大塚 圭

OBJECTIVES: The purpose of this study was to capture the lifestyle characteristics of traumatic brain injury (TBI) patients by administering the Frenchay Activities Index (FAI), a self-assessment questionnaire used for assessing life-related activities, among TBI patients. METHODS: This study was conducted using the revised FAI Self-Assessment Form, administering an interview-based questionnaire survey to TBI patients and healthy participants. The target group comprised 60 traumatic brain injury patients who had progressed from at least 1 year since the injury, with a comparison group of 788 healthy participants. RESULTS: A comparison of FAI scores between TBI patients and healthy participants by questionnaire revealed that TBI patients exhibited significantly higher FAI scores than healthy participants for outdoor walking and transportation use (Mann-Whitney U test, P<0.01). A comparison by occupation revealed that TBI patients were significantly less among the unemployed and other categories (Mann-Whitney U test, P<0.01). For office workers, government employees, high school students, and college students, scores were higher among TBI patients compared with healthy participants, although the differences were not significant. CONCLUSIONS: Although TBI patients were less active than healthy participants in life-related activities, their scores for cleaning up after meals and cleaning and putting things in order were close to those of healthy participants, indicating that TBI patients cannot be considered to be inactive. The findings also revealed differences in TBI patients' engagement in life-related activities and frequency of activities depending on their social position.

OBJECTIVES: This study investigates how online frame-of-reference (FOR) training of raters of the objective structured clinical examination (OSCE) for physical therapy students affects assessment accuracy. METHODS: The research was conducted in a 1-month-long randomized controlled trial. PARTICIPANTS: The participants were 36 physical therapists without experience assessing clinical skills using the OSCE. The training group completed the FOR training online, which was conducted once a week in two 90-minute sessions. The control group self-studied the rubric rating chart used in the assessment. As a measure of accuracy, weighted kappa coefficients were used to check the agreement between correct score and those assessment by the participant in the OSCE. RESULTS: The scores of the training group were higher than those of the control group in both post- and follow-up assessments, showing significant differences. No significant difference was found based on the assessment time and group for the high-agreement groups. Furthermore, scores of the low-accuracy training group were higher in the post- and follow-up assessments than those in the pre-assessment, showing significant differences. CONCLUSIONS: Online FOR training of the raters of the OSCE for physical therapists improved the assessment accuracy of the raters who had low accuracy in the pre-assessment; this improvement was maintained.

OBJECTIVES: In stroke patients, the assessment of gait ability over time is important. For quantitative gait assessment using measuring devices, the walking speed condition for measurement is generally based on the patient's preferred walking speed or the maximum walking speed at the time of measurement. However, because walking speed often increases during the convalescent stage, understanding the effects of change in walking speed on gait when comparing the course of recovery is necessary. Although several previous studies have reported the effects of change in walking speed on gait in stroke patients, the time-distance parameters described in these reports may not be generalizable because of the small case numbers. Therefore, we measured treadmill gait at the preferred walking speed (PWS) and 1.3 times the PWS (130% PWS) in 43 post-stroke hemiplegic patients and analyzed the effects of change in walking speed on time-distance parameters. METHODS: Forty-three patients with hemiplegia after a first stroke, who were able to walk on a treadmill under supervision, were recruited as subjects. Using a three-dimensional motion analysis system, treadmill gait was assessed under two conditions: PWS and 130% PWS. The primary outcome measures were the time-distance parameters, which were compared between the PWS and 130% PWS conditions. RESULTS: Cadence, stride length, and step length of the affected and unaffected lower limbs increased significantly at 130% PWS compared with at PWS. In terms of actual time, single stance time and initial and terminal double stance time in both affected and unaffected limbs decreased significantly at 130% PWS. In terms of relative time (% of the gait cycle), compared with PWS, relative single stance time increased significantly, whereas relative initial and terminal double stance times decreased significantly at 130% PWS in both the affected and unaffected limbs. CONCLUSIONS: This study on treadmill gait in patients with hemiplegia after a first stroke confirmed the effects of change in walking speed on time-distance parameters. Our results will help in the interpretation of time-distance parameters measured under different walking speed conditions.

Objectives: To evaluate the safety and acceptability of a newly developed tele-rehabilitation exercise system using computer-generated animation. Methods: The participants comprised a convenience sample of 38 diverse individuals in Experiment 1 (15 healthy young people, 16 healthy older people, 5 patients with stroke, and 2 patients with respiratory disease) and 18 healthy older individuals in Experiment 2. Experiment 1 assessed safety in terms of cardiopulmonary vascular aspects and risk of fall, and Experiment 2 assessed treatment acceptability via a subjective evaluation. All participants completed the same exercise program. The safety assessment was conducted using heart rate (HR) and saturation of percutaneous oxygen (SpO2), measured before and after exercise. In addition, the occurrence of falls was assessed. For the acceptability assessment, the participants answered five questions (three-point Likert scale) after the exercise program. Results: The safety assessment indicated that HR and SpO2 changed from 70.5±10.2 beats per minute and 97.8±1.3% before exercise to 87.6±13.6 beats per minute and 98.2±0.9% after exercise, respectively. In addition, all participants completed the exercises without experiencing any falls. In the acceptability assessment, the score reflecting continuation desire was the highest of the five items examined (2.71±0.46). In contrast, the adequacy of exercise intensity had the lowest score (1.29±0.57). Conclusions: The present system was confirmed to be safe, and the participants were motivated to continue the exercises. Future developments should incorporate a function to enable participants and medical staff to adjust exercise intensity according to individual physical function.

OBJECTIVES: This study aimed to determine the effects of clinical clerkship in physical and occupational therapy students' education on their stress, sleep, and technical skill acquisition. METHODS: We compared responses to the Brief Job Stress Questionnaire and the Athens Insomnia Scale, and students' clinical training grades between a traditional clinical training group (n=48) and a clinical clerkship group (n=48). RESULTS: Compared with the traditional group, the clinical clerkship group showed significantly higher scores on the Brief Job Stress Questionnaire for quantitative and qualitative burden, and significantly lower scores for the extent of control over tasks, irritability, fatigue, depression, and physical ailment. Scores for vitality and supervisor support were also significantly higher in the clinical clerkship group than the traditional group. The median Athens Insomnia Scale score was significantly lower in the clinical clerkship group. Clinical training grades for fundamental attitude and treatment techniques were significantly higher in the clinical clerkship group than in the traditional group. CONCLUSIONS: Students that experienced clinical clerkship perceived quantitative and qualitative burdens, which may be attributable to the level of interaction with patients during training. Their perception of low control over tasks may be because their supervisors described tasks specifically. However, the clinical clerkship group showed lower mental and physical stress than the traditional group. These students perceived they had supervisor support, which may be attributable to increased communication with their supervisor. Clinical clerkship was also linked to better sleep status than traditional training. Continuing clinical clerkship is necessary to develop students' technical clinical skills.

<p>【はじめに，目的】</p><p></p><p>歩行練習アシスト（Gait Exercise Assist Robot；以下，GEAR）は，脳卒中片麻痺者の歩行練習支援を目的に開発されたロボットであり，立脚中の麻痺側下肢の支持性や遊脚中の膝屈曲などの様々なパラメータ変更による難易度調整が可能である。発症後早期から適切な難易度で多数歩練習を繰り返すことで，効率の良い歩行自立度の改善が期待される。</p><p></p><p>今回，GEARを用いて歩行練習をした患者（以下，GEAR群）の退院時の異常歩行の重症度を，GEARを用いずに従来通りの歩行練習をした患者（以下，従来群）と比較した。</p><p></p><p></p><p>【方法】</p><p></p><p>対象は，GEAR群は藤田保健衛生大学病院で発症後早期からGEARを用いて歩行練習した5症例とし，退院時に歩行計測を実施した。従来群は，初発脳卒中片麻痺患者の歩行データの中から，GEAR群1例に対して，GEAR群の退院時の発症後日数（以下，TAO）と麻痺の重症度（SIAS-mの下肢合計，以下SIAS-LT）が同程度の1症例を選出し，両群の異常歩行の重症度を比較した。GEAR群の内訳は，年齢：66.0±6.3歳，TAO：129.0±47.8日，SIAS-LT：7.6±1.1，トレッドミル歩行速度：1.7±1.1，GEAR練習日数：29.2±16.3日，従来群の内訳は，年齢：53.4±8.8歳，TAO：154.6±104.7日，SIAS-LT：7.6±1.1，トレッドミル歩行速度：1.5±0.6であった。</p><p></p><p>歩行計測は，対象の平地快適歩行速度でのトレッドミル歩行（手すり，短下肢装具使用）を，三次元動作分析システムKinemaTracer^Ⓡ（キッセイコムテック社製）を用いて，サンプリング周波数60Hzで20秒間記録した。得られたデータから，脳卒中片麻痺患者に特徴的な12種類の異常歩行の重症度の指標値を算出，比較した。統計学的処理は対応のあるt検定を用い，有意水準は5%とした。</p><p></p><p></p><p>【結果】</p><p></p><p>両群の年齢と歩行速度に有意差はなかった。従来群において，遊脚期の膝屈曲不全，分回し歩行，骨盤挙上の値が健常範囲を超えて異常を示し，GEAR群ではこれらの指標値が有意に小さかった（遊脚期の膝屈曲不全：GEAR群40.1±14.0，従来群68.5±18.0，分回し歩行：GEAR群7.5±4.1，従来群11.7±2.0，骨盤挙上：GEAR群4.2±1.7，従来群7.7±2.3）。</p><p></p><p></p><p>【結論】</p><p></p><p>遊脚期の膝屈曲不全は機能障害を示し，分回し歩行と骨盤挙上は麻痺側下肢を振り出すための代償動作である。発症後早期から麻痺側の膝を屈曲させて麻痺側下肢の振り出しをアシストすることにより，麻痺側下肢の振り出しにおける機能障害の改善と過剰な代償の抑制につながったと考えた。</p>

Objective: The purpose of this study was to analyze the extent to which lower limb shortening and compensatory movements contribute to toe clearance during swing, and to identify the different strategies employed by healthy individuals and hemiplegic stroke patients to achieve toe clearance.<br /> <br /> Methods: The subjects comprised 18 hemiplegic stroke patients and 18 healthy individuals matched for age, gender, and walking speed. We calculated toe clearance and its components for comparison between the two groups. We also calculated the correlations between the components.<br /> <br /> Results: The foot-to-floor distance during mid-swing was smaller in hemiplegic stroke patients than in healthy individuals. Regarding the components, shortening of hip-toe length (SHTL) was smaller in stroke patients, whereas upward movement of the hip due to pelvic obliquity, upward movement of the foot due to abduction, and upward movement of the contralateral hip were all greater. Among hemiplegic stroke patients, there were significant negative correlations between SHTL and the other components.<br /> <br /> Conclusions: Hemiplegic stroke patients achieved smaller upward movement by lower limb shortening compared with healthy individuals. The contribution of hip hiking and other compensatory movements that correlated to SHTL appeared to be important in achieving toe clearance.<br /> <br />