Botulinum toxin type A (BTXA) has been shown to be an effective treatment in reducing muscle tone and managing spasticity in poststroke patients. However, its effectiveness in improving function in lower limb spasticity has been more controversial. In this report, we present our findings in three cases of chronic stroke patients with lower limb spasticity wherein we examine the effectiveness of a 4-week intensive rehabilitation program following BTXA treatment. For each patient, BTXA was injected into spastic muscles of the affected lower limb and a rehabilitation program was provided for the patient in-hospital for 4 weeks. Before BTXA treatment (baseline) and at 2 and 4 week follow-ups after each treatment, the Stroke Impairment Assessment Set (SIAS), the Modified Ashworth Scale (MAS) and the Range of Motion (ROM) of the ankle, the 10 Meter Walking Test (10MWT), the 6 minutes walking distance (6MD), the Timed Up and Go Test (TUG), the Berg Balance Scale (BBS), and the Functional Independence Measure (FIM) were all assessed. In each patient, ankle MAS and ROM, 10MWT, 6MD, TUG, and BBS after 4 weeks improved from the baseline. Furthermore, the ankle MAS and ROM improved significantly within 2 weeks, as did the 10MWT and 6MD over the total 4 weeks. In conclusion, it is suggested that a better improvement of ambulation and balance, as well as spasticity, would be found with intensive rehabilitation following BTXA treatment for lower limb spasticity.

OBJECTIVE: To outline the association between the National Institutes of Health Stroke Scale (NIHSS) in the acute stage and the Functional Independence Measure (FIM) of motor items several months later. METHODS: Seventy-nine infarct cases with middle-cerebral-artery region transferred to long-term rehabilitation facilities were analyzed. Patients were allocated to either the model-development group or the confirmatory group at a 2:1 ratio. Independent variables were based on the NIHSS during the acute care and on demographic factors such as age and modified Rankin Scale (mRS) before onset. Multivariate logistic analyses were performed to predict the independence of each FIM motor item. These models were evaluated in the confirmatory group. RESULTS: Multivariate logistic analyses in the model-development group (n=53) indicated that at least one NIHSS item was statistically significantly associated with the functional independence of a single FIM motor item. Of the NIHSS items, the affected lower extremity item was the most widely associated with 11 of the FIM motor items, except for eating and shower transfer. The affected upper extremity function was the second widely involved factor associated with 7 of the FIM motor items including eating, grooming, bathing, toileting, bed transfer, toilet transfer, and shower transfer. Age and mRS were also statistically significant contributing factors. The obtained predictive models were assessed in the confirmatory group (n=26); these were successful except for the stairs climb item. CONCLUSION: In combination with age and pre-stroke status, the NIHSS items (especially the affected extremity items) may be useful for the prediction of long-term outcome in terms of activities in daily living.
Animals ; Baths ; Demography ; Eating ; Extremities ; Grooming ; Humans ; Infarction, Middle Cerebral Artery ; Lower Extremity ; Middle Cerebral Artery* ; National Institutes of Health (U.S.) ; Rehabilitation ; Stroke ; Upper Extremity

Objective：Brain disorders are major concerns in rehabilitation medicine in Japan. Of the various categories of brain disorders, rehabilitative treatments for strokes, traumatic brain injuries, and neurodegenerative diseases are different. This study aimed to demonstrate the specificities of the rehabilitative treatments for these three subcategories after statistical analysis of textual data from abstracts indexed during an annual meeting for rehabilitation medicine.Materials and Methods：Abstracts indexed during the 56th annual meeting of the Japanese Association of Rehabilitation Medicine in 2019 were entered into the analytical database. Words associated with each subcategory were extracted using Jaccard's similarity coefficients.Results：The analysies showed that the words strongly associated with strokes were “paresis,” “convalescent,” “admission,” “onset,” “ward,” “function,” “FIM,” “impairment,” “improvement,” and “discharge” (extracted from 402 abstracts；coefficients ranged from 0.36 to 0.23). In parallel, the words such as “trauma,” “traffic,” “higher,” “accident,” “fall,” “brain,” “labor,” “brain-disease,” “hematoma,” and “facility” were related to traumatic brain injuries (extracted from 36 abstracts；coefficients ranged from 0.15 to 0.08). The words strongly associated with neurodegenerative diseases were “cognition,” “MMSE,” “elderly,” “care,” “home,” “nursing home,” “fracture,” “impairment,” “Yahr,” and “disease” (extracted from 96 abstracts；coefficients ranged from 0.18 to 0.09).Conclusions：The specifics of rehabilitative treatments for strokes, traumatic brain injuries, and neurodegenerative diseases were successfully outlined after the analysies of the textual data. This technique may be useful for evaluating information provided in textual forms, such as abstracts of conferences.

Objective：Brain disorders are major concerns in rehabilitation medicine in Japan. Of the various categories of brain disorders, rehabilitative treatments for strokes, traumatic brain injuries, and neurodegenerative diseases are different. This study aimed to demonstrate the specificities of the rehabilitative treatments for these three subcategories after statistical analysis of textual data from abstracts indexed during an annual meeting for rehabilitation medicine.Materials and Methods：Abstracts indexed during the 56th annual meeting of the Japanese Association of Rehabilitation Medicine in 2019 were entered into the analytical database. Words associated with each subcategory were extracted using Jaccard's similarity coefficients.Results：The analysies showed that the words strongly associated with strokes were “paresis,” “convalescent,” “admission,” “onset,” “ward,” “function,” “FIM,” “impairment,” “improvement,” and “discharge” (extracted from 402 abstracts；coefficients ranged from 0.36 to 0.23). In parallel, the words such as “trauma,” “traffic,” “higher,” “accident,” “fall,” “brain,” “labor,” “brain-disease,” “hematoma,” and “facility” were related to traumatic brain injuries (extracted from 36 abstracts；coefficients ranged from 0.15 to 0.08). The words strongly associated with neurodegenerative diseases were “cognition,” “MMSE,” “elderly,” “care,” “home,” “nursing home,” “fracture,” “impairment,” “Yahr,” and “disease” (extracted from 96 abstracts；coefficients ranged from 0.18 to 0.09).Conclusions：The specifics of rehabilitative treatments for strokes, traumatic brain injuries, and neurodegenerative diseases were successfully outlined after the analysies of the textual data. This technique may be useful for evaluating information provided in textual forms, such as abstracts of conferences.

Objective: To develop a new prediction model by combining independence in eating and bladder management functions, and to assess its utility in an acute care setting. Methods: Patients with ischemic stroke who were admitted in our acute stroke care unit (n=250) were enrolled in this study. Functional Independence Measure (FIM) scores for eating and bladder management on the initial day of rehabilitative treatment (median, 3 days) were collected as predictive variables. These scores were divided into low (<5) and high (≥5) and categorized as values 0 and 1, respectively. From the simple summation of these two-level model values, we derived a three-level model that categorized the scores as values 0, 1, and 2. The FIM-motor scores at discharge (median, 14 days) were collected as outcome measurements. The three-level model was assessed by observing the distribution patterns of the outcome FIM-motor scores and logistic regression analyses. Results: The median outcome FIM-motor score was 19 (interquartile range [IQR],13.8–45.3) for the value 0 category (n=14), 66.5 (IQR, 59.5–81.8) for the value 1 category (n=16), and 84 (IQR, 77–89) for the value 2 category (n=95) in the three-level model. Data fitting by logistic regression for FIM-motor scores of 41.3 and 61.4 reached 50% probability of values 1 and 2, respectively. Conclusion Despite the simplicity of the three-level model, it may be useful for predicting outcomes of patients with ischemic stroke in acute care.

Objective: To develop a new prediction model by combining independence in eating and bladder management functions, and to assess its utility in an acute care setting. Methods: Patients with ischemic stroke who were admitted in our acute stroke care unit (n=250) were enrolled in this study. Functional Independence Measure (FIM) scores for eating and bladder management on the initial day of rehabilitative treatment (median, 3 days) were collected as predictive variables. These scores were divided into low (<5) and high (≥5) and categorized as values 0 and 1, respectively. From the simple summation of these two-level model values, we derived a three-level model that categorized the scores as values 0, 1, and 2. The FIM-motor scores at discharge (median, 14 days) were collected as outcome measurements. The three-level model was assessed by observing the distribution patterns of the outcome FIM-motor scores and logistic regression analyses. Results: The median outcome FIM-motor score was 19 (interquartile range [IQR],13.8–45.3) for the value 0 category (n=14), 66.5 (IQR, 59.5–81.8) for the value 1 category (n=16), and 84 (IQR, 77–89) for the value 2 category (n=95) in the three-level model. Data fitting by logistic regression for FIM-motor scores of 41.3 and 61.4 reached 50% probability of values 1 and 2, respectively. Conclusion Despite the simplicity of the three-level model, it may be useful for predicting outcomes of patients with ischemic stroke in acute care.

Objective: This study aimed to clarify the factors influencing the discharge destination of stroke patients in a super-aged rural community in Japan, focusing on functional independence and sociodemographic factors.Patients and Methods: We enrolled patients recovering from stroke with supratentorial lesions who were admitted to our convalescent rehabilitation hospital. The motor components of the Functional Independence Measure (FIM-motor) were assessed for each patient at admission and discharge as explanatory variables. An increase in the FIM-motor scores during hospitalization was also recorded. Additionally, sociodemographic data such as sex, age, and clinical characteristics, such as type of stroke, history of stroke, days from stroke onset to transfer to our convalescent rehabilitation hospital, total duration of hospital stay including acute care, number of co-resident household members, living with a spouse, and number of children were collected. As target values, discharge outcomes were categorized into two groups: returning home and going to a nursing home. Logistic regression analysis was performed.Results: The study sample comprised 160 patients (mean age ± standard deviation, 74.80 ± 12.19 years). Of these, 114 were discharged to their homes, and 46 were transferred to nursing homes. The results of multivariate logistic regression analysis indicated that higher FIM-motor scores at discharge, greater number of co-resident household members, and living with one’s spouse were the most powerful predictors of a higher probability of returning home.Conclusion: This study demonstrated that functional independence levels and the number of co-resident household members were crucial factors in predicting the discharge destination of patients after stroke in a super-aged rural community in Japan. These findings imply that for older patients with lower functional independence, supportive social networks are essential for home discharge, offering clues for providing long-term healthcare in super-aged rural communities worldwide.