櫻井 宏明

BACKGROUND: Patients with Parkinson's disease (PwPDs) experience a progressive decline in their sit-to-stand (STS) ability, including a prolonged STS time, rising failure, and seat-off failure. The clinical and biomechanical factors contributing to this decline are unclear. OBJECTIVES: We investigated clinical and biomechanical factors associated with the different stages of STS decline in PwPDs. METHODS: This cross-sectional study included 23 healthy controls (HCs) plus 40 PwPDs who we categorized by STS ability: 18 successful STS (SS), 12 failure-to-rise (FR), and 10 failure-to-seat-off (FS). Clinical assessments included motor symptoms (Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale), balance (Mini-Balance Evaluation Systems Test), and lower-limb strength. Biomechanical parameters measured using force plates included repetitive movements, slope of first-peak loading, and amplitude and temporal parameters. We conducted group comparisons and determined the age-adjusted area under the receiver operating characteristic curve (AAUC) and Spearman's correlations with the STS time (P < 0.05). RESULTS: In the SS group, prolonged STS time was significantly correlated with amplitude and temporal parameters (rs = -0.849 to 0.986), for example, first-peak feet loading and its slope, reflecting impaired weight shifting from the buttocks onto the soles. These parameters effectively differentiated FR from SS (AAUC = 0.778-0.884) and FS from FR (AAUC = 0.758-0.992). Lower-limb bradykinesia differentiated FR from SS (AAUC = 0.870). All balance-related measures also strongly distinguished FS from FR (AAUC = 0.817-0.925). CONCLUSIONS: These findings highlight that weight-shifting impairments, along with bradykinesia in the earlier stages and balance deficits in the later stages, play pivotal roles in the progressive STS decline in PwPDs. Interventions targeting weight shifting, as well as bradykinesia, and postural control, could potentially help mitigate this decline.

OBJECTIVES: With the recent progression of a super-aging society in Japan, demand for medical and welfare professionals has increased, and occupational therapists are in great demand. Academic performance is important for occupational therapy and rehabilitation students. The current study aimed to determine the influence of self-esteem and psychological factors on academic performance in Japanese occupational therapy students. METHODS: A cross-sectional study was conducted among 60 first-year occupational therapy students (16 male and 44 female) at a private medical university in Japan in June 2022. The State-Trait Anxiety Inventory (STAI) and Beck Depression Inventory Second Edition (BDI-II) were used to assess anxiety and depression symptoms, respectively, and the Rosenberg Self-Esteem Scale (RSES) was used to assess self-esteem. RESULTS: We identified several factors affecting the examination performance of Japanese occupational therapy students. Self-esteem was significantly associated with examination performance in anatomy 1 (p=0.02, β=0.40). RSES-J social work (p=0.07, β=0.31) and anatomy 2 (p=0.08, β=0.30), STAI-JYZ (p=0.09, β=0.38), and STAI-JYZ rehabilitation medicine (p=0.06, β=0.44), and BDI-II (p=0.08, β=-0.43) showed no significant effects but exhibited a trend toward an association. CONCLUSIONS: Understanding the role of psychological aspects and self-esteem is important for constructing systems to support first-year university students. Furthermore, the development of psychological aspects and self-esteem is essential for improving the academic performance of occupational therapy students, and it is crucial to establish educational programs and support systems.

OBJECTIVES: This research used text mining to determine the impact of curricular experiences in each year of study on the formation of professional identity among students aspiring to become physical therapists (PTs) and occupational therapists (OTs). METHODS: This study included 210 students (126 PT and 84 OT) enrolled at a single rehabilitation university in Japan in 2020 and 2021. These participants completed an open-ended questionnaire on personal growth 6, 12, 18 and 24 months after enrollment. Text mining was used to extract frequently occurring nouns from descriptive text data at these four time points. A hierarchical cluster analysis was then performed to generate clusters. The number of students mentioning at least one noun in each cluster was counted, and the proportion of students in each cluster was compared across the four time periods using Cochran's Q test. RESULTS: The 16 nouns that appeared more than 30 times in 1073 sentences were classified into four clusters: "action plan for passing the credit certification examination", "communication skill", "medical knowledge" and "school life with clinical practice in mind". The proportion of students belonging to the four clusters varied across periods. "Action plan for passing the credit certification examination" and "communication skill" differed significantly across periods (p<0.0001 and p=0.0008, respectively). CONCLUSIONS: The results reveal how students have grown in their curriculum. Their growth was transformative.

Objective: To identify factors associated with earlier independence in “real-life walking” during hospitalization in subacute stroke patients.Design: Retrospective cohort study.Subjects/Patients: Two hundred and six hemiplegic patients.Methods: Functional Independence Measure (FIM) walking items were measured biweekly from admission to discharge. Patients were grouped by achieving independent “real-life walking” (FIM-walking score ≥6). Time to independence, stratified by age, FIM motor score (FIM-M), FIM cognitive score (FIM-C), and Functional Ambulation Categories (FAC) scores were compared using Kaplan–Meier plots and log-rank tests. Hazard ratios were calculated via multivariable Cox proportional hazard models.Results: The median time to independence was 4 weeks, with significant differences (p &lt; 0.05) by age, FIM-M, FIM-C, and FAC stratification. Age ≤64 years (hazard ratio 1.92, 95% confidence interval 1.21–3.06), FIM-C ≥25 (hazard ratio 2.42, 95% confidence interval 1.52–3.86), and FAC ≥3 (hazard ratio 1.98, 95% confidence interval 1.22–3.21) significantly affected earlier walking independence (all p &lt; 0.01). Impeding factors were FIM-M ≤38 (hazard ratio 0.23, 95% confidence interval 0.13–0.40; p &lt; 0.01) and FAC = 0 (hazard ratio 0.184, 95% confidence interval 0.06–0.62; p &lt; 0.01).Conclusion: Early improvement in “real-life walking” was associated with younger age, greater cognitive function, and greater “test-setting walking” ability on admission. Low activities of daily living independence and “test-setting walking” ability hindered early progress.