論文

Background: Few studies have examined falls and their predictors in patients with amyotrophic lateral sclerosis (ALS). Objective: The aim of this study was to survey fall incidence and to identify variables predicting the presence or absence of falls occurring within 3 months after discharge of patients with ALS from hospital. Methods: The following variables were evaluated in 14 patients with ALS: Timed up and go test (TUG), functional reach test, 10-m comfortable gait speed, single-leg stance time, manual muscle test (MMT) scores for the lower limb, total modified Ashworth scale score for the lower limbs, fear of falling, and pull test score. The primary outcome variable was the occurrence of a fall within 3 months after discharge. The fall rate was calculated based on fall record forms. The specific circumstances of each fall were also recorded. Univariate and multiple regression analyses were used to identify fall predictors. Results: Seven of the 14 ALS patients (50%) experienced a fall within 3 months. Five fallers reported experiencing a fall that had caused injury, and three reported experiencing a fall that had required a hospital visit. Univariate logistic regression analysis identified TUG time, gait speed and MMT of the ankle dorsiflexors as factors associated with falls (p = 0.02-0.04). Multiple linear regression analysis of fall numbers identified age and TUG time as predictor models (p = 0.03). Conclusion: TUG time and MMT of ankle dorsiflexors may help predict falls in ALS patients. Validation studies in larger cohorts are needed.

Stem cell-based regenerative therapy has opened an avenue for functional recovery of patients with spinal cord injury (SCI). Regenerative rehabilitation is attracting wide attention owing to its synergistic effects, feasibility, non-invasiveness, and diverse and systemic properties. In this review article, we summarize the features of rehabilitation, describe the mechanism of combinatorial treatment, and discuss regenerative rehabilitation in the context of SCI. Although conventional rehabilitative methods have commonly been implemented alone, especially in studies of acute-to-subacute SCI, the combinatorial effects of intensive and advanced methods, including various neurorehabilitative approaches, have also been reported. Separating the concept of combined rehabilitation from regenerative rehabilitation, we suggest that the main roles of regenerative rehabilitation can be categorized as conditioning/reconditioning, functional training, and physical exercise, all of which are indispensable for enhancing functional recovery achieved using stem cell therapies.

© 2018 IEEE. Since exoskeletons show potential for rehabilitation therapy, many scientists have been designing upper extremity exoskeletons. Unfortunately, few have successfully provided a shoulder exoskeleton for severe impairment. Toward Brain-Machine-Interface (BMI) rehabilitation robot therapies for severe upper extremity impairment, this paper introduces a shoulder exoskeleton robot with a modular joint and an off-board modular actuator. We applied a Modular Exoskeletal Joint (MEJ) to a shoulder exoskeleton that was driven by Pneumatic Artificial Muscles (PAMs) transmitted by a Bowden cable. Our objective is generating passive movements triggered by BMI. Since large torque has to be generated for assist a whole arm, we newly designed a more powerful Nested-cylinder PAMs (NcPAMs) than our previous work. As a proof of the concept of the mechatronics design, we show the tracking performance of the periodic trajectory of a joint angle with both human and mannequin arms as simulated impairments. Our result shows that the tracking error is sufficiently small in all of the conditions and that our developed shoulder exoskeleton is an adequate substitute for flexion/extension movements.