寺西 利生

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.

<p>Purpose Detailed reports of the assessments used in rehabilitation wards are lacking. This study aimed to examine the common evaluations used in rehabilitation wards and discuss the necessary assessments for treatment plans and patient management. Methods We conducted a comprehensive literature search of PubMed, Web of Science, MEDLINE, and Ichushi Web for articles published between June 2013 and June 2023. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered with PROSPERO. Data extraction and blind selection were performed, and a consensus was reached among experts in case of conflicts. Results We identified 220 studies, 31 meeting the inclusion criteria post-screening. The Functional Independence Measure was the most used assessment (96.8%), followed by grip strength (32.3%) and the 10-m walk test (9.7%). Other assessments included the Stroke Impairment Assessment Set, Short Physical Performance Battery, and Timed Up and Go Test. Although fall-related incidents are frequent, significantly affecting patient outcomes in rehabilitation units, balance assessments were underutilized. Conclusions Although the FIM is an extensively used assessment in rehabilitation wards, balance assessments critical for fall prevention are significantly underused. Therefore, these assessment tools should be evaluated in future research and clinical practice.</p>

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 studyPatient: 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.