近藤 輝

BACKGROUND: Various digital biomarkers have been explored to detect cognitive impairment in community-dwelling older individuals, among which electricity consumption (EC) data obtained from smart meters are novel and promising because they pose no burden to the individuals. OBJECTIVE: The study aimed to explore the potential of EC as a digital biomarker to screen older individuals with cognitive impairment living alone. METHODS: We recruited 40 older individuals living alone and recorded their 1-year daily household EC data. We used the Japanese version of the Montreal Cognitive Assessment to categorize participants into 2 groups: those with and without cognitive impairment. As the pattern of daily household EC is different between lower and higher temperature ranges because of the use of heating and cooling equipment, we divided the daily household EC into 3 temperature ranges. Using a linear mixed model, we evaluated the association between daily household EC, daily outside temperature, and the groups. RESULTS: After excluding 12 participants, they were categorized into 2 groups: those with (10/28, 36%) and without cognitive impairment (18/28, 64%). The daily household EC data consisting of 9391 points showed two characteristics: (1) daily household EC was significantly lower in the group with cognitive impairment than in the group without cognitive impairment in the high temperature range (2.158 kWh at 25 °C, P=.02; 3.712 kWh at 30 °C, P<.001). The increase in EC with rising temperature from 25 °C to 30 °C was less in the group with cognitive impairment (2.387 kWh, P<.001) than in the group without cognitive impairment (3.940 kWh, P<.001); and (2) a tendency for lower daily household EC in the group with cognitive impairment was observed in the moderate temperature range (1.795 kWh at 15 °C, P=.06; 1.582 kWh at 20 °C, P=.08). CONCLUSIONS: The group with cognitive impairment may use less cooling equipment in the high temperature range and fewer home appliances in the moderate temperature range. Daily household EC might be useful in screening cognitive impairment in older individuals living alone.

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.

UNLABELLED: Itoh S, Tanikawa H, Kondo H, Ozeki S, Ito T, Fujimura K, Teranishi T. Minimal Detectable Change in Muscle Strength Measurements Obtained Using a Hand-Held Dynamometer in Patients with Stroke. Jpn J Compr Rehabil Sci 2025; 16: 9-18. OBJECTIVE: The current study aimed to evaluate the reliability of muscle strength measurements using a hand-held dynamometer (HHD) in patients with chronic stroke. Further, it examined the minimal detectable change (MDC95). METHODS: Patients who presented with chronic stroke hemiplegia for > 180 days post-stroke onset were analyzed. Muscle strength in the paretic lower limb was assessed using an HHD, and gait speed was evaluated. RESULTS: For hip flexion, hip adduction, hip abduction, knee extension, ankle dorsiflexion, and ankle plantarflexion, the intra-rater reliability of the muscle strength measurements, as assessed using the intraclass correlation coefficient (ICC), ranged from 0.989 to 0.998. The inter-rater reliability, as assessed using ICC, ranged from 0.886 to 0.939. Bland-Altman analysis did not indicate systematic errors, and the MDC95 of each joint movement was calculated. Muscle strength in hip flexion, hip adduction, knee extension, ankle dorsiflexion, and ankle plantarflexion were significantly associated with gait speed, but not with hip abduction strength. The MDC95 of each muscle strength measurement was established, thereby providing a criterion for detecting actual changes that exceed the measurement error. CONCLUSIONS: The HHD had a high reliability in measuring lower limb muscle strength in patients with chronic stroke hemiplegia. Moreover, an association was found between individual muscle strength and gait ability. Based on this study, specific target muscles for interventions that aim to improve gait speed can be identified. Further, the use of MDC95 allows for a more accurate assessment of the intervention effects.

This study aimed to clarify the kinematics, particularly of the shoulder and hip joints, during preparation for manual wheelchair-to-bed transfer (i.e. when flipping up the arm and foot supports). This cross-sectional study included 32 able-bodied individuals. The kinematics of the shoulder and hip joints when the arm and foot supports were flipped up of manual wheelchair, were evaluated using a markerless inertial sensor-based motion capture system. We found that flipping the arm support upwards involved a large amount of abduction, internal and external rotation, flexion, and extension at the shoulder joint, whereas flipping the foot support upwards involved a large amount of flexion at the hip joint. The findings suggest that it is necessary to consider the range of motion required to flip up the arm and foot supports of manual wheelchairs, particularly in those with limited shoulder and hip range of motion such as older people, neuromuscular disorders, and orthopedic disorders.

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.