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Daily power-assisted FES home program therapy can effectively improve wrist and finger extension and shoulder flexion. Proprioceptional sensory feedback might play an important role in power-assisted FES therapy.

We previously reported reliability and validity of our newly developed comorbidity scale (CS) for stroke outcome research based on a retrospective sample. The objectives of this study were to cross-validate the comorbidity scale in a new prospective sample and to investigate longitudinal changes of the comorbidity scale during hospitalization. In a prospective sample of 175 stroke patients admitted to five nonacute rehabilitation hospitals in Japan, we analyzed the frequency and grading of comorbidities and compared the comorbidity scale with demographic data, impairment as assessed with the Stroke Impairment Assessment Set (SIAS), and disability as measured with the Functional Independence Measure (FIM(SM)). The results were compared with our previous retrospective study. We also studied longitudinal changes by measuring the comorbidity scale on admission, 2 wk later, and at discharge of 67 patients. As a result, the comorbidity scaling was significantly lower in the prospective sample, and it increased at the second measurement and then plateaued. Among the comorbidities, hypertension ranked first, followed by shoulder pain, and diabetes mellitus. Similar to our previous retrospective study, the comorbidity scale correlated positively with age and length of stay and correlated negatively with the SIAS motor item scores and the FIM scores. In conclusion, the present study suggested concurrent and predictive validity of the comorbidity scale in a prospective sample as well and clarified the comorbidity characteristics of stroke inpatients.

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Abstract:Clinical studies have consistently demonstrated that SEP abnormalities are associated with sensory deficits of joint position, touch, vibration, and stereognosis. However, when we try to use SEP as an objective method of sensory testing, it is difficult to evaluate the degree of SEP waveform abnormalities with conventional methods. The purpose of this study was to determine the usefulness of tibial nerve SEP as an objective method of sensory testing when the interside ratio of sum of squares for SEP waveform analysis was used. We obtained the SEP data and the sensory data in 100 stroke patients (age=59.3+10.5, median duration of stroke 124 days), and as normative data, in 35 volunteer subjects (age=29+7.2) for SEP and in 21 volunteer subjects (age=38.9+14.5) for sensation.The SEP traces were obtained by stimulating the tibial nerve at the ankle on the right side and the left side alternately with an electric pulse. The stimulus intensity was adjusted to produce a good muscle twitch in the abductor hallucis. Thousand sweeps were averaged for each recording and each stimulus side. A complete sweep consisted of 2,000 samples, representing 200ms of time. The scalp recordings were obtained with the recording electrode at the C'z scalp location referred to bilateral earlobes.The interside ratios of sum of squares were calculated using the latency samples between P 35 and P 53 evoked by unaffected and affected side stimulation.Based on the mean and SD of the natural logarithm of the interside ratios of sum of squares for normal subjects, the SEP waveforms in stroke patients were divided into four grades according to the amount of decrease in the interside ratio of sum of squares. We compared the SEP waveform grades to kinetic senses, tactile senses and pain sensations.For statistical analysis, we calculated Spearman's rank order correlation coefficients between the SEP waveform grades and the degrees of sensory deficits. As a result, the correlation coefficients were 0.73 for kinetic senses, 0.46 for tactile senses and 0.23 for pain sensations.The sensitivity and the specificity of this SEP waveform analysis for detecting kinetic sensory deficits were 85 percent and 81 percent respectively. In conclusion, the interside ratio of sum of squares was a useful parameter to analyze the tibial nerve SEP waveform and to evaluate kinetic senses. (Jpn J Rehabil Med 2000; 37: 274-281)