The primary objective was to provide a list of effective motivational strategies based on consensus among rehabilitation experts, generated using the Delphi technique. The secondary objective was to ...identify the types of information that are important when selecting motivational strategies.
Delphi study.
On-site survey at academic conferences and web-based survey.
Rehabilitation experts (N=198) including physicians, physical therapists, occupational therapists, and speech-language-hearing therapists who had worked in stroke rehabilitation for at least 5 years.
Not applicable.
Panelists were asked to rate the effectiveness of motivational strategies and to rate the importance of different types of information using a 5-point Likert scale. Consensus was defined as having been reached for items with an interquartile range of 1 or less.
A total of 116 experts (58.6%) completed the third round of the Delphi survey. Consensus was reached on all of the 26 presented strategies. Seven strategies, such as control of task difficulty and goal setting, were considered to be very effective in increasing patient motivation. In addition, all 11 of the presented types of information regarding patient health status, environmental factors, and personal factors were deemed very important or important in determining which motivational strategies to use.
We generated a list of effective motivational strategies for stroke rehabilitation based on expert consensus. Our results suggest that experts consider a comprehensive range of patient information when choosing motivational strategies. These findings represent a group of consensus-based recommendations for increasing patient adherence to stroke rehabilitation programs, which may be beneficial to many medical professionals working in stroke rehabilitation.
Transcranial direct current stimulation (tDCS) is a procedure to polarize human brain. It has been reported that tDCS over the hand motor cortex transiently improves the performance of hand motor ...tasks. Here, we investigated whether tDCS could also improve leg motor functions. Ten healthy subjects performed pinch force (PF) and reaction time (RT) tasks using the left leg before, during and after anodal, cathodal or sham tDCS over the leg motor cortex. The anodal tDCS transiently enhanced the maximal leg PF but not RT during its application. Neither cathodal nor sham stimulation changed the performance. None of the interventions affected hand PF or RT, showing the spatial specificity of the effect of tDCS. These results indicate that motor performance of not only the hands but also the legs can be enhanced by anodal tDCS. tDCS may be applicable to the neuro-rehabilitation of patients with leg motor disability.
We previously reported that MDA-MB-231 and MCF-7 cells, which are breast cancer cell lines and have cancer and cancer-initiating cells (CICs), were killed following normothermic microwave irradiation ...in which the cellular temperature was maintained at 37°C. In this study, we investigated the percentages of live or dead cells among CD44
+
/CD24
−
cells, which were defined as CICs among MDA-MB-231 and MCF-7 cells, and other types of cells in response to microwave irradiation. CD44
+
/CD24
−
cells among MDA-MB-231 cells were killed, thereby decreasing the number of cells, whereas the number of live CD44
+
/CD24
−
MCF-7 cells was increased following microwave irradiation. Moreover, adhesion, invasion, and migration were decreased in MDA-MB-231 cells, and the activation of matrix metalloproteinase-2 (MMP-2) in MDA-MB-231 cells was increased following microwave irradiation. These decreased cell activities might have been caused by MMP-2 activation and population changes in CD44
+
/CD24
−
in MDA-MB-231 cells.
Abbreviations: APC: allophecocyanin; CBB: coomassie Brilliant Blue; CD: cluster of differentiation; CICs: cancer-initiating cells; FACS: fluorescence-activated cell sorting; FBS: fetal bovine serum; FITC: fluorescein isothiocyanate; FTDT: finite-difference time domain; HER2: human epidermal growth factor receptor type 2; PI: propidium iodide.
Functional changes of MDA-MB-231 cells by normothermic microwave irradiation.
Immunotherapy has become the standard-of-care treatment for hepatocellular carcinoma (HCC), but its efficacy remains limited. To identify immunotherapy-susceptible HCC, we profiled the molecular ...abnormalities and tumor immune microenvironment (TIME) of rapidly increasing nonviral HCC.
We performed RNA-seq of tumor tissues in 113 patients with nonviral HCC and cancer genome sequencing of 69 genes with recurrent genetic alterations reported in HCC. Unsupervised hierarchical clustering classified nonviral HCCs into three molecular classes (Class I, II, III), which stratified patient prognosis. Class I, with the poorest prognosis, was associated with TP53 mutations, whereas class III, with the best prognosis, was associated with cadherin-associated protein beta 1 (CTNNB1) mutations. Thirty-eight percent of nonviral HCC was defined as an immune class characterized by a high frequency of intratumoral steatosis and a low frequency of CTNNB1 mutations. Steatotic HCC, which accounts for 23% of nonviral HCC cases, presented an immune-enriched but immune-exhausted TIME characterized by T cell exhaustion, M2 macrophage and cancer-associated fibroblast (CAF) infiltration, high PD-L1 expression, and TGF-β signaling activation. Spatial transcriptome analysis suggested that M2 macrophages and CAFs may be in close proximity to exhausted CD8+ T cells in steatotic HCC. An in vitro study showed that palmitic acid-induced lipid accumulation in HCC cells upregulated PD-L1 expression and promoted immunosuppressive phenotypes of cocultured macrophages and fibroblasts. Patients with steatotic HCC, confirmed by chemical-shift MR imaging, had significantly longer PFS with combined immunotherapy using anti-PD-L1 and anti-VEGF antibodies.
Multiomics stratified nonviral HCCs according to prognosis or TIME. We identified the link between intratumoral steatosis and immune-exhausted immunotherapy-susceptible TIME.
Functional ceramics with oriented crystals prepared by colloidal processing in a strong magnetic field are expected to show improved functionality. In this study, the orientation rate of particles ...with low magnetic susceptibility in a concentrated slurry under a strong rotating magnetic field was experimentally demonstrated using a fast photopolymerization reaction. A slurry of (Sr,Ca)2NaNb5O15 particles dispersed in an ultraviolet curable resin with a catalyst was consolidated using UV irradiation under a strong rotating magnetic field. The degree of particle orientation increased with increasing processing time and became saturated after 20 s. The orientation time was observed experimentally; the period required to achieve particle orientation was proportional to the measured viscosity of the slurry and the inverse of the square of the magnetic flux density.
The existence of multiple positive even solutions to{u″(x)+(|x|l+λ)u(x)p=0,x∈(−1,1),u(−1)=u(1)=0, is proved, where the parameters l and λ satisfy l≥0 and λ≥0 and the exponent p satisfies p>1. It is ...shown that for fixed p>1, on the majority part of the first quadrant of (l,λ)⊂R2, the uniqueness of positive even solutions of the above problem holds and a very narrow set remains as the possible region of the existence of multiple positive even solutions. Thus, it seems natural to expect the uniqueness of positive even solutions holds on the whole set of the first quadrant of (l,λ)⊂R2. Contrary to this expectation, we find some triples (l,λ,p) in such a narrow set such that positive even solutions exist multiply with the aid of the numerical verification method.
Accurate memory regarding the location of an object with respect to one's own body, termed egocentric visuospatial memory, is essential for action directed toward the object. Although researchers ...have suggested that the brain stores information related to egocentric visuospatial memory not only in the eye-centered reference frame but also in the other egocentric (i.e., head- or body-centered or both) reference frames, experimental evidence is scarce. Here, we tested this possibility by exploiting the perceptual distortion of head/body-centered coordinates via whole-body tilt relative to gravity. We hypothesized that if the head/body-centered reference frames are involved in storing the egocentric representation of a target in memory, then reproduction would be affected by this perceptual distortion. In two experiments, we asked participants to reproduce the remembered location of a visual target relative to their head/body. Using intervening whole-body roll rotations, we manipulated the initial (target presentation) and final (reproduction of the remembered location) body orientations in space and evaluated the effect on the reproduced location. Our results showed significant biases of the reproduced target location and perceived head/body longitudinal axis in the direction of the intervening body rotation. Importantly, the amount of error was correlated across participants. These results provide experimental evidence for the neural encoding and storage of information related to egocentric visuospatial memory in the head/body-centered reference frames.
The Mini‐International Neuropsychiatric Interview (MINI) is a short, structured diagnostic interview used as a tool to diagnose 16 axis I (Diagnostic and Statistical Manual) DSM‐IV disorders and one ...personality disorder. Its original version was developed by Sheehan and Lecrubier. We translated the MINI into Japanese, and investigated the reliability and validity of the Japanese version of MINI. Eighty‐two subjects participated in the validation of the MINI versus the Structured Clinical Interview for DSM‐III‐R (SCID‐P). One hundred and sixty‐nine subjects participated in the validation of the MINI versus an expert's professional opinion. Seventy‐seven subjects were interviewed by two investigators and subsequently readministered by a third interviewer blind to the results of initial evaluation 1–2 days later. In general, kappa values indicated good or excellent agreement between MINI and SCID‐P diagnoses. Kappa values indicated poor agreement between MINI and expert's diagnoses for most diagnoses. Interrater and test–retest reliabilities were good or excellent. The mean durations of the interview were 18.8 min for MINI and 45.4 min for corresponding sections of SCID‐P. Overall, the results suggest that the MINI Japanese version succeeds in reliably and validly eliciting symptom criteria used in making DSM‐III‐R diagnoses, and can be performed in less than half the time required for the SCID‐P.
Abstract
Objective
Various strategies are used to motivate individuals with stroke during rehabilitation. However, how physical therapists select the motivational strategies that they use for each ...individual is yet to be established. Therefore, this study aimed to explore how physical therapists use different motivational strategies for individuals in stroke rehabilitation programs.
Methods
A criterion sample of 15 physical therapists who have worked in rehabilitation for over 10 years and were interested in an individual’s motivation participated in one-on-one semi-structured online interviews. The interviews explored their perspectives and experiences regarding the motivational strategies used depending on each individual’s condition. The collected data were analyzed with thematic analysis.
Results
A total of 9 themes emerged from the data upon thematic analysis and inductive coding. Participants used different strategies to encourage individuals’ active participation in physical therapy depending on (1) their mental health, (2) their physical difficulties, (3) their level of cognitive function, (4) their personality, (5) their activities and participation, (6) their age, (7) their human environment, and (8) the type of rehabilitation service where the individual underwent treatment. For example, in cases where an individual lost self-confidence, participants offered practice tasks that the individual could achieve with little effort to make them experience success. The interviews also revealed (9) motivational strategies used regardless of the individual’s condition. For instance, patient-centered communication was used to build rapport with individuals, irrespective of their condition.
Conclusion
This qualitative study suggests that physical therapists use different strategies depending on the individual’s mental health conditions, physical problems, level of cognitive function, personality, activities and participation, age, human environment, and the type of rehabilitation service where the individual undergoes treatment to motivate individuals with stroke during physical therapy.
Impact
The findings of this study can provide experience-based recommendations regarding the selection of motivational strategies for stroke rehabilitation.
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