小山 総市朗

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.

BACKGROUND: Although the Lee Silverman Voice Treatment BIG® (LSVT BIG®) improves motor symptoms in patients with Parkinson's Disease, no reports exist for patients with Progressive Supranuclear Palsy (PSP). OBJECTIVE: To describe the effect of LSVT BIG® on the motor symptoms of a participant with PSP. CASE DESCRIPTION: The participant was a 74-year-old man with PSP. His goals were to improve limb movement, balance ability, and festinating gait over the 4-week LSVT BIG® program. OUTCOMES: All assessments of limb movement and balance ability showed improvements after intervention for the limb and gait subsections of the PSP rating scale. Scores improved from 9 to 5, and 8 to 6, respectively for the Unified Parkinson's Disease Rating Scale (UPDRS) Part 3, from 30 to 21 and for the Berg balance scale (BBS), from 45 to 50 points. The improvements in UPDRS Part 3 and BBS exceeded the minimum detectable change values (7-8 and 2 points, respectively). After intervention, improvements in festinating gait and rapid walking pace were noted on the UPDRS Part 3 (2 to 1 point) and 10-meter walk test (1.65 m/s to 1.10 m/s). CONCLUSION: The intervention was effective for the participant but further studies with diverse populations are needed.

介護福祉分野のロボット活用は，高い期待が寄せられている．特に，核家族化と高齢者世帯数増加に伴うマンパワー不足の補填として，介護福祉ロボット開発が盛んである．理学療法士は，要介護者・介護者・医療福祉従事者といった多面的な視点から対象者の生活を支援している．この専門性は，介護福祉ロボットの効果的な使用，開発や普及にも貢献できる．本稿では，私が理学療法士として関わった経験から，在宅支援に役立つロボットと理学療法士の立場について概説する．一般住宅で活用される介護ロボットは，住空間に適応する機器の大きさが共存の必要条件である．また，在宅でのロボットの使用者は，要介護者や介護者，その他の支援者と多様である．ロボットは，誰でも誤りなく安全に使用できるように，多機能ではなく，用途が明確で操作理解が容易であることが，普及の条件である．介護ロボットの使用環境が一般住宅である場合，開発初期から一般的な居住空間で使用者である高齢者のユーザー実証試験が欠かせない．介護福祉ロボット分野への理学療法士の参入は，実用的な支援機器の開発・活用・運用・普及に必要である．

BACKGROUND AND PURPOSE: There are no reports regarding the effect of Lee Silverman Voice Treatment® BIG (LSVT® BIG) on standing balance ability evaluated using quantitative assessment. This case report aimed to describe and evaluate the influence of LSVT® BIG on the center of pressure (COP) trajectory in a patient with Parkinson's disease (PD). METHODS: Although this paper focused on one case, quantitative assessment on the effect of LSVT® BIG on standing balance ability was performed. A 67-year-old woman patient diagnosed with PD at age 59, with a Hoehn and Yahr stage 3 disability severity, underwent a 4-weeks supervised LSVT® BIG program. The total distances of the COP trajectory (two-dimensional [2D] horizontal plane, anterior-posterior [AP] direction, and medial-lateral [ML] direction), and the mean COP velocity for each direction, postural stability, and posture subsections of the Unified Parkinson's Disease Rating Scale (UPDRS) Part 3 were assessed at pre- and post-intervention. RESULTS: The total distances of the COP trajectory, mean COP velocities, and scores of postural stability and posture subsections of the UPDRS Part 3 improved after intervention (from 124.6 to 76.6 cm [2D], 89.4 to 57.7 cm [AP], 77.4 to 38.5 cm [ML]; 4.0 to 2.6 cm/s [2D], 3.0 to 1.9 cm/s [AP], 2.6 to 1.3 cm/s [ML]; and 3 to 0, and 3 to 2, respectively). DISCUSSION: LSVT® BIG may be effective in improving the total distance of the COP trajectory, mean COP velocity, and both postural stability and posture subsections of the UPDRS Part 3 in the presented PD case.

BACKGROUND: There are no reports regarding the long-term retention of effects of Lee Silverman Voice Treatment® BIG (LSVT® BIG) on improvements in quality of life (QOL) among patients with Parkinson's disease (PD). OBJECTIVE: This study aimed to evaluate the short-term effect of LSVT® BIG on QOL improvement and its retention in a patient with PD. Motor symptoms, walking ability, and walking speed were evaluated as factors associated with QOL. METHODS: A 63-year-old woman who was diagnosed with PD received a 4-week LSVT® BIG program under the supervision of certified LSVT® BIG physical therapists. The participant's disease severity was classified as Hoehn and Yahr stage 2. The Parkinson's Disease Questionnaire-39 (PDQ-39), Movement Disorder Society-sponsored Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part 3, timed up-and-go test (TUG), and 10 m walk test (10 MWT) were evaluated before, after, and 1-year after the intervention. RESULTS: The results indicated short-term improvements in the PDQ-39, MDS-UPDRS part 3, TUG, and 10 MWT which were retained for up to 1 year. CONCLUSIONS: This case report suggests the possibility of 1-year retention of improvements in QOL, motor symptoms, walking ability, and walking speed resulting from LSVT® BIG intervention in a patient with mild PD.

Introduction: Lee Silverman Voice Treatment® BIG (LSVT® BIG) is widely used to improve motor symptoms in patients with mild-to-moderate Parkinson's disease (PD).Objective: To describe the effect of LSVT® BIG on the motor symptoms of a patient with severe PD.Case Description: A 77-year-old woman who was diagnosed with PD received a 4-week LSVT® BIG program under the supervision of certified LSVT® BIG physical therapists. Her disease severity was classified as Hoehn and Yahr stage 4. The unified Parkinson's disease rating scale (UPDRS) part 3, 10-m walk test (10MWT), timed up-and-go test (TUG), Berg balance scale (BBS), and 30-s chair stand test (30-s CST) were used for assessment before and after intervention.Outcomes: The UPDRS part 3, 10MWT, TUG, BBS, and 30-s CST improved after intervention (33 to 26, 0.51 to 0.69 m/s, 38.1 to 23.2 seconds, 11 to 34, and 3 to 9 times, respectively). All improvements exceeded the Minimal Clinically Important Difference or Minimal Detectable Change values (2.5, 0.16 m/s, 3.5 seconds, 5, and 3 times, respectively).Conclusions: These results indicated that LSVT® BIG appears to have improved motor symptoms in a patient with severe PD. Further studies, ideally randomized controlled trials, are needed to confirm these findings.

Background: The rate of force development (RFD) is an indicator of muscle strength. A previous study reported that the RFD of hip abductor muscles was increased by neuromuscular electrical stimulation (NMES) to gluteus medius (GM) during gait in healthy adults. However, the effects for patients following femoral head replacement for hip fracture are unclear. Purpose: The aim of this case report was to investigate the effects of gait training with sub-motor threshold NMES on RFD of hip abductor muscles in two patients following femoral head replacement for hip fracture compared to gait training without NMES. Case description: Two elderly patients following femoral head replacement for hip fracture received both interventions of gait training with sub-motor threshold NMES to GM and without NMES. Intervention phases involved 14 sessions each, for 28 sessions total. Outcomes: The RFD of hip abductor muscles, maximum walking speed, six-minute walk distance (6MWD), Berg Balance Scale, one-leg standing time (OLST), functional independence measure, and Numeric Pain Rating Scale (NPRS) were used as outcome measures. In both patients, RFD, 6MWD, OLST, and NPRS were improved by gait training with NMES compared to without NMES. Conclusion: Our results suggest the potential of NMES as a treatment methodology for these two patients undergoing femoral head replacement for hip fracture.

理学療法・作業療法専攻学生の教育における診療参加型臨床実習(Clinical Clerkship(CC))の効果を、臨床実習中のストレス、睡眠状態、技能習得の点で検証した。従来の臨床トレーニングを行った学生48名(従来群)とCCを行った学生48名(CC群)を対象に、職業性ストレス簡易調査票(BJSQ)、アテネ不眠尺度(AIS)、技能習得評価の成績を比較した。その結果、CC群は従来群と比較してBJSQの量的負担および質的負担の項目の点数が有意に高く、課題のコントロール度、イライラ感、疲労感、抑うつ感、身体愁訴の項目の点数は有意に低かった。またCC群では活気および指導者のサポート項目に関する点数が高かった。AISスコア中央値はCC群で有意に低かった。臨床実習成績の基本的姿勢、治療技術の項目の点数において、従来群よりもCC群で有意に高かった。以上から、当該学生のストレス、睡眠状態、ある種の技能習得に対するCCの効果が示された。

Purpose/aim of the study: An increase of hip abductor muscle strength contributes to the increase in gait speed. It is known that the rate of force development (RFD), an indicator of muscle strength, is increased by the combined use of low-intensity neuromuscular electrical stimulation (NMES) to the glutaeus medius (GM) and low-load resistance training (RT). However, it is unclear whether low-intensity neuromuscular electrical stimulation of the glutaeus medius during walking also increases the rate of force development. The aim of this study was to clarify whether NMES to the GM during gait modulates the RFD of the hip abductor muscles in healthy adults.Materials and methods: Twenty-two healthy adults randomly received both gait with sub-motor threshold NMES and gait with sham NMES conditions. The RFD was assessed at pre- and post-intervention. A two-way repeated measures analysis of variance was used to analyse the effects of time and intervention.Results: Gait with sub-motor threshold NMES condition significantly increased the RFD in shorter time interval (0-50 and 0-100 ms) compared to gait with sham NMES condition.Conclusions: These findings suggest that the adding low-intensity NMES of the GM to gait is effective in increasing the RFD of the hip abductor muscles.

<p>Objectives: The ability to transfer between surfaces is essential for wheelchair users' independence. We hypothesized that transfer of hemiparetic stroke patients would be improved by using surfaces at the same height with no gap or obstacle between them.</p><p>Methods: A cross-sectional study was conducted to compare the difficulty of two transfer methods as a pilot study. Thirteen hemiparetic stroke patients were transferred from a platform table to a chair (wheelchair or flat chair) and from the chair to the table using the regular and lateral transfer methods. Functional Independence Measure (FIM) transfer score in both transfer methods and Stroke Impairment Assessment Set (SIAS) score were measured.</p><p>Results: The FIM transfer score significantly increased in the lateral transfer condition compared with the regular transfer condition, indicating that the former method reduced the transfer difficulty, regardless of the SIAS scores.</p><p>Conclusions: The transfer difficulty of patients with hemiparetic stroke decreases when using the lateral transfer method. The lateral transfer method is easy, potentially helping prevent care-related injuries among caregivers.</p>