Publications by authors named "Naoaki Ito"

6 Publications

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Nutritional intervention after an early assessment by a flexible endoscopic evaluation of swallowing is associated with a shorter hospital stay for patients with acute cerebral infarction: A retrospective study.

Asia Pac J Clin Nutr 2021 Jun;30(2):199-205

Nutrition Support Team, National Hospital Organization Takasaki General Medical Center, Takasaki, Gunma, Japan. Email:

Background And Objectives: It is important to evaluate the swallowing function of patients with acute cerebral infarction. The effects of nutritional intervention after an early assessment by a flexible endoscopic evaluation of swallowing (FEES) were evaluated.

Methods And Study Design: This retrospective study included 274 patients who were hospitalized for acute cerebral infarction and underwent a FEES between 2016 and 2018. The effects of early nutritional intervention after an assessment by a FEES within 48 h from admission were evaluated. The patients were divided into a shorter hospital stay group (<30 days) and a longer group (≥30 days). A multivariate analysis was performed to identify the predictive factors for a shorter hospital stay.

Results: The overall patient characteristics were as follows: 166 men; median age, 81 years old; and median body mass index (BMI), 21.1 kg/m2. No significant differences in the age, sex, or BMI were found between the shorter and longer hospital stay groups. A FEES within 48 h of admission (odds ratio [OR], 2.040; 95% confidence interval [CI], 1.120-3.700; p=0.019), FILS level ≥6 at admission (OR, 2.300; 95% CI, 1.190-4.440; p=0.013), and an administered energy dose of ≥18.5 kcal/kg on hospital day 3 (OR, 2.360; 95% CI, 1.180-4.690; p=0.015) were independently associated with a hospital stay <30 days.

Conclusions: Patients with acute cerebral infarction are more likely to have a shorter hospital stay (<30 days) if they undergo a FEES early after admission and receive optimal nutritional intervention.
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http://dx.doi.org/10.6133/apjcn.202106_30(2).0003DOI Listing
June 2021

Patients Walking Faster After Anterior Cruciate Ligament Reconstruction Have More Gait Asymmetry.

Int J Sports Phys Ther 2021 Feb 1;16(1):169-176. Epub 2021 Feb 1.

University of Delaware.

Background: Gait asymmetries after anterior cruciate ligament reconstruction (ACLR) may lead to radiographic knee osteoarthritis. Slower walking speeds have been associated with biomarkers suggesting cartilage breakdown. The relationship between walking speed and gait symmetry after ACLR is unknown.

Hypothesis/purpose: To determine the relationship between self-selected walking speeds and gait symmetry in athletes after primary, unilateral ACLR.

Study Design: Secondary analysis of a clinical trial.

Methods: Athletes 24±8 weeks after primary ACLR walked at self-selected speeds as kinematics, kinetics, and electromyography data were collected. An EMG-driven musculoskeletal model was used to calculate peak medial compartment contact force (pMCCF). Variables of interest were peak knee flexion moment (pKFM) and angle (pKFA), knee flexion and extension (KEE) excursions, peak knee adduction moment (pKAM), and pMCCF. Univariate correlations were run for walking speed and each variable in the ACLR knee, contralateral knee, and interlimb difference (ILD).

Results: Weak to moderate positive correlations were observed for walking speed and all variables of interest in the contralateral knee (Pearson's r=.301-.505, p≤0.01). In the ACLR knee, weak positive correlations were observed for only pKFM (r=.280, p=0.02) and pKFA (r=.263, p=0.03). Weak negative correlations were found for ILDs in pKFM (r=-0.248, p=0.04), KEE (r=-.260, p=0.03), pKAM (r=-.323, p<0.01), and pMCCF (r=-.286, p=0.02).

Conclusion: Those who walk faster after ACLR have more asymmetries, which are associated with the development of early OA. This data suggests that interventions that solely increase walking speed may accentuate gait symmetry in athletes early after ACLR. Gait-specific, unilateral, neuromuscular interventions for the ACLR knee may be needed to target gait asymmetries after ACLR.

Level Of Evidence: III.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7872452PMC
February 2021

FUNCTIONAL MEASURES DO NOT DIFFER IN LATE STAGE REHABILITATION AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION ACCORDING TO MECHANISM OF INJURY.

Int J Sports Phys Ther 2020 Oct;15(5):744-754

Background: Anterior cruciate ligament injuries are among the most common knee injuries. Mechanism of injury is classified as contact or non-contact. The majority of anterior cruciate ligament ruptures occur through a non-contact mechanism of injury. Non-contact anterior cruciate ligament ruptures are associated with biomechanical and neuromuscular risk factors that can predispose athletes to injuries and may impact future function. Non-contact mechanism of injury may be preceded by poor dynamic knee stability and therefore those with a non-contact mechanism of injury may be prone to poor dynamic knee stability post-operatively. Understanding how mechanism of injury affects post-operative functional recovery may have clinical implications on rehabilitation.

Purpose: The purpose of this study was to determine if mechanism of injury influenced strength, functional performance, patient-reported outcome measures, and psychological outlook in athletes at four time points in the first two years following anterior cruciate ligament reconstruction.

Study Design: Secondary analysis of a clinical trial.

Methods: Seventy-nine athletes underwent functional testing at enrollment after impairment resolution. Quadriceps strength, hop testing, and patient-reported outcome measures were evaluated post-operatively at enrollment, following return-to-sport training and one year and two years after anterior cruciate ligament reconstruction. Participants were dichotomized by mechanism of injury (29 contact, 50 noncontact). Independent t-tests were used to compare differences between groups.

Results: There were no meaningful differences between contact and non-contact mechanism of injury in any variables at enrollment, post-training, one year, or two years after anterior cruciate ligament reconstruction.

Conclusion: Function did not differ according to mechanism of injury during late stage rehabilitation or one or two years after anterior cruciate ligament reconstruction.

Level Of Evidence: III.
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http://dx.doi.org/10.26603/ijspt20200744DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7575151PMC
October 2020

Sex and mechanism of injury influence knee joint loading symmetry during gait 6 months after ACLR.

J Orthop Res 2021 05 13;39(5):1123-1132. Epub 2020 Aug 13.

Department of Physical Therapy, University of Delaware, Newark, Delaware.

Early-onset knee osteoarthritis (OA) is associated with gait asymmetries after anterior cruciate ligament reconstruction (ACLR). Women have higher risks of sustaining non-contact injuries, and are more likely to present with aberrant movement patterns associated with the mechanism of injury (MOI). We hypothesized that sex and MOI would influence gait after ACLR. Seventy participants, grouped by sex and MOI, completed biomechanical testing during over-ground walking when they had full knee range of motion, trace or less knee effusion, greater than 80% quadriceps strength limb symmetry index, ability to hop on each leg without pain, and initiated running. Bilateral knee kinetics, kinematics, and joint contact forces were compared using mixed-model analysis of variance (α = .05). There was a three-way interaction effect of sex × MOI × limb for peak medial compartment contact force (P = .002), our primary outcome measure previously associated with OA development. Men with non-contact injuries walked with asymmetry characterized by underloading of the involved limb. Men with contact injuries walked with the most symmetrical loading. In women, no clear pattern emerged based on MOI. Targeting, and possibly prioritizing interventions for athletes who present with gait asymmetries after ACLR based on sex and MOI, may be necessary to optimize outcomes. Statement of Clinical Significance: Sex and MOI may influence walking mechanics, and could be considered in future interventions to target gait symmetry, as a response to interventions may vary based on differences in sex and MOI.
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http://dx.doi.org/10.1002/jor.24822DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7864984PMC
May 2021

Slower Walking Speed Is Related to Early Femoral Trochlear Cartilage Degradation After ACL Reconstruction.

J Orthop Res 2020 03 18;38(3):645-652. Epub 2019 Nov 18.

Department of Mechanical Engineering, University of Delaware, Newark, Delaware.

Post-traumatic patellofemoral osteoarthritis (OA) is prevalent after anterior cruciate ligament reconstruction (ACLR) and early cartilage degradation may be especially common in the femoral trochlear cartilage. Determining the presence of and factors associated with early femoral trochlear cartilage degradation, a precursor to OA, is a critical preliminary step in identifying those at risk for patellofemoral OA development and designing interventions to combat the disease. Early cartilage degradation can be detected using quantitative magnetic resonance imaging measures, such as tissue T relaxation time. The purposes of this study were to (i) compare involved (ACLR) versus uninvolved (contralateral) femoral trochlear cartilage T relaxation times 6 months after ACLR, and (ii) determine the relationship between walking speed and walking mechanics 3 months after ACLR and femoral trochlear cartilage T relaxation times 6 months after ACLR. Twenty-six individuals (age 23 ± 7 years) after primary, unilateral ACLR participated in detailed motion analyses 3.3 ± 0.6 months after ACLR and quantitative magnetic resonance imaging 6.3 ± 0.5 months after ACLR. There were no limb differences in femoral trochlear cartilage T relaxation times. Slower walking speed was related to higher (worse) femoral trochlear cartilage T relaxation times in the involved limb (Pearson's r: -0.583, p = 0.002) and greater interlimb differences in trochlear T relaxation times (Pearson's r: -0.349, p = 0.080). Walking mechanics were weakly related to trochlear T relaxation times. Statement of clinical significance: Slower walking speed was by far the strongest predictor of worse femoral trochlear cartilage health, suggesting slow walking speed may be an early clinical indicator of future patellofemoral OA after ACLR. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:645-652, 2020.
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http://dx.doi.org/10.1002/jor.24503DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7028512PMC
March 2020

Gait Mechanics in Women of the ACL-SPORTS Randomized Control Trial: Interlimb Symmetry Improves Over Time Regardless of Treatment Group.

J Orthop Res 2019 08 20;37(8):1743-1753. Epub 2019 May 20.

Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware.

Women after anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) are more likely than men to exhibit asymmetric movement patterns, which are associated with post-traumatic osteoarthritis. We developed the ACL specialized post-operative return-to-sports (ACL-SPORTS) randomized control trial to test the effect of strength, agility, plyometric, and secondary prevention (SAPP) training with and without perturbation training (SAPP + PERT) on gait mechanics in women after ACLR. We hypothesized that movement symmetry would improve over time across both groups but more so among the SAPP + PERT group. Thirty-nine female athletes 3-9 months after primary ACLR were randomized to SAPP or SAPP + PERT training. Biomechanical testing during overground walking occurred before (Pre-training) and after (Post-training) training and one and 2 years post-operatively. Hip and knee kinematic and kinetic variables were compared using repeated measures analysis of variance with Bonferroni corrections for post hoc comparisons (α = 0.05). There was a time by limb interaction effect (p = 0.028) for peak knee flexion angle (PKFA), the primary outcome which powered the study, characterized by smaller PKFA in the involved compared to uninvolved limbs across treatment groups at Pre-training, Post-training, and 1 year, but not 2 years. Similar findings occurred across sagittal plane knee excursions and kinetics and hip extension excursion at midstance. There were no meaningful interactions involving group. Neither SAPP nor SAPP + PERT training improved walking mechanics, which persisted 1 but not 2 years after ACLR. Statement of clinical significance: Asymmetrical movement patterns persisted long after participants achieved symmetrical strength and functional performance, suggesting more time is needed to recover fully after ACLR. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1743-1753, 2019.
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http://dx.doi.org/10.1002/jor.24314DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6824924PMC
August 2019
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