Yuki Uchiyama

Hematopoietic stem cell transplantation (HSCT) is a curative treatment for hematologic diseases. However, corticosteroids used to manage graft-versus-host disease can induce muscle weakness, particularly affecting fast-twitch fibers. The objective of this study was to examine the association between the total corticosteroid dose and the decline in fast-twitch muscle fibers, estimated using surface electromyography (sEMG), as well as to evaluate its impact on muscle strength and physical performance. This prospective observational study included 53 adult patients from a single center in Japan. sEMG of the rectus femoris was performed before and after HSCT to calculate the median frequency (MF), a noninvasive marker of fast-twitch fiber proportion. Additional physical function assessments included isometric knee and hip flexion strength, handgrip strength, body weight, thigh circumference, 30-s chair stand test, and maximum walking speed. Correlations between total corticosteroid dose and changes in each variable were analyzed. Forty-two patients completed both the pre- and post-HSCT assessments. MF, muscle strength, body weight, thigh circumference, 30-s chair stand test performance, and maximum walking speed exhibited significant reductions (all p < 0.01). The total corticosteroid dose negatively correlated with changes in MF (rs = -0.32), hip flexion strength (rs = -0.43), thigh circumference (rs = -0.32 to -0.40), and 30-s chair stand test performance (rs = -0.45). A higher total corticosteroid dose after HSCT may lead to a reduced proportion of fast-twitch fibers, which could be associated with impairments in muscle strength and function.

Objectives: This study aimed to prospectively investigate the factors affecting the diminished ability of patients to stand up following hematopoietic stem cell transplantation (HSCT).Methods: Fifty patients were enrolled in the study. Pre- and post-HSCT physical performance was assessed using the Short Physical Performance Battery (SPPB). Post-HSCT physical performance decline was defined as a decrease of at least 1 point in the SPPB chair rise score at hospital discharge compared with the pre-HSCT score. Factors associated with this decline were analyzed using multiple logistic regression.Results: A functional decline in the ability to stand up post-HSCT was noted. The total corticosteroid dose (odds ratio, 1.03, 95% confidence interval 1.00–1.05) showed an independent association with physical performance decline post-HSCT.Conclusions: The total corticosteroid dose is a valuable predictor of physical performance decline post-HSCT. Therefore, standing up movements should be evaluated cautiously in patients who are expected to receive high corticosteroid doses for the treatment of acute graft-versus-host disease or HSCT regimens.

Head lifting strength can be easily measured without special equipment. The relationship between head lifting strength and dysphagia is well-established. However, its association with Pharyngeal residuals—a risk factor for aspiration—has not yet been explored. This study aimed to determine the association between head lifting strength and Pharyngeal residuals, as assessed through a Videofluoroscopic swallowing study (VFSS), in older inpatients with suspected dysphagia. A total of 50 patients who underwent VFSS for suspected dysphagia were included. Head lifting strength was measured as the number of repetitions of maximum head lifting and the time to maintain maximum head lifting. The Normalized Residue Ratio Scale (NRRS) was scored at the valleculae (NRRSv) and piriform sinus (NRRSp) while swallowing 3 ml of a moderately thick liquid during the VFSS. Univariate and multiple regression analyses examined the relationship between head lifting strength and NRRSv and NRRSp. The time to maintain maximum head lifting and the number of repetitions of maximum head lifting were significantly negatively correlated with the NRRSv and NRRSp. However, in the adjusted multiple regression analysis model, only the number of repetitions of maximum head lifting was related to NRRSv and NRRSp. This study implies that a simple head lifting strength test can be implemented in the clinic to determine the risk of pharyngeal residuals after swallowing and, consequently, the possibility of aspiration.

Objective: To evaluate the association between outcomes, including affected extremity functions and activities of daily living (ADL), and fractional anisotropy (FA) derived from automated tractography incorporating age among patients after stroke.Methods: This study enrolled stroke patients, and diffusion-tensor imaging was conducted during the second week. Standardized automated tractography was utilized to compute FA values in the corticospinal tract (CST), the inferior fronto-occipital fasciculus (IFOF), and the superior longitudinal fasciculus (SLF). Outcome evaluations were performed at discharge from our affiliated rehabilitation facility. Extremity functions were assessed using the total scores of the motor component of the Stroke Impairment Assessment Set (SIAS-motor). Independence levels in ADL were appraised through the motor and cognition components of the Functional Independence Measure (FIM). For each outcome measure, multivariate regression analysis incorporated the FA values of the CST, the IFOF, and the SLF, along with age.Results: Forty-two patients were enrolled in the final analytical database. Among the four explanatory variables, the CST emerged as the most influential factor for SIAS-motor scores. Conversely, age proved to be the primary determinant for both the motor and cognition components of FIM, surpassing the impact of FA metrics, including the CST and the IFOF.Conclusion: The key influencing factors exhibited significant variations based on the targeted outcome assessments. Clinicians should be aware of these differences when utilizing neuroimaging techniques to predict stroke outcomes.

Background: Sarcopenia is characterized by loss of muscle mass and function and is known to impair activities of daily living (ADL) in community-dwelling elderly people. However, the impact of sarcopenia on ADL in patients with interstitial lung disease (ILD) remains unclear. This study aimed to determine the relationship between sarcopenia and ADL in ILD patients and to identify sarcopenia components that contribute to these impairments. Methods: This cross-sectional study included 50 patients (median age 76 years) with stable ILD who were hospitalized at Hyogo Medical University Hospital between June 2022 and February 2024. Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia 2019 criteria. Basic ADL were evaluated using the Barthel Index (BI), and the impact of dyspnea on ADL was assessed using the Barthel Index-dyspnea (BI-d). Clinical assessments included the 6-min walk test, the Hospital Anxiety and Depression Scale score, and the EuroQol-5 Dimensions-5 Levels tool. Statistical analyses were performed to compare outcomes between patients with and without sarcopenia and to identify factors affecting BI and BI-d scores. Results: Sarcopenia was diagnosed in 21 patients (42%). The BI score was significantly lower (85 vs. 90, Pvs. 10, Pvs. 318.5 m, P=0.03), a higher score for the depression component of the Hospital Anxiety and Depression Scale (6.0 vs. 5.0, P=0.02), and a lower EuroQol-5 Dimensions-5 Levels score (0.58 vs. 0.84, PConclusions: Sarcopenia was significantly associated with greater impairment of basic ADL and limitation of ADL by dyspnea in patients with ILD. SMI and gait speed are components of sarcopenia that affect these outcomes. Targeted interventions are needed to improve ADL and quality of life in these patients.

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This study aimed to elucidate the impact of a nosocomial COVID-19 outbreak on convalescent rehabilitation outcomes of post-stroke patients. This retrospective observational study included post-stroke patients who were hospitalized in convalescent rehabilitation wards of our hospital during a COVID-19 outbreak between July 22, 2022 and August 13, 2022 (outbreak group). The control group consisted of patients hospitalized in convalescent rehabilitation wards from October 1 to December 31, 2022 (non-outbreak group). The two groups were compared in terms of motor Functional Independence Measure (FIM) effectiveness at discharge, Brunnstrom Recovery Stage, length of stay, and duration of rehabilitation therapy. Furthermore, within the outbreak group, outcomes were compared according to whether patients were infected with SARS-CoV-2. The impact of the outbreak on motor FIM effectiveness at discharge was also evaluated. There were 30 patients in the outbreak group (COVID-19, n = 18; close contacts, n = 12) and 33 patients in the non-outbreak group. Motor FIM effectiveness at discharge was significantly lower in the outbreak group, but there was no significant difference in outcomes according to SARS-CoV-2 infection status. After adjusting for SARS-CoV-2 infection, the nosocomial outbreak was significantly associated with lower motor FIM effectiveness at discharge. A nosocomial COVID-19 outbreak affected motor FIM effectiveness in convalescent rehabilitation for post-stroke patients, regardless of SARS-CoV-2 infection status.

Stroke-induced upper-extremity paralysis affects a substantial portion of the population, necessitating effective rehabilitation strategies. This study aimed to develop an automated program, incorporating the item response theory, for rehabilitation in patients with post-stroke upper-extremity paralysis, focusing on the ReoGo-J device, and to identify suitable robot parameters for robotic rehabilitation. ReoGo-J, a training device for upper-extremity disorders including 71 items, was administered to over 300 patients with varying degrees of post-stroke upper-extremity paralysis. Each item was rated on a three-point scale (0, very difficult; 1, adequate; 2, very easy). The results were analyzed using the graded response model, an extension of the two-parameter logistic model within the framework of the item response theory, to grade the training items based on ability of the patients. The relationship between the predicted ability, an indicator of the predicted ability the paralyzed upper-extremity to perform an item in the item response theory analysis (higher numbers indicate higher ability, lower numbers indicate lower ability), and the items in the Fugl–Meyer assessment (FMA), which indicate the degree of paralysis, was analyzed using Pearson’s correlation coefficient. This study included 312 patients with post-stroke upper-extremity paralysis. The predicted ability (θ) of the tasks included in the original ReoGo-J test for forward reaching, reaching for mouth, rotational reaching, radial reaching (2D), abduction reaching, reaching in eight directions, radial reach (3D), and reaching for head ranged from − 2.0 to − 0.8, − 1.3 to − 0.8, − 1.0 to − 0.1, − 0.7 to 0.3, − 0.2 to 0.4, − 0.4 to 0.6, − 0.1 to 0.6, and 0.5 to 0.6, respectively. Significantly high correlations (r = 0.80) were observed between the predicted ability of all patients and the upper-extremity items of shoulder-elbow-forearm in the FMA. We have introduced an automated program based on item response theory and determined the order of difficulty of the 71 training items in ReoGo-J. The strong correlation between the predicted ability and the shoulder-elbow-forearm items in FMA may be used to ameliorate post-stroke upper-extremity paralysis. Notably, the program allows for estimation of appropriate ReoGo-J tasks, enhancing clinical efficiency. Trial registration: https://www.umin.ac.jp/ctr/index-j.htm (UMIN000040127).

[This corrects the article DOI: 10.2196/58342.].