Stroke Impairment Assessment Set Research Articles

Factors affecting the efficiency of walking independence in patients with subacute stroke following robot-assisted gait training with conventional rehabilitation.

Factors affecting the efficiency of walking independence in patients with subacute stroke following robot-assisted gait training (RAGT) and conventional treatment (RAGT-CT) were examined. This retrospective cohort study included 37 patients with stroke [ n = 11 ischemic; n = 26 hemorrhagic; median poststroke interval, 28 days (interquartile range, IQR, 24-42)] who underwent RAGT using Welwalk for a median of 3 weeks (IQR, 2-4) followed by conventional training (median, 129 days; IQR, 114-146). The primary outcome was the change in functional independence measure (FIM)-walk item score from before to after RAGT (FIM-walk efficiency). The secondary outcome was the FIM-walk score at discharge. The independent variables included sensorimotor function [lower extremity (LE) motor and sensory scores and trunk function from the Stroke Impairment Assessment Set (SIAS) and Berg Balance Scale (BBS)] and cognitive function (FIM-cognitive, MMSE and Cognitive-related Behavioral Assessment) before RAGT-CT and RAGT dose duration per session, total steps and average treadmill speed at week 1, and number of sessions). We first determined the bivariate associations of each independent variable with the FIM-walk efficiency at the end of the RAGT period as decided by the therapists and with the FIM-walk score at discharge. Hierarchical multiple regression revealed that only the FIM-cognitive score was a significant predictor of the FIM-walk efficiency at the end of the RAGT period ( β = 0.47; P < 0.01, adjusted R2 = 0.21) after accounting for age, days post-stroke, SIAS-total lower extremity (SIAS-LE) motor score, and number of RAGT sessions (all nonsignificant). Furthermore, only the SIAS-trunk score was a significant predictor of the FIM-walk score at discharge ( β = 0.52; P < 0.01; adjusted R2 = 0.65) after accounting for age, days post-stroke, FIM-cognitive score, SIAS-LE motor score, and average treadmill speed at week 1 (all nonsignificant). Although patients with better cognition at the start of locomotor training achieved the pragmatic targets for terminating RAGT and proceeding with conventional therapy at a faster rate, the outcome at discharge is mainly dependent on early trunk function.

Outcome Prediction by Combining Corticospinal Tract Lesion Load with Diffusion-tensor Fractional Anisotropy in Patients after Hemorrhagic Stroke.

The objective of this study was to evaluate the predictive precision of combining the corticospinal tract lesion load (CST-LL) with the diffusion-tensor fractional anisotropy of the corticospinal tract (CST-FA) in the lesioned hemispheres regarding motor outcomes. Patients with putaminal and/or thalamic hemorrhage who had undergone computed tomography (CT) soon after onset in our hospital were retrospectively enrolled. The CST-LL was calculated after registration of the CT images to a standard brain. Diffusion-tensor imaging was performed during the second week after onset. Standardized automated tractography was employed to calculate the CST-FA. Outcomes were assessed at discharge from our affiliated rehabilitation facility using total scores of the motor component of the Stroke Impairment Assessment Set (SIAS-motor total; null to full, 0 to 25). Multivariate regression analysis was performed with CST-LL and CST-FA as explanatory variables and SIAS-motor total as a target value. Twenty-five patients participated in this study. SIAS-motor total ranged from 0 to 25 (median, 17). CST-LL ranged from 0.298 to 7.595 (median, 2.522) mL, and the lesion-side CST-FA ranged from 0.211 to 0.530 (median, 0.409). Analysis revealed that both explanatory variables were detected as statistically significant contributory factors. The estimated t values indicated that the contributions of these two variables were almost equal. The obtained regression model accounted for 63.9% of the variability of the target value. Incorporation of the CST-LL with the lesion-side CST-FA enhances the precision of the stroke outcome prediction model.

The Clinical Variables Predicting the Acquisition of Independent Ambulation in the Acute Phase of Stroke: A Retrospective Study.

Predictive factors associated with independent ambulation post-stroke are less commonly reported for patients during the acute phase of stroke. This study aimed to identify the clinical variables predicting ambulation independence in the acute phase of stroke and test the superiority of their prediction accuracy. Sixty-nine patients, hospitalized in the acute phase for an initial unilateral, supratentorial stroke lesion, were divided into independent (n = 24) and dependent ambulation (n = 45) groups, with functional ambulation category scores of 4-5 and ≤ 3, respectively. They were evaluated upon admission using the modified Rankin scale (mRS), Stroke Impairment Assessment Set (SIAS) concerning the motor function of the lower extremities, Ability for Basic Movement Scale modified version 2 (ABMS2), and Functional Independence Measure (FIM). The scores of the four measures were significantly different between the groups. A univariate logistic regression analysis identified these variables as prognostic factors for independent ambulation. A receiver operating characteristic curve analysis identified the cutoff values (area under the curve) for the mRS, SIAS, FIM, and ABMS2 as 3 (0.74), 12 (0.73), 55 (0.85), and 23 (0.84), respectively. In summary, the FIM and ABMS2 may be more accurate in predicting ambulation independence in patients with stroke during the acute phase.

Comparing the contribution of each clinical indicator in predictive models trained on 980 subacute stroke patients: a retrospective study

Post-stroke disability affects patients’ lifestyles after discharge, and it is essential to predict functional recovery early in hospitalization to allow time for appropriate decisions. Previous studies reported important clinical indicators, but only a few clinical indicators were analyzed due to insufficient numbers of cases. Although review articles can exhaustively identify many prognostic factors, it remains impossible to compare the contribution of each predictor. This study aimed to determine which clinical indicators contribute more to predicting the functional independence measure (FIM) at discharge by comparing standardized coefficients. In this study, 980 participants were enrolled to build predictive models with 32 clinical indicators, including the stroke impairment assessment set (SIAS). Trunk function had the most significant standardized coefficient of 0.221. The predictive models also identified easy FIM sub-items, SIAS, and grip strength on the unaffected side as having positive standardized coefficients. As for the predictive accuracy of this model, R2 was 0.741. This is the first report that included FIM sub-items separately in post-stroke predictive models with other clinical indicators. Trunk function and easy FIM sub-items were included in the predictive model with larger positive standardized coefficients. This predictive model may predict prognosis with high accuracy, fewer clinical indicators, and less effort to predict.

Age-stroke related dysfunction interaction associated with home discharge of stroke inpatients in the rehabilitation ward.

The purpose of this study was to investigate whether interactions exist among cognitive and physical functions and activities of daily living (ADL) associated with home discharge of stroke patients in the rehabilitation ward. The subjects were 231 patients with a first stroke. Age, gender, affected side, the stroke impairment assessment set, ADL and discharge destination were collected from the medical record. Using a decision tree, a combination of variables that might have an interaction effect associated with home discharge was extracted. The existence of an interaction between the extracted variables was confirmed by logistic regression analysis. A combination of total score of the stroke impairment assessment set (≤27 points) and age (>76.5 years) at admission was extracted from the decision tree. As a result of the logistic regression analysis, this interaction term was significantly associated with home discharge. The findings of the present study suggest that there is an interaction between age and stroke-related dysfunction related to home discharge. Stroke patients aged over 76.5 years with the stroke impairment assessment set score of 27 or less at admission to the rehabilitation ward may need rehabilitation program considering the difficulty of home discharge.

Validity of functional assessment for control of trunk in patients with subacute stroke: a multicenter, cross-sectional study.

[Purpose] The purpose of this study was to clarify the criterion validity, construct validity, and feasibility of the Functional Assessment for Control of Trunk (FACT). [Participants and Methods] This study was a multicenter, cross-sectional study of patients with subacute stroke at three Japanese rehabilitation hospitals. To clarify feasibility, we examined the differences in the measurement time between FACT and the Trunk Impairment Scale (TIS). For the criterion validity of FACT, correlations between FACT, TIS, and the trunk items of the Stroke Impairment Assessment Set (SIAS) were examined using Spearman's rank correlation coefficient. For the construct validity of FACT, we examined the correlations with the other assessments. [Results] Seventy-three patients participated in this study. The measurement time was significantly shorter for FACT (212.6 ± 79.2 s) than TIS (372.4 ± 199.6 s). For criterion validity, FACT correlated significantly with TIS (r=0.896) and two SIAS trunk items (r=0.453, 0.594). For construct validity, significant correlations were found for FACT and other tests (r=0.249-0.797). Areas under the curve for FACT and TIS were 0.809 and 0.812, respectively, and the cutoff values for walking independence were 9 and 13 points, respectively. [Conclusion] For inpatients with stroke, FACT offered feasibility, criterion validity, and construct validity.

Influence of sitting posture on anterior buttock sliding during wheelchair propulsion of hemiplegic stroke patients.

This study investigated the influence of different sitting postures on wheelchair propulsion ability. The subjects were stroke patients who scored at least 2 points on the Stroke Impairment Assessment Set for abdominal muscle strength and trunk verticality and 3 points for non-paralytic side lower-limb muscle strength. Moreover, the patients were divided by their everyday wheelchair propulsion posture: Lean on Back Support (LBS); n = 8), those who leaned their back against the back support; and non-LBS (n = 11), those who moved their back away from the back support. For the wheelchair propulsion method, straight one-hand, one-leg propulsion was used on the non-paralyzed side for 10 m, followed by turning around a target 3 m ahead on each of the paralyzed and non-paralyzed sides. We then compared the propulsion times, number of propulsions, and difference in length from the front end of the patella on the non-paralyzed side to the front end of the seat surface (buttock sliding distance) between the groups. The buttock sliding distance was significantly shorter in the non-LBS group than in the LBS group in the paralyzed and non-paralyzed side turning tasks (p < 0.05). Propulsion times, number of propulsions, and grip strength did not differ significantly between the groups. Even in patients with good trunk function, propulsion while leaning against the back support can easily result in anterior buttock sliding, leading to a secondary risk of injury. These results suggest that it is necessary to provide guidance on the propulsion posture and seating to hold the trunk vertically to minimize anterior sliding during propulsion.

Stroke impairment, balance, and cognitive status on admission predict walking independence up to 90 days post-stroke but their contributions change over time.

This study aimed to identify predictors of gait independence in three successive patient cohorts that received inpatient rehabilitation for at least 30 days, 60 days, or 90 days post-stroke. A total of 26 independent variables were collected within 3 days of stroke onset, including basic information (age, sex, stroke type), sensorimotor function (Stroke Impairment Assessment Set), gait function, balance function, and cognitive function. The dependent variable was walking independence (without assistance from another person) at 30, 60, or 90 days post-stroke. A decision tree was developed for predicting gait independence at each assessment time point. The predictors of walking independence differed among the cohorts that received inpatient rehabilitation for at least 30, 60, and 90 days post-stroke. Specifically, the Short Form Berg Balance Scale score was in the higher layer and was a strong predictor of gait at all time points. The cognitive Functional Independence Measure progressed to the higher layer at later time points. The lower extremity motor function was an additional predictor in the 30-day cohort. For later cohorts, the predictive value of balance and cognitive function declined whereas the contribution of the paralyzed grip strength and trunk function increased. These results suggest that sensorimotor and cognitive function within 3 days of stroke can predict walking independence between 1 and 3 months post-stroke; however, the prognostic value of predictors varies among the patients who receive inpatient rehabilitation for shorter versus longer time.

Relationship of the brief-balance evaluation systems test with physical functioning and activities of daily living: A cross-sectional study among hospitalized acute stroke patients.

The Brief-Balance Evaluation Systems Test (Brief-BESTest) has the potential to be used effectively for interventions on specific balance components. However, it has not been utilized for acute stroke cases. This study determined the characteristics of the distribution of the Brief-BESTest scores of patients who suffered acute stroke and examined its relationship with physical function and activities of daily living ability. The Brief-BESTest, sub-items of Stroke Impairment Assessment Set (SIAS), and Functional Independence Measure (FIM) were conducted among 41 hospitalized acute stroke patients (71.3±9.5 years, 32 males). The skewness of the Brief-BESTest and Spearman's rank correlation (ρ) between Brief-BESTest, SIAS, and FIM were analyzed. The skewness of the total score of the Brief-BESTest was -0.038. There were no ceiling or floor effects. The total score of the Brief-BESTest had a weak positive correlation with the SIAS lower extremity motor function (ρ= 0.457) and muscle tone (ρ= 0.374), and the total score on FIM (ρ= 0.365). Each sub-item of the Brief-BESTest was associated with different physical functions. The Brief-BESTest was unaffected by floor and ceiling functions among hospitalized acute stroke patients, and different physical functions were associated with each balance component.

Cognitive function is associated with home discharge in subacute stroke patients: a retrospective cohort study

AimTo investigate the cognitive function and its relation to the home discharge of patients following subacute stroke.MethodsThis retrospective cohort study included 1,229 convalescent patients experiencing their first subacute stroke. We determined discharge destination and demographic and clinical information. We recorded the following measurement scores: Mini-Mental State Examination (MMSE) score, Stroke Impairment Assessment Set score, grip strength, and Functional Independence Measure (FIM). We performed a multivariable logistic regression analysis with the forced-entry method to identify factors related to home discharge.ResultsOf the 1,229 participants (mean age: 68.7 ± 13.5 years), 501 (40.8%), 735 (59.8%), and 1,011 (82.3%) were female, had cerebral infarction, and were home discharged, respectively. Multivariable logistic regression analysis revealed that age (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.91 – 0.96; P < 0.001), duration from stroke onset to admission (OR, 0.98; 95% CI, 0.96 – 0.99; P = 0.003), living situation (OR, 4.40; 95% CI, 2.69 – 7.20; P < 0.001), MMSE score at admission (OR, 1.05; 95% CI, 1.00 – 1.09; P = 0.035), FIM motor score at admission (OR, 1.04; 95% CI, 1.01 – 1.06; P = 0.001), and FIM cognitive score at admission (OR, 1.08; 95% CI, 1.04 – 1.13; P < 0.001) were significantly associated with home discharge.ConclusionsMMSE at admission is significantly associated with home discharge in patients with subacute stroke.

Effectiveness of Repetitive Facilitative Exercise Combined with Electrical Stimulation Therapy to Improve Very Severe Paretic Upper Limbs in with Stroke Patients: A Randomized Controlled Trial

Background The difference in the effects of combined therapy with repetitive facilitative exercise (RFE) and neuromuscular electrical stimulation (NMES) on stroke upper limb paralysis was only reported by a pilot study; it has not been investigated in many patients. Objective We investigated the effect of combined therapy with RFE and NMES on stroke patients with severe upper paresis. Methods This study included 99 of the very severe paresis stroke patients with scores of zero or 1a in the Finger-Function test of the Stroke Impairment Assessment Set (SIAS). We randomly divided the patients into four groups, namely, NMES, RFE, RFE under NMES, and conventional training (CT) groups. A total of 20 min of group-specific training in addition to 40 min of conventional exercise per day, seven times a week for 4 weeks after admission, was performed. The upper extremity items of the Fugl-Meyer Assessment (FMA) were evaluated before and after the training period. Results The total score gains of the FMA, FMA wrist item, and FMA finger item were significantly larger in the RFE under NMES group than those in the CT group (p < 0.05). Conclusion The combination of voluntary movement and electrical stimulation may promote the activation of paralyzed muscles and improve distal function for very severe paralyzed upper limbs.

Factors related to daily step counts of stroke patients during hospitalization in a convalescent rehabilitation ward

ObjectivesClarifying the factors related to decreased physical activity in post-stroke patients is essential for effective disease management. This study aimed to examine the factors influencing the amount of daily steps taken by post-stroke patients in a convalescent rehabilitation ward during activities other than rehabilitation (non-rehabilitation steps). Materials and methodsEighty-nine post-stroke patients (60.8±14.4 years; 55 men) were enrolled. The inclusion criteria were walking independently within the ward and having a walking speed of ≥24 m/min. Data on patient clinical characteristics including age, sex, body mass index, stroke type, hemiparetic side, and time from stroke onset were collected. Stroke impairment and motor and cognitive functional disabilities were assessed using the Stroke Impairment Assessment Set and the Functional Independence Measure, respectively. The non-rehabilitation steps were calculated by subtracting the steps during the rehabilitation activities from the total steps using Fitbit Flex2. ResultsThe average number of non-rehabilitation steps was 4,523±2,339 steps/day. The hierarchical multiple regression analysis revealed that sex, motor disability, and the interaction term of stroke impairment with cognitive disability were significantly related to non-rehabilitation steps. Simple slope analysis demonstrated that the stroke impairment slope was steeper at lower levels than at higher levels of cognitive disability for non-rehabilitation steps. ConclusionsIn addition to independent effects of sex and motor disability, this study found that stroke impairment and cognitive disability were interactively related to non-rehabilitation steps in post-stroke patients in a convalescent rehabilitation ward. These findings may provide useful information for managing physical activity in post-stroke patients after hospital discharge.

Relationship between the vividness of motor imagery and physical function in patients with subacute hemiplegic stroke: a cross-sectional preliminary study

ABSTRACT Purpose The study aimed to clarify whether the vividness of motor imagery is related to lower limb function and walking ability in patients with hemiplegic stroke. Materials and Methods The study was a cross-sectional preliminary study. The subjects were 15 patients with hemiplegic stroke. The vividness of motor imagery was assessed using the kinesthetic and visual imagery questionnaire. The kinesthetic imagery (KI) involves the sensation of one’s own movement, whereas the visual imagery (VI) involves the imagination of a third-person performing the self-movement. Their physical functions were assessed using the Brunnstrom recovery stage, stroke impairment assessment set, 10-m maximum walking speed test, and functional independence measure. KI and VI were compared using the t test. Correlation analysis was performed between KI or VI and various variables as well as between the motor imagery gap (difference between KI and VI) and various variables. Results KI was significantly lower than VI (p < .01). KI was correlated not only with lower limb function (r = 0.68) but also with walking speed (r = −0.64). The motor imagery gap was correlated with hip joint function (r = −0.53). Conclusions KI and motor imagery gap were associated with lower limb function and walking ability.

Gait improvement in stroke patients by Gait Exercise Assist Robot training is related to trunk verticality.

[Purpose] Various types of Gait Exercise Assist Robot (GEAR) have been developed recently, some of which have enabled early improvement in patients with stroke. However, none has yet resulted in independent walking in these patients. Hence, we conducted an exploratory study of the effect of GEAR on achieving independent walking in stroke patients. [Participants and Methods] The participants were 16 patients with severe stroke. We evaluated patients' ability to walk independently after GEAR training. The outcome measure was Stroke Impairment Assessment Set (SIAS) motor score (Hip Flexion, Knee Extension, Foot Pat, Abdominal and Verticality). Differences in five SIAS motor scores were compared between the independent and non-independent walking groups. [Results] There was statistically significant difference between the groups in terms of Verticality among the 5 SIAS items used in the present research . Verticality of SIAS score of 1 was the cut-off value for distinguishing walking independence. [Conclusion] Verticality of SIAS may be a marker of potential walking independence that can be used in rehabilitation plans using walking-assist robots in patients with stroke.

Prediction of gait independence using the Trunk Impairment Scale in patients with acute stroke.

Gait recovery is one of the primary goals of stroke rehabilitation. Gait independence is a key functional component of independent activities in daily living and social participation. Therefore, early prediction of gait independence is essential for stroke rehabilitation. Trunk function is important for recovery of gait, balance, and lower extremity function. The Trunk Impairment Scale (TIS) was developed to assess trunk impairment in patients with stroke. To evaluate the predictive validity of the TIS for gait independence in patients with acute stroke. A total of 102 patients with acute stroke participated in this study. Every participant was assessed using the TIS, Stroke Impairment Assessment Set (SIAS), and Functional Independence Measure (FIM) within 48 h of stroke onset and at discharge. Gait independence was defined as FIM gait scores of 6 and 7. Multiple regression analysis was used to predict the FIM gait score, and multiple logistic regression analysis was used to predict gait independence. Cut-off values were determined using receiver operating characteristic (ROC) curves for variables considered significant in the multiple logistic regression analysis. In addition, the area under the curve (AUC), sensitivity, and specificity were calculated. For the prediction of the FIM gait score at discharge, the TIS at admission showed a good-fitting adjusted coefficient of determination (R 2 = 0.672, p < 0.001). The TIS and age were selected as predictors of gait independence. The ROC curve had a TIS cut-off value of 12 points (sensitivity: 81.4%, specificity: 79.7%) and an AUC of 0.911. The cut-off value for age was 75 years (sensitivity: 74.6%, specificity: 65.1%), and the AUC was 0.709. The TIS is a useful early predictor of gait ability in patients with acute stroke.

Determinants of Step-through Gait Pattern Acquisition in Subacute Stroke Patients.

ABSTRACTObjectives:Stroke patients may have a step-to gait pattern during the early stages of gait reacquisition. This gait provides stability, but it is slow and inefficient. Therefore, acquiring step-through gait is desirable for better efficiency as ability improves. This study aimed to examine the relevant factors affecting the acquisition of step-through gait pattern in subacute stroke patients based on assessments of physical function at admission.Methods:This was a retrospective cohort study. A total of 91 patients with hemiplegic stroke, Functional Independence Measure (FIM) gait item of 4 or less on admission, and FIM gait item of 5 or greater on discharge were included. Factors necessary for the acquisition of step-through gait pattern were examined based on the motor function assessed by Stroke Impairment Assessment Set (SIAS) at the time of admission. Gait pattern was defined by the gait step length of the Tinetti Performance-Oriented Mobility Assessment at discharge.Results:Knee-joint extension function on the paralyzed side was determined as a factor associated with the acquisition of step-through gait pattern at discharge [odds ratio 2.24, 95% confidence interval (CI) 1.44‒3.50, P<0.001]. The area under the receiver operating characteristic curve for predicting the step-through gait pattern at discharge was 0.786 (95% CI 0.676–0.896, P<0.001) for the SIAS knee joint score at admission; the optimal cut-off score being 2 or greater (sensitivity 81%, specificity 61%).Conclusions:Knee function on the paralyzed side in subacute stroke patients is an independent predictor for the acquisition of step-through gait pattern.

Trunk Impairment as a Predictor of Activities of Daily Living in Acute Stroke.

Background and purpose: Trunk function plays a key role in performing activities of daily living (ADL) including locomotion and sitting. Sitting and ADL should be performed as early as possible especially during the acute phase of stroke rehabilitation. Therefore, this study aimed to assess trunk function among patients with acute stroke using the Trunk Impairment Scale (TIS) and to predict its functional outcomes.Methods: Overall, 67 patients with acute stroke (i.e., within 2 days of occurrence of the stroke) were included. The following clinical assessment items were obtained within 48 h after stroke onset and on the day before discharge from the hospital. Trunk function was examined using TIS and Trunk Control Test (TCT). The motor function of the upper and lower extremities was assessed using the stroke impairment assessment set motor (SIAS-M) score, and ADL was assessed using functional independence measure motor (FIM-M) items.Results: Multiple regression analysis was performed using the stepwise regression method, using the total FIM-M score following discharge as the dependent variable and age, TIS, TCT, SIAS-M, and FIM-M within 48 h after stroke onset as the independent variables. Age, TIS, and FIM-M within 48 h after stroke onset were selected as the input variables and showed a high-adjusted determination coefficient (R2 = 0.79; P < 0.001).Conclusion: TIS is a reliable method for evaluating trunk control function and is an early predictor of ADL among patients with acute stroke.

Cognitive Function is a Predictor of the Daily Step Count in Patients With Subacute Stroke With Independent Walking Ability: A Prospective Cohort Study

ObjectivesTo investigate the physical, cognitive, and psychological factors related to daily step count in patients with subacute stroke. DesignProspective cohort study. SettingA subacute rehabilitation ward with 160 beds. ParticipantsPatients with subacute stroke who could walk independently (N=101). Among the 101 participants enrolled in this study (mean age, 64.5±13.5y), 64.4% (n=65) were men and 69.3% (n=70) were patients with cerebral infarction. InterventionsWe assessed ambulatory activity using a pedometer placed in the pants pocket on the nonparalyzed side continuously for 7 consecutive days. We also obtained demographic and clinical information and recorded the following measurement scores: Stroke Impairment Assessment Set, FIM, Mini-Mental State Examination (MMSE), Self-Rating Depression Scale, and Apathy Scale. All measurements were collected at admission and discharge. Main Outcome MeasuresThe outcomes assessed were ambulatory activity, motor and sensory functions, functional disability, cognitive function, depressive symptoms, and motivation. ResultsThe median daily steps ambulated at admission and discharge were 5584 steps (interquartile range, 3763-7096 steps) and 5991 steps (interquartile range, 4329-8204 steps), respectively. In the univariate regression analysis, age, sex, serum albumin level, affected side of the brain, and MMSE score at admission were significantly associated with the daily step count at discharge. Multiple regression analysis using these 5 items as independent variables revealed that the MMSE score at admission (reference, 28-30 points; B, −2.07; 95% confidence interval, −3.89 to −0.35; β, −0.22; P=.027) was significantly associated with the daily step count at discharge. ConclusionsCognitive function at admission had a significant association with the daily step count at discharge in patients with subacute stroke who could walk independently.

Factors related to daily use of the paretic upper limb in patients with chronic hemiparetic stroke-A retrospective cross-sectional study.

AimsThe present study aimed to determine factors associated with the frequency of paralyzed upper extremity (UE) use in chronic stroke patients with severe UE functional deficiency.MethodsWe retrospectively reviewed the medical records of 138 consecutive patients, and 117 was analyzed (median age, 55 [range, 18–85] years; median stroke duration, 24.5 [range, 7–302] months) with chronic hemiparetic stroke who were admitted to our hospital for intensive upper extremity rehabilitation. The mean Fugl-Meyer Assessment (FMA) UE score was 28.6. All of them are independent in their activity of daily living (ADL) and without remarkable cognitive deficits. Amount-of-use score of Motor Activity Log-14 (MAL-AOU) was applied as the index of daily use of affected UE. The following parameters were examined as the explanatory variables: demographics, proximal and distal sub-scores of FMA UE, Modified Ashworth Scale (MAS), and sensory function scores in the Stroke Impairment Assessment Set (SIAS).ResultsThe median MAL-AOU score was 0.57 [range, 0.28–0.80]. Ordinal regression analysis revealed that FMA proximal, FMA distal, and SIAS sensory function (touch) were associated with AOU score of MAL-14 (Pseudo R-square = 0.460).ConclusionNot only motor but also sensory function, especially tactile sensation, play a crucial role in the daily use of affected UE in chronic stroke patients with severe UE hemiparesis.

Interactions of Cognitive and Physical Functions Associated with Toilet Independence in Stroke Patients

ObjectivesThe purpose of this study was to clarify the interaction among cognitive and physical functions associated with toilet independence in stroke patients. Materials and methodsWe retrospectively examined 125 stroke patients. We performed decision tree analysis to detect the interaction associated with toilet independent using assessment of motor function on the affected side, muscle strength on unaffected side, trunk function, neglect, motivation, and cognitive function. The interactions detected via decision tree confirmed the existence and influence using logistic regression. ResultsThe verticality test of the Stroke Impairment Assessment Set (3 or ≤2 points) was selected at the first level, and the Revised Hasegawa's dementia scale (≥19 or ≤18 points) and age (≥70 or ≤69 y) were selected at the second level of decision tree. Interaction terms created by these factors were significantly associated with toilet independence after adjusting for the independent influence of each factor using logistic regression. ConclusionsOur results show an interaction of trunk and cognitive functions or trunk function and age associated with toilet independence. The probability of toilet independence dramatically changes if two factors of each interaction were satisfied in stroke patients.