1
|
Matsuo K, Yoneki K, Tamiya S, Mibu K, Furuzono K, Kobayashi K, Yasuda S, Onoda D, Tatsuki H, Iseki H. Impact of sarcopenia and malnutrition on swallowing function utilizing ultrasonography in patients with acute heart failure: A retrospective cohort study. Clin Nutr ESPEN 2024; 59:296-306. [PMID: 38220390 DOI: 10.1016/j.clnesp.2023.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/25/2023] [Accepted: 12/15/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND & AIMS This study aimed to determine the impact of sarcopenia and nutritional risk on swallowing-related muscles by ultrasonography and dysphagia occurrence in older patients with acute heart failure (AHF) during hospitalization. METHODS Patients with AHF aged ≥65 years without dysphagia (Food Intake LEVEL Scale [FILS] score ≥9) before admission were classified into four groups at admission: robust group, sarcopenia group (Asian Working Group for Sarcopenia 2019), nutritional risk group (geriatric nutritional risk index <92), and complicated group (with both sarcopenia and nutritional risk). Swallowing function (maximal hyoid displacement, geniohyoid muscle area and brightness, and maximal tongue pressure) and FILS were investigated from the medical records. RESULTS In total, 131 patients with AHF (mean age 82.8 ± 7.1 years, 71 males) were enrolled during the study period; 33, 58, 5, and 35 were classified into the robust, sarcopenia, nutritional risk, and complicated groups, respectively. In the covariance analysis adjusted for age, sex, comorbidities, and cardiac function, the complicated group had significantly worse swallowing function than the sarcopenia and robust groups (P < 0.05). In the Cox proportional hazards model, in which event occurrence was defined as the first-time FILS score of ≥9 obtained during hospitalization, the sarcopenia group (hazard ratio [HR]: 0.83, 95 % confidence interval [CI]: 0.51-1.34, P = 0.438) and nutritional risk group (HR: 0.77, 95 % CI:0.25-2.32, P = 0.637) were not significantly different, but the complicated group (HR: 0.54, 95 % CI: 0.31-0.95, P = 0.033) had significantly lower cumulative event rates with the robust group as the reference. CONCLUSION Sarcopenia and nutritional risk in older patients with AHF are risk factors for decreased swallowing function.
Collapse
Affiliation(s)
- Koji Matsuo
- Department of Rehabilitation, Sagamihara Kyodo Hospital, Sagamihara, Japan
| | - Kei Yoneki
- Department of Rehabilitation, Sagamihara Kyodo Hospital, Sagamihara, Japan; Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan.
| | - Seiji Tamiya
- Department of Cardiovascular Medicine, Sagamihara Kyodo Hospital, Sagamihara, Japan
| | - Kazuhiro Mibu
- Department of Rehabilitation, Sagamihara Kyodo Hospital, Sagamihara, Japan
| | - Kento Furuzono
- Department of Rehabilitation, Sagamihara Kyodo Hospital, Sagamihara, Japan
| | - Kikka Kobayashi
- Department of Rehabilitation, Sagamihara Kyodo Hospital, Sagamihara, Japan
| | - Shiori Yasuda
- Department of Rehabilitation, Sagamihara Kyodo Hospital, Sagamihara, Japan
| | - Daiki Onoda
- Department of Rehabilitation, Sagamihara Kyodo Hospital, Sagamihara, Japan
| | - Hiroaki Tatsuki
- Department of Rehabilitation, Sagamihara Kyodo Hospital, Sagamihara, Japan
| | - Harukazu Iseki
- Department of Cardiovascular Medicine, Sagamihara Kyodo Hospital, Sagamihara, Japan
| |
Collapse
|
2
|
Dysphagia is an independent predictor of hospital-acquired disability in older patients with heart failure: a propensity score-matched analysis : Predictors of HAD in older HF patients. Heart Vessels 2023; 38:66-76. [PMID: 35831636 DOI: 10.1007/s00380-022-02133-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/29/2022] [Indexed: 01/06/2023]
Abstract
This study aims to identify the relationship between dysphagia and developing hospital-acquired disability (HAD) in older patients with heart failure (HF). This single-center retrospective cohort study included 360 patients (median age, 84 years: 58.1% female, 41.9% male) who had undergone rehabilitation and were aged 65 years and older. Patients were divided into dysphagia and non-dysphagia groups and compared based on the Functional Oral Intake Scale score. HAD was defined as a decline in the Barthel Index score (indication of daily activity levels) at discharge relative to that before admission. The relationship between dysphagia and HAD was analyzed using bivariate analysis after adjusting for age, sex, body mass index, medical history, clinical and laboratory data, short physical performance battery (SPPB), and cognitive function at the start of rehabilitation, using propensity score matching. HAD was observed in 38.1% of the patients. Patients with dysphagia were significantly older, and had lower body mass index and physical and cognitive function than those without. After propensity score matching, the prevalence of HAD was significantly higher in the dysphagia group than in the non-dysphagia group (61.9% vs. 42.9%, P = 0.032). Dysphagia at the start of rehabilitation was an independent predictor of HAD. The results of this study may contribute to risk stratification of HAD.
Collapse
|
3
|
Yokota J, Takahashi R, Endo R, Chiba T, Sasaki K, Matsushima K. Physical performance and maximum tongue pressure associated with oral intake independence: a retrospective study on hospitalized patients with heart failure. Sci Rep 2022; 12:18549. [PMID: 36329193 PMCID: PMC9633604 DOI: 10.1038/s41598-022-21968-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022] Open
Abstract
Dysphagia in patients with heart failure leads to poorer outcomes during hospitalization and after discharge. Therefore, addressing dysphagia is critical for improving patient prognosis. This retrospective observational study aimed to evaluate associations between improvements in swallowing dysfunction at the time of hospital discharge and the physical function, cognitive function, nutritional status, and maximum tongue pressure (MTP). Overall, 111 patients who underwent cardiac rehabilitation and were deemed to have oral intake impairment were included. The exclusion criteria comprised the following: pre-admission diagnosis of dysphagia, in-hospital death, and missing data. Patients were categorized based on whether they did (n = 65) or did not (n = 46) exhibit improvements in oral intake impairment, which were determined from the functional oral intake scale (FOIS) score at discharge. Associations between potential explanatory variables and the FOIS score at discharge were assessed using a linear regression model. After adjusting for covariates, such as age, sex, heart failure severity, short physical performance battery score, Mini-Mental State Examination score, transthyretin level, and provision of swallowing therapy, the FOIS score at discharge was significantly associated with the MTP (P = 0.024, confidence interval: 0.006-0.046). In conclusion, the MTP was independently associated with improvements in FOIS in patients with heart failure.
Collapse
Affiliation(s)
- Junichi Yokota
- grid.257016.70000 0001 0673 6172Division of Comprehensive Rehabilitation Sciences, Hirosaki University Graduate School of Health Sciences, 66-1, Hon-cho, Hirosaki, Aomori, 036-8564 Japan ,grid.415495.80000 0004 1772 6692Department of Clinical Research, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Ren Takahashi
- grid.415495.80000 0004 1772 6692Department of Rehabilitation, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Ryunosuke Endo
- grid.257016.70000 0001 0673 6172Division of Comprehensive Rehabilitation Sciences, Hirosaki University Graduate School of Health Sciences, 66-1, Hon-cho, Hirosaki, Aomori, 036-8564 Japan
| | - Takaaki Chiba
- grid.415495.80000 0004 1772 6692Department of Rehabilitation, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Kosuke Sasaki
- grid.415495.80000 0004 1772 6692Department of Rehabilitation, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Keisuke Matsushima
- grid.415495.80000 0004 1772 6692Department of Rehabilitation, National Hospital Organization Sendai Medical Center, Sendai, Japan
| |
Collapse
|
4
|
Dibello V, Lobbezoo F, Lozupone M, Sardone R, Ballini A, Berardino G, Mollica A, Coelho-Júnior HJ, De Pergola G, Stallone R, Dibello A, Daniele A, Petruzzi M, Santarcangelo F, Solfrizzi V, Manfredini D, Panza F. Oral frailty indicators to target major adverse health-related outcomes in older age: a systematic review. GeroScience 2022; 45:663-706. [PMID: 36242694 PMCID: PMC9886742 DOI: 10.1007/s11357-022-00663-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/14/2022] [Indexed: 02/03/2023] Open
Abstract
A well-preserved oral function is key to accomplishing essential daily tasks. However, in geriatric medicine and gerodontology, as age-related physiological decline disrupts several biological systems pathways, achieving this objective may pose a challenge. We aimed to make a systematic review of the existing literature on the relationships between poor oral health indicators contributing to the oral frailty phenotype, defined as an age-related gradual loss of oral function together with a decline in cognitive and physical functions, and a cluster of major adverse health-related outcomes in older age, including mortality, physical frailty, functional disability, quality of life, hospitalization, and falls. Six different electronic databases were consulted by two independent researchers, who found 68 eligible studies published from database inception to September 10, 2022. The risk of bias was evaluated using the National Institutes of Health Quality Assessment Toolkits for Observational Cohort and Cross-Sectional Studies. The study is registered on PROSPERO (CRD42021241075). Eleven different indicators of oral health were found to be related to adverse outcomes, which we grouped into four different categories: oral health status deterioration; decline in oral motor skills; chewing, swallowing, and saliva disorders; and oral pain. Oral health status deterioration, mostly number of teeth, was most frequently associated with all six adverse health-related outcomes, followed by chewing, swallowing, and saliva disorders associated with mortality, physical frailty, functional disability, hospitalization, and falls, then decline in oral motor skills associated with mortality, physical frailty, functional disability, hospitalization, and quality of life, and finally oral pain was associated only with physical frailty. The present findings could help to assess the contribution of each oral health indicator to the development of major adverse health-related outcomes in older age. These have important implications for prevention, given the potential reversibility of all these factors.
Collapse
Affiliation(s)
- Vittorio Dibello
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Madia Lozupone
- Unit of Research Methodology and Data Sciences for Population Health, National Institute of Gastroenterology Saverio de Bellis, Research Hospital, Castellana Grotte, Bari, Italy
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Rodolfo Sardone
- Unit of Research Methodology and Data Sciences for Population Health, National Institute of Gastroenterology Saverio de Bellis, Research Hospital, Castellana Grotte, Bari, Italy
| | - Andrea Ballini
- Department of Biosciences, Biotechnologies and Biopharmaceutics, Campus Universitario Ernesto Quagliariello, University of Bari Aldo Moro, Bari, Italy
| | - Giuseppe Berardino
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Anita Mollica
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Hélio José Coelho-Júnior
- School of Physical Education, University of Campinas, Cidade Universitaria Zeferino Vaz, Barao Geraldo, Campinas, Brazil
| | - Giovanni De Pergola
- Department of Biomedical Science and Human Oncology, University of Bari, School of Medicine, Policlinico, Bari, Italy
| | - Roberta Stallone
- Neuroscience and Education, Human Resources Excellence in Research, University of Foggia, Foggia, Italy
| | - Antonio Dibello
- Accident and Emergency Department (AED), F. Perinei Hospital, Altamura, Bari, Italy
| | - Antonio Daniele
- Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy
- Institute of Neurology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Massimo Petruzzi
- Interdisciplinary Department of Medicine, Section of Dentistry, University of Bari Medical School, Bari, Italy
| | | | - Vincenzo Solfrizzi
- Cesare Frugoni Internal and Geriatric Medicine and Memory Unit, University of Bari Aldo Moro, Bari, Italy
| | - Daniele Manfredini
- Department of Biomedical Technologies, School of Dentistry, University of Siena, Siena, Italy
| | - Francesco Panza
- Unit of Research Methodology and Data Sciences for Population Health, National Institute of Gastroenterology Saverio de Bellis, Research Hospital, Castellana Grotte, Bari, Italy.
| |
Collapse
|
5
|
Sato Y, Yoshimura Y, Abe T, Nagano F, Matsumoto A. Impact of trunk and appendicular skeletal muscle mass on improving swallowing function in acute stroke patients. J Stroke Cerebrovasc Dis 2022; 31:106636. [PMID: 35914513 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/20/2022] [Accepted: 06/30/2022] [Indexed: 10/16/2022] Open
Abstract
OBJECTIVES To investigate the effect of trunk and appendicular skeletal muscle mass on the swallowing function at discharge in acute stroke patients. MATERIALS AND METHODS This retrospective cohort study included patients hospitalized after acute strokes. Skeletal muscle mass was measured by bioelectrical impedance analysis within 5 days of admission. The primary outcome was swallowing function at acute hospital discharge, assessed using the Functional Oral Intake Scale (FOIS). Secondary outcomes were Functional Independence Measure-eating (FIM-eating) scores and length of hospital stay. RESULTS Data from 231 patients (age 72.2 years; 151 men) were included in the analysis. The median trunk muscle mass index (TMI) was 8.2 and 6.8 kg/m2 in men and women, respectively. The median appendicular skeletal muscle mass index (ASMI) was 7.7 and 5.7 kg/m2 in men and women, respectively. The high TMI group had higher FIM-eating scores at discharge in each sex (p < 0.001). The high ASMI group had higher FOIS (p = 0.039 and 0.048) and FIM-eating scores at discharge (p = 0.046 and 0.047) in men and women, respectively. On multivariate analysis, TMI was independently associated with FIM-eating scores (β = 0.330, p < 0.001); ASMI was independently associated with FOIS (β = 0.229, p = 0.039) and FIM-eating scores (β = 0.111, p = 0.032). CONCLUSIONS Skeletal muscle mass had site-specific impacts on swallowing function and eating activities. This finding may contribute to the design of more individualized rehabilitation programs.
Collapse
Affiliation(s)
- Yoichi Sato
- Department of Rehabilitation, Uonuma Kikan Hospital, Minamiuonuma, Japan
| | - Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, 760 Magate, Kikuyo-machi, Kikuchi-gun, Kumamoto 869-1106, Japan.
| | - Takafumi Abe
- Department of Rehabilitation, Uonuma Kikan Hospital, Minamiuonuma, Japan
| | - Fumihiko Nagano
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, 760 Magate, Kikuyo-machi, Kikuchi-gun, Kumamoto 869-1106, Japan
| | - Ayaka Matsumoto
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, 760 Magate, Kikuyo-machi, Kikuchi-gun, Kumamoto 869-1106, Japan
| |
Collapse
|
6
|
Ohmura SI, Tamechika SY, Miyamoto T, Kunieda K, Naniwa T. Impact of dysphagia and its severity on long-term survival and swallowing function outcomes in patients with idiopathic inflammatory myopathies other than inclusion body myositis. Int J Rheum Dis 2022; 25:897-909. [PMID: 35678075 DOI: 10.1111/1756-185x.14365] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 04/28/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the impact of dysphagia on long-term survival and swallowing function outcomes in patients with idiopathic inflammatory myopathy other than inclusion body myositis. METHODS We retrospectively evaluated consecutive patients with idiopathic inflammatory myopathy other than inclusion body myositis to investigate the impact of dysphagia and its severity assessed using the Food Intake LEVEL Scale on survival and swallowing function outcomes. Time-to-event analyses were used, including Kaplan-Meier curves with log-rank (trend) test, cumulative incidence with Gray's test, and Cox proportional hazards models. RESULTS Of the 254 patients, 26 were dysphagic, including eight severe (Food Intake LEVEL Scale [FILS] score 2, 3) and six most severe (FILS score 1) cases; 210 were non-dysphagic, and 18 were indeterminate cases. During the 5 years after myositis diagnosis, 15 (57.7%) dysphagic and 31 (14.8%) non-dysphagic patients died, and dysphagic patients had significantly shorter survival. However, multivariate analysis showed that shorter survival was significantly associated with baseline age-adjusted Charlson Comorbidity Index (hazard ratio [HR] 1.57, 95% confidence interval [CI] 1.36-1.82]), but not with dysphagia (HR 1.46, 95% CI 0.69-3.10). Dysphagia severity was significantly associated with delayed recovery of dysphagia. In 20 non-severe or severe dysphagic cases, 19 restored swallowing function within 1 year. The most severe cases had a significantly higher cumulative probability of death before recovery from dysphagia than severe cases. CONCLUSION The poor survival of dysphagic myositis patients was largely confounded by advanced age and comorbid malignancies. However, patients with the most severe dysphagia had a significantly worse swallowing function and survival prognosis than those with milder dysphagia.
Collapse
Affiliation(s)
- Shin-Ichiro Ohmura
- Division of Rheumatology, Department of Internal Medicine, Nagoya City University Hospital, and Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Department of Rheumatology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Shin-Ya Tamechika
- Division of Rheumatology, Department of Internal Medicine, Nagoya City University Hospital, and Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Toshiaki Miyamoto
- Department of Rheumatology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Kenjiro Kunieda
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Taio Naniwa
- Division of Rheumatology, Department of Internal Medicine, Nagoya City University Hospital, and Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| |
Collapse
|
7
|
Tanaka K, Watanabe K, Kashiwagi H. Association between postextubation dysphagia and physical function in survivors of critical illness: A retrospective study. Clin Nutr ESPEN 2022; 47:147-151. [DOI: 10.1016/j.clnesp.2021.12.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/11/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022]
|
8
|
Yokota J, Endo R, Takahashi R, Matsukawa Y, Matsushima K. Dysphagia and malnutrition limit activities of daily living improvement in phase i cardiac rehabilitation: a prospective cohort study for acute phase heart failure patients. Heart Vessels 2021; 36:1306-1316. [PMID: 33675424 DOI: 10.1007/s00380-021-01814-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 02/19/2021] [Indexed: 10/22/2022]
Abstract
Dysphagia and malnutrition combinations in hospitalized patients with acute heart failure (AHF) may affect activities of daily living (ADL) after hospital discharge more than dysphagia or malnutrition alone. The aim of the present study to clarify the impact of the combination of dysphagia and malnutrition on ADL in hospitalized patients with acute phase heart failure who have undergone cardiac rehabilitation (CR). Prospective cohort study. Acute care hospital. Participants were 224 AHF patients undergoing CR. Barthel index (BI), functional oral intake scale (FOIS), controlling nutritional status (CONUT), short physical performance battery (SPPB), and mini-mental state examination were evaluated at baseline. We examined primary effects of predictors (CONUT) and the moderator (FOIS) and the interaction effect of FOIS and CONUT (FOIS × CONUT) using hierarchical linear regression model and simple-slope tests. The ADL independence dropped in 29.5% of the patients on hospitalization; however, 82.6% of the patients successfully regained their independence at discharge. Based on the FOIS score and nutritional status on admission, 58.5% of the patients were classified into the non-dysphagia and non-malnutrition categories, 21.0% into non-dysphagia and malnutrition, 15.2% into dysphagia and non-malnutrition, and 5.3% into dysphagia and malnutrition. Lower FOIS and SPPB scores as well as the FOIS × CONUT interaction predicted a significantly lower BI but not CONUT. Simple slope test revealed a negative association between CONUT and BI with low-level FOIS (B = - 2.917, P < .001) but not with high-level FOIS (B = .476, P = .512). Thus, patients with dysphagia and malnutrition in combination had a greater risk of failed recovery of ADL after cardiac rehabilitation than those without this combination. In hospitalized AHF patients, FOIS and CONUT had an interactive effect on BI at hospital discharge in cases with low-level FOIS. Early detection of dysphagia might improve the accurate identification of hospitalized AHF patients at higher risk of ADL dependence at discharge.
Collapse
Affiliation(s)
- Junichi Yokota
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan. .,Department of Clinical Research, National Hospital Organization Sendai Medical Center, Sendai, Japan. .,Division of Comprehensive Rehabilitation Sciences, Hirosaki University Graduate School of Health Sciences, 66-1, Hon-cho, Hirosaki, Aomori, 036-8564, Japan.
| | - Ryunosuke Endo
- Division of Comprehensive Rehabilitation Sciences, Hirosaki University Graduate School of Health Sciences, 66-1, Hon-cho, Hirosaki, Aomori, 036-8564, Japan
| | - Ren Takahashi
- Department of Rehabilitation, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Yuko Matsukawa
- Department of Rehabilitation, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Keisuke Matsushima
- Department of Rehabilitation, National Hospital Organization Sendai Medical Center, Sendai, Japan
| |
Collapse
|