Kyushu University of Nursing and Social Welfare

Branch atheromatous disease (BAD) often progresses during the acute phase. During acute rehabilitation, clinicians should prioritize monitoring neurological symptom progression. We treated a patient with right-sided, finger-limited motor paralysis and frequent transient motor paralysis fluctuations due to BAD by implementing early upper-limb occupational therapy while maintaining rigorous risk management. Occupational therapy included standard upper limb functional training, continuous neuromuscular electrical stimulation, and repetitive facilitation exercises. During occupational therapy, blood pressure was carefully monitored, and neurological symptoms were regularly assessed. Any symptom changes were promptly communicated among occupational therapists, rehabilitation specialists, and neurosurgeons. Although transient motor paralysis occurred five times, timely treatment, including medication adjustments, prevented further neurological deterioration. Additionally, upper-limb function and object manipulation ability improved over time. Risk management is critically important in occupational therapy for acute BAD. This case demonstrated that repetitive facilitation exercises combined with continuous neuromuscular electrical stimulation can be safely initiated in the early stages of stroke, potentially improving upper limb dysfunction.

介護者の腰痛は介護現場で重要な問題であり、中でもおむつ交換動作は腰部負荷が大きいとされる。そこで本研究では、IMUセンサによる動作データおよび手部負荷測定装置による手部負荷データをもとに筋骨格シミュレータにより、複数のおむつ交換時の姿勢や方法による腰部負荷を比較した。その結果、交換方法によって腰部負荷に明確な違いが見られ、負荷軽減法の示唆が得られた。

本研究は，総務省が指定する過疎地域の８市町村で暮らす，80歳以上の一人暮らし男性の心理的葛藤を明らかにすることを目的とした。調査対象者は，日常生活が自立している34人に半構造化面接を行なった。テキストマイニングにより分析した結果，消滅危惧集落の一人暮らし男性高齢者の心理的葛藤は，【話し相手がいない寂しさ】はあるが【家を離れたくない】と思っていた。80歳を超えて【身体機能の衰えの進行】を自覚しており【歩けなくなったら終わり】と不安があった。生活を継続するには，車の運転が必需であり【運転継続の葛藤】と【買い物へ行けなくなる不安】であった。 消滅危惧集落で暮らす高齢者は，地域で培ってきた人間関係や郷土への愛着があり，最期まで生まれ育った家で暮らすことを望んでいた。同時に人間関係の希薄化に伴う寂しさ，身体的衰えによる自己不全感，地域衰退への危機感の間で葛藤していた。一方で彼らを支える１つの要因は地域を守る使命感である。高齢者が地域との連帯感や地域への貢献を実感できるような地域ケアシステムの構築の必要性が示唆される。

Nurses and caregivers experienced lower back pain (LBP) as a result of patient handling motions to assist in wheelchair or bed transfer and repositioning. Therefore, previous studies provided assistive tools and devices to reduce lumbar loads while these patients handling motions. However, these devices and tools could not be used in several facilities because these facilities require comfortability, time efficiency, and low cost. Therefore, from these backgrounds, LBP prevention is required for any facility and situation without assistive devices and tools. Low load posture and movement of patient handling motions should be provided for LBP prevention without devices and tools. In our previous study, we explored suitable foot placement to reduce the lumbar load during turning a patient on a bed because patient repositioning on a bed is a serious cause of LBP. However, our previous study indicates that lumbar loads while turning patients cannot be improved only by foot placement adjustment. Postural asymmetry is related to lumbar load and cannot be avoided with only suitable foot placement. On the other hand, adjustment of both arm movement and foot placement has a possibility that reduces lumbar loads due to asymmetry posture. This study aims to explore a suitable combination of foot placement and arm movement order while turning patients for LBP prevention. A total of nine lumbar load combinations consisting of three foot placements (parallel stance, left forward, and right forward) and three arm movement orders (parallel, right first, and left first) were investigated via surface electromyography (sEMG) measurement during patient turning. The results of sEMG showed that a combination using anteroposterior foot placement (right forward) and parallel arm movement (both left and right arm operated at the same time) performed turning patient with the smallest activity for both left and right erector spinae muscles. These results indicate that a combination of anteroposterior foot placement and parallel arm movement could provide a suitable posture to reduce lumbar loads during patient turning.

Monitoring of lumbar muscle activity during patient handling is important for the preventing lower back pain among caregivers. Electromyography is used for the measurement of muscle activity; however, EMG has some uncomfortable. Therefore, our previous study proposed measurement method for lumbar muscle activity using wearable sensors and found that the combination of wearable sensors and machine learning can be applied to estimate muscle activity. However, optimal machine learning-based predictor has not been explored. In addition, our previous method requires multiple sensors. Thus, this study explores optimal predictors to estimate lumbar muscle activity during patient handling by a single inertial sensor. The proposed method estimates lumbar muscle activity by acceleration and angular velocity on a trunk and machine learning-based predictor. In the evaluation, five machine learning-based predictors (artificial neural network, gaussian process, k-nearest neighbor, linear regression, and support vector machine) estimated lumbar muscle activity during patient handling. Mean absolute error values of lumbar muscle activity between each predictor and EMG were obtained as actual values. Results show that the proposed method using k-nearest neighbor could estimate muscle activity with minimal error. These results suggest that the proposed method using k-nearest neighbor as an optimal predictor can measure lumbar muscle activity.

The super-aged society of Japan is experiencing an increased demand for dental hygienists, of which there is currently a shortage. This study aimed to investigate the factors related to the working status of dental hygienists in Japan. We conducted a survey by mailing a questionnaire on employment to 1444 dental hygienists and obtained 537 valid responses. We conducted a bivariate analysis using either a chi-square test or t-test as well as a multiple logistic regression analysis to determine the factors related to working status. The overall employment rate was 68.2%, with a significant difference between age groups (p < 0.01). Approximately 80% of respondents considered working hours and human relations at the workplace to be important, and more than 70% of respondents considered wages as important. Finally, the following four variables were found to be significantly associated with employment status: training course attendance, a desire to work full-time, consideration of wages as important, and consideration of working hours as important. These findings suggest that it is necessary to improve working conditions and environments, including wages and working hours, as well as provide a more robust system of continued professional development for dental hygienists to increase the workforce.

視線量が話者印象に影響することが指摘されているが（Cook&Smith, 1975；Kleck&Nuessele, 1978；大森，2010など），視線量の定量的コントロールは実際の人間では困難である。そこで本研究は3DCGキャラクターを用い，視線量と話速を操作することで話者印象の変化を検討した。研究協力者は大学生男女30名。刺激映像として女性の3DCGキャラクターが大学について説明する30秒程度の映像を作成し視線量を0・50・100 %の3段階に変化させた。映像に用いる音声はテキスト読み上げ音声作成ソフトを用い女性話者の音声を2段階の話速（1.00倍・1.25倍）で作成した。これらを組合せた計6種類の映像刺激に対して，話し方の好悪・話の上手さ，人物印象である友好性・有能性に関する印象評定を行なった。尺度ごとの平均評定値に関して二要因分散分析を行った結果，好悪・上手さ・友好性印象は視線量の主効果は有意で，視線量が少ないほど低い評価となっていた。有能性印象は交互作用が有意であった。視線量の少なさはネガティブな印象につながるが，有能性に関してはさらに発話速度が影響することが示された。