Kento Katagiri

BACKGROUND: Gait-a frequently performed activity of daily living-is thought to reflect multiple dimensions of an individual's physical and cognitive status. Individuals with frailty or mild cognitive impairment (MCI) show decreased gait speed. However, previous studies have not simultaneously considered both statuses, although they frequently co-occur and may act as confounders. The direct association between frailty and gait is well-understood. In contrast, the association between cognitive decline-independent of physical function-and decreased gait speed, as well as the relationship among these three factors (frailty, cognitive decline, and gait speed), is not fully understood. METHODS: This study examined the effect of MCI on gait speed after accounting for frailty. Older individuals were categorized as (1) frailty with MCI, (2) frailty without MCI, (3) pre-frailty with MCI, (4) pre-frailty without MCI, (5) non-frailty with MCI, and (6) non-frailty without MCI. Frailty was assessed using the Kihon checklist and MCI using the Montreal Cognitive Assessment. Participants completed a 10-m walk test under two conditions: comfortable walking and fast walking. Two types of analyses were conducted: mediation analysis and two-way analysis of covariance (ANCOVA). RESULTS: Mediation analysis supported independent relationships between frailty and MCI status and gait speed, suggesting a direct association between MCI and gait speed, even when accounting for frailty. In addition, two-way analysis of covariance indicated significant main effects of both frailty and MCI on gait speed, with no significant interaction between them under the two walking conditions. CONCLUSIONS: These findings suggest that the observed association between MCI and gait speed is largely independent from frailty status, providing additional evidence supporting the association between cognitive function and gait performance.

PURPOSE: In real-world care settings, wheelchair operation from multiple directions would be optimal. This study aimed to determine how caregivers operate the omni-directional accessible (OA) wheelchair, which features four swivel casters to achieve omni-directional movement and two vertical handles for caregivers located at the front of the armrest and its effectiveness for reducing time of wheelchair operations. METHOD: Twenty healthy volunteers were randomly assigned to either the OA (n = 10) or conventional (n = 10) wheelchair group. Participants performed a wheelchair operation task in a simulated care setting. We measured the caregiver's position during wheelchair operation and the task completion time required for the wheelchair operation task. RESULT: The results showed that all participants in OA group operated the wheelchair from positions other than the rear. This tendency became more pronounced as the trial number increased, contributing to shorter task completion time than conventional wheelchair. CONCLUSION: These findings suggest that OA wheelchairs are suitable and effective for use in real-world care settings.

Constipation is a prevalent condition that negatively impacts health and quality of life. Inadequate physical activity is a known contributing factor, often associated with reduced gut motility. However, the physiological mechanism linking physical activity and constipation remains unclear. Particularly research on the immediate effects of physical activity on peristalsis is scarce. Therefore, we aimed to elucidate this mechanism by examining the immediate effects of physical activity on gut motility in healthy adults. Twenty-one participants were instructed to walk on a treadmill for 20 min. Bowel sounds were assessed at rest and at intervals up to 15 min after walking. Bowel sounds were used as indirect markers of gut motility. We calculated the sum of the absolute signal amplitudes of bowel sounds, the percentage of bowel sounds duration, and number of discrete bowel sounds, which have been proposed as indices of gut motility. All the indices increased significantly 1-2 min post-exercise compared to resting values. This increase may be attributed to changes in the autonomic nervous system and local reflexes caused by biomechanical oscillations. In addition, gut motility activation might explain the effects of physical activity intervention on constipation and offer insights into its potential role in managing the condition.

OBJECTIVE: To demonstrate the long-term efficacy of repeated botulinum toxin A injections into the same muscles for ameliorating lower limb spasticity and gait function. DESIGN: Single-case study. PATIENT: A 36-year-old woman with right cerebral haemorrhage received her first botulinum toxin A injection 1,296 days after onset. The patient underwent 30 treatments over 12 years after the first injection to improve upper and lower limb spasticity and abnormal gait patterns. The mean duration between injections was 147 days. METHODS: The Modified Ashworth Scale, passive range of motion, gait velocity, and degree of abnormal gait patterns during treadmill gait were evaluated pre-injection and at 2, 6, and 12 weeks after every injection. RESULTS: The follow-up period showed no injection-related adverse events. Comfortable overground gait velocity gradually improved over 30 injections. The Modified Ashworth Scale and passive range of motion improved after each injection. Pre-injection values of the degree of pes varus, circumduction, hip hiking, and knee extensor thrust improved gradually. However, the degree of contralateral vaulting, excessive lateral shift of the trunk, and insufficient knee flexion did not improve after 30 injections. CONCLUSION: Repeated botulinum toxin A injections effectively improve abnormal gait patterns, even when a single injection cannot change these values.