), duration from stroke onset to admission (OR, 0.98; 95% CI, 0.96 – 0.99; P = 0.003), living situation (OR, 4.40; 95% CI, 2.69 – 7.20; P &lt; 0.001), MMSE score at admission (OR, 1.05; 95% CI, 1.00 – 1.09; P = 0.035), FIM motor score at admission (OR, 1.04; 95% CI, 1.01 – 1.06; P = 0.001), and FIM cognitive score at admission (OR, 1.08; 95% CI, 1.04 – 1.13; P &lt; 0.001) were significantly associated with home discharge.

Conclusions

MMSE at admission is significantly associated with home discharge in patients with subacute stroke.

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ASO Visual Abstract: Prognostic Impact of the Loss of Skeletal Muscle Mass during Neoadjuvant Chemotherapy on Older Patients with Esophageal Cancer

Harada, T; Tsuji, T; Ueno, J; Koishihara, Y; Konishi, N; Hijikata, N; Ishikawa, A; Kotani, D; Kojima, T; Fujiwara, H; Fujita, T

ANNALS OF SURGICAL ONCOLOGY 29 （ 13 ） 8142 - 8143 2022年12月

ISSN  1068-9265

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Effects of the COVID-19 Pandemic on Physical Function of Community-Dwelling People with Disabilities in Japan

Kamimoto, T; Kawakami, M; Morita, T; Miyazaki, Y; Hijikata, N; Akimoto, T; Tsujikawa, M; Honaga, K; Suzuki, K; Kondo, K; Tsuji, T

INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 19 （ 19 ）  2022年10月

ISSN  1661-7827

　概要を見る

In 2020, COVID-19 spread throughout the world, and international measures such as travel bans, quarantines, and increased social distancing were implemented. In Japan, the number of infected people increased, and a state of emergency was declared from 16 April to 25 May 2020. Such a change in physical activity could lead to a decline in physical function in people with disabilities. A retrospective study was conducted to determine the impact of the pandemic on the physical function of disabled persons living in the community. Data were collected at four points in time: two points before the declaration of the state of emergency was issued and two points after the declaration period had ended. Time series data of physical function at four points in time were compared for 241 people with disabilities. The mean age was 72.39 years; 157 had stroke, 59 musculoskeletal disease, and 26 other diseases. Overall, there was a long-term decrease in walking speed (p &lt; 0.001) and a worsening of the Timed Up-and-Go (TUG) score (p &lt; 0.001) after the period of the state of emergency. The TUG score worsened only in the group with a walking speed of 1.0 m/s or less before the state of emergency (p = 0.064), suggesting that this group was more susceptible.

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ASO Author Reflections: Significance of Postoperative Loss of Skeletal Muscle Mass in Older Patients with Esophageal Cancer

Harada, T; Tsuji, T; Fujita, T

ANNALS OF SURGICAL ONCOLOGY 29 （ 9 ） 5646 - 5647 2022年09月

ISSN  1068-9265

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ASO Visual Abstract: Prognostic Impact of Postoperative Loss of Skeletal Muscle Mass in Patients Aged 70 Years or Older with Esophageal Cancer

Harada, T; Tatematsu, N; Ueno, J; Koishihara, Y; Konishi, N; Hijikata, N; Ishikawa, A; Tsuji, T; Fujiwara, H; Fujita, T

ANNALS OF SURGICAL ONCOLOGY 29 （ 9 ） 5648 - 5648 2022年09月

ISSN  1068-9265

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COVID-19肺炎後に運動療法を含む外来呼吸リハビリテーション治療により運動耐容能の向上を認めた一症例

平部 顕子, 大森 まいこ, 田代 祥一, 山崎 俊槻, 益田 結子, 中館 陽恵, 岡 阿沙子, 櫛田 幸, 杉山 瑶, 辻 哲也

日本運動療法学会大会抄録集 （日本運動療法学会）  47回   33 - 33 2022年07月

Effect of Postoperative Oral Intake Status on Sarcopenia Six Months After Esophageal Cancer Surgery

Hijikata, N; Ishikawa, A; Matsuda, S; Kawakami, M; Muraoka, K; Ando, M; Mayanagi, S; Irino, T; Kawakubo, H; Kitagawa, Y; Tsuji, T

DYSPHAGIA 38 （ 1 ） 340 - 350 2022年06月

ISSN  0179-051X

　概要を見る

PURPOSE: In patients with esophageal cancer, skeletal muscle mass has been reported to decrease progressively after surgery and be independently associated with a poor prognosis. The purpose of this study was to investigate perioperative changes in dysphagia, oral intake status, and nutritional status and identify factors related to sarcopenia 6 months after esophagectomy. METHODS: A total of 134 patients who underwent radical resection for thoracic esophageal cancer between March 2016 and July 2019 were analyzed retrospectively. The diagnosis of sarcopenia was made by CT taken 6 months postoperatively using the cut-off criteria of skeletal muscle index (SMI) < 52.4 cm2/m2 for male and SMI < 38.5 cm2/m2 for female patients. As factors related to postoperative sarcopenia, dysphagia, oral intake status, nutritional status, and physical function were extracted from the medical records. Multivariate logistic regression analysis was performed to identify perioperative risk factors related to sarcopenia 6 months after surgery. RESULTS: Of the 134 patients, 34.3% were judged to be unable to start oral intake on swallowing assessment. At discharge, 30.6% received tube feeding with or without oral intake. In the non-oral intake group on swallowing assessment, a significantly higher proportion of patients received tube feeding at discharge (p = 0.014). Preoperative BMI, postoperative handgrip strength, and tube feeding at discharge were independent risk factors for sarcopenia 6 months after esophagectomy in male patients. CONCLUSION: Tube feeding at discharge is significantly related to postoperative sarcopenia in patients with esophageal cancer. Identifying high-risk groups might allow early detection of malnutrition and provision of appropriate care.

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Cognitive function is associated with home discharge in subacute stroke patients: a retrospective cohort study

Ito, D; Kawakami, M; Ishii, R; Tsujikawa, M; Honaga, K; Kondo, K; Tsuji, T

BMC NEUROLOGY 22 （ 1 ）  2022年06月

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Cognitive function is associated with home discharge in subacute stroke patients: a retrospective cohort study.

Ito D, Kawakami M, Ishii R, Tsujikawa M, Honaga K, Kondo K, Tsuji T

BMC neurology 22 （ 1 ） 219 2022年06月

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Cognitive function is associated with home discharge in subacute stroke patients: a retrospective cohort study.

Daisuke Ito, Michiyuki Kawakami, Ryota Ishii, Masahiro Tsujikawa, Kaoru Honaga, Kunitsugu Kondo, Tetsuya Tsuji

BMC neurology 22 （ 1 ） 219 - 219 2022年06月

　概要を見る

AIM: To investigate the cognitive function and its relation to the home discharge of patients following subacute stroke. METHODS: This retrospective cohort study included 1,229 convalescent patients experiencing their first subacute stroke. We determined discharge destination and demographic and clinical information. We recorded the following measurement scores: Mini-Mental State Examination (MMSE) score, Stroke Impairment Assessment Set score, grip strength, and Functional Independence Measure (FIM). We performed a multivariable logistic regression analysis with the forced-entry method to identify factors related to home discharge. RESULTS: Of the 1,229 participants (mean age: 68.7 ± 13.5 years), 501 (40.8%), 735 (59.8%), and 1,011 (82.3%) were female, had cerebral infarction, and were home discharged, respectively. Multivariable logistic regression analysis revealed that age (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.91 - 0.96; P < 0.001), duration from stroke onset to admission (OR, 0.98; 95% CI, 0.96 - 0.99; P = 0.003), living situation (OR, 4.40; 95% CI, 2.69 - 7.20; P < 0.001), MMSE score at admission (OR, 1.05; 95% CI, 1.00 - 1.09; P = 0.035), FIM motor score at admission (OR, 1.04; 95% CI, 1.01 - 1.06; P = 0.001), and FIM cognitive score at admission (OR, 1.08; 95% CI, 1.04 - 1.13; P < 0.001) were significantly associated with home discharge. CONCLUSIONS: MMSE at admission is significantly associated with home discharge in patients with subacute stroke.

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Effects of Galvanic Vestibular Stimulation on Subjective Visual Vertical and Sitting Balance in Patients with Stroke

Tomioka, Y; Tohyama, T; Honaga, K; Kawakami, M; Kondo, K; Tsuji, T

JOURNAL OF STROKE & CEREBROVASCULAR DISEASES 31 （ 5 ） 106430 - 106430 2022年05月

ISSN  1052-3057

　概要を見る

OBJECTIVE: This study aimed to examine the effects of galvanic vestibular stimulation (GVS) on visual vertical cognition and sitting balance in stroke patients. MATERIALS AND METHODS: Patients with unilateral supratentorial infarction and hemorrhagic lesions and healthy controls were recruited. Bipolar GVS was performed through the bilateral mastoid processes with an 1.5-mA electric current. Each participant received three stimulation patterns: right anode-left cathode, left anode-right cathode, and sham. The subjective visual vertical (SVV) and center of gravity positions in the sitting posture were measured in three groups of participants: patients with right hemisphere lesions, patients with left hemisphere lesions, and in healthy controls. Changes in the SVV and center of gravity positions before and during galvanic vestibular stimulation were assessed. RESULTS: In each group, eight individuals were recruited for SVV measurements and nine individuals for center of gravity measurements. We found changes due to polarity of stimulation on the SVV and mediolateral changes in the center of gravity in the sitting position of patients with stroke, while there was no significant difference between groups or interaction of the two factors (polarity vs. group). CONCLUSION: Changes in the visual vertical cognition and sitting balance occur during GVS in patients with stroke. GVS is a potential tool for ameliorating balance dysfunction in patients with stroke.

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Differences in the Relationships Between Muscle Strength, Muscle Mass, Balance Function, and Quality of Life for Middle-Aged and Older Breast Cancer Survivors

Morishita, S; Kasahara, R; Yamamoto, Y; Jinbo, R; Takano, A; Yasuda, M; Tsubaki, A; Aoki, O; Fu, JB; Tsuji, T

INTEGRATIVE CANCER THERAPIES 21   15347354221138574 - 15347354221138574 2022年

ISSN  1534-7354

　概要を見る

PURPOSE: The purpose of this study was to investigate the differences in muscle strength, muscle mass, balance function, and quality of life (QOL) among middle-aged breast cancer survivors (BCSs) and older BCSs. METHODS: The study included 53 middle-aged (<65 years old) BCSs and 49 older (≥65 years old) BCSs. Muscle strength was evaluated via handgrip and knee extensor strength, and muscle mass was assessed using a body composition test. Balance function was assessed using the Timed Up and Go test and the body sway test. QOL was assessed using the Medical Outcome Study 36-item Short-Form Health Survey. RESULTS: The older BCSs had significantly lower right grip strength, right knee extension strength, and muscle mass (P < .05) than the middle-aged BCSs. In addition, the body sway test showed that older BCSs had a significant increase in the length of center of pressure compared to middle-aged BCSs (P < .05). Older BCSs showed significantly lower physical functioning subscales in QOL compared to middle-aged BCSs (P < .05). The associations among muscle strength, muscle mass and QOL were more significantly observed in the older BCSs (P < .05). Furthermore, a significant correlation between QOL and balance function was observed in the older BCSs, but not in the middle-aged BCSs (P < .05). CONCLUSION: There may be associations among muscle strength, muscle mass, balance and QOL in older BCSs, but not in middle-aged BCSs. We believe that the findings of this study will be relevant in the context of planning rehabilitation for older BCSs.

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Cancer Rehabilitation Provided by Designated Cancer Hospitals in Japan: The Current State of Outpatient Setting and Coordination after Discharge

Fukushima, T; Tsuji, T; Watanabe, N; Sakurai, T; Matsuoka, A; Kojima, K; Yahiro, S; Oki, M; Okita, Y; Yokota, S; Nakano, J; Sugihara, S; Sato, H; Kawakami, J; Kagaya, H; Tanuma, A; Sekine, R; Mori, K; Zenda, S; Kawai, A

Progress in Rehabilitation Medicine （公益社団法人 日本リハビリテーション医学会）  7 （ 0 ） n/a - n/a 2022年

　概要を見る

<p><b>Objectives: </b>The aim of the present study was to clarify the current state of outpatient cancer rehabilitation and coordination systems provided by designated cancer hospitals in Japan.</p><p><b>Methods: </b>A questionnaire was sent to 427 designated cancer hospitals in Japan to investigate the status of outpatient cancer rehabilitation and whether it was sufficiently conducted. The status of regional coordination with post-discharge rehabilitation facilities was surveyed.</p><p><b>Results: </b>Responses were received from 235/427 facilities (55.0%). Outpatient cancer rehabilitation was implemented in 92 (39.1% of responding facilities), and of these facilities, 83.7% answered that the provision of rehabilitation was insufficient. The reasons were ineligibility for reimbursement of medical fees, a lack of human resources, a lack of awareness of the need, and a lack of education. Regional coordination was conducted by 39.1% of responding facilities, yet a regional alliance path had been established in only 9.8% of centers. The absence of coordination was associated with large facility size, the absence of physiatrists, and few rehabilitation professionals who had completed the training program; an insufficient framework for regional coordination was also given as a reason.</p><p><b>Conclusions: </b>To provide adequate outpatient cancer rehabilitation, sufficient human resources, the reimbursement of medical fees in the outpatient setting, and education and a framework to promote regional coordination are necessary.</p>

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Current progress of rehabilitative strategies in stem cell therapy for spinal cord injury: a review

Tashiro, S; Tsuji, O; Shinozaki, M; Shibata, T; Yoshida, T; Tomioka, Y; Unai, K; Kondo, T; Itakura, G; Kobayashi, Y; Yasuda, A; Nori, S; Fujiyoshi, K; Nagoshi, N; Kawakami, M; Uemura, O; Yamada, S; Tsuji, T; Okano, H; Nakamura, M

NPJ REGENERATIVE MEDICINE 6 （ 1 ） 81 - 81 2021年11月

　概要を見る

Stem cell-based regenerative therapy has opened an avenue for functional recovery of patients with spinal cord injury (SCI). Regenerative rehabilitation is attracting wide attention owing to its synergistic effects, feasibility, non-invasiveness, and diverse and systemic properties. In this review article, we summarize the features of rehabilitation, describe the mechanism of combinatorial treatment, and discuss regenerative rehabilitation in the context of SCI. Although conventional rehabilitative methods have commonly been implemented alone, especially in studies of acute-to-subacute SCI, the combinatorial effects of intensive and advanced methods, including various neurorehabilitative approaches, have also been reported. Separating the concept of combined rehabilitation from regenerative rehabilitation, we suggest that the main roles of regenerative rehabilitation can be categorized as conditioning/reconditioning, functional training, and physical exercise, all of which are indispensable for enhancing functional recovery achieved using stem cell therapies.

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FACTORS ASSOCIATED WITH COGNITIVE IMPROVEMENT IN SUBACUTE STROKE SURVIVORS

Mori, N; Otaka, Y; Honaga, K; Matsuura, D; Kondo, K; Liu, M; Tsuji, T

JOURNAL OF REHABILITATION MEDICINE 53 （ 8 ） jrm00220 2021年08月

ISSN  1650-1977

　概要を見る

OBJECTIVE: To elucidate the characteristics of subacute stroke survivors with post-stroke cognitive impairment, and examine the factors associated with cognitive recovery. DESIGN: Retrospective cohort study. PARTICIPANTS: A total of 218 consecutive stroke survivors, who were admitted to a rehabilitation hospital between April 2014 and March 2015, were included. METHODS: The prevalence of post-stroke cognitive impairment, defined as having a Mini-Mental State Examination (MMSE) score < 24 was investigated. Among those with post-stroke cognitive impairment, the characteristics of patients with clinically significant improvement in MMSE scores (change ≥ 4) were explored. Univariable and multivariable regression analyses were performed to examine the relationship between Functional Independence Measure (FIM) items and improvement in post-stroke cognitive impairment. RESULTS: Post-stroke cognitive impairment occurred in 47.7% of participants. The mean improvement in their MMSE scores was 3.43. Participants who showed improvement had significantly higher FIM scores at discharge than those who did not show improvement. Regarding FIM items, eating (odds ratio 1.3; 95% confidence interval 1.0-1.7; p = 0.041) and social interaction (odds ratio 1.5, 95% CI 1.1-2.1, p = 0.010) were associated with cognitive improvement. CONCLUSION: Approximately half of subacute stroke survivors have post-stroke cognitive impairment. Eating and social interaction are significantly associated with cognitive improvement.

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Development of home-based resistance training for older patients with advanced cancer: The exercise component of the nutrition and exercise treatment for advanced cancer program

Tatematsu, N; Naito, T; Okayama, T; Tsuji, T; Iwamura, A; Tanuma, A; Mitsunaga, S; Miura, S; Omae, K; Mori, K; Takayama, K

JOURNAL OF GERIATRIC ONCOLOGY 12 （ 6 ） 952 - 955 2021年07月

ISSN  1879-4068

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Conservative rehabilitation for a patient presenting with severe orthostatic hypotension after surgical management of brainstem tumor: illustrative case

Nagumo, M; Tashiro, S; Hijikata, N; Ishikawa, A; Akiyama, T; Tsuji, T

JOURNAL OF NEUROSURGERY-CASE LESSONS 1 （ 25 ） CASE2136 2021年06月

　概要を見る

BACKGROUND: Blood pressure (BP) dysregulation is frequently observed in patients after surgical management of brainstem lesions; however, there has been no standard rehabilitation. Considering the conflicting risks for hypoperfusion and disuse syndrome in these patients, a safe and effective rehabilitative strategy is warranted. OBSERVATIONS: A 50-year-old man who had undergone craniotomy for resection of a recurrent dorsal medullary epidermoid cyst developed persistent orthostatic hypotension. It was resistant to physical exercise, pharmacological therapy, abdominal binders, and compression stockings; therefore, it inhibited postoperative rehabilitation. Although the responsible lesion was not clearly visible on the postoperative image, accompanying symptoms, including segmental sensory impairment, implied an improvement in BP control. Although there was a trade-off between the risk of developing disuse syndrome and a delay in functional recovery, the authors decided to continue a conservative rehabilitation strategy rather than increasing the workload. The patient's BP control was gradually restored by the seventh postoperative week, and the authors proceeded with basic activity training. LESSONS: A conservative prognostic prediction-based rehabilitation strategy was applied in this case. The precise evaluation of the accompanying neurological symptoms was helpful in deciding the treatment regimen. The conflicting risks for hypoperfusion and disuse syndrome in such cases must be considered.

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Correlation between the brain activity with gait imagery and gait performance in adults with Parkinson's disease: A data set

Nishida, D; Mizuno, K; Yamada, E; Tsuji, T; Hanakawa, T; Liu, MG

DATA IN BRIEF 36   106993 - 106993 2021年06月

ISSN  2352-3409

　概要を見る

This article describes data related to the research study entitled "The neural correlate of gait improvement by rhythmic sound stimulation in adults with Parkinson's disease - A functional magnetic resonance imaging study" [1]. We evaluated gait performance using the 10-meter walk test (10MWT) in adults with Parkinson's disease (PD) and age-matched healthy controls (HC). Gait speed (GS) and step length (SL) were calculated from the results of the 10MWT. We also evaluated neural activities in regions that were significantly activated by gait imagery in adults with PD using functional magnetic resonance imaging (fMRI). The correlation among GS, SL, and activation of blood oxygenation level-dependent (BOLD) signals by gait imagery in adults with PD. Both GS and SL were smaller in adults with PD than in HCs. The left parietal operculum (PO), left supplementary motor area (SMA), and right cerebellum were activated by gait imagery in adults with PD. No significant correlation was found in any pair of gait performance and neural activation of such regions. This data set could be reused for studies to investigate the relationship between gait performance and neural activities in adults with PD.

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Fugl-Meyer Assessment上肢運動項目の難易度-回復期脳卒中患者での検討

新藤 恵一郎, 森 直樹, 辻川 将弘, 紙本 貴之, 下村 忠賛, 秋本 知則, 中尾 桂子, 川上 途行, 辻 哲也, 近藤 国嗣

The Japanese Journal of Rehabilitation Medicine （(公社)日本リハビリテーション医学会）  58 （ 特別号 ） 2 - 3 2021年05月

ISSN  1881-3526

Fugl-Meyer Assessment上肢運動項目の難易度-回復期脳卒中患者での検討

新藤 恵一郎, 森 直樹, 辻川 将弘, 紙本 貴之, 下村 忠賛, 秋本 知則, 中尾 桂子, 川上 途行, 辻 哲也, 近藤 国嗣

The Japanese Journal of Rehabilitation Medicine （(公社)日本リハビリテーション医学会）  58 （ 特別号 ） 2 - 3 2021年05月

ISSN  1881-3526

COVID-19感染拡大下におけるエアロゾル発生を伴う診療への非対面リハビリテーション診療の試み

田島 浩之, 和田 彩子, 川上 途行, 山田 祐歌, 森 直樹, 石川 愛子, 辻 哲也

The Japanese Journal of Rehabilitation Medicine （(公社)日本リハビリテーション医学会）  58 （ 特別号 ） 2 - 2 2021年05月

ISSN  1881-3526

COVID-19感染拡大下におけるエアロゾル発生を伴う診療への非対面リハビリテーション診療の試み

田島 浩之, 和田 彩子, 川上 途行, 山田 祐歌, 森 直樹, 石川 愛子, 辻 哲也

The Japanese Journal of Rehabilitation Medicine （(公社)日本リハビリテーション医学会）  58 （ 特別号 ） 2 - 2 2021年05月

ISSN  1881-3526

COVID-19感染拡大下におけるエアロゾル発生を伴う診療への非対面リハビリテーション診療の試み

田島 浩之, 和田 彩子, 川上 途行, 山田 祐歌, 森 直樹, 石川 愛子, 辻 哲也

The Japanese Journal of Rehabilitation Medicine （(公社)日本リハビリテーション医学会）  58 （ 特別号 ） 2 - 15 2021年05月

ISSN  1881-3526

COVID-19の感染拡大による、通所リハビリテーションの利用自粛に伴う身体機能低下

紙本 貴之, 川上 途行, 平部 顕子, 宮崎 裕大, 土方 奈奈子, 山田 健, 秋本 知則, 辻川 将弘, 鈴木 幹次郎, 忽那 岳志, 平松 和嗣久, 近藤 国嗣, 辻 哲也

The Japanese Journal of Rehabilitation Medicine （(公社)日本リハビリテーション医学会）  58 （ 特別号 ） 1 - 2 2021年05月

ISSN  1881-3526

COVID-19の感染拡大による、通所リハビリテーションの利用自粛に伴う身体機能低下

紙本 貴之, 川上 途行, 平部 顕子, 宮崎 裕大, 土方 奈奈子, 山田 健, 秋本 知則, 辻川 将弘, 鈴木 幹次郎, 忽那 岳志, 平松 和嗣久, 近藤 国嗣, 辻 哲也

The Japanese Journal of Rehabilitation Medicine （(公社)日本リハビリテーション医学会）  58 （ 特別号 ） 1 - 2 2021年05月

ISSN  1881-3526

Functional Status and Instrumental Activities of Daily Living After Transcatheter Aortic Valve Replacement

Fukui, S; Kawakami, M; Hayashida, K; Ishikawa, A; Mori, N; Oguma, Y; Fukuda, K; Tsuji, T

TOPICS IN GERIATRIC REHABILITATION （Ovid Technologies (Wolters Kluwer Health)）  37 （ 2 ） 128 - 131 2021年04月

ISSN  0882-7524

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Effect of Prism Adaptation Therapy on the Activities of Daily Living and Awareness for Spatial Neglect: A Secondary Analysis of the Randomized, Controlled Trial

Mizuno, K; Tsujimoto, K; Tsuji, T

BRAIN SCIENCES 11 （ 3 ）  2021年03月

ISSN  2076-3425

　概要を見る

BACKGROUND: Rehabilitation for unilateral spatial neglect (USN) using prism adaptation (PA) is one of the most widely used methods, and the effectiveness of PA is well-evidenced. Although the effect of PA generalized various neglect symptoms, the effectiveness for some aspects of neglect is not fully proven. The Catherine Bergego Scale (CBS) was developed to identify problems with the activities of daily living (ADL) caused by USN. The CBS is composed of 10 observation assessments and a self-assessment questionnaire. To assess the self-awareness of USN, the anosognosia score is calculated as the difference between the observational scores and the self-assessment scores. To investigate how PA affects ADL and self-awareness in subacute USN patients during rehabilitation, we analyzed each item of the CBS and self-awareness from a randomized, controlled trial (RCT) that we previously conducted (Mizuno et al., 2011). METHODS: A double-masked randomized, controlled trial was conducted to evaluate the effects of a 2-week PA therapy on USN in 8 hospitals in Japan. We compared each item of the CBS, anosognosia score, and absolute value of the anosognosia score between the prism group and the control group. RESULTS: Two of ten items (gaze orientation and exploration of personal belongings) were significantly improved in the prism group compared with those in the control group. The absolute value of the anosognosia score was significantly improved by PA. CONCLUSIONS: Improvement of oculomotor exploration by PA may generalize the behavioral level in a daily living environment. This study suggested that PA could accelerate the self-awareness of neglect during subacute rehabilitation.

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Factors related to instrumental activities of daily living in persons with chronic thromboembolic pulmonary hypertension

Iwasawa, T; Fukui, S; Kawakami, M; Kawakami, T; Kataoka, M; Yuasa, S; Fukuda, K; Fujiwara, T; Tsuji, T

CHRONIC RESPIRATORY DISEASE （SAGE Publications）  18   147997312110466 - 147997312110466 2021年01月

ISSN  1479-9731

　概要を見る

Instrumental activities of daily living (IADL) are significantly related to quality of life and mortality among individuals with heart disease. However, few reports have examined IADL in persons with chronic thromboembolic pulmonary hypertension (CTEPH). The aim of this study was to clarify factors related to IADL in persons with CTEPH. This retrospective, observational study enrolled 163 persons with CTEPH (mean ± standard deviation age = 65 ± 13 years; 68% female) admitted to the Department of Cardiology at Keio University Hospital between January 2015 and July 2019. The Frenchay Activities Index (FAI) was used to assess IADL. Age, sex, body mass index, World Health Organization functional class (WHO-FC), cardiac function (mean pulmonary arterial pressure, mean right atrial pressure, pulmonary capillary wedge pressure, and cardiac index), pulmonary function (percentage vital capacity, percentage forced expiratory volume in 1 s, diffusion capacity of carbon monoxide (DLCO)/alveolar volume (VA)), physical function (knee extension strength and walking speed), and 6-min walking distance (6MWD) were assessed. Multiple regression analysis was performed to identify factors significantly associated with FAI. Mean FAI was 25 ± 8. Univariate analysis showed that sex, WHO-FC, DLCO/VA, walking speed, and 6MWD were correlated with FAI. Multiple regression analysis showed that 6MWD (sβ = 0.338, 95% CI 0.014–0.034, p &lt; .001), sex (sβ = 0.268, 95% CI 2.238–7.165, p &lt; .001), and DLCO/VA (sβ = 0.257, 95% CI 1.011–3.528, p &lt; .001) were significantly correlated with FAI ( R² = 0.261). IADL were associated with exercise tolerance, sex, and DLCO/VA in persons with CTEPH. In the future, more details of IADL are expected to be clarified by analyzing individual components of IADL and investigating social background characteristics, including living environment.

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Factors related to daily use of the paretic upper limb in patients with chronic hemiparetic stroke-A retrospective cross-sectional study

Tashiro, S; Kuroki, M; Okuyama, K; Oshima, O; Ogura, M; Hijikata, N; Nakamura, T; Oka, A; Kawakami, M; Tsuji, T; Liu, MG

PLOS ONE 16 （ 3 ） e0247998 2021年

ISSN  1932-6203

　概要を見る

AIMS: The present study aimed to determine factors associated with the frequency of paralyzed upper extremity (UE) use in chronic stroke patients with severe UE functional deficiency. METHODS: We retrospectively reviewed the medical records of 138 consecutive patients, and 117 was analyzed (median age, 55 [range, 18-85] years; median stroke duration, 24.5 [range, 7-302] months) with chronic hemiparetic stroke who were admitted to our hospital for intensive upper extremity rehabilitation. The mean Fugl-Meyer Assessment (FMA) UE score was 28.6. All of them are independent in their activity of daily living (ADL) and without remarkable cognitive deficits. Amount-of-use score of Motor Activity Log-14 (MAL-AOU) was applied as the index of daily use of affected UE. The following parameters were examined as the explanatory variables: demographics, proximal and distal sub-scores of FMA UE, Modified Ashworth Scale (MAS), and sensory function scores in the Stroke Impairment Assessment Set (SIAS). RESULTS: The median MAL-AOU score was 0.57 [range, 0.28-0.80]. Ordinal regression analysis revealed that FMA proximal, FMA distal, and SIAS sensory function (touch) were associated with AOU score of MAL-14 (Pseudo R-square = 0.460). CONCLUSION: Not only motor but also sensory function, especially tactile sensation, play a crucial role in the daily use of affected UE in chronic stroke patients with severe UE hemiparesis.

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Do somatosensory deficits predict efficacy of neurorehabilitation using neuromuscular electrical stimulation for moderate to severe motor paralysis of the upper limb in chronic stroke?

Tsuzuki, K; Kawakami, M; Nakamura, T; Oshima, O; Hijikata, N; Suda, M; Yamada, Y; Okuyama, K; Tsuji, T

THERAPEUTIC ADVANCES IN NEUROLOGICAL DISORDERS 14   17562864211039335 - 17562864211039335 2021年

ISSN  1756-2856

　概要を見る

Background: Various neurorehabilitation programs have been developed to promote recovery from motor impairment of upper extremities. However, the response of patients with chronic-phase stroke varies greatly. Prediction of the treatment response is important to provide appropriate and efficient rehabilitation. This study aimed to clarify whether clinical assessments, such as motor impairments and somatosensory deficits, before treatment could predict the treatment response in neurorehabilitation. Methods: The data from patients who underwent neurorehabilitation using closed-loop electromyography (EMG)-controlled neuromuscular electrical stimulation were retrospectively analyzed. A total of 66 patients with chronic-phase stroke with moderate to severe paralysis were included. The changes from baseline in the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and the Motor Activity Log-14 (MAL-14) of amount of use (AOU) and quality of movement (QOM) were used to assess treatment response, and multivariate logistic regression analysis was performed using the extracted candidate predictors, such as baseline clinical assessments, to identify predictors of FMA-UE and MAL-14 improvement. Results: FMA-UE and MAL-14 scores improved significantly after the intervention (FMA-UE p < 0.01, AOU p < 0.01, QOM p < 0.01). On multivariate logistic regression analysis, tactile sensory (p = 0.043) and hand function (p = 0.030) were both identified as significant predictors of FMA-UE improvement, tactile sensory (p = 0.047) was a significant predictor of AOU improvement, and hand function (p = 0.026) was a significant predictor of QOM improvement. The regression equations explained 71.2% of the variance in the improvement of FMA-UE, 69.7% of AOU, and 69.7% of QOM. Conclusion: Both motor and tactile sensory impairments predict improvement in motor function, tactile sensory impairment predicts improvement in the amount of paralytic hand use, and motor impairment predicts improvement in the quality of paralytic hand use following neurorehabilitation treatment in patients with moderate to severe paralysis in chronic-phase stroke. These findings may help select the appropriate treatment for patients with more severe paralysis and to maximize the treatment effect.

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Behavioral Assessment of Unilateral Spatial Neglect with the Catherine Bergego Scale (CBS) Using the Kessler Foundation Neglect Assessment Process (KF-NAP) in Patients with Subacute Stroke during Rehabilitation in Japan

Nishida, D; Mizuno, K; Tahara, M; Shindo, S; Watanabe, Y; Ebata, H; Tsuji, T

BEHAVIOURAL NEUROLOGY 2021   8825192 - 8825192 2021年

ISSN  0953-4180

　概要を見る

The Kessler Foundation Neglect Assessment Process (KF-NAP) is an assessment tool for unilateral spatial neglect (USN), which is the scoring method for the Catherine Bergego Scale (CBS) based on detailed instructions. This study is aimed at determining the reliability and validity of the Japanese version of the KF-NAP (KF-NAP-J), evaluating the improvement of neglect assessment with KF-NAP-J, and comparing it with the original CBS for subacute stroke patients. We assessed subacute stroke patients admitted to our intensive rehabilitation hospital. Two KF-NAP-trained occupational therapists (OTs) assessed 22 patients. Before implementing the KF-NAP at the hospital, two other OTs assessed the other 23 patients using the CBS. We evaluated the interrater reliability of the KF-NAP and CBS using intraclass correlation coefficients (ICC) for the total scores, weighted kappa statistics for each subscale, and internal consistency using Cronbach's alpha. We assessed the validity of the KF-NAP against the Behavioral Inattention Test (BIT) and Functional Independence Measure (FIM) using Spearman's correlation coefficient. The reliability of both the KF-NAP and CBS was excellent. The weighted kappa results demonstrated that each subscale was in better agreement with the KF-NAP than with the CBS. In the KF-NAP, all eight subscales in which weighted kappa could be calculated were in significant agreement, and two were almost in perfect agreement. The KF-NAP moderately correlated with the subscales of BIT and FIM representing USN and activities of daily living. The USN detection rates of KF-NAP and BIT in the KF-NAP group were 63.6% and 22.7%, respectively. These results suggest that the KF-NAP, as well as the CBS, is useful to assess USN, which strongly impacts the rehabilitation outcomes in subacute stroke patients.

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Association of preoperative sarcopenia with postoperative dysphagia in patients with thoracic esophageal cancer

Mayanagi, S; Ishikawa, A; Matsui, K; Matsuda, S; Irino, T; Nakamura, R; Fukuda, K; Wada, N; Kawakubo, H; Hijikata, N; Ando, M; Tsuji, T; Kitagawa, Y

DISEASES OF THE ESOPHAGUS 34 （ 9 ）  2020年12月

ISSN  1120-8694

　概要を見る

BACKGROUND: The purpose of the current study was to clarify the relationship between clinical features of dysphagia after esophagectomy and preoperative sarcopenia. METHODS: A total of 187 cases were included in the current study. The psoas cross-sectional area on pre-treatment computed tomography was measured in thoracic esophageal cancer patients who underwent curative resection. The psoas muscle index (PMI) cut-off levels for sarcopenia were 6.36 cm2/m2 for men and 3.92 cm2/m2 for women. Swallowing function was evaluated using videofluoroscopic swallowing study (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES) at postoperative days 7-15, and classified according to the food intake level scale (FILS). Perioperative swallowing rehabilitation was performed in all cases. RESULTS: In the 187 included patients, the median PMI was 5.42 cm2/m2 for men and 3.43 cm2/m2 for women, and 133 cases (71%) met the sarcopenia criteria. The FILS <4 (no oral intake) was 15% in the non-sarcopenia group, and 38% in the sarcopenia group (P = 0.003). There was no significant difference in the incidence of postoperative complications, including pneumonia and re-admission due to pneumonia, between the two groups. Preoperative sarcopenia and recurrent laryngeal nerve palsy were be independent risk factors for postoperative dysphagia. CONCLUSIONS: Sarcopenic patients with esophageal cancer develop postoperative dysphagia more often than non-sarcopenic patients. Prehabilitation and nutritional support for patients with preoperative sarcopenia could play an important role to mitigate postoperative dysphagia.

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Quality of life and the prevalence of urinary incontinence after surgical treatment for gynecologic cancer: a questionnaire survey

Nakayama Noriko, Tsuji Tetsuya, Aoyama Makoto, Fujino Takafumi, Liu Meigen

BMC WOMENS HEALTH 20 （ 1 ） 148 2020年07月

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Rehabilitation for Cancer Patients in Inpatient Hospices/Palliative Care Units and Achievement of a Good Death: Analyses of Combined Data From Nationwide Surveys Among Bereaved Family Members.

Hasegawa T, Sekine R, Akechi T, Osaga S, Tsuji T, Okuyama T, Sakurai H, Masukawa K, Aoyama M, Morita T, Kizawa Y, Tsuneto S, Shima Y, Miyashita M

Journal of pain and symptom management 2020年06月

ISSN  0885-3924

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Subcutaneous lymphatic vessels in the lower extremities: Comparison between photoacoustic lymphangiography and near-infrared fluorescence lymphangiography

Suzuki Y., Kajita H., Konishi N., Oh A., Urano M., Watanabe S., Asao Y., Imanishi N., Tsuji T., Jinzaki M., Aiso S., Kishi K.

Radiology （Radiology）  295 （ 2 ） 469 - 474 2020年05月

ISSN  00338419

　概要を見る

© RSNA, 2020. Background: Detailed visualization of the lymphatic vessels would greatly assist in the diagnosis and monitoring of lymphatic diseases and aid in preoperative planning of lymphedema surgery and postoperative evaluation. Purpose: To evaluate the usefulness of photoacoustic imaging (PAI) for obtaining three-dimensional images of both lymphatic vessels and surrounding venules. Materials and Methods: In this prospective study, the authors recruited healthy participants from March 2018 to January 2019 and imaged lymphatic vessels in the lower limbs. Indocyanine green (5.0 mg/mL) was injected into the subcutaneous tissue of the first and fourth web spaces of the toes and below the lateral malleolus. After confirmation of the lymphatic flow with near-infrared fluorescence (NIRF) imaging as the reference standard, PAI was performed over a field of view of 270 3 180 mm. Subsequently, the number of enhancing lymphatic vessels was counted in both proximal and distal areas of the calf and compared between PAI and NIRF. Results: Images of the lower limbs were obtained with PAI and NIRF in 15 participants (three men, 12 women; average age, 42 years 6 12 [standard deviation]). All participants exhibited a linear pattern on NIRF images, which is generally considered a reflection of good lymphatic function. A greater number of lymphatic vessels were observed with PAI than with NIRF in both the distal (mean: 3.6 vessels 6 1.2 vs 2.0 vessels 6 1.1, respectively; P , .05) and proximal (mean: 6.5 vessels 6 2.6 vs 2.6 vessels 6 1.6; P , .05) regions of the calf. Conclusion: Compared with near-infrared fluorescence imaging, photoacoustic imaging provided a detailed, three-dimensional representation of the lymphatic vessels and facilitated an increased understanding of their relationship with the surrounding venules.

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Physical exercise is safe and feasible in thrombocytopenic patients with hematologic malignancies: a narrative review

Morishita S., Nakano J., Fu J.B., Tsuji T.

Hematology (United Kingdom) （Hematology (United Kingdom)）  25 （ 1 ） 95 - 100 2020年01月

ISSN  10245332

　概要を見る

© 2020, © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. Many studies have reported that physical exercise can improve the levels of function, quality of life (QoL), and fatigue in patients with hematologic malignancies. However, exercises should be prescribed with caution in patients with thrombocytopenia to prevent exercise-related bleeding. Some studies have suggested threshold platelet counts at which physical exercise can safely be performed. Herein, we review the current literature to determine the platelet count thresholds and types of physical exercise that may be prescribed to reduce the risk of exercise-related bleeding in those with hematological malignancies while undergoing chemotherapy.

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緩和ケア主体の時期のがんリハビリテーション診療

辻 哲也

The Japanese Journal of Rehabilitation Medicine （公益社団法人 日本リハビリテーション医学会）  57 （ 9 ） 828 - 835 2020年

ISSN  1881-3526

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支持・緩和療法

奥坂 拓志, 保田 知生, 眞島 喜幸, 小川 朝生, 余宮 きのみ, 辻 哲也, 森 雅紀, 鈴木 賢一, 丹藤 雄介, 藤森 麻衣子, 坂本 はと恵

膵臓 （日本膵臓学会）  35 （ 1 ） 79 - 82 2020年

ISSN  0913-0071

　概要を見る

<p>癌患者に必要とされる支持・緩和療法は多岐にわたり，その一部については専門学会からのガイドラインも出版されているが，膵癌患者に特に重要と考えられる臨床的疑問については本ガイドラインにおいて指針を提示することが必要との議論がなされ，2016年版より精神心理的苦痛への対応方法，上腹部痛・背部痛に対する治療法，栄養療法，が取り上げられることとなった．2019年版ではさらに，膵癌術後患者に対する運動療法，アドバンス・ケア・プランニング，化学療法における末梢神経障害への対応方法，を新たなCQとして設定し，エビデンスの収集と推奨の提言を行った．また，悪液質を伴う膵癌患者における栄養支持療法，患者向け資材（パンフレット），コミュニケーション・スキル，心理的・社会的・経済的問題に対する支援，患者会，についてコラムで取り上げて情報提供を行うこととした．</p>

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Risk factors of impairment of shoulder function after axillary dissection for breast cancer

Kikuuchi M., Akezaki Y., Nakata E., Yamashita N., Tominaga R., Kurokawa H., Hamada M., Aogi K., Ohsumi S., Tsuji T., Sugihara S.

Supportive Care in Cancer （Supportive Care in Cancer）  2020年

ISSN  09414355

　概要を見る

© 2020, Springer-Verlag GmbH Germany, part of Springer Nature. Objectives: Postoperative shoulder joint dysfunction has been observed at a certain rate after breast cancer surgery with axillary lymph node dissection. The purposes of this study were to verify the feasibility and effects of home-based exercise using a DVD and clarify the target of intensive intervention with physiotherapy by identifying the factors that cause postoperative shoulder dysfunction. Methods: The study comprised 237 female patients who underwent breast cancer surgery with axillary lymph node dissection, whose data were acquired until 3 months postoperatively. All patients were instructed to exercise at home using a DVD. Range of motion (ROM) of shoulder flexion and abduction and the disability of the arm, shoulder, and hand (DASH) score were measured before surgery, 1 week and 1, 2, and 3 months after surgery. As factors influencing the recovery of shoulder ROM at 3 months after surgery, the presence or absence of radiation and factors up to 1 month after surgery (age, body mass index, the relationship between operated side and dominant side of the hand, treatment modalities, and complications). Results: Shoulder ROM and DASH scores had gradually recovered from 1 week to 3 months postoperatively. As the results of the multivariate analysis, the factors that were associated with the recovery of ROM of shoulder flexion at 3 months were the side of surgery corresponding to the dominant hand (negative factor) and the presence of paresthesia at 1 week postoperatively (positive factor) (p < 0.05). Radiation therapy and the side of surgery corresponding to the dominant hand were negative factors for the recovery of shoulder abduction (p < 0.01). Regarding the feasibility of the home exercise, 214/229 (93.4%), 172/210 (81.9%), and 139/206 (67.5%) of patients performed exercise at least once a day at 1, 2, and 3 months after surgery, respectively. Conclusion: Our result indicated that the side of surgery corresponding to the dominant hand was the inhibiting factor for recovery for both shoulder flexion and abduction at 3 months after surgery. Home-based exercise with DVD was considered feasible. For the verification of this effectiveness, a randomized control study should be planned in the future.

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Landscape of education and clinical practice in geriatric oncology: a Japanese nationwide survey

Nishijima Tomohiro F., Tamura Kazuo, Nagashima Fumio, Aiba Keisuke, Saito Mitsue, Saeki Toshiaki, Karasawa Kumiko, Uchitomi Yosuke, Takahashi Takao, Kaibori Masaki, Sakuda Hiromi, Imamura Chiyo, Tsuji Tetsuya

JAPANESE JOURNAL OF CLINICAL ONCOLOGY 49 （ 12 ） 1114 - 1119 2019年12月

ISSN  0368-2811

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Assessment of the Mini-Balance Evaluation Systems Test, Timed Up and Go test, and body sway test between cancer survivors and healthy participants

Morishita S., Hirabayashi R., Tsubaki A., Aoki O., Fu J., Onishi H., Tsuji T.

Clinical Biomechanics （Clinical Biomechanics）  69   28 - 33 2019年10月

ISSN  02680033

　概要を見る

© 2019 Elsevier Ltd Background: Cancer survivors experience late and long-term effects of treatment; also, the disease itself might be responsible for persisting functional impairments. The purpose of this study was to investigate muscle strength, balance function using the Mini-Balance Evaluation Systems Test and Timed Up and Go test with single and cognitive dual tasks and body sway in breast cancer survivors and healthy women and non-breast cancer survivors and healthy participants. Methods: Twenty-six cancer survivors and 19 healthy participants were assessed for grip and knee extension strength with the Mini-Balance Evaluation Systems Test, Timed Up and Go, and body sway test performance. Findings: Breast cancer survivors had significantly lower hand grip strength (p < .05) and Mini-Balance Evaluation Systems Test scores than healthy women (p < .05). Additionally, in breast cancer survivors, hand grip strength had a significant relationship with Mini-Balance Evaluation Systems Test and Timed Up and Go scores (p < .05) but had no relationship with the total center of pressure length. Hand grip strength and Mini-Balance Evaluation Systems Test scores were not significantly different in non-breast cancer survivors and healthy participants. In non-breast cancer survivors, knee extension strength had a significant relationship with the Timed Up and Go scores (p < .05). Interpretation: The relationship between muscle strength and balance function may be characterized by the different diagnoses in cancer survivors. The current findings showed the changes in balance function and muscle strength among cancer survivors.

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A randomized phase II study of nutritional and exercise treatment for elderly patients with advanced non-small cell lung or pancreatic cancer: The NEXTAC-TWO study protocol

Miura S., Naito T., Mitsunaga S., Omae K., Mori K., Inano T., Yamaguchi T., Tatematsu N., Okayama T., Morikawa A., Mouri T., Tanaka H., Kimura M., Imai H., Mizukami T., Imoto A., Kondoh C., Shiotsu S., Okuyama H., Ueno M., Takahashi T., Tsuji T., Aragane H., Inui A., Higashiguchi T., Takayama K.

BMC Cancer （BMC Cancer）  19 （ 1 ） 528 - 528 2019年05月

ISSN  1471-2407

　概要を見る

© 2019 The Author(s). Background: Most advanced elderly cancer patients experience fatigue, anorexia, and declining physical function due to cancer cachexia, for which effective interventions have not been established. We performed a phase I study of a new nonpharmacological multimodal intervention called the nutritional and exercise treatment for advanced cancer (NEXTAC) program and reported the excellent feasibility of and compliance with this program in elderly patients with advanced cancer who were at risk for cancer cachexia. We report here the background, hypothesis, and design of the next-step multicenter, randomized phase II study to evaluate the efficacy of the program, the NEXTAC-TWO study. Methods: Patients with chemo-naïve advanced non-small cell lung cancer or pancreatic cancer, age ≥ 70 years, performance status ≤2, with adequate organ function and without disability according to the modified Katz index will be eligible. In total, 130 participants will be recruited from 15 Japanese institutions and will be randomized into either the intervention group or a control group. Computer-generated random numbers are allocated to each participant. Stratification factors include performance status (0 to 1 vs. 2), site of primary cancer (lung vs. pancreas), stage (III vs. IV), and type of chemotherapy (cytotoxic vs. others). Interventions and assessment will be performed 4 times every 4 ± 2 weeks from the date of randomization. Interventions will consist of nutritional counseling, nutritional supplements (rich in branched-chain amino acids), and a home-based exercise program. The exercise program will include low-intensity daily muscle training and lifestyle education to promote physical activity. The primary endpoint is disability-free survival. It is defined as the period from the date of randomization to the date of developing disability or death due to any cause. This trial also plans to evaluate the improvements in nutritional status, physical condition, quality of life, activities of daily living, overall survival, and safety as secondary endpoints. Enrollment began in August 2017. The study results will demonstrate the efficacy of multimodal interventions for elderly cancer patients and their application for the maintenance of physical and nutritional conditions in patients with cancer cachexia. This work is supported by a grant-in-aid from the Japan Agency for Medical Research and Development. Discussion: This is the first randomized trial to evaluate the efficacy and safety of a multimodal intervention specific for elderly patients with advanced cancer.

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Factors affecting lower limb muscle strength and cardiopulmonary fitness after allogeneic hematopoietic stem cell transplantation

Ishikawa A., Otaka Y., Kamisako M., Suzuki T., Miyata C., Tsuji T., Matsumoto H., Kato J., Mori T., Okamoto S., Liu M.

Supportive Care in Cancer （Supportive Care in Cancer）  27 （ 5 ） 1793 - 1800 2019年05月

査読有り,  ISSN  09414355

　概要を見る

© 2018, The Author(s). Purpose: The aim of this study is to clarify the factors affecting physical function after allogeneic hematopoietic stem cell transplantation (HSCT). Methods: We retrospectively analyzed 88 patients (median age, 44.5 years) who received allogeneic HSCT. Leg extension torque and peak oxygen consumption (VO 2 ) were evaluated before and after HSCT. Patient factors (age, sex, underlying diseases, hemoglobin, serum albumin, and Karnofsky performance status score before transplant) and transplant factors (conditioning regimen, days to neutrophil engraftment, grades of acute graft-versus-host disease [GVHD], infections, and the interval between pre- and post-evaluation) were collected via chart review, and were used for correlational and comparison analyses in order to identify the variables associated with reduced post-HSCT leg extension torque and peak VO 2 . Stepwise multiple regression analyses for post-HSCT leg extension torque and post-HSCT peak VO 2 were performed using age, sex, and the related variables with a p value < 0.2 in the correlational and comparison analyses. Results: Leg extension torque and peak VO 2 were significantly reduced after HSCT (p < 0.001). Pre-HSCT leg extension torque, grades of acute GVHD, age, and the interval between pre- and post-evaluation were identified as significant factors associated with reduced post-HSCT leg extension torque. However, none of these factors were significantly associated with reduced post-HSCT peak VO 2 , and only its pre-transplant value was identified as a significant factor. Conclusions: These findings suggest that improvements in muscle strength and cardiopulmonary fitness before HSCT are crucial for maintaining post-treatment physical function, especially in elderly individuals with acute GVHD requiring a long-term stay in a protective environment.

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Feasibility of early multimodal interventions for elderly patients with advanced pancreatic and non-small-cell lung cancer

Naito T., Mitsunaga S., Miura S., Tatematsu N., Inano T., Mouri T., Tsuji T., Higashiguchi T., Inui A., Okayama T., Yamaguchi T., Morikawa A., Mori N., Takahashi T., Strasser F., Omae K., Mori K., Takayama K.

Journal of Cachexia, Sarcopenia and Muscle （Journal of Cachexia, Sarcopenia and Muscle）  10 （ 1 ） 73 - 83 2019年02月

ISSN  21905991

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© 2018 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of the Society on Sarcopenia, Cachexia and Wasting Disorders Background: Combinations of exercise and nutritional interventions might improve the functional prognosis for cachectic cancer patients. However, high attrition and poor compliance with interventions limit their efficacy. We aimed to test the feasibility of the early induction of new multimodal interventions specific for elderly patients with advanced cancer Nutrition and Exercise Treatment for Advanced Cancer (NEXTAC) programme. Methods: This was a multicentre prospective single-arm study. We recruited 30 of 46 screened patients aged ≥70 years scheduled to receive first-line chemotherapy for newly diagnosed, advanced pancreatic, or non-small-cell lung cancer. Physical activity was measured using pedometers/accelerometer (Lifecorder ® , Suzuken Co., Ltd., Japan). An 8 week educational intervention comprised three exercise and three nutritional sessions. The exercise interventions combined home-based low-intensity resistance training and counselling to promote physical activity. Nutritional interventions included standard nutritional counselling and instruction on how to manage symptoms that interfere with patient's appetite and oral intake. Supplements rich in branched-chain amino acids (Inner Power ® , Otsuka Pharmaceutical Co., Ltd., Japan) were provided. The primary endpoint of the study was feasibility, which was defined as the proportion of patients attending ≥4 of six sessions. Secondary endpoints included compliance and safety. Results: The median patient age was 75 years (range, 70–84). Twelve patients (40%) were cachectic at baseline. Twenty-nine patients attended ≥4 of the six planned sessions (96.7%, 95% confidence interval, 83.3 to 99.4). One patient dropped out due to deteriorating health status. The median proportion of days of compliance with supplement consumption and exercise performance were 99% and 91%, respectively. Adverse events possibly related to the NEXTAC programme were observed in five patients and included muscle pain (Grade 1 in two patients), arthralgia (Grade 1 in one patient), dyspnoea on exertion (Grade 1 in one patient), and plantar aponeurositis (Grade 1 in one patient). Conclusions: The early induction of multimodal interventions showed excellent compliance and safety in elderly patients with newly diagnosed pancreatic and non-small-cell lung cancer receiving concurrent chemotherapy. We are now conducting a randomized phase II study to measure the impact of these interventions on functional prognosis.

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Risk Factors for Lymphedema in Breast Cancer Survivors Following Axillary Lymph Node Dissection

Akezaki Yoshiteru, Sugihara Shinsuke, Tominaga Ritsuko, Kikuuchi Masato, Kurokawa Hideaki, Hamada Makiko, Aogi Kenjiro, Ohsumi Shozo, Tsuji Tetsuya, Kawamura Susumu

Progress in Rehabilitation Medicine （公益社団法人 日本リハビリテーション医学会）  4 （ 0 ） 20190021 2019年

　概要を見る

<p><b>Objective</b>: The aim of the current study was to assess the risk factors for developing lymphedema following breast cancer treatment. <b>Methods</b>: The subjects of this study were 238 consecutive patients who underwent axillary lymph node dissection for breast cancer at Shikoku Cancer Center. The study variables were the occurrence of lymphedema, the body mass index, the follow-up period, the drain removal time, the level of lymph node dissection, the presence or absence of co-resident household members, radiation therapy, neoadjuvant chemotherapy, and adjuvant chemotherapy. <b>Results</b>: We observed lymphedema in 23.9% of patients after axillary lymph node dissection for breast cancer. Neoadjuvant chemotherapy and adjuvant chemotherapy using docetaxel and cyclophosphamide increased the risk of developing lymphedema (P <0.05). <b>Conclusions</b>: Those patients treated with neoadjuvant chemotherapy and adjuvant chemotherapy using docetaxel and cyclophosphamide should be observed closely after axillary lymph node dissection, and appropriate intervention should be considered from an early stage. </p>

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Neuromuscular electrical stimulation-enhanced rehabilitation is associated with not only motor but also somatosensory cortical plasticity in chronic stroke patients: an interventional study

Tashiro S., Mizuno K., Kawakami M., Takahashi O., Nakamura T., Suda M., Haruyama K., Otaka Y., Tsuji T., Liu M.

Therapeutic Advances in Chronic Disease （Therapeutic Advances in Chronic Disease）  10   2040622319889259 2019年

ISSN  20406223

　概要を見る

© The Author(s), 2019. Background: Somatosensory function has been frequently overlooked in clinics and research in the field of chronic stroke. The effects of neurorehabilitation interventions on sensory processing have still to be investigated using electrophysiological means. This study investigated the effect of hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy utilizing closed-loop electromyography-controlled neuromuscular electrical stimulation (NMES), on sensory changes and cortical plasticity among patients with chronic stroke. Methods: This study was a prespecified analysis of 23 participants involved in an ongoing large interventional study. Patients with severe upper limb hemiplegia dues to chronic stroke underwent 3 weeks of inpatient HANDS therapy, where daily treatment consisted of 8 h of NMES combined with wrist splinting, 90 min of comprehensive occupational therapy, and the practice of bimanual activities of daily living. Somatosensory evoked potentials (SEPs) and functional sensory assessments, including the Semmes–Weinstein monofilament test (SWMT) and thumb localizing test (TLT), were compared pre and post-treatment. Results: While no significant recovery of tactile sensation was observed, significant improvements in proprioception and motor function were induced. The number of cortical peaks significantly increased in the median nerve, but not in the tibial nerve. A total of 9 out of 11 participants who initially lacked certain peaks responded to treatment. Further analysis revealed a significant improvement in latency and amplitude of SEP peaks. Conclusions: Our results suggest that NMES-based neurorehabilitation induces certain plastic changes in the primary sensory cortex and in cortices associated with sensorimotor processing in people with chronic stroke sequelae, which may explain the observed improvements in proprioception.

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Factors affecting the performance of activities of daily living in patients with advanced cancer undergoing inpatient rehabilitation: results from a retrospective observational study

Shimoda Kaori, Imai Hisao, Tsuji Tetsuya, Tsuchiya Kenji, Tajima Hiroshi, Kanemaki Hatsumi, Tozato Fusae

Journal of Physical Therapy Science （理学療法科学学会）  31 （ 10 ） 795 - 801 2019年

ISSN  0915-5287

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<p> [Purpose] Many clinicians believe that rehabilitation for patients with advanced cancer is futile. We determined factors affecting the performance of activities of daily living in patients with advanced cancer based on age, gender, marital status, living arrangement, rehabilitation intensity, type of cancer, impairment, metastasis, and active cancer treatment. [Participants and Methods] We assessed the Barthel Index to evaluate the performance of activities of daily living. Of the 120 adult patients with cancer who underwent inpatient rehabilitation, we analyzed the Barthel Index scores, consisting of 10 items, and reviewed the clinical characteristics from the medical records of 48 patients who completed supportive or palliative rehabilitation according to Dietz and showed an increased or maintained total Barthel Index score at final evaluation. [Results] The median total Barthel Index score increased from 45 (5–95) to 72.5 (5–100); the rehabilitation intensity was 320 (40–1,240) minutes. The analytical results showed that the increase of total Barthel Index score was positively associated with rehabilitation intensity (β=0.350) and negatively associated with the initial grooming score (β=−0.277). [Conclusion] Adequate rehabilitation positively affects performance of activities of daily living, especially in patients with advanced cancer who lost their grooming ability at the onset of rehabilitation. Importantly, rehabilitation may be beneficial for patients with advanced cancer.</p>

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Differences in Balance Function Between Cancer Survivors and Healthy Subjects: A Pilot Study

Morishita S., Mitobe Y., Tsubaki A., Aoki O., Fu J., Onishi H., Tsuji T.

Integrative cancer therapies （Integrative cancer therapies）  17 （ 4 ） 1144 - 1149 2018年12月

査読有り,  ISSN  15347354

　概要を見る

Older adults who have survived cancer experience significantly more falls compared with healthy adults. Adult cancer survivors may also have a lower balance function than healthy adults. We examined muscle strength and balance function among 19 cancer survivors and 14 healthy subjects. The mean age of the cancer survivors was 51.5 ± 11.2 years; 6 men and 13 women. Cancer diagnoses included breast cancer, retroperitoneal sarcoma, acute leukemia, lung cancer, colorectal cancer, thyroid cancer, Ewing's sarcoma, and tongue cancer. The mean age of healthy subjects was 47.4 ± 14 years; 3 men, 11 women. Muscle strength was assessed using hand grip and knee extensor strength tests. Balance function was evaluated using the Timed Up and Go (TUG) test, and body sway was tested using a force platform. No significant differences were found with respect to right and left grip strength or right and left knee extension strength between the 2 groups. A significantly higher TUG time was observed in cancer survivors than in healthy subjects ( P < .05). With eyes open, the area of the center of pressure was significantly larger in cancer survivors than in healthy subjects ( P < .05). Similarly, the length per area was significantly lower both with eyes open and closed for cancer survivors than for healthy subjects ( P < .05). TUG was significantly correlated with muscle strength in both groups ( P < .05). However, no body sway parameters were related to muscle strength in either group. Cancer survivors had lower balance function that might not have been related to muscle strength. Cancer survivors should be evaluated for balance function as there is a potential for impairment. The findings of this study will be relevant for planning the prevention of falls for cancer survivors.

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悪液質高リスクの高齢進行がん患者に対する在宅ベースの下肢筋力トレーニングプログラムの開発　NEXTAC-ONE試験の運動介入の詳細

立松 典篤, 岡山 太郎, 辻 哲也, 岩村 明, 田沼 明, 内藤 立暁, 光永 修一, 三浦 理, 大前 勝弘, 盛 啓太, 高山 浩一

Palliative Care Research （(NPO)日本緩和医療学会）  13 （ 4 ） 373 - 381 2018年12月

　概要を見る

【目的】悪液質リスクの高い高齢進行がん患者に対して、初回化学療法導入時より栄養と運動を組み合わせたマルチモーダルな介入プログラムを開発した。本研究の目的は、その中の下肢筋力トレーニングの詳細と安全性および忍容性を報告することである。【方法】対象は、初回化学療法導入予定の70歳以上の進行非小細胞肺がんおよび進行膵がん患者30例とした。下肢筋力トレーニングは約8週間の在宅ベースプログラムとし、対象者別にトレーニング内容および負荷量を設定した。【結果】介入期間中の下肢筋力トレーニングの実施割合は91(69〜95)%であった。治療継続や日常生活に影響を及ぼすような有害事象発生はなく、介入前後で身体機能や活動量の有意な低下は認められなかった。【結論】悪液質リスクの高い高齢進行がん患者において、われわれが開発した下肢筋力トレーニングは高い実施割合を有し、身体機能や身体活動量の維持に寄与した可能性が示唆された。(著者抄録)

肺がん患者が自宅復帰に至るまでの心理的適応

下田 佳央莉, 外里 冨佐江, 山谷 礼輝, 土屋 謙仕, 辻 哲也

ぐんま作業療法研究 （(一社)群馬県作業療法士会）  20   23 - 28 2018年08月

ISSN  1344-4344

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進行がん患者がdistress:苦痛を抱える可能性は高いが、その適切な介入法は確立していない。著者らは肺がん患者の自宅復帰支援を多職種で行う機会を得た。その結果、対象者は自身の身体機能の低下や疼痛に影響を受けながらも、日常生活動作能力を向上させると共に、distressの症状を軽減させた。我々は、(1)正のフィードバックを行い対象者の自尊心を保持する、(2)対象者や家族のニーズを聴取し、目標に向け多職種で協働する、(3)外泊訓練を実施するなどの取り組みを行った。本介入は、心身に配慮した多職種でのリハビリテーションは、対象者の自宅復帰に至るまでの再適応の心理的過程である、心理的適応を促進させる可能性を示した。(著者抄録)

Cancer survivors exhibit a different relationship between muscle strength and health-related quality of life/fatigue compared to healthy subjects

Morishita S., Tsubaki A., Fu J., Mitobe Y., Onishi H., Tsuji T.

European Journal of Cancer Care （European Journal of Cancer Care）  27 （ 4 ）  2018年07月

研究論文（学術雑誌）, 共著, 査読有り,  ISSN  09615423

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© 2018 John Wiley & Sons Ltd We investigated the difference in relationship between muscle strength and quality of life (QOL)/fatigue in long-term cancer survivors and healthy subjects. Thirty-six cancer survivors and 29 healthy subjects were assessed for body composition and bone status at the calcaneus using the Osteo Sono Assessment Index. Muscle strength was evaluated via handgrip and knee extensor strength. Health-related QOL was assessed using the Medical Outcome Study 36-item Short-Form Health Survey. Fatigue was measured using the brief fatigue inventory. Cancer survivors exhibited lower QOL scores in the physical functioning, physical role function, bodily pain and general health domains (p <.05). Grip and knee extension muscle strength in cancer survivors was positively correlated with the physical function and bodily pain of QOL (p <.05). The usual fatigue subscale score was only significantly higher in cancer survivors than in healthy subjects (p <.05). However, there were no correlations between muscle strength and fatigue in cancer survivors. Our results showed that muscle strength was an important factor for improving QOL in cancer survivors. We believe that the findings of this study will be relevant in the context of planning rehabilitation for cancer survivors.

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A randomized phase II study of the nutritional and exercise treatment for the elderly patients with advanced non-small cell lung or pancreatic cancer: The NEXTAC-TWO study.

Miura Satoru, Naito Tateaki, Mitsunaga Shuichi, Omae Katsuhiro, Mori Keita, Inano Toshimi, Yamaguchi Teiko, Mori Naoharu, Tatematsu Noriatsu, Okayama Taro, Morikawa Ayumu, Mouri Takako, Tsuji Tetsuya, Aragane Hideki, Inui Akio, Higashiguchi Takashi, Takayama Koichi

JOURNAL OF CLINICAL ONCOLOGY 36 （ 15 ）  2018年05月

ISSN  0732-183X

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リハビリテーション医学・医療のすべて 支持・緩和医療主体の時期のがんリハビリテーション医療

辻哲也

医学のあゆみ 2018年03月

研究論文（学術雑誌）, 単著

Anamorelin (ONO-7643) for the treatment of patients with non–small cell lung cancer and cachexia: Results from a randomized, double-blind, placebo-controlled, multicenter study of Japanese patients (ONO-7643-04)

Katakami N., Uchino J., Yokoyama T., Naito T., Kondo M., Yamada K., Kitajima H., Yoshimori K., Sato K., Saito H., Aoe K., Tsuji T., Takiguchi Y., Takayama K., Komura N., Takiguchi T., Eguchi K.

Cancer （Cancer）  124 （ 3 ） 606 - 616 2018年02月

査読有り,  ISSN  0008543X

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© 2017 American Cancer Society BACKGROUND: Cachexia, described as weight loss (mainly in lean body mass [LBM]) and anorexia, is common in patients with advanced cancer. This study examined the efficacy and safety of anamorelin (ONO-7643), a novel selective ghrelin receptor agonist, in Japanese cancer patients with cachexia. METHODS: This double-blind clinical trial (ONO-7643-04) enrolled 174 patients with unresectable stage III/IV non–small cell lung cancer (NSCLC) and cachexia in Japan. Patients were randomized to daily oral anamorelin (100 mg) or a placebo for 12 weeks. The primary endpoint was the change from the baseline LBM (measured with dual-energy x-ray absorptiometry) over 12 weeks. The secondary endpoints were changes in appetite, body weight, quality of life, handgrip strength (HGS), and 6-minute walk test (6MWT) results. RESULTS: The least squares mean change (plus or minus the standard error) in LBM from the baseline over 12 weeks was 1.38 ± 0.18 and −0.17 ± 0.17 kg in the anamorelin and placebo groups, respectively (P <.0001). Changes from the baseline in LBM, body weight, and anorexia symptoms showed significant differences between the 2 treatment groups at all time points. Anamorelin increased prealbumin at weeks 3 and 9. No changes in HGS or 6MWT were detected between the groups. Twelve weeks' treatment with anamorelin was safe and well tolerated in NSCLC patients. CONCLUSIONS: Anamorelin significantly increased LBM and improved anorexia symptoms and the nutritional state, but not motor function, in Japanese patients with advanced NSCLC. Because no effective treatment for cancer cachexia is currently available, anamorelin can be a beneficial treatment option. Cancer 2018;124:606-16. © 2017 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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Anamorelin (ONO-7643) for the Treatment of Patients with Non-small Cell Lung Cancer and Cachexia: Results from a Randomized, Double-Blind, Placebo-Controlled, Multicenter, Study on Japanese Patients (ONO-7643-04)

Katakami N, Uchino J, Yokoyama T, Naito T, Kondo M, Yamada K, Kitajima H, Yoshimori K, Sato K, Saito H, Aoe K, Tsuji T, Takiguchi Y, Takayama K, Komura N, Takiguchi T, Eguchi K

Cancer 2018年02月

研究論文（学術雑誌）, 共著, 査読有り

悪液質高リスクの高齢進行がん患者に対する在宅ベースの下肢筋力トレーニングプログラムの開発─NEXTAC-ONE試験の運動介入の詳細─

立松 典篤, 盛 啓太, 高山 浩一, 岡山 太郎, 辻 哲也, 岩村 明, 田沼 明, 内藤 立暁, 光永 修一, 三浦 理, 大前 勝弘

Palliative Care Research （日本緩和医療学会）  13 （ 4 ） 373 - 381 2018年

　概要を見る

<p>【目的】悪液質リスクの高い高齢進行がん患者に対して，初回化学療法導入時より栄養と運動を組み合わせたマルチモーダルな介入プログラムを開発した．本研究の目的は，その中の下肢筋力トレーニングの詳細と安全性および忍容性を報告することである．【方法】対象は，初回化学療法導入予定の70歳以上の進行非小細胞肺がんおよび進行膵がん患者30例とした．下肢筋力トレーニングは約8週間の在宅ベースプログラムとし，対象者別にトレーニング内容および負荷量を設定した．【結果】介入期間中の下肢筋力トレーニングの実施割合は91（69〜95）％であった．治療継続や日常生活に影響を及ぼすような有害事象発生はなく，介入前後で身体機能や活動量の有意な低下は認められなかった．【結論】悪液質リスクの高い高齢進行がん患者において，われわれが開発した下肢筋力トレーニングは高い実施割合を有し，身体機能や身体活動量の維持に寄与した可能性が示唆された．</p>

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Immediate effects of active exercise with compression therapy on lower-limb lymphedema

Fukushima T, Tsuji T, Sano Y, Miyata C, Kamisako M, Hohri H, Yoshimura C, Asakura M, Okitsu T, Muraoka K, Liu M

Supportive Care in cancer 25 （ 8 ） 2603 - 2610 2017年

研究論文（学術雑誌）, 共著, 査読有り

Feasibility of a respiratory movement evaluation tool to quantify thoracoabdominal movement for neuromuscular diseases

Liu F., Kawakami M., Tamura K., Taki Y., Shimizu K., Otsuka T., Tsuji T., Miyata C., Tashiro S., Wada A., Mizuno K., Aoki Y., Liu M.

Respiratory Care 62 （ 4 ） 423 - 431 2017年

研究論文（学術雑誌）, 共著, 査読有り,  ISSN  00201324

　概要を見る

BACKGROUND: An objective method to evaluate thoracoabdominal movement is needed in daily clinical practice to detect patients at risk of hypoventilation and to allow for timely interventions in neuromuscular diseases. The clinical feasibility, reliability, and validity of a newly developed method for quantifying respiratory movement using fiber grating sensors, called the Respiratory Movement Evaluation Tool (RMET), was evaluated. METHODS: The time needed to measure respiratory movement and the usability of the measurement were determined by 5 clinicians using the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) 2.0 questionnaire. Thoracoabdominal movement was measured using RMET 3 times in 10 healthy subjects to evaluate intraclass correlation coefficients (ICC). The subjects were encouraged to breathe 10 times while voluntarily changing the amount of air during ventilation simultaneously with the RMET and a spirometer, and their correlations were evaluated to test validity using Pearson’s product-moment correlation coefficients. The same measurements were also performed in 10 subjects with Duchenne muscular dystrophy. RESULTS: Real-time recordings of thoracoabdominal movements were obtained over a mean time of 374 ± 23.9 s. With QUEST 2.0, the median score of each item exceeded 3 (more or less satisfied). In healthy subjects, ICC(1,1) ranged from 0.82 to 0.99, and ICC(2,1) ranged from 0.83 to 0.97. Significant correlations were observed between the respiratory amplitudes measured with RMET, and the amount of air during ventilation was measured with a spirometer (r = 0.995, P <.001). In subjects with Duchenne muscular dystrophy, ICC(1,1) ranged from 0.87 to 0.97, and ICC(2,1) ranged from 0.84 to 0.99. The respiratory amplitudes measured with RMET correlated significantly with the amount of air during ventilation with a spirometer (r = 0.957, P <.001). CONCLUSIONS: We developed a novel method of quantifying respiratory movement called RMET that was feasible to use in daily clinical practice.

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Physical frailty in older people with severe aortic stenosis

Fukui S, Kawakami M, Otaka Y, Ishikawa A, Mizuno K, Tsuji T, Hayashida K, Inohara T, Yashima F, Liu M

Aging Clinical and Experimental Research 28 （ 6 ） 1081 - 1087 2016年

研究論文（学術雑誌）, 共著, 査読有り

Spatial and temporal dynamics of visual search tasks distinguish subtypes of unilateral spatial neglect

Mizuno Katsuhiro, Kato Kenji, Tsuji Tetsuya, Shindo Keiichiro, Kobayashi Yukiko, Liu Meigen

Neuropsychological Rehabilitation    1 - 25 2015年06月

ISSN  0960-2011

　概要を見る

<p>We developed a computerised test to evaluate unilateral spatial neglect (USN) using a touchscreen display, and estimated the spatial and temporal patterns of visual search in USN patients. The results between a viewer-centered USN patient and a stimulus-centered USN patient were compared. Two right-brain-damaged patients with USN, a patient without USN, and 16 healthy subjects performed a simple cancellation test, the circle test, a visuomotor search test, and a visual search test. According to the results of the circle test, one USN patient had stimulus-centered neglect and a one had viewer-centered neglect. The spatial and temporal patterns of these two USN patients were compared. The spatial and temporal patterns of cancellation were different in the stimulus-centered USN patient and the viewer-centered USN patient. The viewer-centered USN patient completed the simple cancellation task, but paused when transferring from the right side to the left side of the display. Unexpectedly, this patient did not exhibit rightward attention bias on the visuomotor and visual search tests, but the stimulus-centered USN patient did. The computer-based assessment system provided information on the dynamic visual search strategy of patients with USN. The spatial and temporal pattern of cancellation and visual search were different across the two patients with different subtypes of neglect.</p>

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Fiber grating(FG)センサーを用いた胸腹部運動の定量化手法の開発と妥当性の検討

里宇 文生, 大塚 友吉, 清水 克己, 滝 良仁, 田村 仁優, 安西 敦子, 和田 彩子, 青木 義満, 辻 哲也, 里宇 明元

The Japanese Journal of Rehabilitation Medicine （(公社)日本リハビリテーション医学会）  52 （ Suppl. ） S368 - S368 2015年05月

ISSN  1881-3526

Brain-computer interface training combined with transcranial direct current stimulation in patients with chronic severe hemiparesis: Proof of concept study

Kasashima-Shindo Y., Fujiwara T., Ushiba J., Matsushika Y., Kamatani D., Oto M., Ono T., Nishimoto A., Shindo K., Kawakami M., Tsuji T., Liu M.

Journal of Rehabilitation Medicine 47 （ 4 ） 318 - 324 2015年04月

ISSN  1650-1977

　概要を見る

Objective: Brain-computer interface technology has been applied to stroke patients to improve their motor function. Event-related desynchronization during motor imagery, which is used as a brain-computer interface trigger, is sometimes difficult to detect in stroke patients. Anodal transcranial direct current stimulation (tDCS) is known to increase event-related desynchronization. This study investigated the adjunctive effect of anodal tDCS for brain-computer interface training in patients with severe hemiparesis. Subjects: Eighteen patients with chronic stroke. Design: A non-randomized controlled study. Methods: Subjects were divided between a brain-computer interface group and a tDCS-brain-computer interface group and participated in a 10-day brain-computer interface training. Event-related desynchronization was detected in the affected hemisphere during motor imagery of the affected fingers. The tDCS-brain-computer interface group received anodal tDCS before brain-computer interface training. Event-related desynchronization was evaluated before and after the intervention. The Fugl-Meyer Assessment upper extremity motor score (FM-U) was assessed before, immediately after, and 3 months after, the intervention. Results: Event-related desynchronization was significantly increased in the tDCS-brain-computer interface group. The FM-U was significantly increased in both groups. The FM-U improvement was maintained at 3 months in the tDCS brain-computer interface group. Conclusion: Anodal tDCS can be a conditioning tool for brain-computer interface training in patients with severe hemiparetic stroke.

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Fiber grating(FG)センサーを用いた胸腹部運動の定量化手法の開発

里宇 文生, 清水 克己, 滝 良仁, 田村 仁優, 青木 義満, 大塚 友吉, 安西 敦子, 和田 彩子, 片平 真佐子, 辻 哲也, 里宇 明元

The Japanese Journal of Rehabilitation Medicine （(公社)日本リハビリテーション医学会）  51 （ Suppl. ） S282 - S282 2014年05月

ISSN  1881-3526

Executive dysfunction is related with decreased frontal lobe blood flow in patients with subarachnoid haemorrhage

Uchikawa K., Inaba M., Kagami H., Ichimura S., Fujiwara T., Tsuji T., Otaka Y., Liu M.

Brain Injury 28 （ 1 ） 15 - 19 2014年

ISSN  0269-9052

　概要を見る

Objective: This study evaluated executive dysfunction in patients with subarachnoid haemorrhage (SAH) using the Behavioural Assessment of the Dysexecutive Syndrome (BADS) and correlated the occurrence of executive dysfunction with cerebral blood flow (CBF) reduction in the frontal lobe as assessed by single photon emission computed tomography (SPECT). Design: Correlational study. Subjects: Twenty-Two patients who underwent microsurgical clipping at least 3 months after SAH. Methods: This study evaluated the BADS and the Wechsler Adult Intelligence Scale-III (WAIS-III). In addition, it assessed activities of daily living (ADL). CBF was evaluated using SPECT. The patients were divided into the following groups according to the results of SPECT: (1) those with reduced CBF in the frontal lobe (reduced CBF group, n = 8) and (2) those with intact CBF (intact CBF group, n = 14). Results: The BADS score was significantly lower in the reduced CBF group compared with that of the intact CBF group, while there was no significant difference in the WAIS-III scores and ADL scale between the two groups. Conclusion: Although this result was conducted with a small sample size, executive dysfunction correlates with reduced CBF in the frontal lobes of SAH patients. A detailed evaluation of executive function is suggested in SAH patients, even if the patient's intelligence test and ADL scale reveal no abnormalities. © 2014 Informa UK Ltd. All rights reserved: reproduction in whole or part not permitted.

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Cancer functional assessment set: A new tool for functional evaluation in cancer

Miyata C., Tsuji T., Tanuma A., Ishikawa A., Honaga K., Liu M.

American Journal of Physical Medicine and Rehabilitation 93 （ 8 ） 656 - 664 2014年

ISSN  0894-9115

　概要を見る

OBJECTIVE: The aim of this study was to develop and evaluate the psychometric properties of a new measurement tool, the Cancer Functional Assessment Set (cFAS). DESIGN: A total of 119 inpatients with cancer participated in this prospective cohort study. This study took place in three phases: (1) item generation, literature search, and a round-table discussion by 32 rehabilitation specialists; (2) item reduction and selection of appropriate items from the first item pool; and (3) evaluation of psychometric properties. Concurrent validity (Spearman correlation coefficients with existing scales), internal reliability (Cronbach coefficient alpha), interrater reliability (weighted kappa statistics and intraclass correlation coefficient), cross-validation, and responsiveness (standardized response mean values) were examined. RESULTS: The cFAS consisted of 24 items. Significant correlations were found between the cFAS and existing scales. Cronbach α for the total score was 0.92. Weighted κ values for each item ranged from 0.74 to 1.00. The intraclass correlation for the total score was 0.97. Concurrent validity and internal consistency were similar at two different hospitals. The cFAS was more responsive to changes than the other tools. CONCLUSIONS: The cFAS has acceptable psychometric properties, supporting its broad generalizability. It can be a useful tool in clinical trials and can contribute to the development of cancer rehabilitation. Copyright © 2014 Lippincott Williams & Wilkins.

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Early visual processing is affected by clinical subtype in patients with unilateral spatial neglect: A magnetoencephalography study

Mizuno K., Tsuji T., Rossetti Y., Pisella L., Ohde H., Liu M.

Frontiers in Human Neuroscience 7 （ JUL ）  2013年07月

ISSN  1662-5161

　概要を見る

Objective: To determine whether visual evoked fields (VEFs) elicited by right and left hemifield stimulation differ in patients with unilateral spatial neglect that results from cerebrovascular accident. Methods: Pattern-reversal stimulation of the right and left hemifield was performed in three patients with left unilateral spatial neglect. Magnetoencephalography was recorded using a 160-channel system, and VEFs were quantified in the 400 ms after each stimulus. The presence or absence of VEF components at around 100 ms (P100m component) and 145 ms (N145m component) after stimulus onset was determined. The source of the VEF was determined using a single equivalent current dipole model for spherical volume conduction. All patients were evaluated using the behavioral inattention test (BIT). Results: In response to right hemifield stimulation, the P100m and N145m components of the VEF were evident in all three patients. In response to left hemifield stimulation, both components were evident in Patient 3, whereas only the P100m component was evident in Patient 1 and only the N145m component was evident in Patient 2. Patient 1 exhibited impairments on the line bisection and cancellation tasks of the BIT, Patient 2 exhibited impairments on the copying, drawing and cancellation tasks of the BIT, and Patient 3 exhibited impairments on the cancellation task of the BIT. Conclusions: These results demonstrate that early VEFs are disrupted in patients with unilateral spatial neglect and support the concept that deficits in visual processing differ according to the clinical subtype of unilateral spatial neglect and the lesion location. This study also demonstrates the feasibility of using magnetoencephalography to explore subtypes of neglect. © 2013 Mizuno, Tsuji, Rossetti, Pisella, Ohde and Liu.

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The effect of active pedaling combined with electrical stimulation on spinal reciprocal inhibition

Yamaguchi Tomofumi, Fujiwara Toshiyuki, Saito Kei, Tanabe Shigeo, Muraoka Yoshihiro, Otaka Yohei, Osu Rieko, Tsuji Tetsuya, Hase Kimitaka, Liu Meigen

Journal of Electromyography and Kinesiology 23 （ 1 ） 190 - 194 2013年02月

ISSN  1050-6411

　概要を見る

<p>Objective: Pedaling is widely used for rehabilitation of locomotion because it induces muscle activity very similar to locomotion. Afferent stimulation is important for the modulation of spinal reflexes. Furthermore, supraspinal modulation plays an important role in spinal plasticity induced by electrical stimulation. We, therefore, expected that active pedaling combined with electrical stimulation could induce strong after-effects on spinal reflexes. Design: Twelve healthy adults participated in this study. They were instructed to perform 7. min of pedaling. We applied electrical stimulation to the common peroneal nerve during the extension phase of the pedaling cycle. We assessed reciprocal inhibition using a soleus H-reflex conditioning-test paradigm. The magnitude of reciprocal inhibition was measured before, immediately after, 15 and 30. min after active pedaling alone, electrical stimulation alone and active pedaling combined with electrical stimulation (pedaling. +. ES). Results: The amount of reciprocal inhibition was significantly increased after pedaling. +. ES. The after-effect of pedaling. +. ES on reciprocal inhibition was more prominent and longer lasting compared with pedaling or electrical stimulation alone. Conclusions: Pedaling. +. ES could induce stronger after-effects on spinal reciprocal inhibitory neurons compared with either intervention alone. Pedaling. +. ES might be used as a tool to improve locomotion and functional abnormalities in the patient with central nervous lesion. © 2012 Elsevier Ltd.</p>

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State of intracortical inhibitory interneuron activity in patients with chronic stroke

Honaga Kaoru, Fujiwara Toshiyuki, Tsuji Tetsuya, Hase Kimitaka, Ushiba Junichi, Liu Meigen

Clinical Neurophysiology 124 （ 2 ） 364 - 370 2013年02月

ISSN  1388-2457

　概要を見る

<p>Objectives: Few studies have assessed short intracortical inhibition (SICI) in the affected hemisphere (AH) in a large number of patients with chronic stroke. In this study, SICI was assessed in chronic stroke patients with severe hemiparesis, and its relationship to clinical parameters was examined. Methods: The participants were 72 patients with chronic hemiparetic stroke. SICI of both the AH and the unaffected hemisphere (UH) was assessed. The relationships between SICI and the location of lesion, time from onset, and finger function were studied. Motor function of the paretic finger was assessed with the Stroke Impairment Assessment Set (SIAS) and the Fugl-Meyer test upper extremity motor score. To compare the results with those of healthy subjects, SICI was assessed in seven age-matched control subjects. Results: MEPs of the UH were evoked in all 72 subjects, and MEPs of the AH were evoked in 24 subjects. SICI of the AH was inversely correlated with paretic finger motor function and time from stroke onset. SICI of the UH was not correlated with either one. SICI of the UH was higher in the cortical lesion group than in the control group. Conclusions: The state of intracortical inhibitory neuron activity depends on the state of motor function and lesion site even in chronic stroke patients with severe hemiparesis. Significance: The inhibitory system of the AH is involved in functional recovery of the paretic hand even in the chronic stage of stroke. © 2012 International Federation of Clinical Neurophysiology.</p>

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Natural history of lymph pumping pressure after pelvic lymphadenectomy

Okitsu T., Tsuji Tetsuya, Fujii T., Mihara M., Hara H., Kisu I., Aoki D., Miyata C., Otaka Y., Liu M.

Lymphology 45 （ 4 ） 165 - 176 2012年12月

ISSN  0024-7766

　概要を見る

<p>Lower limb lymphedema is difficult to prevent and diagnose early because its natural history is unclear. Therefore, the aim of this study was to clarify its pathogenesis and to identify risk factors that may lead to early diagnosis. In 29 patients, aged 25 to 74 years with cervical, uterine, or ovarian cancer who underwent pelvic lymphadenectomy, indocyanine green fluorescence lymphangiography was performed with an infrared camera system, and lymph pumping pressure was measured indirectly preoperatively, and one, two, three, and six months postoperatively. Of these 29 patients, 22 (75.9%) completed the examinations. In the non-lymphedema group, the average lymph pumping pressure did not change significantly at postoperative follow-up compared with preoperative values. On the other hand, lymph pumping pressure increased at various time points in five patients who developed early lymphatic changes with dermal diffusion at the level of the proximal femur. An increase in lymph flow path resistance due to pelvic lymphadenectomy resulted in an initial increase in lymph pumping pressure, followed by a subsequent decrease, in the early lymphatic changes group. This trend in the pressure change signifies that the lymph vessels became dysfunctional as they were overwhelmed by the overload condition and this feature may be a clinically useful signal for the early diagnosis of developing lymphedema.</p>

Newer challenges to restore hemiparetic upper extremity after stroke: HANDS therapy and BMI neurorehabilitation

Liu Meigen, Fujiwara Toshiyuki, Shindo Keiichiro, Kasashima Yuko, Otaka Yohei, Tsuji Tetsuya, Ushiba Junichi

Hong Kong Physiotherapy Journal 30 （ 2 ） 83 - 92 2012年12月

　概要を見る

<p>Because recovery of upper extremity (UE) functions to a practical level has been considered difficult in many patients with stroke, compensatory approaches have been emphasised. Recently, based on basic and clinical research indicating a greater potential for plastic changes in the brain, approaches directed toward functional restoration are becoming increasingly popular. Meta-analysis has indicated the effectiveness of constraint-induced movement therapy, electromyography biofeedback, electrostimulation, mental practice, and robot exercise to improve UE functions, but not hand functions. Therefore, we devised two new interventions to improve the paretic hand. One is hybrid assistive neuromuscular dynamic stimulation therapy, designed to facilitate daily use of the hemiparetic UE by combining electromyography (EMG)-triggered electrical stimulation with a wrist splint. We demonstrated improvement of motor function, spasticity, functional scores, and neurophysiologic parameters in chronic hemiparetic stroke. With a randomised controlled trial, we also demonstrated its effectiveness in subacute stroke. The other is brain-machine interface neurofeedback training, which provides real-time feedback based on analysis of volitionally decreased amplitudes of sensory motor rhythm during motor imagery involving extension of the affected fingers. This elicited new voluntary EMG activities, and improved finger functions and neurophysiological parameters. These interventions may offer powerful neurorehabilitative tools for improving hemiparetic UE function after stroke. © 2012 Hong Kong Physiotherapy Association Ltd.</p>

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Comparison of the after-effects of transcranial direct current stimulation over the motor cortex in patients with stroke and healthy volunteers

Suzuki K., Fujiwara T., Tanaka N., Tsuji T., Masakado Y., Hase K., Kimura A., Liu M.

International Journal of Neuroscience 122 （ 11 ） 675 - 681 2012年11月

ISSN  0020-7454

　概要を見る

It is known that weak transcranial direct current stimulation (tDCS) induces persistent excitability changes in the cerebral cortex. There are, however, few studies that compare the after-effects of anodal versus cathodal tDCS in patients with stroke. This study assessed the after-effects of tDCS over the motor cortex in patients with hemiparetic stroke and healthy volunteers. Seven stroke patients and nine healthy volunteers were recruited. Ten minutes of anodal and cathodal tDCS (1 mA) and sham stimulation were applied to the affected primary motor cortex (M1) on different days. In healthy subjects, tDCS was applied to the right M1. Before and after tDCS, motor-evoked potentials (MEPs) in the first dorsal interosseous (FDI) muscle and silent period were measured. Anodal tDCS increased the MEPs of the affected FDI in patients with stroke as well as in healthy subjects. Cathodal tDCS increased the MEPs of the affected FDI in patients with stroke. In healthy subjects, however, cathodal tDCS decreased the MEPs. We found no significant change in the duration of the silent period after anodal or cathodal tDCS. We found that both anodal and cathodal tDCS increased the affected M1 excitability in patients with stroke. It is thought that the after-effects of tDCS are different in patients with stroke compared with healthy subjects. © 2012 Informa Healthcare USA, Inc.

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Modulation of event-related desynchronization during motor imagery with transcranial direct current stimulation (tDCS) in patients with chronic hemiparetic stroke

Kasashima Yuko, Fujiwara Toshiyuki, Matsushika Yayoi, Tsuji Tetsuya, Hase Kimitaka, Ushiyama Junichi, Ushiba Junichi, Liu Meigen

Experimental Brain Research 221 （ 3 ） 263 - 268 2012年09月

ISSN  0014-4819

　概要を見る

<p>Electroencephalogram-based brain-computer interface (BCI) has been developed as a new neurorehabilitative tool for patients with severe hemiparesis. However, its application has been limited because of difficulty detecting stable brain signals from the affected hemisphere. It has been reported that transcranial direct current stimulation (tDCS) can modulate event-related desynchronization (ERD) in healthy persons. The objective of this study was to test the hypothesis that anodal tDCS could modulate ERD in patients with severe hemiparetic stroke. The participants were six patients with chronic hemiparetic stroke (mean age, 56.8 ± 9.5 years; mean time from the onset, 70.0 ± 19.6 months; Fugl-Meyer Assessment upper extremity motor score, 30.8 ± 16.5). We applied anodal tDCS (10 min, 1 mA) and sham stimulation over the affected primary motor cortex in a random order. ERD of the mu rhythm (mu ERD) with motor imagery of extension of the affected finger was assessed before and after anodal tDCS and sham stimulation. Mu ERD of the affected hemisphere increased significantly after anodal tDCS, whereas it did not change after sham stimulation. Our results show that anodal tDCS can increase mu ERD in patients with hemiparetic stroke, indicating that anodal tDCS could be used as a conditioning tool for BCI in stroke patients. © Springer-Verlag 2012.</p>

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Immediate effects of electrical stimulation combined with passive locomotion-like movement on gait velocity and spasticity in persons with hemiparetic stroke

Yamaguchi Tomofumi, Tanabe Shigeo, Muraoka Yoshihiro, Masakado Yoshihisa, Kimura Akio, Tsuji Tetsuya, Liu Meigen

Clinical Rehabilitation 26 （ 7 ） 619 - 628 2012年07月

ISSN  0269-2155

　概要を見る

<p>Objective: Research to examine the immediate effects of electrical stimulation combined with passive locomotion-like movement on gait velocity and spasticity.Design: A single-masked, randomized controlled trial design.Subjects: Twenty-seven stroke inpatients in subacute phase (ischemic n=16, hemorrhagic n=11).Interventions: A novel approach using electrical stimulation combined with passive locomotion-like movement.Main measures: We assessed the maximum gait speed and modified Ashworth scale before and 20 minutes after the interventions.Results: The gait velocity of the electrical stimulation combined with passive locomotion-like movement group showed the increase form 0.68±0.28 (mean±SD, unit: m) to 0.76±0.32 after the intervention. Both the electrical stimulation group and passive locomotion-like movement group also showed increases after the interventions (from 0.76±0.37 to 0.79±0.40, from 0.74±0.35 to 0.77±0.36, respectively). The gait velocity of the electrical stimulation combined with passive locomotion-like movement group differed significantly from those of the other groups (electrical stimulation combined with passive locomotion-like movement versus electrical stimulation: P=0.049, electrical stimulation combined with passive locomotion-like movement versus passive locomotion-like movement: P=0.025). Although there was no statistically significant difference in the modified Ashworth scale among the three groups, six of the nine subjects (66.6%) in the electrical stimulation combined with passive locomotion-like movement group showed improvement in the modified Ashworth scale score, while only three of the nine subjects (33.3%) in the electrical stimulation group and two of the nine subjects (22.2%) improved in the passive locomotion-like movement group.Conclusion: These findings suggest electrical stimulation combined with passive locomotion-like movement could improve gait velocity in stroke patients. © The Author(s) 2011.</p>

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Contraction level-related modulation of corticomuscular coherence differs between the tibialis anterior and soleus muscles in humans

Ushiyama J., Masakado Y., Fujiwara T., Tsuji T., Hase K., Kimura A., Liu M., Ushiba J.

Journal of Applied Physiology 112 （ 8 ） 1258 - 1267 2012年04月

ISSN  8750-7587

　概要を見る

The sensorimotor cortex activity measured by scalp EEG shows coherence with electromyogram (EMG) activity within the 15- to 35-Hz frequency band (β-band) during weak to moderate intensity of isometric voluntary contraction. This coupling is known to change its frequency band to the 35- to 60-Hz band (γ-band) during strong contraction. This study aimed to examine whether such contraction level-related modulation of corticomuscular coupling differs between muscles with different muscle compositions and functions. In 11 healthy young adults, we quantified the coherence between EEG over the sensorimotor cortex and rectified EMG during tonic isometric voluntary contraction at 10-70% of maximal voluntary contraction of the tibialis anterior (TA) and soleus (SOL) muscles, respectively. In the TA, the EEG-EMG coherence shifted from the β-band to the γ-band with increasing contraction level. Indeed, the magnitude of β-band EEG-EMG coherence was significantly decreased, whereas that of γ-band coherence was significantly increased, when the contraction level was above 60% of maximal voluntary contraction. In contrast to the TA, the SOL showed no such frequency changes of EEG-EMG coherence with alterations in the contraction levels. In other words, the maximal peak of EEG-EMG coherence in the SOL existed within the β-band, irrespective of the contraction levels. These findings suggest that the central nervous system regulates the frequency of corticomuscular coupling to exert the desired levels of muscle force and, notably, that the applicable rhythmicity of the coupling for performing strong contractions differs between muscles, depending on the physiological muscle compositions and functions of the contracting muscle. Copyright © 2012 the American Physiological Society.

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Modulation of event-related desynchronization during motor imagery with transcranial direct current stimulation in a patient with severe hemiparetic stroke

Tohyama Takamichi, Fujiwara Toshiyuki, Matsumoto Jun, Honaga Kaoru, Ushiba Junichi, Tsuji Tetsuya, Hase Kimitaka, Liu Meigen

Keio Journal of Medicine 60 （ 4 ） 114 - 118 2011年12月

ISSN  0022-9717

　概要を見る

<p>Recently, surface electroencephalogram (EEG)-based brain-machine interfaces (BMI) have been used for people with disabilities. As a BMI signal source, event-related desynchronization of alpha-band EEG (8-13 Hz) during motor imagery (mu ERD), which is interpreted as desynchronized activities of the activated neurons, is commonly used. However, it is often difficult for patients with severe hemiparesis to produce mu ERD of sufficient strength to activate BMI. Therefore, whether it is possible to modulate mu ERD during motor imagery with anodal transcranial direct-current stimulation (tDCS) was assessed in a severe left hemiparetic stroke patient. EEG was recorded over the primary motor cortex (M1), and mu ERD during finger flexion imagery was measured before and after a 5-day course of tDCS applied to M1. The ERD recorded over the affected M1 increased significantly after tDCS intervention. Anodal tDCS may increase motor cortex excitability and potentiate ERD during motor imagery in patients with severe hemiparetic stroke. © 2011 by The Keio Journal of Medicine.</p>

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Effectiveness of hybrid assistive neuromuscular dynamic stimulation therapy in patients with subacute stroke: A randomized controlled pilot trial

Shindo K., Fujiwara T., Hara J., Oba H., Hotta F., Tsuji T., Hase K., Liu M.

Neurorehabilitation and Neural Repair 25 （ 9 ） 830 - 837 2011年11月

ISSN  1545-9683

　概要を見る

Background and objective. Hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy was devised to facilitate the use of the hemiparetic upper extremity in daily life by combining assistive neuromuscular electrical stimulation, referred to as the integrated volitional electrical stimulator (IVES), with a splint. The aim of this study is to assess the effectiveness of HANDS therapy for patients with subacute stroke. Methods. The participants were 24 inpatients receiving rehabilitation for hemiparetic stroke within 60 days of onset. Entry criteria included inability to individuate finger extension. Patients were randomly assigned to 2 groups. The HANDS group (n = 12) used the IVES combined with a wrist splint for 8 hours a day for 3 weeks, and the control group (n = 12) wore a wrist splint alone. All patients received the same daily dose and length of standard poststroke multidisciplinary rehabilitation. Outcome measures were the upper extremity portion of the Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Motor Activity Log-14 (MAL). Results. In all, 10 patients in each group completed the interventions. Compared with the control group, the HANDS group showed significantly greater gains in distal (wrist/hand) portion of the FMA (P <.01) and improvement of the ARAT (P <.05). The gains in the MAL did not differ. No adverse effects occurred and the HANDS therapy was well accepted. Conclusion. HANDS therapy in addition to conventional therapy may improve hand function in patients with moderate to severe hand impairment during early rehabilitation. © 2011 American Society of Neurorehabilitation.

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Prism adaptation therapy enhances rehabilitation of stroke patients with unilateral spatial neglect: a randomized, controlled trial

Mizuno Katsuhiro, Tsuji Tetsuya, Takebayashi Toru, Fujiwara Toshiyuki, Hase Kimitaka, Liu Meigen

Neurorehabilitation and Neural Repair 25 （ 8 ） 711 - 720 2011年10月

ISSN  1545-9683

　概要を見る

<p>Background and objective. Unilateral spatial neglect (USN) can interfere with rehabilitation processes and lead to poor functional outcome. The purpose of this study was to determine whether prism adaptation (PA) therapy improves USN and functional outcomes in stroke patients in the subacute stage. Methods. A multicenter, double-masked, randomized, controlled trial was conducted to evaluate the effects of a 2-week PA therapy on USN assessed with the Behavioral Inattention Test (BIT), the Catherine Bergego Scale (CBS), and activities of daily living (ADL) as evaluated with the Functional Independence Measure (FIM). A total of 38 USN patients with right-brain damage were divided into prism (n = 20) and control (n = 18) groups. Patients were divided into mild and severe USN groups according to BIT behavioral test (mild 55 and severe&lt;55). The prism group performed repetitive pointing with prism glasses that induce rightward optical shift twice daily, 5 days per week, for 2 weeks, whereas the control group performed similar pointing training with neutral glasses. Results. The FIM improved significantly more in the prism group. In mild USN patients, there was significantly greater improvement of BIT and FIM in the prism group. Conclusions. PA therapy can significantly improve ADL in patients with subacute stroke. © 2011 American Society of Neurorehabilitation.</p>

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Transcranial direct current stimulation modulates the spinal plasticity induced with patterned electrical stimulation

Fujiwara Toshiyuki, Tsuji Tetsuya, Honaga Kaoru, Hase Kimitaka, Ushiba Junichi, Liu Meigen

Clinical Neurophysiology 122 （ 9 ） 1834 - 1837 2011年09月

ISSN  1388-2457

　概要を見る

<p>Objective: Patterned sensory electrical stimulation (PES) has been shown to induce plasticity in spinal reciprocal Ia inhibition of the calf muscles. To study the cortical modulation of spinal plasticity, we examined the effects of giving transcranial direct current stimulation (tDCS) to the motor cortex before PES. Methods: Seven healthy volunteers participated in this study. PES involved stimulating the left common peroneal nerve at the fibular head with a train of 10 pulses at 100. Hz every 1.5. s for 20. min using an intensity equal to the motor threshold of the tibialis anterior. tDCS was applied for 10. min before PES. For anodal stimulation, the electrode was placed over the motor cortex, and the cathodal electrode over the contralateral supraorbital area. For cathodal stimulation, the electrodes were reversed. Reciprocal inhibition was assessed using a soleus H reflex conditioning-test paradigm. Results: PES increased disynaptic reciprocal inhibition from the peroneal nerve to the soleus H reflex. When cathodal tDCS was applied before PES, PES no longer increased reciprocal inhibition. Conclusions: Applying tDCS before PES modulated the effects of PES on spinal reciprocal inhibition in a polarity specific manner. Significance: We suggest that the motor cortex may play a role in spinal plasticity. © 2011 International Federation of Clinical Neurophysiology.</p>

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Considerartions for establishing community liaison for stroke: from a rehabilitation perspective

Tsuji Tetsuya

Japan Medical Association Journal 53 （ 5 ） 311 - 318 2010年09月

ISSN  1346-8650

　概要を見る

<p>Each stage of stoke requires different approach in treatment. In the acute phase, treatment is centered on the "disease" itself according to the critical path specific to the disease. In the convalescent phase, treatment is centered on the "impairments" through rehabilitation programs to treat functional impairments such as motor paralysis and aphasia as well as disability in walking and activities of daily living (ADL). In the chronic phase, the focus is on the "life quality," and patients receive disease management mainly from primary care physicians to prevent the recurrence of stroke and to control comorbidities, while taking advantages of social welfare services and undergoing rehabilitation management that aims at preventing the deterioration of walking ability and ADL. Since the approach to stroke patients shifts from "disease" to "impairment" and then to "life quality" according to the disease stage, therefore, it is necessary to formulate a system that facilitate appropriate treatment and care across disease stages with mutual understanding and consent among involved parties. Such system will entail close collaborative relationships among the various care facilities to share awareness, information, assessment procedures, etc., and should provide rational explanations to patients and their families who transfer from one facility to another. In this regard, a community liaison path can serve as a tool to smoothly connect various facilities designed for particular stages of disease. This paper describes the concept of a community liaison path for stroke from a perspective of rehabilitation medicine.</p>

Considerations for establishing community liaison for stroke: From a rehabilitation perspective

Tsuji T.

Japan Medical Association Journal 53 （ 5 ） 311 - 318 2010年09月

ISSN  13468650

　概要を見る

Each stage of stoke requires different approach in treatment. In the acute phase, treatment is centered on the "disease" itself according to the critical path specific to the disease. In the convalescent phase, treatment is centered on the "impairments" through rehabilitation programs to treat functional impairments such as motor paralysis and aphasia as well as disability in walking and activities of daily living (ADL). In the chronic phase, the focus is on the "life quality," and patients receive disease management mainly from primary care physicians to prevent the recurrence of stroke and to control comorbidities, while taking advantages of social welfare services and undergoing rehabilitation management that aims at preventing the deterioration of walking ability and ADL. Since the approach to stroke patients shifts from "disease" to "impairment" and then to "life quality" according to the disease stage, therefore, it is necessary to formulate a system that facilitate appropriate treatment and care across disease stages with mutual understanding and consent among involved parties. Such system will entail close collaborative relationships among the various care facilities to share awareness, information, assessment procedures, etc., and should provide rational explanations to patients and their families who transfer from one facility to another. In this regard, a community liaison path can serve as a tool to smoothly connect various facilities designed for particular stages of disease. This paper describes the concept of a community liaison path for stroke from a perspective of rehabilitation medicine.

Activities of daily living (ADL) structure of patients with Duchenne muscular dystrophy, including adults

Fujiwara T., Tanabe A., Uchikawa K., Tsuji T., Tanuma A., Hase K., Liu M.

Keio Journal of Medicine 58 （ 4 ） 223 - 226 2009年12月

ISSN  0022-9717

　概要を見る

Objective: To study the activities of daily living (ADL) structure of patients with Duchenne muscular dystrophy (DMD). Design: Cross-sectional survey. Subjects: Seventy-two patients with DMD (mean [SD] age, 17.2 [8.1] years), recruited in 160-bed regional center for neuromuscular disease. Methods: We assessed 72 participants with the Functional Independence Measure (FIM ^SM), and determined the difficulty order of the FIM^SM items with the percentage of patients who were independent (6 or 7) for each FIM item (% independence). Results: The ADL of patients with DMD had an order in terms of difficulty. For the motor subscale, the most difficult item was stairs, and the easiest item was locomotion. On the cognitive subscale, problem solving was the most difficult item. When we compared item difficulty between patients <15 years of age and those ≥ 15 years, the % independence was lower in the older age group for all motor items. The decrease in the % independence of the eating item with age was significant; however bladder management was well maintained. Conclusions: ADL of patients with DMD has a specific difficulty order. The order of difficulty is based on the relative level of independence/dependence. The difficulty order was maintained, although the structure of ADL changed with age.

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Motor improvement and corticospinal modulation induced by hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy in patients with chronic stroke

Fujiwara Toshiyuki, Kasashima Yuko, Honaga Kaoru, Muraoka Yoshihiro, Tsuji Tetsuya, Osu Rieko, Hase Kimitaka, Masakado Yoshihisa, Liu Meigen

Neurorehabilitation and Neural Repair 23 （ 2 ） 125 - 132 2009年02月

ISSN  1545-9683

　概要を見る

<p>Background and objective. We devised a therapeutic approach to facilitate the use of the hemiparetic upper extremity (UE) in daily life by combining integrated volitional control electrical stimulation with a wrist splint, called hybrid assistive neuromuscular dynamic stimulation (HANDS). Methods. Twenty patients with chronic hemiparetic stroke (median 17.5 months) had moderate to severe UE weakness. Before and immediately after completing 3 weeks of training in 40-minute sessions, 5 days per week over 3 weeks and wearing the system for 8 hours each day, clinical measures of motor impairment, spasticity, and UE functional scores, as well as neurophysiological measures including electromyography activity, reciprocal inhibition, and intracortical inhibition were assessed. A follow-up clinical assessment was performed 3 months later. Results. UE motor function, spasticity, and functional scores improved after the intervention. Neurophysiologically, the intervention induced restoration of presynaptic and long loop inhibitory connections as well as disynaptic reciprocal inhibition. Paired pulse transcranial magnetic stimulation study indicated disinhibition of the short intracortical inhibition in the affected hemisphere. The follow-up assessment showed that improved UE functions were maintained at 3 months. Conclusion. The combination of hand splint and volitional and electrically induced muscle contraction can induce corticospinal plasticity and may offer a promising option for the management of the paretic UE in patients with stroke. A larger sample size with randomized controls is needed to demonstrate effectiveness. © 2009 The American Society of Neurorehabilitation.</p>

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Identification of quasi-in-need-of-care state (QUINOCS) among community dwelling elderly people using a seven-item subset of the Functional Independence Measure (FIM™)

Yamada Shin, Liu Meigen, Fujimoto Mikio, Hase Kimitaka, Tsuji Tetsuya, Fujiwara Toshiyuki, Okajima Yasutomo

Disability and Rehabilitation 31 （ 5 ） 381 - 386 2009年

ISSN  0963-8288

　概要を見る

<p>Purpose. To develop a screening test to identify community dwelling elderly people who are in need of assistive care but whose activities of daily living (ADLs) can be improved by appropriate rehabilitation intervention, so-called 'quasi-in-need-of-care state (QUINOCS)'. Method. A total of 32 persons (mean age 77.3 years) from the metropolitan area and 51 persons (mean age 82.7 years) from a rural area were enrolled. Two physiatrists examined them and judged whether they could benefit from rehabilitation intervention while visiting nurses evaluated their ADLs using the Functional Independence Measure (FIM™). A screening test to identify the QUINOCS was created using a seven-item subset score of the FIM™ (feeding, bathing, dressing lower-body, bladder management, bed/chair/wheel chair transfer, walking/wheel chair, stairs). Results. Fourteen in the metropolitan and 19 in the rural inhabitants were judged as the QUINOCS by the physiatrists. Persons whose subset scores included or ran across the intermediate range of independent levels (scores 3 and 4 of the FIM™) showed tendency to be judged suitable for rehabilitation intervention. This finding was applied for screening algorism to identify the QUINOCS. Sensitivity and specificity of this test were 0.71 and 0.78 for the metropolitan, and 0.74 and 0.78 for the rural groups, respectively. Conclusion. The screening method using the 7-item subset of the FIM™ can be used for identification of the QUINOCS among elderly people efficiently.</p>

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Effects of prosthetic gait training for stroke patients to induce use of the paretic leg: A report of three cases

Hase K., Fujiwara T., Tsuji T., Liu M.

Keio Journal of Medicine 57 （ 3 ） 162 - 167 2008年09月

ISSN  0022-9717

　概要を見る

During recovery from a stroke, body weight-bearing on a paretic leg is spontaneously avoided. In physiotherapy for hemiparetic gait, as long as the patients can use their non-paretic leg, adaptive and compensatory strategies are always used to support and move the body. We examined the effects of gait training using prosthetics to induce the use of a paretic leg during walking. The prosthesis was applied to the non-paretic leg of three right hemiparetic patients. Prosthetic gait training was performed until finishing 5 successive motor learning sessions involving walking over 200 m and the changes of asymmetric gait performances were analyzed. The ground reaction forces during the initial stance phase of the paretic leg were increased in all patients after prosthetic gait training. Simultaneously, the propulsive force produced by the paretic leg was increased in 2 patients. By contrast, another patient developed more use of his non-paretic leg for propulsion corresponding to acquiring stability on the paretic leg, resulting in an improvement in single-support-time asymmetry. Task-specific effects provided by prosthetic gait training may be able to reorganize the motor strategy for hemiparetic gait by inducing the use of the paretic leg to support and propell the body.

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Dysphagia in patients with duchenne muscular dystrophy evaluated with a questionnaire and videofluorography

Hanayama K., Liu M., Higuchi Y., Fujiwara T., Tsuji T., Hase K., Ishihara T.

Disability and Rehabilitation 30 （ 7 ） 517 - 522 2008年

ISSN  0963-8288

　概要を見る

Purpose. To investigate swallowing problems in patients with Duchenne muscular dystrophy (DMD) using a questionnaire and videofluorography (VF). Method. A questionnaire survey was performed of swallowing-related symptoms and VF in 31 male patients with DMD (mean age 19.9 years, range 9-26 years). The relationships among age, frequency of symptoms and VF abnormalities were analysed using Spearman's rank correlation. The differences in VF abnormalities among different food textures were analysed with the Kruskal-Wallis test. Results. Symptoms related to pharyngeal phase dysfunction were more frequent than those related to oral and oesophageal phases. Coughing while eating was seen in 71% of the patients, choking while eating in 32% and the need to clear the throat in 26%. VF abnormalities were observed in 30 patients (96.8%). Common VF abnormalities included pooling in the valleculae (90.3%) and in the pyriform sinus (90.3%). Pharyngo-oral regurgitation was seen in 35.5% of the patients. Pooling in the pyriform sinus after repeated swallowing seen in VF correlated significantly with symptoms related to the pharyngeal phase (Spearman's rho 0.356-0.544). Conclusion. Because oropharyngeal dysphagia in DMD was evident in teenage patients as well as those without clinical symptoms, VF is recommended in patients with DMD.

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Electromyographic findings after different selective neck dissections

Tsuji T., Tanuma A., Onitsuka T., Ebihara M., Iida Y., Kimura A., Liu M.

Laryngoscope 117 （ 2 ） 319 - 322 2007年02月

ISSN  0023-852X

　概要を見る

OBJECTIVES: The objective was to compare electrophysiologic investigations of the upper trapezius muscle (UT) after different selective neck dissections (SND) and analyze the differences between types of SND and the preservation and excision of the cervical nerves (the C2-4 rami of the cervical plexus). STUDY DESIGN: Retrospective study of 54 patients (average age, 65.1 ± 9.6 yr, 45 males) with 70 SND. METHODS: Patients underwent needle electromyography (EMG) of the UT by 4 months after surgery. The findings were rated according to the 5 point EMG scale system from 1 (total denervation: positive sharp wave or fibrillation potential at rest and electrical silence at voluntary contraction) to 5 (normal pattern). RESULTS: The average EMG scale was 1.7 ± 1.1, 58.6% for score 1 and only 5.7% for score 5. There was not a significant difference in the EMG scale between the types of SND, whereas the group in which the cervical nerves were excised was significantly lower than in that in which it was preserved. The average EMG scales in the former and latter were 1.5 ± 0.8 and 2.0 ± 1.3, 68.8%. CONCLUSIONS: The study data confirm that complete or incomplete denervation of the UT was caused by axonal injury of the spinal accessory nerve, even though it was spared, because of traction of the nerve during neck dissection. Second, the excision of the C2 to 4 rami of the cervical plexus caused worse damage of the UT. It is suggested that it is important to preserve the cervical nerves to avoid denervation of the UT. © The American Laryngological, Rhinological & Otological Society, Inc.

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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

　概要を見る

<p>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&lt;.001), and external rotation (P&lt;.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&lt;.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.</p>

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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

　概要を見る

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

　概要を見る

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

　概要を見る

<p>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.</p>

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

　概要を見る

<p>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 &lt; 0.05). Conclusion: We recommend our modified 30 ml water-swallowing test as a useful single task-screening tool to detect aspiration. © 2005 Taylor &amp; Francis.</p>

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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

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<p>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.</p>

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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

　概要を見る

<p>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.</p>

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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

　概要を見る

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

　概要を見る

<p>Pedaling consists of reciprocating muscle activities similar to gait. Recent studies show that pedaling exercise is useful for rehabilitation of stroke patients and other central nervous system disorders. We reviewed studies of the neurophysiological basis of pedaling, pedaling in patients with central nervous system lesions, and the therapeutic application of pedaling exercises to patients with stroke. © 2005 by Begell House, Inc.</p>

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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

　概要を見る

<p>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.</p>

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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

　概要を見る

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

　概要を見る

<p>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 &lt; 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.</p>

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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

　概要を見る

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

　概要を見る

<p>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.</p>

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

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<p>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.</p>

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

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<p>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 &gt; ipsilateral; II: contralateral = ipsilateral; III: contralateral &lt; 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.</p>

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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

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<p>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.</p>

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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

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<p>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.</p>

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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

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<p>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 &lt; .0001). Stability of the predictive equation was confirmed in the cross-validation sample (R² = .68, p &lt; .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.</p>

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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 M., Tsuji T., Tsujiuchi K., Chino N.

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

ISSN  0894-9115

　概要を見る

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 T., Liu M., Tsujiuchi K., Chino N.

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

ISSN  0003-9993

　概要を見る

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 (Vo<inf>2</inf>), heart rate (HR), and HR oxygen coefficient (regression coefficient between HR and Vo<inf>2</inf>). Results: The testing protocol was applicable to 88.6% of hemiplegic patients. The relationship between HR and Vo<inf>2</inf> 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 Vo<inf>2</inf>, 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 VO<inf>2</inf> 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 T., Liu M., Toikawa H., Hanayama K., Sonoda S., Chino N.

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

ISSN  0894-9115

　概要を見る

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

　概要を見る

<p>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.</p>

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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

　概要を見る

<p>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.</p>

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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

　概要を見る

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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