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BACKGROUND: The factors necessary for successful use of chopsticks or a spoon, by patients with a paretic upper extremity (UE) following stroke are unknown. OBJECTIVES: We identified the functional capacities and interactions related to chopsticks or spoon use in patients with right hemiplegia following stroke. METHODS: Participants were 139 stroke patients with right hemiplegia who required rehabilitation, divided into the following three categories: able to use chopsticks, able to use a spoon, or unable to use a spoon. We collected sociodemographic data, medical data, physical and cognitive function data, and functional grades associated with chopsticks or spoon use by the paretic dominant UE while eating. We identified a complex interaction of variables relating to functional use of chopsticks or a spoon using a classification and regression tree analytic process. RESULTS: Patients with UE Brunnstrom recovery stage (BRS) >IV, and a Hasegawa Dementia Scale - Revised (HDS-R) score >16 had a 91.3% probability of being able to use chopsticks. Moreover, patients with a UE BRS of >IV, and the HDS-R score ≤16 had a 66.7% probability of being able to use a spoon. By contrast, patients with a UE BRS of ≤IV had a 90.5% probability of not being able to use a spoon. CONCLUSIONS: The interaction of BRS as a measure of UE function and HDS-R score as a measure of cognitive function affect the ability of patients with stroke histories to functionally use the paretic UE to operate chopsticks or a spoon.

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OBJECTIVES: In this study, we aim to predict the recovery of upper limb function in patients in the acute phase of cerebrovascular disease. Here, we describe the study design and patients' characteristics at baseline. METHODS: Subjects were admitted to Takeda General Hospital with cerebrovascular disease, and were prescribed to undergo rehabilitation. The assessment was conducted between June 2010 and March 2011. The baseline survey assessed the following factors: socio-demographic profiles (age, sex, number of family members, key person, occupation, and activities in daily life), medical profiles (types of cerebrovascular disease, location of brain damage, and history of diseases), and acute symptoms (Japan Coma Scale score, the Barre arm sign, the Brunnstrom recovery stage, tendon reflex, sensation, pain, ataxia, range of motion, muscle tone, grip strength, agnosia, apraxia, aphasia, dysarthria, the Hasegawa Dementia Scale-Revised score, and the Barthel index). RESULTS: A total of 357 patients with cerebrovascular disease were analyzed on the basis of diagnosis [cerebral infarction (CI; 77.6%), cerebral hemorrhage (CH; 20.2%), subarachnoid hemorrhage (SAH; 2.2%)]. There was a significant difference in the average age between the types of cerebrovascular disease. In acute symptoms, sensation, grip strength, cognitive function, and activities of daily living were statistically significantly different between the types of cerebrovascular disease. CONCLUSIONS: In this report, we described the study design and characteristics of patients with cerebrovascular disease at baseline. In the future, this study could be used for predicting the recovery of upper limb function in these patients.

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BACKGROUND: Prediction of upper limb function recovery in the acute phase of cerebrovascular disease can help clarify goal setting in rehabilitation and subsequently shorten hospital stay. The present study aimed to develop regression equations that can be used to predict the Manual Function Test (MFT) score 3 weeks after onset and to determine the optimal cutoff MFT score for the identification of "Functional Hand." METHODS: In all, 190 patients with cerebrovascular disease were included in this study. The baseline survey performed within 1 week after onset assessed sociodemographic profiles, medical profiles, and acute symptoms. MFT was performed to determine the cutoff score to indicate Functional Hand. We used stepwise multiple regression analysis to establish the prediction equations with the best fit for the MFT score 3 weeks after onset. In addition, the sensitivity and specificity of the MFT as an indicator of Functional Hand with cutoff values were determined. RESULTS: The multiple regression analysis showed that the following factors had a significant influence on the MFT: Brunnstrom recovery stage, cognitive function, range of motion, age, and sensation. The area under the curve was .93 for the MFT score as an indicator of Functional Hand. The cutoff MFT score to identify Functional Hand was 22/21 points, with a sensitivity and specificity of 91.1% and 82.1%, respectively. CONCLUSIONS: Our findings helped develop regression equations that can be used to predict the MFT score 3 weeks after onset of cerebrovascular disease by evaluating factors reportedly associated with upper limb function recovery.

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Evidence linking air pollution with adverse cardiopulmonary outcomes is accumulating. However, few studies have been conducted to evaluate whether vehicle emission control improves public health. We thus evaluated the effect of a diesel emission control law on mortality rates in 23 wards of Tokyo metropolitan area, Japan. We obtained daily counts of mortality and concentrations of nitrogen dioxide (NO(2)) and particulate matter less than 2.5 µm in diameter (PM(2.5)) from April 2003 to December 2008. Time-series and interrupted time-series analysis were employed to analyze the data in two periods: prior to the introduction of tighter restrictions (April 2003 to March 2006) and after the enforcement (April 2006 to December 2008). Concentrations of air pollutants gradually decreased during the study period: from 36.3 ppb (NO(2)) and 22.8 µg/m(3) (PM(2.5)) to 32.1 ppb and 20.3 µg/m(3), respectively. Air pollutants were positively associated with circulatory and pulmonary disease mortality, especially cerebrovascular disease. Each same-day PM(2.5) increase of 10 µg/m(3) was associated with a 1.3% increase in cerebrovascular mortality rate (95% confidence interval: 0.2-2.4). Rate ratios were attenuated after the enforcement in most of the outcomes, probably due to reduced toxicity of the pollutants. In the crude interrupted time-series analysis, reductions of standardized mortality rates after the enforcement were the greatest in high traffic areas. Even after adjustment of longer-time trend, mortality rate from cerebrovascular disease was reduced by 8.50% (p<.001) with dose-response relationship. However, the declines in other cause-specific mortality became equivocal. This natural experiment in Tokyo suggests that emission controls improved air quality. Although suggestive, further data are needed to conclusively demonstrate an impact on mortality rates.

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BACKGROUND: Prevention and reduction of disability among community-dwelling older adults have been an important health policy concern in Japan. Moreover, it has also become a gendered issue due to the recent rapid growth in older females than males with disability living in their own homes. The aim of this study is to examine whether there is a gender difference in the use of community rehabilitation programs in Japan, and if so, whether the lack of transportation services and accompanying caregivers are the reasons for the gender difference. METHODS: This study was based on surveys of the program administrators and the primary caregivers of the program participants from 55 randomly selected community rehabilitation programs (CRP) in the Tokyo metropolitan area. Questions included sociodemographic characteristics of program participants, types of transportation services provided by the CRP, caregiver's relationship to participant, and the nature of family support. Bivariate statistical analysis was conducted. RESULTS: Although there were more females than males with disability residing in communities, our findings showed that females were less likely to use CRP than males (1.3% and 2.3%, respectively; Chi2 = 93.0, p < 0.0001). Lower CRP use by females was related to lower availability of transportation services (36% without transportation service and 46% door-to-door services) and fewer caregivers accompanying the participants to CRP. CONCLUSION: This study builds on previous research findings, which suggest gender inequality in access to CRP.

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